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This essay examines the origin of a literary hypermedia which centres on the Divine Comedy, highlighting the motivational value and the coherence in terms of language teaching of the use of effective methodologies tailored to the cognitive capacities of the new generation. Thus teaching is no longer simply transmission of information, but becomes a process involv- ing conscious emotional collaboration on the part of the student in order to build his or her own knowledge.

We report on a patient with a recognizable phenotype of intellectual disability, multiple congenital anomalies, musculoskeletal anomalies and craniofacial dysmorphisms, carrying a de novo 0.4 Mb duplication of chromosome region 16p13.3 detected by SNP-array analysis. In addition, myopia, microcephaly and growth retardation were observed. The causal 16p13.3 duplication is one of the smallest reported so far, and includes the CREB binding protein gene (CREBBP, MIM 600140), whose haploinsufficiency is responsible for the Rubinstein-Taybi syndrome, and the adenylate cyclase 9 gene (ADCY9, MIM 603302). By comparing the clinical manifestations of our patient with those of patients carrying similar rearrangements, we confirmed that 16p13.3 microduplications of the Rubinstein-Taybi region result in a recognizable clinical condition that likely represents a single gene disorder. In addition, our case allowed us to define with more precision the smallest region of overlap (SRO) in all patients reported so far, encompassing only the CREBBP gene, and is useful to confirm and further define the phenotypic characteristics due to duplication of the CREBBP gene, being the first case of interstitial duplication with microcephaly and growth defects reported to date., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Over 1800 Cystic Fibrosis Transmembrane Conductance Regulator gene (CFTR) mutations have been identified so far, determining different degrees of CFTR dysfunction and a range of different cystic fibrosis phenotypes. The P5L CFTR mutation is a recently described N-terminus missense variant which may cause defect of protein folding and processing/trafficking, but the functional classification is still unclear. Given the rarity of the mutation, the associated clinical phenotype is still unknown. The aim of our study was to describe the clinical phenotypes in a group of 7 patients with the P5L mutation including 2 adults, 2 adolescents and 3 children. The P5L variant was associated with ΔF508 in 5 patients and with W1282X in two patients. All patients had positive or borderline sweat test values. All had pancreatic sufficiency, no hepatobiliary disease, no or mild respiratory symptoms and normal lung function. The two adult males were fertile. Most of the patients presented recurrent episodes of dehydration and hypochloronatremia. We conclude that, although it has been speculated that the N-terminus CFTR missense variants may severely affect the behaviour of the CFTR chloride channel, patients with the P5L CFTR mutation, in association with a severe class II mutation, may be asymptomatic or may be affected by mild disease., (Copyright © 2011 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.)

The spatial variability of the nitrate (NO₃-) uptake along the maize primary root axis was investigated at physiological and molecular levels. Net NO₃- uptake rate (NNUR) and its kinetic parameters, together with the gene expression of a high-affinity NO₃- transporter (NRT2.1), were evaluated. The activity and the expression of plasma membrane H⁺ -ATPase (PM H⁺ -ATPase), key enzyme in plant nutrition, were also analysed. The NNUR showed a heterogeneous spatial pattern along the root, where the regions closer to the root tip early exhibited higher capacity to absorb NO₃- than the basal regions, because of a higher maximum NNUR and faster induction of the inducible high-affinity transport system (iHATS), the presence of the high-affinity transport system (HATS) also at external NO₃- concentrations >100 µm and an improved NO₃- transport because of lower K(m) values. ZmNRT2.1 transcript abundances were not spatially correlated with NNUR, suggesting that post-translational effects or NAR2 protein co-expression could be involved. By contrast, PM H⁺ -ATPase displayed a similar spatial-temporal pattern as that of nitrate uptake, resulting in higher activity in the root tip than in the basal regions. Increased activities of the enzyme after nitrate supply resulted in enhanced expression of MAH3 and MAH4, PM H⁺ -ATPase subfamily II genes, while MAH1 was not expressed., (© 2011 Blackwell Publishing Ltd.)

Collagen has an important role in controlling mechanical function and physiopathology of intestinal wall. Swine small intestine may be used as biomaterial source for tissue repairing. Changes of collagen arrangement and three-dimensional (3D) distribution may be related to the dissimilar biomechanical proprieties showed by different intestine tracts. 3D spatial distribution of collagen bundles of swine submucosal terminal ileum (SSTI) was studied by a correlated analysis of light (LM) and scanning electron microscopy (SEM) of NaOH macerated samples. Bundles of collagen fibers were greatly represented in the submucosa at the mesenteric border and also extended along the longitudinal folds beneath mucosa layer. Polarized LM of picrosirius stained samples evidenced yellow and red fibers (type I collagen), and green fibers (type III collagen). Silver-impregnated sections showed predominant brown-stained fibers and, in a smaller amount, black-stained ones. By SEM submucosal collagen, isolated by NaOH maceration, appeared arranged in wide bundles forming a complicated 3-D network. The bundles presented a sinuous course, opened and closed repeatedly forming meshes fashioned in a regular net. These observations originally demonstrated that 3-D distribution of SSTI collagen is different from that observed in other gut segments and species. The arrangement of SSTI collagen fibers that we observed seems to be morphofunctionally adjusted to provide appropriate resistance to mechanical forces and to assure compliance to deformations induced by intestinal wall motion. The studies for selection of optimal intestinal patches for surgical replacement should take into consideration the basic morphological evaluation of parietal collagen 3D distribution.

The descriptions of the morphology of the human pes anserinus (the combined insertions of the tendons expansions of medial muscles of the thigh) vary on the arrangement of the muscles and tendons that originate the so-called "goose's foot". Although descriptions found in the literature include up to 7 muscles, most of the authors indicated this anatomical structure as formed only by the insertions of the gracilis, sartorius and semitendinosus muscles. Our aim is to find out in Brazilian male adult cadavers the most frequent disposition of the tendons for application in the orthopedic practice. So far, 60 inferior members of 30 cadavers from the laboratories of the Anatomy Departments of the Medical Schools of the Universities of Mogi das Cruzes and Santos were studied. The dissection was performed in cadavers fixed in 10% formaldehyde solution. The specimens were then drawn and photographed. In all 30 cadavers only 3 muscles participated in the formation of the pes anserinus but several variations were found in the disposition of the tendons. Applications of the anatomical knowledge of this tendinous arrangement were discussed.

The present study examined the efficacy of a cognitive-behavioral intervention at improving compliance with CPAP and vigilance in older adults with obstructive sleep apnea/hypopnea syndrome (OSAHS). Participants included 12 subjects who were randomized into one of two groups controlling for age, education, disease severity, and vigilance. The experimental group received two 45-min sessions designed to educate subjects on the consequences of OSAHS and the efficacy of CPAP. The control group received the same extent of therapist contact but did not receive information on OSAHS or CPAP. All subjects were administered a test of vigilance both before and after the study. Compliance data were collected using CPAP devices with internal microprocessors at were read at 1, 4, and 12 weeks after treatment initiation. The results showed that the experimental condition did not enhance compliance after 1 week of treatment but did so by the 12-week follow-up. Subjects in the experimental condition had a run time of 3.2-h per night longer than did those in the control group. Those using CPAP more regularly at 12 weeks also showed greater improvement on vigilance at follow-up. Performance on vigilance testing before the introduction of CPAP was predictive of CPAP use at 12 weeks. In conclusion, a modest cognitive-behavioral intervention may substantially increase CPAP use and vigilance in older adults.

The arrangement of the bundles of muscular fibers in the transition between the small and the large intestines was studied in 12 male adult crossbred swine by dissection, after immersion in 50% nitric acid solution. The connection between the small and the large intestines was formed by the association of the muscular tissue, the connective tissue and the fat tissue. The tunica muscularis of these organs was organized in thin thread-like bundles and wide ribbon-like bundles of variable width and thickness. The superficial bundles of the longitudinal stratum of the tunica muscularis of the ileum established the continuity with the large intestine; the deep bundles penetrated into the ileal papilla. The limit between the cecum and the ascending colon was externally marked by the sulcus cecocolicus dorsalis and ventralis. The connection between the cecum and the ascending colon was formed by bundles of muscular fibers coming from the ileum, and the taeniae ventralis, lateralis and medialis of the cecum. Some bundles of muscular fibers from the ascending colon and the cecum headed toward the sulcus cecocolicus. The median bundles of muscular fibers of the taenia ventralis of the cecum, near the termination of the ileum, were arranged to form a loop around the termination of the ileum, mixing with the musculature of the ascending colon at the level of this junction.

The morphology of the ileocecocolic transition, between the small and large intestine was studied in 33 male, adult pigs of unknown breed. The results were analyzed by the Wilcoxon Test (alpha < or = 0.05). The ileum opened into the large intestine, in all of the cases, at the level of the cecocolic junction in the form of a conical papilla (ileal papilla) turned towards the large intestine, with an oblique caudal and lateral direction, pointing to the cecal lumen. The cranial contour is higher than the caudal one, with average values of 3.0 cm, and 1.5 cm in the fresh specimens and 2.8 cm and 1.4 cm after fixation of the specimens. The average diameter of the papilla apex was 1.5 cm, both in the fresh specimens and in the fixed ones. In 100% of the cases the ileal papilla appeared with a star-shaped orifice in its apex in both the fresh and in the fixed specimens. Our studies showed that the transition between the small and large intestine of the swine is ileocecocolic, thus similar to humans and different from the ileocecal (Perissodactyla, Rodentia, Lagomorpha) and, according to most descriptions, ileocolic (dog) transitions found in other animals.

A rare case of a 32-year-old male with situs inversus totalis viscerum admitted to hospital for hematemesis owing to portal hypertension of Laennec cirrhosis was treated for the first time by videolaparoscopic surgery. Situs inversus diagnosis was confirmed by thoracic radiography, electrocardiogram, echocardiogram, abdominal echography and computed tomography. Upper gastrointestinal endoscopy showed esophageal varices and large varices in the fundus of the stomach. A successful operation (azygo-portal disconnection, splenic artery ligation without splenectomy; transesophageal suturing of esophageal varices without opening the esophagus and cholecystectomy), was performed by videolaparoscopy. The uneventful postoperative evolution (4-day hospitalization) reinforces the viability of the videolaparoscopic approach and the possibility of the application of this procedure even to situs inversus totalis organorum.

The purpose of rendering easier for priests to hear confessions from Brazilian indians, in the beginning of the colonization of Brazil by the Portuguese, and in order to serve indians for better communication led Pero de Castilho, a jesuit born in Vila do Esp¿rito Santo, to prepare a list of names of parts of the human body. Such a list of tupi (language of the native indians) and portuguese terms of anatomical structures, in alphabetical order, seems to be the first Nomina Anatomica published in Brazil. Such a bilingual vocabulary constitutes a subsidy for the study of both languages spoken soon after the discovery of Brazil and represents a religious related document that contributes to the history of anatomy and medicine.

The arrangement of the bundles of muscular fibers in the ileal papilla was studied in 32 adult male crossbred swine by dissection of the muscular bundles in this region, after immersion in 50% nitric acid, and by observation under the stereomicroscope of material preserved in a 10% formaldehyde solution. In the ileal papilla, the cranial (ileocolic) contour of the tunica muscularis was formed by the circular strata of the ascending colon and the ileum, and the caudal (ileocecal) contour by the circular strata of the cecum and the ileum. The longitudinal stratum was located between the circular strata with predominance of muscular bundles originating in the terminal ileum. The tunica muscularis showed an increased thickness at the base of the eminence and at the free border, not reaching the apex. In the ileal papilla, the circular and longitudinal components characterize a "pylorus", the ileocecocolic or ileal pylorus as a transit regulation device for the flow of contents between the small and large intestine of swine.

The diaphragma of 4 "Myrmecophaga tridactyla" was described. The diaphragma follows the general pattern of EDENTATA, but it has special features which make it possible to differentiate it from that of "Bradypus tridactylus.

The parotid gland of Praomys (Mastomys) natalensis follows the same anatomical pattern of Rodentia since no peculiar morphological and histochemical features were found in the present study that differentiate it from homologous glands in other rodents. It consists of serous secreting components and intralobular ducts that demonstrate no sexual dimorphism. Histochemical studies reveal that the glandular cells of the Praomys' parotid gland contain no acid mucosubstance, but that material of a neutral glycoprotein nature can be found in the secreting cells of acini, epithelium of the ducts, and the ductal lumina.

The ventral lobes of the prostate in the female and male Praomys (Mastomys) natalensis were studied using light microscopic techniques for the demonstration and localization of carbohydrates. A weakly PAS-positive material appeared in the secretory product and secretory granules in epithelial cells of both female and male ventral lobes. This reaction is unaffected by diastase and is completely blocked by acetylation. Alcian blue, toluidine blue and methylene blue stains demonstrate metachromatic changes only after sulphation. All reactions indicate the presence of neutral mucosubstances in the secretory product and secretory granules of epithelial cells of the ventral lobes in either sex.