Obstructive sleep apnea is common among patients referred for coronary artery bypass grafting and can be diagnosed by portable monitoring

Background Obstructive sleep apnea (OSA) is common among patients with coronary artery disease. However, OSA remains largely under recognized. The lack of clinical suspicion and difficulties to access full polysomnography (PSG) are limiting factors. The aim of this study was to evaluate, among patients referred to coronary artery bypass grafting (CABG): (i) the prevalence of OSA, (ii) the association of OSA with clinical symptoms, (iii) the performance of overnight unattended portable monitoring (PM) as an alternative method for the diagnosis of OSA. Methods Consecutive patients referred for CABG were evaluated by standard physical evaluation and validated questionnaires (Berlin questionnaire and Epworth Sleepiness Scale) and underwent full PSG and PM (Stardust II). Results We studied 70 consecutive patients (76% men), age 58 +/- 7 years (mean +/- SD), BMI [median (interquartile range)] 27.6 kg/m(2) (25.8-31.1). The prevalence of OSA (full PSG) using an apnea-hypopnea index of at least 5 events/h was 87%. Commonly used clinical traits for the screening of OSA such as the Epworth Sleepiness Scale and neck circumference had low sensitivities to detect OSA. In contrast, the Berlin questionnaire showed a good sensitivity (72%) to detect OSA. PM showed good sensitivity (92%) and specificity (67%) for the diagnosis of OSA. Conclusion OSA is strikingly common among patients referred for CABG. The Berlin questionnaire, but not symptom of excessive daytime sleepiness is a useful tool to screen OSA. PM is useful for the diagnosis of OSA and therefore is an attractive tool for widespread use among patients with coronary artery disease. Coron Artery Dis 23:31-38 (C) 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.

In Patients With Acute Myocardial Infarction, the Impact of Hyperglycemia as a Risk Factor for Mortality Is Not Homogeneous Across Age-Groups

OBJECTIVE To assess the impact of hyperglycemia in different age-groups of patients with acute myocardial infarction (AM I). RESEARCH DESIGN AND METHODS A total of 2,027 patients with AMI were categorized into one of five age-groups: <50 years (n = 301), >= 50 and <60 (n = 477),>= 60 and <70 (n = 545), >= 70 and <80 (n = 495), and years (n = 209). Hyperglycemia was defined as initial glucose >= 115 mg/dL. RESULTS The adjusted odds ratios for hyperglycemia predicting hospital mortality in groups 1-5 were, respectively, 7.57 (P = 0.004), 3.21 (P 0.046), 3.50 (P = 0.003), 3.20 (P < 0.001.), and 2.16 (P = 0.021). The adjusted P values for correlation between glucose level (as a continuous variable) and mortality were 0.007, <0.001, 0.043, <0.001, and 0.064. The areas under the ROC curves (AUCs) were 0.785, 0.709, 0.657, 0.648, and 0.613. The AUC in group 1 was significantly higher than those in groups 3-5. CONCLUSIONS The impact of hyperglycemia as a risk factor for hospital mortality in AMI is more pronounced in younger patients.

First report on the kinetics of the uncatalyzed esterification of cellulose under homogeneous reaction conditions: a rationale for the effect of carboxylic acid anhydride chain-length on the degree of biopolymer substitution

The kinetics of the homogeneous acylation of microcrystalline cellulose, MCC, with carboxylic acid anhydrides with different acyl chain-length (Nc; ethanoic to hexanoic) in LiCl/N,N-dimethylacetamide have been studied by conductivity measurements from 65 to 85 A degrees C. We have employed cyclohexylmethanol, CHM, and trans-1,2-cyclohexanediol, CHD, as model compounds for the hydroxyl groups of the anhydroglucose unit of cellulose. The ratios of rate constants of acylation of primary (CHM; Prim-OH) and secondary (CHD; Sec-OH) groups have been employed, after correction, in order to split the overall rate constants of the reaction of MCC into contributions from the discrete OH groups. For the model compounds, we have found that k((Prim-OH))/k((Sec-OH)) > 1, akin to reactions of cellulose under heterogeneous conditions; this ratio increases as a function of increasing Nc. The overall, and partial rate constants of the acylation of MCC decrease from ethanoic- to butanoic-anhydride and then increase for pentanoic- and hexanoic anhydride, due to subtle changes in- and compensations of the enthalpy and entropy of activation.

On the Milnor fibre and L numbers of semi-weighted homogeneous arrangements

Inthispaperwestudygermsofpolynomialsformedbytheproductofsemi-weighted homogeneous polynomials of the same type, which we call semi-weighted homogeneous arrangements. It is shown how the L numbers of such polynomials are computed using only their weights and degree of homogeneity. A key point of the main theorem is to find the number called polar ratio of this polynomial class. An important consequence is the description of the Euler characteristic of the Milnor fibre of such arrangements only depending on their weights and degree of homogeneity. The constancy of the L numbers in families formed by such arrangements is shown, with the deformed terms having weighted degree greater than the weighted degree of the initial germ. Moreover, using the results of Massey applied to families of function germs, we obtain the constancy of the homology of the Milnor fibre in this family of semi-weighted homogeneous arrangements.

EVALUATION OF PHOTODEGRADABLE TAPE ON GRAFTING IN CITRUS NURSERY TREES

The use of a photodegradable tape was evaluated on 'Valencia' sweet orange nursery trees budded both on Rangpur lime and Swingle citrumelo in a greenhouse in Bebedouro-SP, Brazil, from September to November 2009. On both rootstocks three wrapping procedures were evaluated: i) conventional polyethylene tape wrapped around the bud eye; ii) photodegradable tape wrapped around the bud eye, and iii) photodegradable tape wrapped around the graft junction without covering the bud eye. The following variables were measured: time spent for wrapping, percentage of bud sprouting, length and stem diameter of the scion shoot, and percentage of commercially valuable nursery trees. The trial was conducted following a randomized complete block design, with six treatments, four replications and 12 trees per plot. The use of photodegradable tape, with or without covering the bud eye, anticipated bud sprouting; despite of the longer time spent with wrapping when the photodegradable tape was used. Plants grafted onto the less vigorous Swingle citrumelo rootstock showed lower bud sprout percentages when the bud eye was covered with the photodegradable tape.

Timing of Alveolar Bone Grafting Determines Different Outcomes in Patients With Unilateral Cleft Palate

The objective of the current study was to assess the outcome of the alveolar bone grafting (ABG) in patients with cleft palate. Thirty-one patients with complete unilateral cleft lip and palate were prospectively divided into 2 groups according to the timing of surgery: (1) secondary ABG (SABG), undertaken during mixed dentition (n = 16); and (2) tertiary ABG (TABG), undertaken during permanent dentition (n = 15). Septum height was assessed using cone beam computed tomography in 3 views (buccal, intermediate, palatal) and classified according to the modified Bergland Index, which scores the results into 5 types according to the height of the neoformed bone septum (excellent: septum with a normal height; good: septum with minor deficiency; regular: marginal defect of >25% of the root length; bad: bone deficiency on the nasal aspect; and failure). In the SABG group, 6 to 12 months postoperatively, 75% of the patients were classified as having excellent/good conditions and 25% as having regular/bad conditions. No patients were observed as having failure conditions. In the TABG group, 53% of the patients were classified as having excellent/good, 21% were classified as having regular/bad conditions, and 26% were classified as having failure conditions. Significantly better outcomes were observed for the SABG group when compared with the TABG group. In conclusion, the age at which ABG is performed is a factor that impacts on the surgical outcome. Specifically, increasing age is associated with worse outcomes.

Previous Percutaneous Coronary Intervention as Risk Factor for Coronary Artery Bypass Grafting

Background: Percutaneous coronary intervention (PCI) has increased as the initial revascularization strategy in chronic coronary artery disease. Consequently, more patients undergoing coronary artery bypass grafting (CABG) have history of coronary stent. Objective: Evaluate the impact of previous PCI on in-hospital mortality after CABG in patients with multivessel coronary artery disease. Methods: Between May/2007 and June/2009, 1099 consecutive patients underwent CABG on cardiopulmonary bypass. Patients with no PCI (n=938, 85.3%) were compared with patients with previous PCI (n=161, 14.6%). Logistic regression models and propensity score matching analysis were used to assess the risk-adjusted impact of previous PCI on in-hospital mortality. Results: Both groups were similar, except for the fact that patients with previous PCI were more likely to have unstable angina (16.1% x 9.9%, p=0.019). In-hospital mortality after CABG was higher in patients with previous PCI (9.3% x 5.1%, p=0.034) and it was comparable with EuroSCORE and 2000 Bernstein-Parsonnet risk score. Using multivariate logistic regression analysis, previous PCI emerged as an independent predictor of postoperative in-hospital mortality (odds ratio 1.94, 95% CI 1.02-3.68, p=0.044) as strong as diabetes (odds ratio 1.86, 95% CI 1.07-3.24, p=0.028). After computed propensity score matching based on preoperative risk factors, in-hospital mortality remained higher among patients with previous PCI (odds ratio 3.46, 95% CI 1.10-10.93, p=0.034). Conclusions: Previous PCI in patients with multivessel coronary artery disease is an independent risk factor for in-hospital mortality after CABG. This fact must be considered when PCI is indicated as initial alternative in patients with more severe coronary artery disease. (Arq Bras Cardiol 2012;99(1):586-595)

Further results in J and CTOD estimation procedures for SE(T) fracture specimens - Part I: Homogeneous materials

This study provides further developments of the evaluation procedure for J and CTOD in SE(T) fracture specimens based on plastic eta-factors and load separation analysis. Non-linear finite element analyses for plane-strain and 3-D models provide the relationship between plastic work and crack driving forces which define the eta-values. Further analyses based on the load separation method define alternative eta-values for the analyzed specimen configurations. Overall, the present results provide improved estimation equations for J and CTOD as a function of loading condition (pin load vs. clamp ends), crack geometry and strain hardening properties. (C) 2011 Elsevier Ltd. All rights reserved.

Buccal Bone Plate Remodeling After Immediate Implant Placement With and Without Synthetic Bone Grafting and Flapless Surgery: Radiographic Study in Dogs

Recent studies in animals have shown pronounced resorption of the buccal bone plate after immediate implantation. The use of flapless surgical procedures prior to the installation of immediate implants, as well as the use of synthetic bone graft in the gaps represent viable alternatives to minimize buccal bone resorption and to favor osseointegration. The aim of this study was to evaluate the healing of the buccal bone plate following immediate implantation using the flapless approach, and to compare this process with sites in which a synthetic bone graft was or was not inserted into the gap between the implant and the buccal bone plate. Lower bicuspids from 8 dogs were bilaterally extracted without the use of flaps, and 4 implants were installed in the alveoli in each side of the mandible and were positioned 2.0 mm from the buccal bone plate (gap). Four groups were devised: 2.0-mm subcrestal implants (3.3 x 8 mm) using bone grafts (SCTG), 2.0-mm subcrestal implants without bone grafts (SCCG), equicrestal implants (3.3 x 10 mm) with bone grafts (EGG), and equicrestal implants without bone grafts (ECCG). One week following the surgical procedures, metallic prostheses were installed, and within 12 weeks the dogs were sacrificed. The blocks containing the individual implants were turned sideways, and radiographic imaging was obtained to analyze the remodeling of the buccal bone plate. In the analysis of the resulting distance between the implant shoulder and the bone crest, statistically significant differences were found in the SCTG when compared to the ECTG (P = .02) and ECCG (P = .03). For mean value comparison of the resulting linear distance between the implant surface and the buccal plate, no statistically significant difference was found among all groups (P > .05). The same result was observed in the parameter for presence or absence of tissue formation between the implant surface and buccal plate. Equicrestally placed implants, in this methodology, presented little or no loss of the buccal bone. The subcrestally positioned implants presented loss of buccal bone, even though synthetic bone graft was used. The buccal bone, however, was always coronal to the implant shoulder.

Homogeneous structures and rigidity of isoparametric submanifolds in Hilbert space

We study isoparametric submanifolds of rank at least two in a separable Hilbert space, which are known to be homogeneous by the main result in [E. Heintze and X. Liu, Ann. of Math. (2), 149 (1999), 149-181], and with such a submanifold M and a point x in M we associate a canonical homogeneous structure I" (x) (a certain bilinear map defined on a subspace of T (x) M x T (x) M). We prove that I" (x) , together with the second fundamental form alpha (x) , encodes all the information about M, and we deduce from this the rigidity result that M is completely determined by alpha (x) and (Delta alpha) (x) , thereby making such submanifolds accessible to classification. As an essential step, we show that the one-parameter groups of isometries constructed in [E. Heintze and X. Liu, Ann. of Math. (2), 149 (1999), 149-181] to prove their homogeneity induce smooth and hence everywhere defined Killing fields, implying the continuity of I" (this result also seems to close a gap in [U. Christ, J. Differential Geom., 62 (2002), 1-15]). Here an important tool is the introduction of affine root systems of isoparametric submanifolds.

Identification and characterization of drought/wet events homogeneous environments based on regional climate simulations

The objective of this study was to identify and characterize homogeneous environments based on the probability of drought/wet occurrence in the central-northern Brazil, considering Rondonia, Mato Grosso, Goias and Tocantins States. The drought index denominated the moisture anomaly Z-index (Z-index) was used. The input climate data for the drought index was generated by the regional climate model RegCM3 for the period from 1975 to 1989. As result of cluster analysis, it was identified 13 homogeneous environments. These environments were characterized based on the probability of drought/wet, relative density of drought/wet occurrence, annual rainfall variability and probability of drought occurrence during the rainy season (October to March). The Mato Grosso State had the highest number of homogeneous environments and the environment 11, located at southwest of this State had the highest probability of drought occurrence, 9%. The environment 10, located at the extreme east of Goias State, showed the lowest median for the total annual rainfall. The climatic event with the highest probability of occurrence in the study area is close to normal or normality moisture.

Influence of Pleural Drain Insertion in Lung Function of Patients Undergoing Coronary Artery Bypass Grafting

Background and objectives: Longitudinal, prospective, randomized, blinded Trial to assess the influence of pleural drain (non-toxic PVC) site of insertion on lung function and postoperative pain of patients undergoing coronary artery bypass grafting in the first three days post-surgery and immediately after chest tube removal. Method: Thirty six patients scheduled for elective myocardial revascularization with cardiopulmonary bypass (CPB) were randomly allocated into two groups: SX group (subxiphoid) and IC group (intercostal drain). Spirometry, arterial blood gases, and pain tests were recorded. Results: Thirty one patients were selected, 16 in SX group and 15 in IC group. Postoperative (PO) spirometric values were higher in SX than in IC group (p < 0.05), showing less influence of pleural drain location on breathing. PaO2 on the second PO increased significantly in SX group compared with IC group (p < 0.0188). The intensity of pain before and after spirometry was lower in SX group than in IC group (p < 0.005). Spirometric values were significantly increased in both groups after chest tube removal. Conclusion: Drain with insertion in the subxiphoid region causes less change in lung function and discomfort, allowing better recovery of respiratory parameters.

EQUIVALENCE OF REAL MILNOR FIBRATIONS FOR QUASI-HOMOGENEOUS SINGULARITIES

We show that for real quasi-homogeneous singularities f : (R-m, 0) -> (R-2, 0) with isolated singular point at the origin, the projection map of the Milnor fibration S-epsilon(m-1) \ K-epsilon -> S-1 is given by f/parallel to f parallel to. Moreover, for these singularities the two versions of the Milnor fibration, on the sphere and on a Milnor tube, are equivalent. In order to prove this, we show that the flow of the Euler vector field plays and important role. In addition, we present, in an easy way, a characterization of the critical points of the projection (f/parallel to f parallel to) : S-epsilon(m-1) \ K-epsilon -> S-1.

Homogeneous metallicities and radial velocities for Galactic globular clusters

Well determined radial velocities and abundances are essential for analyzing the properties of the globular cluster system of the Milky Way. However more than 50% of these clusters have no spectroscopic measure of their metallicity. In this context, this work provides new radial velocities and abundances for twenty Milky Way globular clusters which lack or have poorly known values for these quantities. The radial velocities and abundances are derived from spectra obtained at the Ca II triplet using the FORS2 imager and spectrograph at the VLT, calibrated with spectra of red giants in a number of clusters with well determined abundances. For about half of the clusters in our sample we present significant revisions of the existing velocities or abundances, or both. We also confirm the existence of a sizable abundance spread in the globular cluster M 54, which lies at the center of the Sagittarius dwarf galaxy. In addition evidence is provided for the existence of a small intrinsic internal abundance spread (sigma[Fe/H](int) approximate to 0.11-0.14 dex, similar to that of M 54) in the luminous distant globular cluster NGC 5824. This cluster thus joins the small number of Galactic globular clusters known to possess internal metallicity ([Fe/H]) spreads.

Estimation of lung vital capacity before and after coronary artery bypass grafting surgery: a comparison of incentive spirometer and ventilometry

Abstract Background Measurement of vital capacity (VC) by spirometry is the most widely used technique for lung function evaluation, however, this form of assessment is costly and further investigation of other reliable methods at lower cost is necessary. Objective: To analyze the correlation between direct vital capacity measured with ventilometer and with incentive inspirometer in patients in pre and post cardiac surgery. Methodology Cross-sectional comparative study with patients undergoing cardiac surgery. Respiratory parameters were evaluated through the measurement of VC performed by ventilometer and inspirometer. To analyze data normality the Kolmogorov-Smirnov test was applied, for correlation the Pearson correlation coefficient was used and for comparison of variables in pre and post operative period Student's t test was adopted. We established a level of ignificance of 5%. Data was presented as an average, standard deviation and relative frequency when needed. The significance level was set at 5%. Results We studied 52 patients undergoing cardiac surgery, 20 patients in preoperative with VC-ventilometer: 32.95 ± 11.4 ml/kg and VC-inspirometer: 28.9 ± 11 ml/Kg, r = 0.7 p < 0.001. In the post operatory, 32 patients were evaluated with VC-ventilometer: 28.27 ± 12.48 ml/kg and VC-inspirometer: 26.98 ± 11 ml/Kg, r = 0.95 p < 0.001. Presenting a very high correlation between the evaluation forms studied. Conclusion There was a high correlation between DVC measures with ventilometer and incentive spirometer in pre and post CABG surgery. Despite this, arises the necessity of further studies to evaluate the repercussion of this method in lowering costs at hospitals.