Very Long-Term Prognostic Role of Admission BNP in Non-ST Segment Elevation Acute Coronary Syndrome

Abstract Background: BNP has been extensively evaluated to determine short- and intermediate-term prognosis in patients with acute coronary syndrome, but its role in long-term mortality is not known. Objective: To determine the very long-term prognostic role of B-type natriuretic peptide (BNP) for all-cause mortality in patients with non-ST segment elevation acute coronary syndrome (NSTEACS). Methods: A cohort of 224 consecutive patients with NSTEACS, prospectively seen in the Emergency Department, had BNP measured on arrival to establish prognosis, and underwent a median 9.34-year follow-up for all-cause mortality. Results: Unstable angina was diagnosed in 52.2%, and non-ST segment elevation myocardial infarction, in 47.8%. Median admission BNP was 81.9 pg/mL (IQ range = 22.2; 225) and mortality rate was correlated with increasing BNP quartiles: 14.3; 16.1; 48.2; and 73.2% (p < 0.0001). ROC curve disclosed 100 pg/mL as the best BNP cut-off value for mortality prediction (area under the curve = 0.789, 95% CI= 0.723-0.854), being a strong predictor of late mortality: BNP < 100 = 17.3% vs. BNP ≥ 100 = 65.0%, RR = 3.76 (95% CI = 2.49-5.63, p < 0.001). On logistic regression analysis, age >72 years (OR = 3.79, 95% CI = 1.62-8.86, p = 0.002), BNP ≥ 100 pg/mL (OR = 6.24, 95% CI = 2.95-13.23, p < 0.001) and estimated glomerular filtration rate (OR = 0.98, 95% CI = 0.97-0.99, p = 0.049) were independent late-mortality predictors. Conclusions: BNP measured at hospital admission in patients with NSTEACS is a strong, independent predictor of very long-term all-cause mortality. This study allows raising the hypothesis that BNP should be measured in all patients with NSTEACS at the index event for long-term risk stratification.

When is the Best Time for the Second Antiplatelet Agent in Non-St Elevation Acute Coronary Syndrome?

Abstract Dual antiplatelet therapy is a well-established treatment in patients with non-ST elevation acute coronary syndrome (NSTE-ACS), with class I of recommendation (level of evidence A) in current national and international guidelines. Nonetheless, these guidelines are not precise or consensual regarding the best time to start the second antiplatelet agent. The evidences are conflicting, and after more than a decade using clopidogrel in this scenario, benefits from the routine pretreatment, i.e. without knowing the coronary anatomy, with dual antiplatelet therapy remain uncertain. The recommendation for the upfront treatment with clopidogrel in NSTE-ACS is based on the reduction of non-fatal events in studies that used the conservative strategy with eventual invasive stratification, after many days of the acute event. This approach is different from the current management of these patients, considering the established benefits from the early invasive strategy, especially in moderate to high-risk patients. The only randomized study to date that specifically tested the pretreatment in NSTE-ACS in the context of early invasive strategy, used prasugrel, and it did not show any benefit in reducing ischemic events with pretreatment. On the contrary, its administration increased the risk of bleeding events. This study has brought the pretreatment again into discussion, and led to changes in recent guidelines of the American and European cardiology societies. In this paper, the authors review the main evidence of the pretreatment with dual antiplatelet therapy in NSTE-ACS.

III - Contribuição para o estudo biológico e ecológico das Podostemaceae do salto do Piracicaba

1 - The Author, in this 3 thd. contribution, concludes the study of the biology and ecology of the species Tristicha trifaria (Willd.) Spreng. and Mourera aspera (Bong.) Tul., both of the Piracicaba Fall. 2 - According to the results of Dr. Peter van Royen (State Herbarium of Leiden, Holland), who made a complete revision of Podostemaceae of the Piracicaba Fall, the species Tristicha hypnoides (St. Hil.) Spreng. var. Hilarii Tul. and Mnioppsis Glazioviana Warm, correspond, respectively, to theTristicha trifaria (Willd.) Spreng. and Mniopsis weddelliana Tul. Apinagia Accorsii Toledo was transferred by Royen to the genus Wettsteiniola. So, its new name is Wettsteiniola accorsii (Toledo) v. Royen. 3 - Propagation by seeds may occur in the following places: a) placenta of partially open fruits; b) external and internal walls of the open capsules; c) pedicels of the fruits; d) remains of rhizomes, branches, etc. e) organic residues accumulated in water holes in the fall; f) clean rocks, in which the little groups of seedlings seems to be a colony of algae. Seeds adhere to the substrata above by means, of a mucilage produced by the transformation of the external integuments in contact with water. 4 - In the growth of the four species below it was found in Piracicaba Fall conspicuous zoning so scattered: a) Wettsteiniola accorsii (Toledo) v. Royen, in rocks situated just within the water fall, where velocity of the current and aeration of the water are very high. b) Tristicha trifaria (Willd.) Spreng. and Mniopsis weddelliana Tul., in rocks at some distance (100 m more or less) upstream until near the bridge across the river. c) Mourera aspera (Bong.) Tul., 300 m upwards the bridge. 5- During 1949, the ecological conditions of the Piracicaba Fall were changed due to the following factors: a) dry season very long, begining from last period of June until 30 november; b) stopping, during four months, of water from the Atibaia river (one of the components of Piracicaba river) near to the city of Americana, in the place where a new station of the Companhia Paulista de Força e Luz was build. In consequence, most of the Podostemaceae died. On the dry rocks there were only fruits and dried plants. 6 - Tristicha trifaria has the same biological and ecological behavior as the Mniopsis weddelliana,. 7 - The vegetative propagation of Tristicha trifaria is made by increasing of its branches, production of stolons with vegetatives buds and regeneration of old parts in especial conditions of water and aeration. 8 - Mourera aspera has the same vegetative propagation as the Wettsteiniola accorsii; it produces stolons (in very little percentage) with vegetative buds, branches of the rhizomes and regeneration of active old parts. 9 - Frequently, there is, on the plants an accumulation of sand, silt, loam, organic substances, and so on. The quantity of material stored depends of the purity of the water, of the morphology of the plants and of the situation on the fall. 10 - In extrem conditions of dry heat, the surviving of the species in its habitat depends exclusively from germination of seeds in the mentioned substrata. Exceptionally, some plants survive in a few water pockets full with the weak remaining current.

Diversity and stability of fishes (Teleostei) in a temporary river of the Brazilian semiarid region

The effects of hydrological disturbances by flooding and drought on the diversity and stability in a temporary river fish community in the Brazilian semiarid region were analyzed over the 1996 hydrological cycle. Twelve collections of fishes were made during the wet and dry phases, and 789 individuals of 16 species were collected. Diversity was measured using Simpson's Index (S) and community stability was analyzed by the variation in abundance using Kendall's W concordance test. Fish diversity in the Taperoá river was subjected to hydrological disturbances by flooding and drought. During the wet phase the diversity was higher (S = 0.855) than during the dry phase (S = 0.771). The community was considered stable during the whole annual hydrological cycle (W = 0.418 p < 0.001), but a higher stability in the community was found during the dry phase. During the dry phase the number of dominant species was smaller than during the wet phase.

Fish assemblage composition in a tributary of the Mogi Guaçu river basin, southeastern Brazil

Fish assemblage composition and seasonal patterns of species abundance were studied in Cabaceiras stream, a tributary of the Mogi Guaçu river in São Paulo State, Brazil. Three stations were sampled monthly from June 1999 to May 2000 using sieves and small trawl net and gill nets. Fifteen fish families, 37 genera and 45 species were captured. Characiformes (27 spp.) and Siluriformes (13 spp.) were the most species-rich orders. Gymnotiformes and Perciformes were represented by two species each, and Synbranchiformes had only a single species. One group of species (approximately 75 %) persisted in the stream throughout the year. A second group (approximately 25 %) contained species that only occupy the stream for a limited period of their life cycle, and overall fish assemblage composition was associated with the seasonal flood cycle.

Reproductive biology of the sesarmid crab Armases rubripes (Decapoda, Brachyura) from an estuarine area of the Sahy River, Sepetiba Bay, Rio de Janeiro, Brazil

The aim of this work was to gain knowledge about reproductive biology of the crab Armases rubripes (Rathbun, 1897) from an estuarine area of the Sepetiba Bay. Samples were taken monthly from February 2003 to January 2004 in the Sahy River estuary (22º56'S; 44º01'W), Rio de Janeiro, Brazil. The crabs were collected by hand during 15-minute catch-effort sessions conducted by two people. In the laboratory, the specimens were separated by sex, carapace width was measured and gonadal stage was checked macroscopically. A total of 830 individuals were caught - 304 males, 373 females (60 ovigerous females) and 153 juveniles. The ovigerous females were found almost year-round, except in November and April, showing a continuous reproductive period. They presented a size range from 8.2 to 15.0 mm carapace width (12.1 ± 1.7 mm). Color and macroscopical aspects determined five gonadal stages for males and females (immature, rudimentary, intermediary, developed and resting). First sexual maturity was estimated at 6.5 mm of carapace width for males and 8.1 mm for females. Individual fecundity varied from 200 to 11,460 eggs (4,458 ± 2,739 eggs). Mean egg size was 0.248 ± 0.026 mm, varying from 0.213 to 0.333 mm, while the volume ranged from 0.0051 to 0.0188 mm³ (0.0082 ± 0.0029 mm³).

Composition and diversity of Trichoptera (Insecta) larvae communities in the middle section of the Jacuí river and some tributaries, State of Rio Grande do Sul, Brazil

The taxonomic composition and diversity of Trichoptera larvae communities were studied in four lotic sites in central region of State of Rio Grande do Sul. Sampling was done monthly from June, 2001 to May, 2002 in four sites located at the middle section of Jacuí River (Point 4) and in three tributaries (Carijinho River - Point 1; Lajeado da Gringa - Point 2 and Lajeado do Gringo - Point 3), with a Surber sampler. The total number of larvae collected was 29,143, belonging to 25 genera distributed in nine families; twenty of these genera are new records for the State. The highest abundance was found at Point 2 (n = 12,547). The highest standardized richness, for a 1,177 specimens sample chosen by chance, was recorded at Point 1, followed by Point 4 (17.7 and 16 genera, respectively). The highest diversity was found at Point 1, and the lowest at Point 3 (H' = 1.31 and H' = 0.77, respectively). Point 1 had the lowest anthropic influence and the best preserved riparian vegetation, while Point 3 presented the highest anthropic impact, and a very reduced riparian vegetation. The diversity of Trichoptera observed in this study is low, compared to the estimated maximum theoretical diversity. Low diversity values are related to the low evenness, since the richness was relatively high. The Trichoptera larvae communities seem to be related to the food availability and physical features (riparian vegetation and anthropic influence) of the study sites.

Quantitative fidelity of recent freshwater mollusk assemblages from the Touro Passo River, Rio Grande do Sul, Brazil

This study represents one of the first contributions to the knowledge on the quantitative fidelity of the recent freshwater molluscan assemblages in subtropical rivers. Thanatocoenoses and biocoenoses were studied in straight and meandering to braided sectors, in the middle course of the Touro Passo River, a fourth-order tributary of the Uruguay River, located in the westernmost part of the State of Rio Grande do Sul. Samplings were carried out through quadrats of 5 m², five in each sector. A total area of 50 m² was sampled. Samplings were also made in a lentic environment (abandoned meander), with intermittent communication with the Touro Passo River, aiming to record out-of-habitat shell transportation from the lentic communities to the main river channel. The results show that, despite the frequent oscillation of the water level, the biocoenosis of the Touro Passo River shows high ecological fidelity and undergoes little influence from the lentic vicinal environments. The taxonomic composition and some features of the structure of communities, especially the dominant species, also reflect some ecological differences between the two main sectors sampled, such as the complexity of habitats in the meandering-sector. Regarding the quantitative fidelity, 60% of the species found alive were also found dead and 47.3% of the species found dead were also found alive, at river-scale. However, 72% of the dead individuals belong to species also found alive. This value might be related with the good rank order correlation obtained for live/dead assemblages. Consequently, the dominant species of the thanatocoenoses could be used to infer the ecological attributes of the biocoenoses. The values of all the indexes analyzed were very variable in small-scale samplings (quadrat), but were more similar to others registered in previous studies, when they were analyzed in a station and river scale.

Species richness and community structure of arboreal spider assemblages in fragments of three vegetational types at Banhado Grande wet plain, Gravataí River, Rio Grande do Sul, Brazil

The taxonomic composition, observed and estimated species richness, and patterns of community structure of arboreal spider assemblages in eleven sites surrounding the "Banhado Grande" wet plain in the state of Rio Grande do Sul, Brazil, are presented. These sites represent three different vegetational types: hillside (four sites), riparian (five sites) and flooded forests (two sites). The spiders were captured by beating on foliage and "aerial litter". A sample was defined as the result of beating on twenty bushes, tree branches or "aerial litter" clusters, which roughly corresponds to one-hour search effort per sample. Fifty five samples (five per site) were obtained, resulting in an observed richness of 212 species present as adult or identifiable juveniles. The total richness for all samples was estimated to be between 250 (Bootstrap) to 354 species (Jackknife 2). Confidence intervals of both sample and individual-based rarefaction curves for each vegetation type clearly indicated that flooded forest is the poorest vegetation type with respect to spider species richness, with hillside and riparian forests having a similar number of species. The percentage complementarity between the eleven sites indicated that all sites contain a distinct set of species, irrespective of their vegetation types. Nevertheless, the spider assemblages in riparian and hillside forests are more similar with respect to each other than when compared to flooded forest. Both cluster and nonmetric multidimensional scaling analyses showed no strong correspondence between the spider arboreal fauna and the three vegetation types. Moreover, a Mantel test revealed no significant association between species composition and geographic distance among sites.

Diet of Iheringichthys labrosus (Siluriformes, Pimelodidae) in the Ibicuí River, Southern Brazil

The diet of the benthic-feeding fish Iheringichthys labrosus (Lütken, 1874) was analyzed. Samples were taken bimonthly from December 1999 to January 2002, in three sites of the Ibicuí River, a tributary of Uruguay River basin (Rio Grande do Sul, Brazil). In each sampling point the specimens were collected in lentic and lotic environments. Gillnets and trammel nets were examined every 6 hours (6h, 12h, 18h and 24h). Diet description was based on the frequency of occurrence and the volume of each food item to obtain the Alimentary Index (IAi). The average stomach fullness was adopted to detect variations in the feeding activity according to the season, the circadian rhythm and the environment. Chironomids were the most important food item, followed by mollusks, and feeding activity was highest in summer, during daylight (6h and 12h), and in the lotic environment of the second sampling point.

Composition and diversity of Ephemeroptera (Insecta) nymph communities in the middle section of the Jacuí River and some tributaries, southern Brazil

The taxonomic composition and diversity of assemblages of Ephemeroptera nymphs of four lotic environments in the central region of State of Rio Grande do Sul, a subtropical area in southern Brazil, were evaluated. Samplings were done monthly, with a Surber sampler, from June 2001 to May 2002, in the Jacuí River and three of its tributaries. The total number of nymphs collected in the four sampling sites was 11,007 in five families and 19 genera, of these, 11 are new records for the State. The highest diversity occurred in Point 4 (H'=2.41) and the lowest in Point 2 (H'=1.69). Point 4 had the highest environmental stability, conservation of the riparian vegetation and the lowest anthropic impact, while Point 2 presented a large environmental simplification due to a direct anthropic influence (e.g. domestic sewerage, trampling by cattle). The diversity of nymphs observed in the total area is high, compared to the estimated maximum theoretical diversity; a result of the high evenness and richness recorded. Rarefaction curves, calculated for a sample of 1,018 specimens, showed a similar expectation of richness for the four sampling sites. This result seems to be associated with the overall environmental homogeneity of the region caused by long-term alterations (land use and deforestation). In summary, higher diversity of Ephemeroptera nymph assemblages seems to be associated with habitat complexity, a good vegetation cover and a lower anthropic influence.

Microsatellite genotyping from faeces of Lontra longicaudis from southern Brazil

A genetic study of the neotropical river otter Lontra longicaudis (Olfers, 1818), which has an unknown conservation status, was carried out at the Taim Ecological Station and the margins of the Vargas stream, Rio Grande do Sul, southern Brazil. Faecal samples were collected, and DNA was extracted using a silica-guanidine method. Five microsatellite loci were amplified using PCR with heterologous primers previously described for Lutra lutra (Linnaeus, 1758). Sixteen faecal samples out of 29 from Taim and 11 out of 14 from Vargas stream margins contained enough DNA for genetic analysis. A total of 49 different alleles were found at both localities, from which 18 were exclusively found in individuals from Taim and 17 were exclusives from Vargas individuals. The most common allele was the same at both locations for three loci (Lut715, Lut733, and Lut818). A high level of genetic diversity was found at both sites (NeTaim=4.1, HoTaim=0.299, HeTaim=0.681; NeVargas=4.9, HoVargas=0.355, HeVargas=0.724), being higher at the Vargas stream site. A high and significant level of heterozygote deficiency was observed at most loci according to the χ2 test. The homogeneity χ2 test (P<0.001) showed that there were significant differences in the allele frequencies between the two locations. Genotyping for more than one locus was possible in 81.5% of samples, from which only 37% were possible to genotype for more than three loci. A low degree of relatedness was found among individuals from Taim (R=0.055±0.310), but an even lower value of relatedness was found at the Vargas site (R= -0.285±0.440). The significant degree of differentiation (I=0.890; F ST=0.059) found between Taim and Vargas individuals suggests that there is more than one population of otters in the southern extreme of Brazil, which probably are associated with the water body systems found in this region, the Mirim and the Caiuvá/Flores/Mangueira Lagoons. The high genetic diversity and low relatedness found at the Vargas stream, lead us to believe that the Vargas stream may be acting as a corridor between these water bodies for otter dispersion.

Acanthotylotra alvarengai (Porifera, Demospongiae) new genus and species of sponge from Tocantins river, Pará State, Brazil

Acanthotylotra a new monotypic genus of freshwater sponge is defined. Its sole species A. alvarengai sp. nov. is described based upon microscopic specimens recovered from the Tocantins river, Pará State, Brazil, when the deep rocky substrate was temporarily exposed downstream from the dam at the time it was closed for lake formation. A unique set of megascleres, allied to the paucity of spongin, the renieroid skeleton and the fact that gemmules or new specimens remain undetected, call for the proposition of a new monospecific genus to be retained as incertae sedis until new larger and probably gemmuliferous specimens come to be found.

Fish assemblages in two sandy beaches in lower Purus river, Amazonas, Brazil

Fish assemblages from two sandy beaches in the lower Purus river (Amazonas, Brazil) were compared. Four sampling groups were represented by: day and night samples in sandy beach inside the Reserva Biológica de Abufari (biological reserve) and day and night samples in the Reserva de Desenvolvimento Sustentável Piagaçu-Purus (sustainable development reserve). Samples were collected during low water levels (November) in 2007. The fish were sampled by means of seines with mesh size of 5 mm between opposing knots, 11 m long and 6 m wide. A total of 112 fish species belonging to nine orders and 27 families was captured. The vast majority of the dominant forms consisted of small fishes (< 100 mm SL) or juveniles. Samples collected in Abufari at night presented more specimens (3,540), higher richness (84 spp.), larger total biomass (76,614 g) and higher diversity (H'= 2.57) than the other groups. The composition of fish assemblages was significantly different among all analyzed groups (ANOSIM, p < 0.0001, R= 0.71). NMDS analysis also clustered all species in four distinct groups according to species composition per period and site. SIMPER analyses showed that 80% of variation of species composition among the groups examined was due to 12 species. However, fish composition did not show any correlation with the abiotic factors examined. Different levels of use in both reserves may explain differences in fish composition.

Reproductive traits of Gymnogeophagus labiatus (Teleostei, Cichlidae), in an upper stretch of Sinos river, Caraá, Brazil

This work describes the reproduction of Gymnogeophagus labiatus (Hensel, 1870) from an upper stretch of Sinos river, southern Brazil, based on the analysis of 174 males and 132 females captured in monthly samples taken from January to December 2007. Results showed that reproductive activity occur in spring and summer although ripe males were found along the year. The standard length of the smallest ripe male was 104.74 mm (Lt) and the smallest ripe female was 55.00 mm (Lt). There was a significant difference in total sex ratio, with 1.32 males to each female (χ2 = 5.76). Males were much more abundant in March (1.75 males: 1 female) and December (5 males: 1 female). Females were more abundant in the 62├77 mm interval (1 male: 2.36 female) while males were more abundant in the 77├92 mm size interval (2.57 males: 1 female). The largest length intervals were composed of only males. Mean absolute fecundity was 113.4 (± 31.24 sd) and mean relative fecundity was 0.0125 (± 0.0026 sd) oocytes/mg. In ripe ovaries, small-diameter oocytes were observed at high frequencies while larger ones occurred at lower frequencies. This pattern is common in fishes with asynchronous oocyte development. Characteristics of G. labiatus, such as low fecundity, asynchrony in oocyte development, multiple spawning, and its well-known parental care behavior, are consistent with an equilibrium strategy, as proposed for other cichlids.