Predictors of restenosis after percutaneous coronary intervention using bare-metal stents: a comparison between patients with and without dysglycemia

The objective of this study was to identify intravascular ultrasound (IVUS), angiographic and metabolic parameters related to restenosis in patients with dysglycemia. Seventy consecutive patients (77 lesions) selected according to inclusion and exclusion criteria were evaluated by the oral glucose tolerance test and the determination of insulinemia after a successful percutaneous coronary intervention (PCI) with a bare-metal stent. The degree of insulin resistance was calculated by the homeostasis model assessment of insulin resistance (HOMA-IR). Six-month IVUS and angiogram follow-up were performed. Thirty-nine patients (55.7%) had dysglycemia. The restenosis rate in the dysglycemic group was 37.2 vs 23.5% in the euglycemic group (P = 0.299). The predictors of restenosis using bivariate analysis were reference vessel diameter (RVD): £2.93 mm (RR = 0.54; 95%CI = 0.05-0.78; P = 0.048), stent area (SA): <8.91 mm² (RR = 0.66; 95%CI = 0.24-0.85; P = 0.006), stent volume (SV): <119.75 mm³ (RR = 0.74; 95%CI = 0.38-0.89; P = 0.0005), HOMA-IR: >2.063 (RR = 0.44; 95%CI = 0.14-0.64; P = 0.027), and fasting plasma glucose (FPG): ≤108.8 mg/dL (RR = 0.53; 95%CI = 0.13-0.75; P = 0.046). SV was an independent predictor of restenosis by multivariable analysis. Dysglycemia is a common clinical condition in patients submitted to PCI. The degree of insulin resistance, FPG, RVD, SA, and SV were correlated with restenosis. SV was inversely correlated with an independent predictor of restenosis in patients treated with a bare-metal stent.

Increased levels of glutamate in the central nervous system are associated with behavioral symptoms in experimental malaria

Cerebral malaria (CM) is a severe complication resulting from Plasmodium falciparum infection. This condition has been associated with cognitive, behavioral and motor dysfunctions, seizures and coma. The underlying mechanisms of CM are incompletely understood. Glutamate and other metabolites such as lactate have been implicated in its pathogenesis. In the present study, we investigated the involvement of glutamate in the behavioral symptoms of CM. Seventeen female C57BL/6 mice (20-25 g) aged 6-8 weeks were infected with P. berghei ANKA by the intraperitoneal route using a standardized inoculation of 10(6) parasitized red blood cells suspended in 0.2 mL PBS. Control animals (N = 17) received the same volume of PBS. Behavioral and neurological symptoms were analyzed by the SmithKline/Harwell/Imperial College/Royal Hospital/Phenotype Assessment (SHIRPA) battery. Glutamate release was measured in the cerebral cortex and cerebrospinal fluid of infected and control mice by fluorimetric assay. All functional categories of the SHIRPA battery were significantly altered in the infected mice at 6 days post-infection (dpi) (P ≤ 0.05). In parallel to CM symptoms, we found a significant increase in glutamate levels in the cerebral cortex (mean ± SEM; control: 11.62 ± 0.90 nmol/mg protein; infected at 3 dpi: 10.36 ± 1.17 nmol/mg protein; infected at 6 dpi: 26.65 ± 0.73 nmol/mg protein; with EGTA, control: 5.60 ± 1.92 nmol/mg protein; infected at 3 dpi: 6.24 ± 1.87 nmol/mg protein; infected at 6 dpi: 14.14 ± 0.84 nmol/mg protein) and in the cerebrospinal fluid (control: 128 ± 51.23 pmol/mg protein; infected: 301.4 ± 22.52 pmol/mg protein) of infected mice (P ≤ 0.05). These findings suggest a role of glutamate in the central nervous system dysfunction found in CM.

Time motion analysis of football (soccer) referees during official matches in relation to the type of fluid consumed

The aim of the present study was to determine the effect of volume and composition of fluid replacement on the physical performance of male football referees. Ten referees were evaluated during three official matches. In one match the participants were asked to consume mineral water ad libitum, and in the others they consumed a pre-determined volume of mineral water or a carbohydrate electrolyte solution (6.4% carbohydrate and 22 mM Na+) equivalent to 1% of their baseline body mass (half before the match and half during the interval). Total water loss, sweat rate and match physiological performance were measured. When rehydrated ad libitum (pre-match and at half time) participants lost 1.97 ± 0.18% of their pre-match body mass (2.14 ± 0.19 L). This parameter was significantly reduced when they consumed a pre-determined volume of fluid. Sweat rate was significantly reduced when the referees ingested a pre-determined volume of a carbohydrate electrolyte solution, 0.72 ± 0.12 vs 1.16 ± 0.11 L/h ad libitum. The high percentage (74.1%) of movements at low speed (walking, jogging) observed when they ingested fluid ad libitum was significantly reduced to 71% with mineral water and to 69.9% with carbohydrate solution. An increase in percent movement expended in backward running was observed when they consumed a pre-determined volume of carbohydrate solution, 7.7 ± 0.5 vs 5.5 ± 0.5% ad libitum. The improved hydration status achieved with the carbohydrate electrolyte solution reduced the length of time spent in activities at low-speed movements and increased the time spent in activities demanding high-energy expenditure.

Maternal protein restriction affects gene expression and enzyme activity of intestinal disaccharidases in adult rat offspring

This study investigated the consequences of intrauterine protein restriction on the gastrointestinal tract and particularly on the gene expression and activity of intestinal disaccharidases in the adult offspring. Wistar rat dams were fed isocaloric diets containing 6% protein (restricted, n = 8) or 17% protein (control, n = 8) throughout gestation. Male offspring (n = 5-8 in each group) were evaluated at 3 or 16 weeks of age. Maternal protein restriction during pregnancy produced offspring with growth restriction from birth (5.7 ± 0.1 vs 6.3 ± 0.1 g; mean ± SE) to weaning (42.4 ± 1.3 vs 49.1 ± 1.6 g), although at 16 weeks of age their body weight was similar to control (421.7 ± 8.9 and 428.5 ± 8.5 g). Maternal protein restriction also increased lactase activity in the proximal (0.23 ± 0.02vs 0.15 ± 0.02), medial (0.30 ± 0.06vs 0.14 ± 0.01) and distal (0.43 ± 0.07vs 0.07 ± 0.02 U·g-1·min-1) small intestine, and mRNA lactase abundance in the proximal intestine (7.96 ± 1.11vs 2.38 ± 0.47 relative units) of 3-week-old offspring rats. In addition, maternal protein restriction increased sucrase activity (1.20 ± 0.02 vs 0.91 ± 0.02 U·g-1·min-1) and sucrase mRNA abundance (4.48 ± 0.51 vs 1.95 ± 0.17 relative units) in the duodenum of 16-week-old rats. In conclusion, the present study shows for the first time that intrauterine protein restriction affects gene expression of intestinal enzymes in offspring.

Serum uric acid and disorders of glucose metabolism: the role of glycosuria

Hyperuricemia has been associated with hypertension, diabetes mellitus, and metabolic syndrome. We studied the association between hyperuricemia and glycemic status in a nonrandomized sample of primary care patients. This was a cross-sectional study of adults ≥20 years old who were members of a community-based health care program. Hyperuricemia was defined as a value >7.0 mg/dL for men and >6.0 mg/dL for women. The sample comprised 720 participants including controls (n=257) and patients who were hypertensive and euglycemic (n=118), prediabetic (n=222), or diabetic (n=123). The mean age was 42.4±12.5 years, 45% were male, and 30% were white. The prevalence of hyperuricemia increased from controls (3.9%) to euglycemic hypertension (7.6%) and prediabetic state (14.0%), with values in prediabetic patients being statistically different from controls. Overall, diabetic patients had an 11.4% prevalence of hyperuricemia, which was also statistically different from controls. Of note, diabetic subjects with glycosuria, who represented 24% of the diabetic participants, had a null prevalence of hyperuricemia, and statistically higher values for fractional excretion of uric acid, Na excretion index, and prevalence of microalbuminuria than those without glycosuria. Participants who were prediabetic or diabetic but without glycosuria had a similarly elevated prevalence of hyperuricemia. In contrast, diabetic patients with glycosuria had a null prevalence of hyperuricemia and excreted more uric acid and Na than diabetic subjects without glycosuria. The findings can be explained by enhanced proximal tubule reabsorption early in the course of dysglycemia that decreases with the ensuing glycosuria at the late stage of the disorder.

Comparative efficacy and safety of the left versus right radial approach for percutaneous coronary procedures: a meta-analysis including 6870 patients

The radial approach is widely used in the treatment of patients with coronary artery disease. We conducted a meta-analysis of published results on the efficacy and safety of the left and right radial approaches in patients undergoing percutaneous coronary procedures. A systematic search of reference databases was conducted, and data from 14 randomized controlled trials involving 6870 participants were analyzed. The left radial approach was associated with significant reductions in fluoroscopy time [standardized mean difference (SMD)=-0.14, 95% confidence interval (CI)=-0.19 to -0.09; P<0.00001] and contrast volume (SMD=-0.07, 95%CI=-0.12 to -0.02; P=0.009). There were no significant differences in rate of procedural failure of the left and the right radial approaches [risk ratios (RR)=0.98; 95%CI=0.77-1.25; P=0.88] or procedural time (SMD=-0.05, 95%CI=0.17-0.06; P=0.38). Tortuosity of the subclavian artery (RR=0.27, 95%CI=0.14-0.50; P<0.0001) was reported more frequently with the right radial approach. A greater number of catheters were used with the left than with the right radial approach (SMD=0.25, 95%CI=0.04-0.46; P=0.02). We conclude that the left radial approach is as safe as the right radial approach, and that the left radial approach should be recommended for use in percutaneous coronary procedures, especially in percutaneous coronary angiograms.

Composição em carboidratos de alguns cultivares de banana (Musa spp.) durante o amadurecimento

Durante o amadurecimento da banana ocorre redução dos teores de amido e acúmulo de açúcares como frutose, glicose, com predominância de sacarose, com reflexos importantes na qualidade do fruto. Essas alterações têm sido estudadas em nosso laboratório no cultivar Nanicão. O objetivo deste trabalho foi avaliar em outros cultivares as diferenças na degradação do amido e acúmulo de açúcares solúveis nos estágios pré-climatérico e climatérico do amadurecimento, visando também sua possível utilização comercial. Para tanto, os frutos foram analisados quanto ao teor de açúcares solúveis (glicose, frutose e sacarose) e de amido pelo método enzimático, após extração com etanol 80% e hidróxido de sódio, respectivamente. Os cultivares estudados apresentaram diferenças acentuadas nos teores de açúcares solúveis nos frutos maduros, variando desde 9,7% no cultivar Mysore até 20,6% na banana Nanica. Observou-se uma queda no teor de amido paralelamente ao acúmulo de açúcares solúveis. No cultivar Ouro Colatina o teor de amido variou de 22,0% no fruto verde a 1,2% no fruto maduro, havendo acúmulo de sacarose no decorrer do amadurecimento atingindo níveis de 12,0%. Nos cultivares Nanica e Nanicão os teores de amido foram de 21,7% a 0,9% e 23,1% a 0,9% com acúmulo de sacarose a 15,2% e 14,0% no fruto maduro, respectivamente.

Comportamento higroscópico do resíduo seco de camarão-rosa

Estudou-se o comportamento higroscópico do resíduo seco de camarão-rosa (Peneaus subtilis), o qual foi caracterizado como sendo rico em proteínas totais (42,59%) e resíduo mineral fixo (22,01%). Foram construídas isotermas de adsorção e dessorção de umidade a 10, 25, e 40 °C. Determinou-se o valor da monocamada e o calor de dessorção, e testou-se a aplicabilidade de treze modelos matemáticos na predição dos dados de sorção. O produto apresentou isotermas do Tipo II. Os dados de adsorção mostraram que para que o produto apresente estabilidade microbiológica (a w < 0,6), o resíduo seco necessitará estar com umidade inferior a 13,0 g H2O.100 g -1 b.s. na adsorção e 14,0 g H2O.100 g-1 b.s. na dessorção. Os valores da monocamada, para a dessorção, indicam que o resíduo não deve ser seco a níveis de umidade inferiores a 7,29 g H2O.100 g -1 b.s., para evitar gasto desnecessário de energia. Os calores de dessorção evidenciaram a não necessidade de grandes quantidades de energia para secar o resíduo até níveis de umidade que o tornem microbiologicamente estável (a w< 0,6). De acordo com os ajustes os modelos de Oswin e Halsey (bi-paramétricos) e GAB, BET modificada, Hailwood-Horrobin, Anderson, Anderson-Hall e Gascoyne-Pethig (tri-paramétricos), podem ser utilizados na predição das isotermas de sorção do resíduo.

Proximate composition and quantification of fatty acids in five major Brazilian chocolate brands

The objective of the present study was to characterize the centesimal composition and quantify fatty acids in regular and diet chocolate brands with emphasis on trans fatty acids. Regular and diet dark chocolate samples from the major brands analyzed were purchased from different local supermarkets in the city of Maringá. The brands were labeled with letters and five lots of each brand with three chocolate units per lot were analyzed in triplicate. We observed that the diet chocolates from the same brands presented larger lipid contents. The main fatty acids observed were saturated fatty acids (SFA), myristic acid (14:0), palmitic acid (16:0), and estearic acid (18:0). Among the monounsaturated fatty acids (MUFA), polyunsaturated fatty acids (PUFA) and trans fatty acids, oleic acid (18:1n-9), linoleic acid (18:2n-6), and elaidic acid (18:1-9t) predominated. The trans fatty acid contents found in the analyzed samples were lower than and/or in accordance with the limits proposed by the Brazilian regulation.

Microencapsulation of babassu coconut milk

The objective of this study was to obtain babassu coconut milk powder microencapsulated by spray drying process using gum Arabic as wall material. Coconut milk was extracted by babassu peeling, grinding (with two parts of water), and vacuum filtration. The milk was pasteurized at 85 ºC for 15 minutes and homogenized to break up the fat globules, rendering the milk a uniform consistency. A central composite rotatable design with a range of independent variables was used: inlet air temperature in the dryer (170-220 ºC) and gum Arabic concentration (10-20%, w/w) on the responses: moisture content (0.52-2.39%), hygroscopicity (6.98-9.86 g adsorbed water/100g solids), water activity (0.14-0.58), lipid oxidation (0.012-0.064 meq peroxide/kg oil), and process yield (20.33-30.19%). All variables influenced significantly the responses evaluated. Microencapsulation was optimized for maximum process yield and minimal lipid oxidation. The coconut milk powder obtained at optimum conditions was characterized in terms of morphology, particle size distribution, bulk and absolute density, porosity, and wettability.

Changes in the physicochemical and microbiological properties of frozen araça pulp during storage

Araça belongs to the Myrtaceae family and is popularly known as araçá-comum, araçá-azedo, or araçá-do-campo. Frozen fruit pulp is of great importance for the food industry, which can produce it at the time of harvest, store it, and use it according to the demand of the consumer market and/or as an ingredient in the formulation of products such as yogurt, candies, and ice creams among others. The aim of this study was to evaluate the physical, chemical, and microbiological stability of frozen araça pulp during 12 months of frozen storage. It was observed that the levels of moisture (90.55-88.75%), ash (0.34-0.26%) total soluble sugars (7.11-6.62%), sucrose (3.55-1.39%), soluble pectin (0.24-0.23%), total pectin (0.5-0.46%), pH (3.82-2.31%), organic acids (698.12-122.25 µg.g-1 citric acid), and phenolic compounds (6.22-0.00 mg GAE.100 g-1) decreased during storage, whereas the levels of protein (0.61-0.83%), lipids (0.14-0.38%), total carbohydrates (8.36-9.78%), calorific value (37.14-45.86 kcal.100 g-1), reducing sugars (3.51-5.21%), soluble solids (5.17-6.0%), total antioxidant capacity (6.89-35.13%), and color parameters (L*49.75-50.67; a*0.79-1.82 and b*22.5-25.19) increased over the one-year storage period. According to the chemical and microbiological parameters assessed, the product can be stored for 12 months without loss of quality with addition of citric acid as a preservative.

Insuficiência e deficiência de vitamina D em pacientes portadores de doença renal crônica

INTRODUÇÃO: Hipovitaminose D é bem documentada em pacientes portadores de doença renal crônica (DRC). Espera-se níveis inferiores em habitantes de regiões não tropicais em relação aos habitantes de regiões tropicais, pela inferição de uma maior exposição solar e maior produção de vitamina D. OBJETIVO: Analisar os níveis séricos de vitamina D, como 25-hidroxivitamina D - 25(OH)D, de 125 pacientes brasileiros portadores de DRC em fase pré-dialítica. MÉTODOS: Foram estudados 125 pacientes (57,4 ± 16,2 anos, 78 brancos e 55,2% homens), com creatinina de 2,67 ± 1,73 mg/dL e o clearance estimado 43,7 ± 34,5 mL/min. O índice de massa corporal era de 27,4 ± 4,7 kg/m² e a circunferência abdominal de 95,0 ± 14,0 cm. O cálcio era de 9,3 ± 0,6 mg/dL, o paratormônio intacto (PTHi) 212,6 ± 221,2 pg/mL e a albumina sérica 4,2 ± 0,6 g/dL. A média de 25(OH)D era de 23,9 ± 10,7 ng/mL. RESULTADOS: Dos 125 pacientes, 92 (72,6%) apresentavam níveis de 25(OH)D < 30 ng/mL, sendo que 65 (52%) apresentavam insuficiência (15-29 ng/mL); 27 (21,5%) apresentavam deficiência (5-14 ng/mL) e apenas um paciente apresentava deficiência severa < 5 ng/mL. Não foram observadas diferenças entre os níveis de 25(OH)D nos pacientes estratificados quanto ao estágio de DRC. Os níveis de 25(OH)D foram maiores nos homens (38,1 ± 20,6 versus 22,4 ± 9,7 ng/ml; p < 0,0001), havendo também uma correlação inversa entre os níveis de 25(OH)D e de PTHi, proteinúria e circunferência abdominal, e uma correlação positiva entre 25(OH)D e cálcio total e albumina sérica. Na análise multivariada, encontrou-se apenas correlação inversa entre 25(OH)D e circunferência abdominal e PTHi. CONCLUSÃO: A despeito de a população do Brasil estar em um clima tropical, a maioria dos pacientes analisados apresentou níveis séricos subótimos de vitamina D, podendo este achado estar relacionado ao desenvolvimento de hiperparatireoidismo.

Massa ventricular esquerda e índice cardiotorácico em pacientes com doença renal crônica em hemodiálise

Introdução: A hipertrofia ventricular esquerda (HVE) é um fator preditor independente de risco cardiovascular em pacientes com doença renal crônica (DRC) em hemodiálise (HD). Objetivo: Mostrar a utilidade da radiografia de tórax no diagnóstico de HVE em pacientes com DRC em HD. Métodos: Estudo transversal que incluiu 100 pacientes (58 homens e 42 mulheres), idade média de 46,2 ± 14,0 anos, com DRC de todas as etiologias, há pelo menos seis meses em HD. Foram obtidos ecocardiograma e radiografia de tórax dos pacientes, sempre até uma hora após o término das sessões de HD. Resultados: A HVE foi detectada em 83 pacientes (83%), dos quais 56 (67,4%) apresentavam o padrão concêntrico e 27 (32,6%) a padrão excêntrico de HVE. Cardiomegalia - definida por índice cardiotorácico (ICT) > 0,5 - esteve presente em 61 pacientes (61%). Foram os seguintes os valores de sensibilidade, especificidade e acurácia, respectivamente, para a variável ICT: 66,2%, 70,5% e 68,0%. A correlação de Pearson entre ICT e índice de massa do ventrículo esquerdo (IMVE) foi de 0,552 (p < 0,05) e razão de verossimilhança positivo de 2,2. Conclusão: A radiografia de tórax é um exame seguro e útil como ferramenta diagnóstica de HVE em pacientes com DRC em HD.

Sarampo: inquérito sobre antecedentes vacinal e de doença em crianças de 0 a 14 anos, atendidas nos Centros de Saúde Estaduais do Município de São Paulo, 1976

Em julho de 1976 foi realizado um inquérito em 3.096 crianças de 0 a 14 anos, que freqüentavam Centros de Saúde Estaduais no Município de São Paulo , Brasil, com o objetivo de identificar a população ainda suscetível ao sarampo, quer por não ter tido a doença quer por não ter sido vacinada. Também destinava-se, esta pesquisa, a obter outras informações locais de importância para a vigilância epidemiológica da moléstia.