Relação entre a persistência da condução pela via lenta nodal após ablação de taquicardia por reentrada nodal e a recorrência clínica

OBJETIVO: Verificar se a persistência de salto nodal relaciona-se à taxa de recorrência de taquicardia por reentrada nodal (TRN) após ablação com radiofreqüência (RF) da via lenta do nó atrioventricular. MÉTODOS: Num seguimento de 20±12 meses, foi analisada a recorrência de TRN em 126 pacientes consecutivos submetidos a ablação com RF da via lenta nodal. O critério de interrupção do procedimento foi a não reindução da TRN, após estimulação atrial programada, com e sem isoproterenol intravenoso. Ao final do procedimento, 98 pacientes não apresentavam salto nodal, e em 28 persistia o salto nodal e/ou o eco atrial. RESULTADOS: Houve recorrência clínica de TRN em 15 (11%) pacientes: 9 no grupo sem salto nodal e/ou eco atrial e em 6 do grupo que persistiu com salto e/ou eco atrial. A recorrência tendeu a ser maior no 2º grupo (9% vs 21%), mas não houve significância estatística entre os resultados (p=0,09). CONCLUSÃO: Desde que a TRN não possa ser induzida após a infusão de isoproterenol, a recorrência espontânea da arritmia após a ablação por RF da via lenta nodal não é diferente entre pacientes que persistem ou não com salto nodal e/ou eco atrial.

Contribuição da análise eletrofisiológica e anatômica do circuito atípico da taquicardia atrioventricular nodal

OBJETIVOS: Analisar a condução retrógrada durante os episódios de ritmo juncional ectópico acelerado (JET) e avaliar a existência da relação entre a presença de um bloqueio retrógrado e o risco de desenvolvimento de bloqueio atrioventricular (BAV) durante os procedimentos de ablação por radiofreqüência de pacientes portadores de taquicardia atrioventricular nodal (TAVN). MÉTODOS: Foram 145 pacientes portadores de TAVN, de ambos os sexos, com 16 a 84 anos submetidos à ablação com cateter de radiofreqüência na região póstero-septal do átrio direito. Critérios avaliados: localização anatômica e comportamento eletrofisiológico da condução retrógrada durante TAVN (definindo a taquicardia como típica ou atípica) e monitorização da condução retrógrada durante o JET para eventos de risco para BAV. RESULTADOS: Dos 145 pacientes estudados, 132 (91%) preencheram critérios eletrofisiológicos e anatômicos da forma típica da TAVN e 13 (9%), da atípica. Durante a ablação, 5,3% do grupo das típicas e 30,8% das atípicas apresentaram eventos de risco para BAV. Complicações após ablação foram um episódio de BAV total e outro de BAV de primeiro grau nas típicas e um de BAV de primeiro grau nas atípicas. Os três episódios foram precedidos de eventos de risco que resultaram em uma injúria nodal após procedimento. CONCLUSÃO: Portadores de TAVN atípica apresentaram porcentualmente mais eventos preditores de risco para BAV do que os da típica (p = 0,021), sendo fundamental a observação criteriosa da condução retrógrada durante o JET, afim de se evitar permanente da condução nodal, como o BAVT, após o procedimento ablativo.

In vitro culture of Spondias mombin L. nodal segments

Spondias mombin L. shoot cultures were initiated from nodal explants taken from plants propagated by seeds. Explants coming from 4-6 months old plants, previously disinfected, were cultivated on WPM medium supplemented with a wide range of concentrations of BAP (0.0, 0.22, 0.44, 2.22 and 4.44 muM) and NAA (0.0, 0.27 and 2.70 muM). After four weeks, the responses obtained were axillary shoot and root formation. The first response were preferentially induced with the medium containing only BAP, regardless of the BAP concentration. The addition of NAA on medium reduced significantly axillary shoot formation and induced rhizogenesis. Roots were formed on nodal explant basis, preferentially on medium supplemented with 4.44 muM NAA. The medium supplemented with BAP reduced significantly root formation.

Numbers and sets

In this paper I discuss the intuition behind Frege's and Russell's definitions of numbers as sets, as well as Benacerraf's criticism of it. I argue that Benacerraf's argument is not as strong as some philosophers tend to think. Moreover, I examine an alternative to the Fregean-Russellian definition of numbers proposed by Maddy, and point out some problems faced by it.

Prediction of free-stall occupancy rate in dairycattle barns through fuzzy sets

The goal of this study was to develop a fuzzy model to predict the occupancy rate of free-stalls facilities of dairy cattle, aiding to optimize the design of projects. The following input variables were defined for the development of the fuzzy system: dry bulb temperature (Tdb, °C), wet bulb temperature (Twb, °C) and black globe temperature (Tbg, °C). Based on the input variables, the fuzzy system predicts the occupancy rate (OR, %) of dairy cattle in free-stall barns. For the model validation, data collecting were conducted on the facilities of the Intensive System of Milk Production (SIPL), in the Dairy Cattle National Research Center (CNPGL) of Embrapa. The OR values, estimated by the fuzzy system, presented values of average standard deviation of 3.93%, indicating low rate of errors in the simulation. Simulated and measured results were statistically equal (P>0.05, t Test). After validating the proposed model, the average percentage of correct answers for the simulated data was 89.7%. Therefore, the fuzzy system developed for the occupancy rate prediction of free-stalls facilities for dairy cattle allowed a realistic prediction of stalls occupancy rate, allowing the planning and design of free-stall barns.

Clinical signs of pneumonia in children: association with and prediction of diagnosis by fuzzy sets theory

The present study compares the performance of stochastic and fuzzy models for the analysis of the relationship between clinical signs and diagnosis. Data obtained for 153 children concerning diagnosis (pneumonia, other non-pneumonia diseases, absence of disease) and seven clinical signs were divided into two samples, one for analysis and other for validation. The former was used to derive relations by multi-discriminant analysis (MDA) and by fuzzy max-min compositions (fuzzy), and the latter was used to assess the predictions drawn from each type of relation. MDA and fuzzy were closely similar in terms of prediction, with correct allocation of 75.7 to 78.3% of patients in the validation sample, and displaying only a single instance of disagreement: a patient with low level of toxemia was mistaken as not diseased by MDA and correctly taken as somehow ill by fuzzy. Concerning relations, each method provided different information, each revealing different aspects of the relations between clinical signs and diagnoses. Both methods agreed on pointing X-ray, dyspnea, and auscultation as better related with pneumonia, but only fuzzy was able to detect relations of heart rate, body temperature, toxemia and respiratory rate with pneumonia. Moreover, only fuzzy was able to detect a relationship between heart rate and absence of disease, which allowed the detection of six malnourished children whose diagnoses as healthy are, indeed, disputable. The conclusion is that even though fuzzy sets theory might not improve prediction, it certainly does enhance clinical knowledge since it detects relationships not visible to stochastic models.

Selection of patients for myocardial perfusion scintigraphy based on fuzzy sets theory applied to clinical-epidemiological data and treadmill test results

Coronary artery disease (CAD) is a worldwide leading cause of death. The standard method for evaluating critical partial occlusions is coronary arteriography, a catheterization technique which is invasive, time consuming, and costly. There are noninvasive approaches for the early detection of CAD. The basis for the noninvasive diagnosis of CAD has been laid in a sequential analysis of the risk factors, and the results of the treadmill test and myocardial perfusion scintigraphy (MPS). Many investigators have demonstrated that the diagnostic applications of MPS are appropriate for patients who have an intermediate likelihood of disease. Although this information is useful, it is only partially utilized in clinical practice due to the difficulty to properly classify the patients. Since the seminal work of Lotfi Zadeh, fuzzy logic has been applied in numerous areas. In the present study, we proposed and tested a model to select patients for MPS based on fuzzy sets theory. A group of 1053 patients was used to develop the model and another group of 1045 patients was used to test it. Receiver operating characteristic curves were used to compare the performance of the fuzzy model against expert physician opinions, and showed that the performance of the fuzzy model was equal or superior to that of the physicians. Therefore, we conclude that the fuzzy model could be a useful tool to assist the general practitioner in the selection of patients for MPS.

Linfoma não-Hodgkin envolvendo tonsila palatina: relato de 3 casos

O objetivo deste trabalho consiste em relatar três casos de linfoma não-Hodgkin (LNH) com acometimento de tonsilas palatinas acompanhados no Hospital Universitário Clementino Fraga Filho (HUCFF) da Universidade Federal do Rio de Janeiro (UFRJ), com pequena revisão de literatura. Os LNH acometem sítios extra-nodais em 25-30% dos casos. Dos casos extra-nodais, 10-30% acometem cabeça e pescoço. Destes casos de LNH em cabeça e pescoço, 60-70% estão presentes no anel de Waldeyer, e deste grupo, algumas séries relatam que 80% encontram-se na tonsila palatina. Concluímos, portanto, que o acometimento das tonsilas pelo LNH constitui uma apresentação incomum desta malignidade hematológica, que merece atenção e destaque para que seja feito diagnóstico precoce, seguido de tratamento e acompanhamento corretos.

Chemical sterilization in in vitro propagation of Arundina bambusifolia Lindl. and Epidendrum ibaguense Kunth

There is a great demand for simpler and less costly laboratory techniques and for more accessible procedures for orchid breeders who do not have the necessary theoretical basis to use the traditional seed and clone production methods of orchids in vitro. The aim of this study was to assess the use of sodium hypochlorite (NaClO) as a decontaminant in the process of inoculating adult orchid explants of Arundina bambusifolia and Epidendrum ibaguenses. Solutions of NaClO (1.200, 2.400, 3.600, 4.800 and 6.000 mg L-1 - equivalent to 50, 100, 150, 200 and 250 mL L-1 of commercial bleach - CB) were sprayed on the explants (1.0 mL) and the culture medium (GB5), in the presence or absence of activated charcoal (2 g L-1). The explants used were nodal segments of field-grown adult plants. The procedures for inoculating the explants were conducted outside the laminar flow chamber (LFC), except for the control treatment (autoclaved medium and explant inoculation inside the LFC). The best results for fresh weight yield, height and number of shoots were obtained using NaClO in solution at 1.200 mg L-1 (equivalent to 50 mL L-1 commercial bleach) with activated charcoal in the culture medium. Fresh weight figures were 1.10 g/jar for Arundina bambusifolia and 0.16 g/jar for Epidendrum ibaguenses. Spraying the NaClO solutions controls the contamination of the culture medium already inoculated with the explants.

Cantaloupe melon ( Cucumis melo L.) conservation using hydrocooling

ABSTRACT Maintaining cantaloupe melon at field temperature impairs conservation as it speeds up cell metabolism and transpiration, and, consequently, reduces shelf life. This study aimed to evaluate the conservation of Torreon hybrid cantaloupe using the hydrocooling treatment. Fruits were harvested at the commercial maturity stage (60 days after planting), in the morning, at the Nova California Farm, municipality of Mossoró-RN, in September 2007. One set of fruit was immersed in chilled water at 5 ºC for 5 min, at the packing house, while the remaining set was not hydro cooled. Then, both sets (treated and untreated with hydrocooling) were pre-cooled in air forced tunnels at 7 ºC, until the temperature in the pulp reached 10 ºC. Both fruit sets were stored for 0, 14, 21, 28 and 35 days under modified atmosphere at 3 ± 1 oC and 90 ± 5% RH. After each storage period, the fruits were incubated in an atmosphere-controlled chamber at 20 ± 2 oC and 80 ± 5% de RH, for seven days. The following characteristics were evaluated: external and internal appearance, mass loss, soluble solids, firmness and titrable acidity. The experiment was arranged in a completely randomized split-plot design with four replications of three fruits. The plots consisted of the hydrocooling conditions (with and without fruit soaking in chilled water), and the sub-plots consisted of the storage times (0, 14, 21, 28 and 35 days).The treatment with hydrocooling was efficient in keeping the firmness and soluble solids of the fruits and shortened the pre-cooling time in the cooling tunnel. However, hydrocooling did not increase fruit shelf-life.

Linking strategy and the knowledge of the firm

Discovering the ways through which firms develop and maintain competitive advantage is a central research stream in management theory. The objective of this paper is to present a contribution to the discussion of the knowledge of the firm as a source of competitive advantage. The paper states that a firm's success is a consequence of its ability in the continuous development of core competencies that will sustain its competitiveness over time. Core competencies are understood as the sets of knowledge that differentiate a company strategically. The firm must discover, develop, share and update the knowledge that sustains the present and future core competencies. Knowledge management, through processes of knowledge creation and integration, is one way of doing this.

Organizing resistance movements: contribution of the political discourse theory

The main purpose of this paper is to explore the possibility of articulating Political Discourse Theory (PDT) together with Organizational Studies (OS), while using the opportunity to introduce PDT to those OS scholars who have not yet come across it. The bulk of this paper introduces the main concepts of PDT, discussing how they have been applied to concrete, empirical studies of resistance movements. In recent years, PDT has been increasingly appropriated by OS scholars to problematize and analyze resistances and other forms of social antagonisms within organizational settings, taking the relational and contingent aspects of struggles into consideration. While the paper supports the idea of a joint articulation of PDT and OS, it raises a number of critical questions of how PDT concepts have been empirically used to explain the organization of resistance movements. The paper sets out a research agenda for how both PDT and OS can together contribute to our understanding of new, emerging organizational forms of resistance movements.

O planejamento econômico no Brasil: considerações críticas

In the past thirty years, a series of plans have been developed by successive Brazilian governments in a continuing effort to maximize the nation's resources for economic and social growth. This planning history has been quantitatively rich but qualitatively poor. The disjunction has stimulated Professor Mello e Souza to address himself to the problem of national planning and to offer some criticisms of Brazilian planning experience. Though political instability has obviously been a factor promoting discontinuity, his criticisms are aimed at the attitudes and strategic concepts which have sought to link planning to national goals and administration. He criticizes the fascination with techniques and plans to the exclusion of proper diagnosis of the socio-political reality, developing instruments to coordinate and carry out objectives, and creating an administrative structure centralized enough to make national decisions and decentralized enough to perform on the basis of those decisions. Thus, fixed, quantified objectives abound while the problem of functioning mechanisms for the coordinated, rational use of resources has been left unattended. Although his interest and criticism are focused on the process and experience of national planning, he recognized variation in the level and results of Brazilian planning. National plans have failed due to faulty conception of the function of planning. Sectorial plans, save in the sector of the petroleum industry under government responsibility, ha e not succeeded in overcoming the problems of formulation and execution thereby repeating old technical errors. Planning for the private sector has a somewhat brighter history due to the use of Grupos Executivos which has enabled the planning process to transcend the formalism and tradition-bound attitudes of the regular bureaucracy. Regional planning offers two relatively successful experiences, Sudene and the strategy of the regionally oriented autarchy. Thus, planning history in Brazil is not entirely black but a certain shade of grey. The major part of the article, however, is devoted to a descriptive analysis of the national planning experience. The plans included in this analysis are: The Works and Equipment Plan (POE); The Health, Food, Transportation and Energy Plan (Salte); The Program of Goals; The Trienal Plan of Economic and Social Development; and the Plan of Governmental Economic Action (Paeg). Using these five plans for his historical experience the author sets out a series of errors of formulation and execution by which he analyzes that experience. With respect to formulation, he speaks of a lack of elaboration of programs and projects, of coordination among diverse goals, and of provision of qualified staff and techniques. He mentions the absence of the definition of resources necessary to the financing of the plan and the inadequate quantification of sectorial and national goals due to the lack of reliable statistical information. Finally, he notes the failure to coordinate the annual budget with the multi-year plans. He sees the problems of execution as beginning in the absence of coordination between the various sectors of the public administration, the failure to develop an operative system of decentralization, the absence of any system of financial and fiscal control over execution, the difficulties imposed by the system of public accounting, and the absence of an adequate program of allocation for the liberation of resources. He ends by pointing to the failure to develop and use an integrated system of political economic tools in a mode compatible with the objective of the plans. The body of the article analyzes national planning experience in Brazil using these lists of errors as rough model of criticism. Several conclusions emerge from this analysis with regard to planning in Brazil and in developing countries, in general. Plans have generally been of little avail in Brazil because of the lack of a continuous, bureaucratized (in the Weberian sense) planning organization set in an instrumentally suitable administrative structure and based on thorough diagnoses of socio-economic conditions and problems. Plans have become the justification for planning. Planning has come to be conceived as a rational method of orienting the process of decisions through the establishment of a precise and quantified relation between means and ends. But this conception has led to a planning history rimmed with frustration, and failure, because of its rigidity in the face of flexible and changing reality. Rather, he suggests a conception of planning which understands it "as a rational process of formulating decisions about the policy, economy, and society whose only demand is that of managing the instrumentarium in a harmonious and integrated form in order to reach explicit, but not quantified ends". He calls this "planning without plans": the establishment of broad-scale tendencies through diagnosis whose implementation is carried out through an adjustable, coherent instrumentarium of political-economic tools. Administration according to a plan of multiple, integrated goals is a sound procedure if the nation's administrative machinery contains the technical development needed to control the multiple variables linked to any situation of socio-economic change. Brazil does not possess this level of refinement and any strategy of planning relevant to its problems must recognize this. The reforms which have been attempted fail to make this recognition as is true of the conception of planning informing the Brazilian experience. Therefore, unworkable plans, ill-diagnosed with little or no supportive instrumentarium or flexibility have been Brazil's legacy. This legacy seems likely to continue until the conception of planning comes to live in the reality of Brazil.

Child-care attendance and common morbidity: evidence of association in the literature and questions of design

Papers on child-care attendance as a risk factor for acute respiratory infections and diarrhea were reviewed. There was great variety among the studies with regard to the design, definition of exposure and definition of outcomes. All the traditional epidemiological study designs have been used. The studies varied in terms of how child-care attendance in general was defined, and for different settings. These definitions differed especially in relation to the minimum time of attendance required. The outcomes were also defined and measured in several different ways. The analyses performed were not always appropriate, leading to sets of results of uneven quality, and composed of different measures of association relating different exposures and outcomes, that made summarizing difficult. Despite that, the results reported were remarkably consistent. Only two of the papers reviewed failed to show some association between child-care attendance and increased acute respiratory infections, or diarrhea. On the other hand, the magnitude of the associations reported varied widely, especially for lower respiratory infections. Taken together, the studies so far published provide evidence that children attending child-care centers, especially those under three years of age, are at a higher risk of upper respiratory infections, lower respiratory infections, and diarrhea. The studies were not consistent, however, in relation to attendance at child-care homes. Children in such settings were sometimes similar to those in child-care centers, sometimes similar to those cared for at home, and sometimes presented an intermediate risk.