Variação diurno-noturna do potencial mátrico e gradiente de potencial total da água no solo

O potencial mátrico em solos não saturados é um importante componente do potencial total e, portanto, deve ser medido da melhor forma possível. Este trabalho teve por objetivo avaliar a influência da temperatura do solo sobre o potencial mátrico e o gradiente de potencial total, durante a redistribuição da água num Latossolo Vermelho-Amarelo, em Piracicaba, SP, a partir de dados coletados por tensiometria. Em uma parcela circular de 3 m de diâmetro, foram instalados 10 tensiômetros com transdutor de tensão, modelo SWT3 da Delta-T, nas profundidades de 0,10; 0,15; 0,20; 0,25; 0,30; 0,35; 0,40; 0,45; 0,50; e 0,55 m, com os quais foram obtidos os potenciais mátricos para essas profundidades e o gradiente de potencial total, (ΔΦm/Δz)+1, para a profundidade de 0,25 m, com Δz de 0,1; 0,2; e 0,3 m, utilizando os tensiômetros instalados nas profundidades de 0,20 e 0,30; 0,15 e 0,35; e 0,10 e 0,40 m para ΔΦm, respectivamente. Na mesma parcela, foram também instalados termopares tipo T na superfície e nas profundidades 0,025; 0,050; e 0,075 m de solo. Ambas as leituras dos tensiômetros e termopares foram armazenadas em um Datalogger, Modelo DL2, da Delta-T, a idênticos intervalos de tempo. As avaliações detectaram oscilações na leitura do potencial mátrico da água no solo ao longo do dia e nos efeitos diferenciados nos tensiômetros instalados em profundidades diferentes, ocasionando oscilações também no gradiente de potencial total da água no solo. Os melhores horários para a realização das leituras dos tensiômetros são nas primeiras sete horas do dia ou após às 18 h.

Adipokines as uremic toxins.

The adipose tissue has pleiotropic functions far beyond the mere storage of energy, and it secretes a number of hormones and cytokines, called adipokines, which have biological effects that impact heath and disease. Adipokines are markedly elevated in the plasma of uremic patients, mainly due to decreased renal excretion. They have pluripotent signaling effects on inflammation/oxidative stress (leptin, adiponectin, resistin), protein-energy wasting (leptin, adiponectin), insulin signaling (adiponectin, leptin, visfatin), endothelial dysfunction (visfatin), and vascular damage (adiponectin, leptin, resistin), which are prevalent in uremic patients. Obesity superimposed to uremia may further aggravate hyperadipokinemia, with the exception of adiponectinemia, which is mitigated by adiposity. Among adipokines and until more data become available, only leptin may be considered as a full uremic toxin owing to adverse effects on protein-energy wasting, cardiovascular damage, inflammation, and the immune system, which have been documented both clinically and experimentally. Resistin and visfatin display some features of uremic toxins, but more data are needed to consider these adipokines as true uremic toxins. In contrast, high levels of adiponectin and chemerin seen in uremia appear to be beneficial. Further research is needed to investigate whether selective removal of leptin, resistin, and visfatin and increments of adiponectin and chemerin levels may have clinical relevance in uremic patients.

Néphropathie au produit de contraste [Contrast-induced nephropathy].

Iodine and gadolinium-based contrast induced nephropathy is the third leading cause of hospital-acquired acute kidney injury. It is essentially observed in patients with defined risk factors and is associated with increased morbidity and mortality. The prevention of contrast induced nephropathy consists in volume expansion through intravenous sodium chloride 0.9% or sodium bicarbonate 1.4%. Comparative randomized controlled trials appear to show a benefit in favor of sodium bicarbonate over saline fluids. According to last evidence, N-acetylcysteine does not provide additional benefit over intravenous fluids.

Optimal and continuous anaemia control in a cohort of dialysis patients in Switzerland.

BACKGROUND: Guidelines for the management of anaemia in patients with chronic kidney disease (CKD) recommend a minimal haemoglobin (Hb) target of 11 g/dL. Recent surveys indicate that this requirement is not met in many patients in Europe. In most studies, Hb is only assessed over a short-term period. The aim of this study was to examine the control of anaemia over a continuous long-term period in Switzerland. METHODS: A prospective multi-centre observational study was conducted in dialysed patients treated with recombinant human epoetin (EPO) beta, over a one-year follow-up period, with monthly assessments of anaemia parameters. RESULTS: Three hundred and fifty patients from 27 centres, representing 14% of the dialysis population in Switzerland, were included. Mean Hb was 11.9 +/- 1.0 g/dL, and remained stable over time. Eighty-five % of the patients achieved mean Hb >or= 11 g/dL. Mean EPO dose was 155 +/- 118 IU/kg/week, being delivered mostly by subcutaneous route (64-71%). Mean serum ferritin and transferrin saturation were 435 +/- 253 microg/L and 30 +/- 11%, respectively. At month 12, adequate iron stores were found in 72.5% of patients, whereas absolute and functional iron deficiencies were observed in only 5.1% and 17.8%, respectively. Multivariate analysis showed that diabetes unexpectedly influenced Hb towards higher levels (12.1 +/- 0.9 g/dL; p = 0.02). One year survival was significantly higher in patients with Hb >or= 11 g/dL than in those with Hb <11 g/dL (19.7% vs 7.3%, p = 0.006). CONCLUSION: In comparison to European studies of reference, this survey shows a remarkable and continuous control of anaemia in Swiss dialysis centres. These results were reached through moderately high EPO doses, mostly given subcutaneously, and careful iron therapy management.

Blood pressure modifies the association between serum adiponectin and uric acid, in a sex-dependent manner

Purpose: Plasma adiponectin and serum uric acid (SUA) levels are negatively correlated. To better understand the possible mechanisms linking adiponectin and uric acid, we analyzed whether the association between adiponectin and SUA differed by hypertension status (or blood pressure level) and by sex. Methods and materials: We analyzed data from the populationbased CoLaus study (Switzerland). Fasting plasma adiponectin levels were assessed by ELISA and SUA by uricase-PAP. Blood pressure (BP) was measured using a validated automated device and hypertension was defined as having office BP 140/90 mm Hg or being on current antihypertensive treatment. Results: In the 2897 men and 3181 women, aged 35-74, BMI (mean ± SD) was 26.6 ± 4.0 and 25.1 ± 4.8 Kg/m2, systolic blood pressure (SBP) was 132.2 ± 16.6 and 124.8 ± 18.3 mm Hg, median (interquartile range) plasma adiponectin was 6.2 (4.1-9.2) and 10.6 (6.9-15.4) mg/dL, and hypertension prevalence was 42.0% and 30.2%, respectively. The age- and BMI- adjusted partial correlation coefficients between log-adiponectin and SUA were 0.09 and 0.06 in normotensive men and women (P <0.01), and 0.004 (P = 0.88) and 0.15 (P <0.001) in hypertensive men and women, respectively. In median regression adjusted for BMI, insulin, smoking, alcohol consumption, menopausal status and HDL-cholesterol, there was a significant three-way interaction between SUA, SBP and sex for their effect on adiponectin (dependent variable, P = 0.005), as well as interactions between SBP and sex (P = 0.014) and between SUA and sex (P = 0.033). Conclusion: Plasma adiponectin and SUA are negatively associated, independently of BMI and insulin, in a population-based study in Caucasians. However, BP modifies this inverse relationship, as it was significant mainly in women with elevated BP. This observation suggests that the link between adiponectin and SUA may be mediated by sex hormones and the hypertension status.

Evidence-Based Recommendations for Optimal Dietary Protein Intake in Older People: A Position Paper From the PROT-AGE Study Group.

New evidence shows that older adults need more dietary protein than do younger adults to support good health, promote recovery from illness, and maintain functionality. Older people need to make up for age-related changes in protein metabolism, such as high splanchnic extraction and declining anabolic responses to ingested protein. They also need more protein to offset inflammatory and catabolic conditions associated with chronic and acute diseases that occur commonly with aging. With the goal of developing updated, evidence-based recommendations for optimal protein intake by older people, the European Union Geriatric Medicine Society (EUGMS), in cooperation with other scientific organizations, appointed an international study group to review dietary protein needs with aging (PROT-AGE Study Group). To help older people (>65 years) maintain and regain lean body mass and function, the PROT-AGE study group recommends average daily intake at least in the range of 1.0 to 1.2 g protein per kilogram of body weight per day. Both endurance- and resistance-type exercises are recommended at individualized levels that are safe and tolerated, and higher protein intake (ie, ≥1.2 g/kg body weight/d) is advised for those who are exercising and otherwise active. Most older adults who have acute or chronic diseases need even more dietary protein (ie, 1.2-1.5 g/kg body weight/d). Older people with severe kidney disease (ie, estimated GFR <30 mL/min/1.73m(2)), but who are not on dialysis, are an exception to this rule; these individuals may need to limit protein intake. Protein quality, timing of ingestion, and intake of other nutritional supplements may be relevant, but evidence is not yet sufficient to support specific recommendations. Older people are vulnerable to losses in physical function capacity, and such losses predict loss of independence, falls, and even mortality. Thus, future studies aimed at pinpointing optimal protein intake in specific populations of older people need to include measures of physical function.

Avaliação de parâmetros hidráulicos para modelos de distribuição de água no solo sob gotejamento

As soluções analíticas de distribuição de água para ponto fonte e regime de fluxo não- permanente são dependentes de parâmetros de solos considerados constantes em suas deduções. Erros na determinação desses parâmetros implicam insucesso dessas soluções. Este trabalho teve por objetivo avaliar o comportamento dos parâmetros alfada equação de Gardner k(h) = Ks ealfah e o parâmetro de linearização k = dK(teta)/dteta em diferentes posições do bulbo molhado, considerando os processos de infiltração isolado e seguido de redistribuição de água, à semelhança de um ciclo de irrigação. Dados de potencial matricial foram coletados em diversas posições do bulbo molhado em duas situações:(i) início da irrigação até atingir regime permanente em todo o bulbo molhado (infiltração); e (ii) durante dois ciclos de irrigação envolvendo infiltração e redistribuição de água. Os resultados mostraram que os parâmetros alfa e k variaram nas posições do bulbo molhado em relação ao gotejador, de acordo com o regime de umidade a que tais posições estiveram sujeitas. A obtenção desses parâmetros pelo método inverso requer testes que considerem as fases de infiltração e redistribuição em pelo menos dois ciclos de irrigação.

A new measurement of energy expenditure and physical activity in patients treated by maintenance hemodialysis

Purpose: The accurate estimation of total energy expenditure (TEE) is essential to allow the provision of nutritional requirements in patients treated by maintenance hemodialysis (MHD). The measurement of TEE and resting energy expenditure (REE) by direct or indirect calorimetry and doubly labeled water are complicated, timeconsuming and cumbersome in this population. Recently, a new system called SenseWear® armband (SWA) was developed to assess TEE, physical activity and REE. This device works by measurements of body acceleration in two axes, heat production and steps counts. REE measured by indirect calorimetry and SWA are well correlated. The aim of this study was to determine TEE, physical activity and REE on patients on MHD using this new device. Methods and materials: Daily TEE, REE, step count, activity time, intensity of activity and lying time were determined for 7 consecutive days in unselected stable patients on MHD and sex, age and weightmatched healthy controls (HC). Patients with malnutrition, cancer, use of immunosuppressive drugs, hypoalbumemia <35 g/L and those hospitalized in the last 3 months, were excluded. For MHD patients, separate analyses were conducted in dialysis and non-dialysis days. Relevant parameters known to affect REE, such as BMI, albumin, pre-albumin, hemoglobin, Kt/V, CRP, bicarbonate, PTH, TSH, were recorded. Results: Thirty patients on MHD and 30 HC were included. In MHD patients, there were 20 men and 10 women. Age was 60,13 years ± 14.97 (mean ± SD), BMI was 25.77 kg/m² ± 4.73 and body weight was 74.65 kg ± 16.16. There were no significant differences between the two groups. TEE was lower in MHD patients compared to HC (28.79 ± 5.51 SD versus 32.91 ± 5.75 SD kcal/kg/day; p <0.01). Activity time was significantly lower in patients on MHD (101.3 ± 12.6SD versus 50.7 ± 9.4 SD min; p = 0.0021). Energy expenditure during the time of activity was significantly lower in MHD patients. MHD patients walked 4543 ± 643 SD vs 8537 ± 744 SD steps per day (p <0.0001). Age was negatively correlated with TEE (r = -0.70) and intensity of activity (r = -0.61) in HC, but not in patients on MHD. TEE showed no difference between dialysis and non-dialysis days (29.92 ± 2.03 SD versus 28.44 ± 1.90 SD kcal/kg/day; p = NS), reflecting a lack of difference in activity (number of steps, time of physical activity) and REE. This finding was observed in MHD patients both older and younger than 60 years. However, age stratification appeared to have an influence on TEE, regardless of dialysis day, (29.92 ± 2.07 SD kcal/kg/day for <60 years-old versus 27.41 ± 1.04 SD kcal/kg/day for ≥60 years old), although failing to reach statistical significance. Conclusion: Using SWA, we have shown that stable patients on MHD have a lower TEE than matched HC. On average, a TEE of 28.79 kcal/kg/day, partially affected by age, was measured. This finding gives support to the clinical impression that it is difficult and probably unnecessary to provide an energy amount of 30-35 kcal/kg/day, as proposed by international guidelines for this population. In addition, we documented for the first time that MHD patients exert a reduced physical activity as compared to HC. There were surprisingly no differences in TEE, REE and physical activity parameters between dialysis and non-dialysis days. This observation might be due to the fact that patients on MHD produce a physical effort to reach the dialysis centre. Age per se did not influence physical activity in MHD patients, contrary to HC, reflecting the impact of co-morbidities on physical activity in this group of patients.

Incidence, complications and risk factors for severe falls in patients on maintenance haemodialysis.

BACKGROUND: Falls have been insufficiently studied in patients on maintenance haemodialysis (MHD). This study assessed the incidence and complications of severe falls and the ability of risk factors, including the Performance-Oriented Mobility Assessment (POMA) test, to predict them in this population. METHODS: All patients on MHD from our centre were asked to participate in this survey. POMA test and a record of risk factors for falls were obtained at baseline. Severe falls, as defined by an admission in an emergency ward, were documented prospectively. RESULTS: Eighty-four patients (median age 69.5 years, minimum 26 years, maximum 85 years) were enrolled. Predialytic POMA scores were low (median 20, minimum 5, maximum 26). After a mean follow-up of 20.6 months (142.2 patient-years), 31 severe falls were recorded in 24 patients (28.6%; incidence 0.22 per patient-year) and complicated by fractures in 54.8% of severe falls. In univariate analysis, age, a past history of falls, malnutrition, depression, but not POMA score, were associated with severe falls. A POMA score of >21 had a negative predictive value of 82%. CONCLUSIONS: Severe falls were common in MHD patients in this study and resulted in fractures in >50% of the cases. They were associated with ageing, a past history of falls, malnutrition and depression. Although there was a trend towards a lower POMA score in fallers as compared to non-fallers, the POMA score was not an independent predictor of severe falls in this study. These data may help to stratify the patient's risk of falling in order to target programmes to prevent falls in this population.

Aplicações da curva de resistência no controle da qualidade física de um solo sob pastagem

A degradação da qualidade física do solo pode estar associada com a compactação causada pelo pisoteio dos animais. A resistência do solo à penetração (RP) é um parâmetro físico utilizado para estabelecer o grau de compactação do solo. Contudo, esta varia com a umidade (teta) e densidade do solo (Ds). O objetivo deste trabalho foi obter a curva de resistência do solo e utilizá-la na avaliação da qualidade física do solo num sistema de pastejo intensivo rotacionado de capim-elefante. A curva de resistência do solo foi determinada por meio de 48 amostras indeformadas, obtidas na profundidade de 0-10 cm numa Terra Roxa Estruturada utilizada com pastagem em sistema intensivo de exploração. Os resultados demonstraram correlação negativa entre a RP e teta, e correlação positiva entre RP e Ds. Estimativas indicaram que no potencial de -0,01 MPa a RP não atinge valores considerados restritivos ao crescimento radicular. Entretanto, no potencial de -0,3 MPa, a RP atinge níveis limitantes em toda a área. Quanto ao sistema de manejo e a espécie estudada, os resultados sugerem que a curva de resistência do solo pode ser utilizada para orientar as práticas de manejo visando à manutenção de uma qualidade física do solo adequada para o crescimento das plantas.

Parâmetros escroto-testiculares e de sêmen em caprinos adultos submetidos à insulação escrotal

Ejaculados de seis bodes Moxotó e seis ½ sangue Moxotó-Pardo Alpina, adultos, mantidos em confinamento, foram avaliados antes e após a insulação do saco escrotal com bolsa de plástico, de parede dupla, durante 6,5 dias. A degeneração seminal ocorreu em todos os animais na 4ª semana após o início da insulação, ressaltando-se a redução na concentração, o aumento dos defeitos espermáticos e a redução do vigor celular, culminando com a necrospermia. A motilidade individual progressiva (MIP) atingiu os valores mais baixos na 3ª semana após o início da insulação, retornando aos valores normais entre a 8ª e 9ª semanas. Os defeitos espermáticos começaram a aumentar aos sete dias após o início da insulação escrotal. O volume apresentou oscilações atípicas e o aumento da temperatura escrotal afetou os parâmetros físicos e morfológicos do ejaculado de maneira consistente evidenciando-se o efeito negativo sobre a qualidade do sêmen.