Facteurs de risque de calcifications vasculaires en insuffisance rénale constituant une contre-indication à la greffe rénale

On estime que des calcifications vasculaires (CVs) sont présentes chez 60% des patients avec insuffisance rénale terminale (IRT) et que ces CVs contribuent à l’augmentation de la maladie cardiovasculaire chez ces patients. La maladie cardiovasculaire est la première cause de mortalité chez les patients en IRT. La transplantation rénale est le traitement de choix en IRT mais peut être contre-indiquée pour des raisons chirurgicales liées au CVs ou en raison d’un risque de complications cardiovasculaires postopératoires trop élevé associé à la présence de CVs sévères. Il est donc primordial de déterminer quels facteurs sont associés à la présence de CVs qui rendraient le patient non-éligible pour une greffe rénale. En particulier il serait intéressant de vérifier si un produit phosphocalcique élevé est un facteur de risque de non-éligibilité pour une greffe rénale en raison de CVs. L’étude actuelle utilise la base de données de transplantation du CHUM. C’est une étude de type cas-témoins avec une cohorte de 1472 patients de 1992 à 2009. Les cas sont les patients jugés non-éligibles pour une transplantation rénale en raison de la présence de CVs sévères. Les contrôles sont les patients jugés éligibles: 80 cas et 80 contrôles ont été inclus. Les facteurs de risque qui ont été identifiés pour la non-éligibilité en raison de CVs sont le diabète (adjusted Odds Ratio (OR): 5.55 (1.98 - 15.59)), l’âge (OR: 1.14 (1.09 – 1.2)), le tabagisme (OR: 9.51 (2.55 – 35.51)) et la dialyse (OR: 6.83 (2.33 – 20.05)). La durée de la dialyse a aussi été identifiée comme facteur de risque (OR : 8.61 (2.34-31.68) pour une durée de dialyse de 8 mois et plus, OR : 4.57 (1.42-14.65) pour une durée de dialyse de 1 à 7 mois. Bien que significatif en univarié, le produit phosphocalcique n’a pas été identifié comme facteur de risque significatif dans les analyses multivariées. En conclusion, cette étude montre que le produit phosphocalcique pourrait être un marqueur d’une insuffisance rénale prolongée et moins bien contrôlée plutôt qu’un facteur de risque de calcifications rendant le patient non-éligible à la greffe. De plus cette étude met de l’emphase sur la notion qu’il est primordial 1) de référer précocement les patients à haut risque de CVs vers un centre de transplantation pour une évaluation et 2) de prendre en charge agressivement l’arrêt du tabac chez tous les patients qui sont potentiellement éligibles pour une transplantation.

IV Conferencia General Extraordinaria de la Unesco.

Título anterior de la publicación : Boletín de la Comisión Española de la UNESCO.

Avaliação nutricional de estratégias de suplementação para bovinos de corte durante a estação da seca

Objetivou-se avaliar o efeito da frequência de oferta de suplementos proteicos sobre as características nutricionais de bovinos de corte em pastejo durante o período de seca. Utilizaram-se cinco novilhos mestiços Nelore nãocastrados, com peso médio inicial de 290 kg, fistulados no esôfago e rúmen e distribuídos em delineamento quadrado latino 5 × 5. A área experimental foi composta de cinco piquetes de Brachiaria decumbens, cada um com 0,40 hectare. O experimento foi composto de cinco períodos experimentais de 15 dias, com os sete primeiros dias destinados à adaptação dos animais. As estratégias estudadas foram autocontrole de consumo e oferta de suplementos (1,0 kg/dia) em três frequências: 3 vezes/semana (às segundas, quartas e sextas-feiras), 5 vezes/semana (de segunda a sexta-feira), 6 vezes/semana (de segunda a sábado) e diariamente. Não houve efeito das frequencias de suplementação sobre os consumos expressos em kg/dia ou % PV. A frequência de suplementação teve efeito nas digestibilidades aparentes total e ruminal da MS e da PB, que foram maiores nos animais do grupo autocontrole. Os valores médios de pH observados no dia em que os animais não receberam suplemento foram de: 6,54±0,13; 6,48 ± 0,15 e 6,61 ± 0,07, respectivamente, para as frequências 3 vezes/semana, 5 vezes/semana e 6 vezes/semana. A concentração do NH3 foi 14,65 ± 5,78; 13,57 ± 5,30 e 15,30 ± 4,98 mg/dL de líquido ruminal, respectivamente, para as frequências 3 vezes/semana, 5 vezes/semana e 6 vezes/semana nos dias em que os animais não receberam suplemento. As eficiências microbianas e as concentrações de nitrogênio na urina e no soro sanguíneo são afetadas pelas estratégias estudadas e maiores nos animais alimentados com suplemento autocontrole.

Marcadores imunológicos na exposição mercurial na Região Amazônica

Disfunções imunes podem surgir pela combinação entre susceptibilidade genética e fatores ambientais. Existem evidências, em humanos expostos ao mercúrio (Hg), de alterações da resposta imunológica por auto-anticorpos induzidos por Hg. Este trabalho investigou a ocorrência de auto-imunidade induzida por Hgtotal entre indivíduos ribeirinhos da região do Tapajós (Brasília Legal, São Luiz do Tapajós e Barreiras), expostos ao Hgtotal, e da comunidade ribeirinha da região do Tocantins (Panacauera) não exposta ao Hgtotal. No período de junho de 2004 a dezembro de 2006 foram coletadas 236 pares de amostras de cabelo e sangue, nas quais a concentração de Hgtotal no cabelo foi determinada por espectrofotometria de absorção atômica, e no soro, os auto-anticorpos foram analisados por microscopia de imunofluorescência (IF) usando substrato de células epiteliais humanas (Hep-2). Os mais altos níveis de Hgtotal no cabelo foram os de São Luiz do Tapajós (11,24 ± 2,23 μg/g), seguido por Brasília Legal (10,00 ± 0,99) e Barreiras (8,64 ± 1,13), e os mais baixos foram os de Panacauera (2,98 ± 0,20). Em relação à variável sexo, foi observada associação somente em Brasília Legal, com níveis de Hgtotal mais altos no cabelo dos homens. Cerca de 79,65% ribeirinhos do Tapajós e 31,25% da região do Tocantins apresentaram no soro autoanticorpos induzidos por Hg. Os padrões de auto-anticorpos identificados por IF foram: misto (50,96%), nuclear (31,21%), nucleolar (14,65%) e aparelho mitótico/citoplasmático (3,18%), observando-se maior prevalência dos padrões misto e nuclear nas comunidades expostas (p<0,01). Os auto-anticorpos mais freqüentes foram, por ordem de prevalência: NuMa1, PM/Scl, Ssa-Ro, rRNP/Sm, golgi/Ssa/Ro, PCNA, rRNP, Ku, além de outros auto-anticorpos com especificidade ainda não definida. A intensidade de IF (p< 0,0001) foi mais reativa nos ribeirinhos do Tapajós. Análise por regressão logística múltipla indicou que o risco de apresentar auto-anticorpos foi aproximadamente duas vezes maior nos expostos ao mercúrio com faixa etária acima de 50 anos (p>0,01). Finalmente, estudos adicionais são indispensáveis para confirmar a especificidade destes auto-anticorpos induzidos pela exposição mercurial, bem como elucidar os mecanismos imunotoxicológicos da ação do mercúrio sobre o sistema imune humano.

Mídia e desenvolvimento social no documentário transmídia

The genre documentary in itself characterized by citizen emancipation from the content discussed in his works. Termed as images of the people by Jean-Claude Bernardet (2003), the documentary is gaining traction in social development when added to citizen participation offered by transmedia storytelling. This study presents the results obtained from a literature search, the film analysis and experimentation supported in quasi-experimental methodology, results that support these conditions. Hopefully, from this discussion, consolidate the systematic development of transmedia documentary works in new media ecology and that maximizes the role of journalism by a traditionally audiovisual platform, now with other strands to the representation of the news.

Parâmetros industriais para produção de Pleurotus ostreatus

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Protocol for a randomized, placebo-controlled, double-blind clinical trial investigating sacral neuromodulation for neurogenic lower urinary tract dysfunction

BACKGROUND Sacral neuromodulation has become a well-established and widely accepted treatment for refractory non-neurogenic lower urinary tract dysfunction, but its value in patients with a neurological cause is unclear. Although there is evidence indicating that sacral neuromodulation may be effective and safe for treating neurogenic lower urinary tract dysfunction, the number of investigated patients is low and there is a lack of randomized controlled trials. METHODS AND DESIGN This study is a prospective, randomized, placebo-controlled, double-blind multicenter trial including 4 sacral neuromodulation referral centers in Switzerland. Patients with refractory neurogenic lower urinary tract dysfunction are enrolled. After minimally invasive bilateral tined lead placement into the sacral foramina S3 and/or S4, patients undergo prolonged sacral neuromodulation testing for 3-6 weeks. In case of successful (defined as improvement of at least 50% in key bladder diary variables (i.e. number of voids and/or number of leakages, post void residual) compared to baseline values) prolonged sacral neuromodulation testing, the neuromodulator is implanted in the upper buttock. After a 2 months post-implantation phase when the neuromodulator is turned ON to optimize the effectiveness of neuromodulation using sub-sensory threshold stimulation, the patients are randomized in a 1:1 allocation in sacral neuromodulation ON or OFF. At the end of the 2 months double-blind sacral neuromodulation phase, the patients have a neuro-urological re-evaluation, unblinding takes place, and the neuromodulator is turned ON in all patients. The primary outcome measure is success of sacral neuromodulation, secondary outcome measures are adverse events, urodynamic parameters, questionnaires, and costs of sacral neuromodulation. DISCUSSION It is of utmost importance to know whether the minimally invasive and completely reversible sacral neuromodulation would be a valuable treatment option for patients with refractory neurogenic lower urinary tract dysfunction. If this type of treatment is effective in the neurological population, it would revolutionize the management of neurogenic lower urinary tract dysfunction. TRIAL REGISTRATION TRIAL REGISTRATION NUMBER http://www.clinicaltrials.gov; Identifier: NCT02165774.

Hydrochemical Atlas of the Arctic Ocean

Introduction: Chemical composition of water determines its physical properties and character of processes proceeding in it: freezing temperature, volume of evaporation, density, color, transparency, filtration capacity, etc. Presence of chemical elements in water solution confers waters special physical properties exerting significant influence on their circulation, creates necessary conditions for development and inhabitance of flora and fauna, and imparts to the ocean waters some chemical features that radically differ them from the land waters (Alekin & Liakhin, 1984). Hydrochemical information helps to determine elements of water circulation, convection depth, makes it easier to distinguish water masses and gives additional knowledge of climatic variability of ocean conditions. Hydrochemical information is a necessary part of biological research. Water chemical composition can be the governing characteristics determining possibility and limits of use of marine objects, both stationary and moving in sea water. Subject of investigation of hydrochemistry is study of dynamics of chemical composition, i.e. processes of its formation and hydrochemical conditions of water bodies (Alekin & Liakhin 1984). The hydrochemical processes in the Arctic Ocean are the least known. Some information on these processes can be obtained in odd publications. A generalizing study of hydrochemical conditions in the Arctic Ocean based on expeditions conducted in the years 1948-1975 has been carried out by Rusanov et al. (1979). The "Atlas of the World Ocean: the Arctic Ocean" contains a special section "Hydrochemistry" (Gorshkov, 1980). Typical vertical profiles, transects and maps for different depths - 0, 100, 300, 500, 1000, 2000, 3000 m are given in this section for the following parameters: dissolved oxygen, phosphate, silicate, pH and alkaline-chlorine coefficient. The maps were constructed using the data of expeditions conducted in the years 1948-1975. The illustrations reflect main features of distribution of the hydrochemical elements for multi-year period and represent a static image of hydrochemical conditions. Distribution of the hydrochemical elements on the ocean surface is given for two seasons - winter and summer, for the other depths are given mean annual fields. Aim of the present Atlas is description of hydrochemical conditions in the Arctic Ocean on the basis of a greater body of hydrochemical information for the years 1948-2000 and using the up-to-date methods of analysis and electronic forms of presentation of hydrochemical information. The most wide-spread characteristics determined in water samples were used as hydrochemical indices. They are: dissolved oxygen, phosphate, silicate, pH, total alkalinity, nitrite and nitrate. An important characteristics of water salt composition - "salinity" has been considered in the Oceanographic Atlas of the Arctic Ocean (1997, 1998). Presentation of the hydrochemical characteristics in this Hydrochemical Atlas is wider if compared with that of the former Atlas (Gorshkov, 1980). Maps of climatic distribution of the hydrochemical elements were constructed for all the standard depths, and seasonal variability of the hydrochemical parameters is given not only for the surface, but also for the underlying standard depths up to 400 m and including. Statistical characteristics of the hydrochemical elements are given for the first time. Detailed accuracy estimates of initial data and map construction are also given in the Atlas. Calculated values of mean-root deviations, maximum and minimum values of the parameters demonstrate limits of their variability for the analyzed period of observations. Therefore, not only investigations of chemical statics are summarized in the Atlas, but also some elements of chemical dynamics are demonstrated. Digital arrays of the hydrochemical elements obtained in nodes of a regular grid are the new form of characteristics presentation in the Atlas. It should be mentioned that the same grid and the same boxes were used in the Atlas, as those that had been used by creation of the US-Russian climatic Oceanographic Atlas. It allows to combine hydrochemical and oceanographic information of these Atlases. The first block of the digital arrays contains climatic characteristics calculated using direct observational data. These climatic characteristics were not calculated in the regions without observations, and the information arrays for these regions have gaps. The other block of climatic information in a gridded form was obtained with the help of objective analysis of observational data. Procedure of the objective analysis allowed us to obtain climatic estimates of the hydrochemical characteristics for the whole water area of the Arctic Ocean including the regions not covered by observations. Data of the objective analysis can be widely used, in particular, in hydrobiological investigations and in modeling of hydrochemical conditions of the Arctic Ocean. Array of initial measurements is a separate block. It includes all the available materials of hydrochemical observations in the form, as they were presented in different sources. While keeping in mind that this array contains some amount of perverted information, the authors of the Atlas assumed it necessary to store this information in its primary form. Methods of data quality control can be developed in future in the process of hydrochemical information accumulation. It can be supposed that attitude can vary in future to the data that were rejected according to the procedure accepted in the Atlas. The hydrochemical Atlas of the Arctic Ocean is the first specialized and electronic generalization of hydrochemical observations in the Arctic Ocean and finishes the program of joint efforts of Russian and US specialists in preparation of a number of atlases for the Arctic. The published Oceanographic Atlas (1997, 1998), Atlas of Arctic Meteorology and Climate (2000), Ice Atlas of the Arctic Ocean prepared for publication and Hydrochemical Atlas of the Arctic Ocean represent a united series of fundamental generalizations of empirical knowledge of Arctic Ocean nature at climatic level. The Hydrochemical Atlas of the Arctic Ocean was elaborated in the result of joint efforts of the SRC of the RF AARI and IARC. Dr. Ye. Nikiforov was scientific supervisor of the Atlas, Dr. R. Colony was manager on behalf of the USA and Dr. L. Timokhov - on behalf of Russia.