Pioglitazone improves fat distribution, the adipokine profile and hepatic insulin sensitivity in non-diabetic end-stage renal disease subjects on maintenance dialysis: a randomized cross-over pilot study.

BACKGROUND: Fat redistribution, increased inflammation and insulin resistance are prevalent in non-diabetic subjects treated with maintenance dialysis. The aim of this study was to test whether pioglitazone, a powerful insulin sensitizer, alters body fat distribution and adipokine secretion in these subjects and whether it is associated with improved insulin sensitivity. TRIAL DESIGN: This was a double blind cross-over study with 16 weeks of pioglitazone 45 mg vs placebo involving 12 subjects. METHODS: At the end of each phase, body composition (anthropometric measurements, dual energy X-ray absorptometry (DEXA), abdominal CT), hepatic and muscle insulin sensitivity (2-step hyperinsulinemic euglycemic clamp with 2H2-glucose) were measured and fasting blood adipokines and cardiometabolic risk markers were monitored. RESULTS: Four months treatment with pioglitazone had no effect on total body weight or total fat but decreased the visceral/sub-cutaneous adipose tissue ratio by 16% and decreased the leptin/adiponectin (L/A) ratio from 3.63×10-3 to 0.76×10-3. This was associated with a 20% increase in hepatic insulin sensitivity without changes in muscle insulin sensitivity, a 12% increase in HDL cholesterol and a 50% decrease in CRP. CONCLUSIONS/LIMITATIONS: Pioglitazone significantly changes the visceral-subcutaneous fat distribution and plasma L/A ratio in non diabetic subjects on maintenance dialysis. This was associated with improved hepatic insulin sensitivity and a reduction of cardio-metabolic risk markers. Whether these effects may improve the outcome of non diabetic end-stage renal disease subjects on maintenance dialysis still needs further evaluation. TRIAL REGISTRATION: ClinicalTrial.gov NCT01253928.

Subclinical hypothyroidism and the risk of heart failure, other cardiovascular events, and death.

BACKGROUND: Subclinical hypothyroidism has been associated with systolic and diastolic cardiac dysfunction and an elevated cholesterol level, but data on cardiovascular outcomes and death are limited. METHODS: We studied 2730 men and women, aged 70 to 79 years, with baseline thyrotropin (TSH) measurements and 4-year follow-up data to determine whether subclinical hypothyroidism was associated with congestive heart failure (CHF), coronary heart disease, stroke, peripheral arterial disease, and cardiovascular-related and total mortality. After the exclusion of participants with abnormal thyroxine levels, subclinical hypothyroidism was defined as a TSH level of 4.5 mIU/L or greater, and was further classified according to TSH levels (4.5-6.9, 7.0-9.9, and > or = 10.0 mIU/L). RESULTS: Subclinical hypothyroidism was present in 338 (12.4%) of the participants. Compared with euthyroid participants, CHF events occurred more frequently among those with a TSH level of 7.0 mIU/L or greater (35.0 vs 16.5 per 1000 person-years; P = .006), but not among those with TSH levels between 4.5 and 6.9 mIU/L. In multivariate analyses, the risk of CHF was higher among those with high TSH levels (TSH of 7.0-9.9 mIU/L: hazard ratio, 2.58 [95% confidence interval, 1.19-5.60]; and TSH of > or = 10.0 mIU/L: hazard ratio, 3.26 [95% confidence interval, 1.37-7.77]). Among the 2555 participants without CHF at baseline, the hazard ratio for incident CHF events was 2.33 (95% confidence interval, 1.10-4.96; P = .03) in those with a TSH of 7.0 mIU/L or greater. Subclinical hypothyroidism was not associated with increased risk for coronary heart disease, stroke, peripheral arterial disease, or cardiovascular-related or total mortality. CONCLUSIONS: Subclinical hypothyroidism is associated with an increased risk of CHF among older adults with a TSH level of 7.0 mIU/L or greater, but not with other cardiovascular events and mortality. Further investigation is warranted to assess whether subclinical hypothyroidism causes or worsens preexisting heart failure.

Influence of Bacille Calmette-Guérin vaccination on size of tuberculin skin test reaction : to what size ?

RESUME Le diagnostic d'infection tuberculeuse repose essentiellement sur le test tuberculinique (test de Mantoux). Cependant, le résultat de ce dernier est également influencé par d'autres facteurs, le plus important étant la vaccination par le Bacille Calmette-Guérin (BCG), interaction connue depuis de nombreuses années. Il est généralement admis que l'effet de la vaccination peut entraîner des réactions positives jusqu'à un diamètre d'induration de 15 mm. Au-delà, la positivité du test est en général attribuée à une primo-infection tuberculeuse. Peu d'études se sont réellement penchées sur le sujet. Chez le personnel de soins soumis à des Mantoux répétés, cette notion revêt une importance particulière pour interpréter correctement une réaction fortement positive en l'absence de facteurs de risque tuberculeux, dans un pays à faible endémie tuberculeuse. Notre étude a cherché à déterminer si le diamètre transversal de l'induration du Mantoux était un critère fiable pour distinguer une positivité associée à une infection tuberculeuse de celle associée à une ancienne vaccination. Elle s'est attachée à rechercher un seuil au-delà duquel l'infection tuberculeuse pourrait être considérée comme probable. Entre janvier 1991 et mars 1998, tous les nouveaux employés du CHUV ont été invités à recevoir un test tuberculinique à l'occasion de leur visite d'entrée à la Médecine du personnel. En cas de réponse négative, un deuxième test a été pratiqué une semaine plus tard, pour détecter un éventuel effet booster. Lors de la première visite, l'infirmière a rempli un questionnaire comprenant les données démographiques usuelles, des informations concernant les facteurs pouvant influencer la positivité du test, notamment les antécédents de vaccination par le BCG, les expositions à la tuberculose et l'existence d'antécédents d'infection tuberculeuse. Parmi les 5117 sujets inclus dans l'étude, nous avons trouvé que l'influence de la vaccination variait en fonction de l'âge. Chez les sujets de moins de 40 ans, la vaccination par le BCG était le prédicteur le plus important d'un Mantoux positif inférieur à 18 mm, de loin supérieur aux facteurs de risque habituels pour une infection tuberculeuse, eux aussi significatifs. L'effet du BCG était présent pour des réactions allant jusqu'à 20 mm. Pour les Mantoux supérieurs à 20 mm, l'odds ratio (OR) relatif au BCG demeure clairement élevé (supérieur à 3,4) bien que non significatif. Par contre, pour les employés âgés de plus de 40 ans, le BCG est un facteur prédictif pour les tests supérieurs à 10 mm (OR 2.4) mais n'est plus un facteur significatif pour une taille supérieure à 15 mm. Ces résultats montrent que l'interprétation d'un test tuberculinique même fortement positif, doit être faite avec prudence et discernement. En effet, notre étude démontre que chez les sujets vaccinés de moins de 40 ans, dans les zones de faible endémie tuberculeuse particulièrement en l'absence de facteurs de risque pour une infection tuberculeuse, un Mantoux positif jusqu'à 18 mm est dû, le plus probablement, à une ancienne vaccination par le BCG, plutôt qu'à une infection par M tuberczilosis. L'interprétation des Mantoux de taille inférieure à 18 mm et les Mantoux effectués chez des sujets de moins de 40 ans, doit prendre en compte l'existence d'un BCG antérieur. En conséquence, la mise en évidence d'une réaction de Mantoux fortement positive ne devrait pas conduire systématiquement à un traitement préventif. L'absence de spécificité du test Mantoux, utilisé pour le dépistage de la tuberculose depuis bientôt une centaine d'année, est un problème connu. Nous démontrons que la taille de l'induration ne peut pas être utilisée de façon fiable comme critère pour identifier une infection tuberculeuse chez une personne vaccinée avec le BCG, avec le risque de sui-traiter un nombre important de sujets. Dans notre étude, 21% des sujets avaient un Mantoux supérieur ou égal à 15 mm et auraient dû être traités selon les recommandations en vigueur en Suisse si l'on ne tenait pas compte du BCG antérieur. Des tests plus spécifiques sont actuellement à l'étude et permettront vraisemblablement, à l'avenir, de palier au problème de l'absence de spécificité du test de Mantoux. Abstract : Background. Previous bacillus Calmette-Guerin (BCG) vaccination can confound the results of a tuberculin skin test (TST). We sought to determine a cutoff diameter of TST induration beyond which the influence of BCG vaccination was negligible in evaluating potential Mycobacterium tuberculosis infection in a population of health care workers with a high vaccination rate and low incidence of tuberculosis. Methods. From 1991 through 1998, all new employees at the University Hospital of Lausanne, Switzerland, underwent a 2-step TST at entry visit. We also gathered information on demographic characteristics, along with factors commonly associated with tuberculin positivity, including previous BCG vaccination, history of latent M. tuberculosis infection, and predictors for M. tuberculosis infection. Results. Among the 5117 investigated subjects, we found that influence of BCG vaccination on TST results varied across categories of age (likelihood ratio test, 0.0001). Prior BCG vaccination had a strong influence on skin test results of mm in diameter among persons <40 years old, compared with the influence of factors predictive of M. tuberculosis infection. Prior latent M. tuberculosis infection and travel or employment in a country in which tuberculosis is endemic also had significant influences. Conclusions. Interpretation of TST reactions of mm among BCG-vaccinated persons <40 years of age must be done with caution in areas with a low incidence of tuberculosis. In such a population, except for persons who have never been vaccinated, TST reactions of ---518 mm are more likely to be the result of prior vaccination than infection and should not systematically lead to preventive treatment.

Limits on the validity of infinite length assumptions for modelling shallow landslides

The infinite slope method is widely used as the geotechnical component of geomorphic and landscape evolution models. Its assumption that shallow landslides are infinitely long (in a downslope direction) is usually considered valid for natural landslides on the basis that they are generally long relative to their depth. However, this is rarely justified, because the critical length/depth (L/H) ratio below which edge effects become important is unknown. We establish this critical L/H ratio by benchmarking infinite slope stability predictions against finite element predictions for a set of synthetic two-dimensional slopes, assuming that the difference between the predictions is due to error in the infinite slope method. We test the infinite slope method for six different L/H ratios to find the critical ratio at which its predictions fall within 5% of those from the finite element method. We repeat these tests for 5000 synthetic slopes with a range of failure plane depths, pore water pressures, friction angles, soil cohesions, soil unit weights and slope angles characteristic of natural slopes. We find that: (1) infinite slope stability predictions are consistently too conservative for small L/H ratios; (2) the predictions always converge to within 5% of the finite element benchmarks by a L/H ratio of 25 (i.e. the infinite slope assumption is reasonable for landslides 25 times longer than they are deep); but (3) they can converge at much lower ratios depending on slope properties, particularly for low cohesion soils. The implication for catchment scale stability models is that the infinite length assumption is reasonable if their grid resolution is coarse (e.g. >25?m). However, it may also be valid even at much finer grid resolutions (e.g. 1?m), because spatial organization in the predicted pore water pressure field reduces the probability of short landslides and minimizes the risk that predicted landslides will have L/H ratios less than 25. Copyright (c) 2012 John Wiley & Sons, Ltd.

Prognostic importance of hyponatremia in patients with acute pulmonary embolism.

Rationale: Although associated with adverse outcomes in other cardiopulmonary conditions, the prognostic value of hyponatremia, a marker of neurohormonal activation, in patients with acute pulmonary embolism (PE) is unknown. Objectives: To examine the associations between hyponatremia and mortality and hospital readmission rates for patients hospitalized with PE. METHODS: We evaluated 13,728 patient discharges with a primary diagnosis of PE from 185 hospitals in Pennsylvania (January 2000 to November 2002). We used random-intercept logistic regression to assess the independent association between serum sodium levels at the time of presentation and mortality and hospital readmission within 30 days, adjusting for patient (race, insurance, severity of illness, use of thrombolytic therapy) and hospital factors (region, size, teaching status). Measurements and Main Results: Hyponatremia (sodium ?135 mmol/L) was present in 2,907 patients (21.1%). Patients with a sodium level greater than 135, 130-135, and less than 130 mmol/L had a cumulative 30-day mortality of 8.0, 13.6, and 28.5% (P < 0.001), and a readmission rate of 11.8, 15.6, and 19.3% (P < 0.001), respectively. Compared with patients with a sodium greater than 135 mmol/L, the adjusted odds of dying were significantly greater for patients with a sodium 130-135 mmol/L (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.33-1.76) and a sodium less than 130 mmol/L (OR, 3.26; 95% CI, 2.48-4.29). The adjusted odds of readmission were also increased for patients with a sodium of 130-135 mmol/L (OR, 1.28; 95% CI, 1.12-1.46) and a sodium less than 130 mmol/L (OR, 1.44; 95% CI, 1.02-2.02). Conclusions: Hyponatremia is common in patients presenting with PE, and is an independent predictor of short-term mortality and hospital readmission.

Effect of preharvest spraying with thidiazuron on fruit quality and maturity of apples

Apple trees, cultivars Gala and Fuji, were sprayed at full bloom with thidiazuron (TDZ) at the doses of 0, 5, 10, or 20 g (a.i.) ha-1 and fruit were assessed for quality and maturity. In both cultivars, the increase of TDZ dose had detrimental effects on fruit quality, causing a reduction of fruit red surface and an increase of percentage of fruit that was asymmetrical and with calyx-end rot. TDZ caused an increment of calyx-end aperture that might have increased calyx-end rot. TDZ increased density and the length : diameter (L : D) ratio of the fruit. The number of viable seeds was not affected by TDZ. TDZ resulted in a substantial delay of fruit maturity in 'Gala' but not in 'Fuji'. TDZ also reduced soluble solids content (SSC) in 'Gala' and reduced titratable acidity in both cultivars.

Powdery mildew of Ruta graveolens in Brazil caused by Oidiopsis haplophylli

Oidiopsis haplophylli is described causing powdery mildew on Ruta graveolens for the first time in Brazil (Viçosa, MG). The fungus causes yellowing of infected leaves accompanied by the presence of a whitish mycelial colony abaxially. The following combination of characters typical of this species was observed on the specimens collected in Viçosa: mycelium hypophyllous, hemiendophytic (partly external and partly internal), entering the leaves through the stomata; conidiophores hypophyllous, produced from the internal mycelium emerging through the stomata, cylindrical, hyaline, smooth; conidia, isolate, dimorphic - primary conidia lanceolate, 66.5-91.5 x 11.0-20.0 mm l/w ratio 3.5-6.2, secondary conidia cylindrical with rounded ends, 57.0-81.5 x 13.5-20.0 mm, l/w ratio 3.1 - 5.3, aseptate, hyaline, smooth.

Grass Weeds Interfering with Eucalypt: Effects of the Distance of Coexistence on the Initial Plant Growth

Two experiments were carried out to evaluate the initial plant growth of Eucalyptus urograndis growing in coexistence with Urochloa decumbens and U. ruziziensis. In 100-L box, one plant of U. decumbens or U. ruziziensis grew in coexistence with one plant of E. urograndis clones C219H or H15, respectively, in the distances of 0, 5, 10, 15, 20, 25, 30, 35, and 40 cm from the crop. After 30, 60, 90 (both clones), and 150 days (just for H15), growth characteristics were evaluated. Plants of both clones, growing in weed-free situations, showed a better growth and development than plants that grew in weedy situations, independently of the distance, having the highest plant height, stem diameter, dry mass of stem, and dry mass of leaves. As the same way, the number of branches, number of leaves, and leaf area of the clone C219H were similarly affected. Urochloa ruziziensis reduced the dry mass accumulation of stem and leaves by the rate of 0.06 and 0.32 g per plant, respectively, per each centimeter growing nearest to the crop, while U. decumbens reduced by 0.03 and 0.14 g per plant. The interference of U. decumbens and U. ruziziensis with E. urograndis is more intense when weedy plants grow in short distances from the crop.

Difluorinated analogues of shikimic acid

Investigations into the quinate to shikimate transformation have been carried out, the results of which have been exploited in the synthesis of a novel difluoromethylene homologue of shikimic acid from (-)-quinic acid. Martin's sulfurane {Ph2S[OC(CF3)(2)Ph](2)} was the reagent of choice for the key dehydration step of this synthesis. The results of investigations into the synthesis of the important natural product analogue, 6,6-difluoroshikimic acid are also reported. (C) 2003 Elsevier Science Ltd. All rights reserved.

Produção de biomassa e composição química de adubos verdes cultivados no Vale do Ribeira

The contribution of green manure to soil improvement and crop production depends primarily on biomass production and its chemical composition, which vary depending on the species, region and growing season. The aim of this research was to evaluate the chemical composition of biomass produced by green manures in Vale do Ribeira, São Paulo, Brazil. In order to develop this research, was carried an experiment in Pariquera-Acu, in 2006/2007, in completely randomized blocks design with four treatments (three green manure and spontaneous vegetation) and five replications. At 30, 60, 90 and 120 after sowing samples were collected in 1m(2) of the shoots and determined fresh and dry, and chemical composition biomass. Sunhemp, pigeon pea and mucuna produced, in decreasing order, the largest quantities of biomass and were more efficient than the spontaneous vegetation. The biomass produced by green manure had higher quality than that produced by spontaneous vegetation. Sunhemp and pigeon pea have a higher proportion of dry matter in stems which have low N, high C/N and L/N ratio, variables indicating slow decomposition of residues. The analysis of dry matter partitioned to better indication of the chemical composition of the residues and the prevision of the availability of nutrients in the soil.

Aperfeiçoamento no projeto de um protótipo de misturador-decantador à inversão de fases visando aplicação na indústria do petróleo

In the oil industry the mixture oil/water occurs in the operations of production, transportation and refining, as well as during the use of its derivatives. The amount of water produced associated with the oil varies and can reach values of 90% in volume in the case of mature phase of the production fields. The present work deals with the development of new design of the Mixer Settler based on Phase Inversion (MDIF) in a laboratory scale. We envisage this application in industrial scale so the phases of project, construction and operation are considered. The modifications most significant, in comparison with the original prototype, include the materials of construction and the substitution of the equipment used in the mixing stage of the process. It was tested the viability of substitution of the original system of mechanical mixing by a static mixer. A statistical treatment by means of an experimental design of composed central type was used in order to evaluate the behavior of the main variables of the separation process as function of the efficiency of separation for the new device. This procedure is useful to delimit an optimal region of operation with the equipment. The variables of process considered on the experimental design were: oil concentration in the feeding water (mg/L); Total volumetric flow rate (L/h); Ratio organic/water on volumetric basis (O/A). The separation efficiency is calculated by comparison of the content of oil and greases in the inlet and outlet of the equipment. For determination of TOG (Total Oil and Grease), the method used was based in the absorption of radiation in the infra-red region. The equipment used for these determinations was InfraCal® TOG/TPH Model HATR-T2 of the Wilks Enterprise, Incorporation. It´s important to stand out that this method of measure has being used by PETROBRAS S.A. Results of global efficiency of separation oil/water varied from 75.3 to 97.7% for contaminated waters containing up to 1664,1 mg/L of oil. By means of tests carried out with a real sample of contaminated water supplied by PETROBRAS we have got an effluent specified in terms of the legal standards required for discharging. Thus, the new design of equipment constitutes a real alternative for the conventional systems of treatment of produced water in the oil industry

Development of a novel fermented soymilk product with potential probiotic properties

The study was carried out to test the ability of Enterococcus faecium, Lactobacillus acidophilus, L. jugurti, Streptococcus thermophilus and L. delbrueckii ssp bulgaricus to decrease cholesterol in vitro and to grow in the presence of bile salts. Both properties were dependent on the species under study. The cultures were also inoculated into soymilk fortified with dry milk whey powder as single or mixed starters. The physicochemical and sensory evaluations of the fermented products showed that E. faecium plus L. jugurti (ratio 1:1) is the best combination, and this mixture also produces a 43% decrease in cholesterol. © Springer-Verlag 1999.

Estudo da formação de domínios em bicamadas lipídicas induzidos por peptídeos antimicrobianos

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Estudo da viabilidade do emprego do pó de mármore para produção de concreto autoadensável e substituição parcial dos agregados por pérolas de poliestireno expandido (EPS)

Pós-graduação em Engenharia Civil - FEIS

Sugar markers in aerosol particles from an agro-industrial region in Brazil

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)