Mortality and Embolic Potential of Cardiac Tumors

Background: Cardiac tumors are rare, mostly benign with high embolic potential. Objectives: To correlate the histological type of cardiac masses with their embolic potential, implantation site and long term follow up in patients undergoing surgery. Methods: Between January 1986 and December 2011, we retrospectively analyzed 185 consecutive patients who underwent excision of intracardiac mass (119 females, mean age 48±20 years). In 145 patients, the left atrium was the origin site. 72% were asymptomatic and prior embolization was often observed (19.8%). The diagnosis was established by echocardiography, magnetic resonance and histological examination. Results: Most tumors were located in the left side of the heart. Myxoma was the most common (72.6%), followed by fibromas (6.9%), thrombi (6.4%) and sarcomas (6.4%). Ranging from 0.6cm to 15cm (mean 4.6 ± 2.5cm) 37 (19.8%) patients had prior embolization, stroke 10.2%, coronary 4.8%, peripheral 4.3% 5.4% of hospital death, with a predominance of malignant tumors (40% p < 0.0001). The histological type was a predictor of mortality (rhabdomyomas and sarcomas p = 0.002) and embolic event (sarcoma, lipoma and fibroelastoma p = 0.006), but not recurrence. Tumor size, atrial fibrillation, cavity and valve impairment were not associated with the embolic event. During follow-up (mean 80±63 months), there were 2 deaths (1.1%) and two recurrences 1 and 11 years after the operation, to the same cavity. Conclusion: Most tumors were located in the left side of the heart. The histological type was predictor of death and preoperative embolic event, while the implantation site carries no relation with mortality or to embolic event.

4-Second Exercise Test: Reference Values for Ages 18–81 Years

Background: Physiological reflexes modulated primarily by the vagus nerve allow the heart to decelerate and accelerate rapidly after a deep inspiration followed by rapid movement of the limbs. This is the physiological and pharmacologically validated basis for the 4-s exercise test (4sET) used to assess the vagal modulation of cardiac chronotropism. Objective: To present reference data for 4sET in healthy adults. Methods: After applying strict clinical inclusion/exclusion criteria, 1,605 healthy adults (61% men) aged between 18 and 81 years subjected to 4sET were evaluated between 1994 and 2014. Using 4sET, the cardiac vagal index (CVI) was obtained by calculating the ratio between the duration of two RR intervals in the electrocardiogram: 1) after a 4-s rapid and deep breath and immediately before pedaling and 2) at the end of a rapid and resistance-free 4-s pedaling exercise. Results: CVI varied inversely with age (r = -0.33, p < 0.01), and the intercepts and slopes of the linear regressions between CVI and age were similar for men and women (p > 0.05). Considering the heteroscedasticity and the asymmetry of the distribution of the CVI values according to age, we chose to express the reference values in percentiles for eight age groups (years): 18–30, 31–40, 41–45, 46–50, 51–55, 56–60, 61–65, and 66+, obtaining progressively lower median CVI values ranging from 1.63 to 1.24. Conclusion: The availability of CVI percentiles for different age groups should promote the clinical use of 4sET, which is a simple and safe procedure for the evaluation of vagal modulation of cardiac chronotropism.

Echocardiographic Predictors of Worse Outcome After Cardiac Resynchronization Therapy

Abstract Background: Cardiac resynchronization therapy (CRT) is the recommended treatment by leading global guidelines. However, 30%-40% of selected patients are non-responders. Objective: To develop an echocardiographic model to predict cardiac death or transplantation (Tx) 1 year after CRT. Method: Observational, prospective study, with the inclusion of 116 patients, aged 64.89 ± 11.18 years, 69.8% male, 68,1% in NYHA FC III and 31,9% in FC IV, 71.55% with left bundle-branch block, and median ejection fraction (EF) of 29%. Evaluations were made in the pre‑implantation period and 6-12 months after that, and correlated with cardiac mortality/Tx at the end of follow-up. Cox and logistic regression analyses were performed with ROC and Kaplan-Meier curves. The model was internally validated by bootstrapping. Results: There were 29 (25%) deaths/Tx during follow-up of 34.09 ± 17.9 months. Cardiac mortality/Tx was 16.3%. In the multivariate Cox model, EF < 30%, grade III/IV diastolic dysfunction and grade III mitral regurgitation at 6‑12 months were independently related to increased cardiac mortality or Tx, with hazard ratios of 3.1, 4.63 and 7.11, respectively. The area under the ROC curve was 0.78. Conclusion: EF lower than 30%, severe diastolic dysfunction and severe mitral regurgitation indicate poor prognosis 1 year after CRT. The combination of two of those variables indicate the need for other treatment options.

Formação das castas no gênero Melípona (Illiger, 1806)

The present work is destinated to prove that the castes : workers and queens, in Melipona bees are due to genetic factors and not to differences in food. 2) Material used: Hives of Melipona quadri-fasciata anthidioides (Lep. 1836), M. schenki schenki (Gribodo, 1893), M. fasciata rufiventris (Lep. 1836), M. quadri-fasciata vicina (Lep. 1836), M. marginata marginata (Lep. 1836), Apis mellifera (L. 1758). 3) It should be pointed out that in Melipona bees there are no royal cells for the queens, but all the cells are of the same size independently of being destinated for workers, queens or drones. The numerous queens which are born are killed soon after emerging from their cells. 4) Changes of feeding in quality and in quantity caused no variation of castes. The only variable factor is the size, which becomes bigger when the bee is well nourished. 5) The offsprings of 5 hives were examined : 3 of M. quadri-fasciata anthidioides (n.o 1, n.o 2 and n.o 3), 1 of M. quadri-fasciata vicina (n.o 4) and 1 of M. marginata marginata (n.o 5). Combs of about 40 cells were taken into laboratory and the type of bee registered immediately after emerging. The results of the counts were: BOX COMB WORKER QUEEN PERCENTAGE Σ X2 to 12,5% Nº 1 1th 69 8 10,4% 0, 3139 " 1 2nd 144 18 11,1% 0, 2856 " 2 1th 52 8 13,3% 0, 0384 " 3 1th 45 10 18,2% 1, 6736 " 4 1th 56 4 6,7% 1, 8686 " 4 2nd 29 4 12,1% 0,00432 Σ X2 to 25% " 5 1th 34 14 29,2% 0,44444 "5 2nd 83 27 24,5% 0, 0121 In the 4 first boxes there is a percentage of 11,63% queens and in the last there is a percentage of 25,95%. 6) These percentages are very near two genetical ratios: 12,5% or 7:1, and 25% or 3:1, which correspond to a trifactorial and a bifactorial back-cross. Carrying out a X² test no significant deviations were found ( X² to 12,5% and to 25% and table 1 to 4). 7) We suppose that the formula for the queen in the first case (11,65%) is: AaBbCc. Since the Melipona bees are arrhenotokous hymenopteres, the drones are haploid and may have any one of the following eight formulas, corresponding to the gonic segregation of the queem : ABC, ABc, Abc, Abc, AbC, aBC, aBc, abC, abc. Anyone combination of these males with the queen will give a segregation of 7 workers to 1 queen, since there is always only one triple heterozygote among the eight possible segregates (table 5). 8) In order to explain the second case, it is suffient to assume that in this species there are only two pairs of factors, the queen being the double heterozygote : AaBb, while the drones may have any one of the following constitutions: AB, Ab, aB and ab. Workers are again all diploids which are homozygous for one or both factors, for instance: AABB, AABb, AaBB, aaBb, AAbb, etc. (table 6). 9) It is suggested that the genus Melipona is an intermediary type between the solitary bees, where all females are fertile independently of their feeding, and the genera Apis and Trigona, where without special feeding all females are born sterile, while only specially fed females develop into fertile queens. 10) No speculations are put forward with regards to the evolutionary mechanism which may have been responsible for the development of the genetical determination of castes in Melipona, since it seems advisable point to extend the studies to other insects with complicated caste systems.

Fatôres que afetam a determinação da vitamina C na goiaba (Psidium guajava L.)

In the present paper the authors deal with the content of ascorbic acid in guavas (Psidium guajava L.) and the methods of sampling used. Ascorbic acid was determined directly in the photoeletric colorimeter (EEL), after extraction with a 4 per cent solution of oxalic acid. Guavas from various parts of State of S.Paulo were used and the general mean found was around 100 mgm of ascorbic acid per 100 gm fresh weight of the material used for extraction. It was found that there is great variation in the ascorbic acid content according to the condition of the fruit: Ascorbic acid Condition content in Mean mgm/100 gm Green and hard 93,36 - 119,54 102,43 Small green 57,34 - 92,30 83,40 Firm ripe 71,28 - 115,98 90,32 Overripe 63,22 - 85,98 77,36 Of the diferent parts of the fruit, the skin has the highest content; the pulp between the skin and the parts containing the seeds, the "inner pulp" contains little and finallw the central parts, formed by the pulp between seeds, the "inter pulp" a engligible amount. The proportion of ascorbic acid found in the skin, inner pulp and inter pulp may be as high as 1.6: 1: 0. Furthermore, the section near the peduncule and the sepals are richer than equatorial crossections. It was proved that the amount and intensity of sun-light is at least one important factant factor determining differences in the ascorbic acid content of the fruit, which is higer in the parts which have received more light. A sharp decrease was found in the vitamin C content of ripe fruite stored in a home refrigerator. The periods of the preservation were 12-24-48-96 hours and the decrease of the ascorbic acid content m per cent was 23.4 - 42.0 - 66.8 - 76.4 of the initial content of 144.28 mgm/100 gm. The following five different methods of sampling in the determination of the amount of vitamin C were tested, with extraction in a Waring blendor: 1) whole fruit; 2,) sample taken form fruits cut into many small pieces; 3) half of a fruit divided by a crossection at equal distance from both ends; 4) half of fruit divided lenghtwise; 5) a transversal slice of about 1 cm. It was found that the two first methods geve the most reliable results.

Assayentwicklung zur Analyse des proteolytischen Abbaus von Abetafibrillen 1-40, 3-40 und pE3-40

Alzheimer ist eine neurodegenerative Erkrankung deren molekulare Ursache, die Anhäufung von Amyloid-Plaques im Gehirn und die Bildung von Neurofibrillen in den Nervenzellen ist. Grund für diese molekularen Ursachen ist das Peptid Amylois beta, welches sich im Gehirn von Alzheimer Patienten anhäuft und zu Fibrillen aggregiert. In der Arbeit wurde untersucht, ob es Unterschiede bezüglich des proteolytischen Abbaus zwischen Abetafibrillen 1-40, 3-40 und pE3-40 gibt und ob die Fibrillen von unterschiedlichen Enzymen abgebaut werden können. Zudem wurden die Spaltprodukte, die bei diesem Abbau entstanden, miteinander verglichen und analysiert. Es wurde also untersucht, ob die Enzyme eine abbauende Wirkung auf aggregierte Aβ-Peptide haben und wie sich diese im Vergleich zu den gelösten Abeta-Peptiden verhalten. Die Untersuchungen fanden mit den Enzymen Neprilysin, Neprilysin 2, Insulysin, Matrix-Metalloproteinasen 2, 3, 9, 13, Plasmin, Plasma Kallikrein, Tissue Kallikrein und Meprin A statt und wurden Mittels MALDO-TOF analysiert.

Deficiências minerais em plantas de bertalha ( Basella alba, L.)

Plantas de bertalha (Basella alba, L.) INPA-1 foram cultivadas em casa de vegetação em quartzo moído, irrigadas com soluções nutritivas conforme SARRUGE (1975) e submetidas aos seguintes tratamentos: completo, omissão de N, omissão de P, omissão de K, omissão de Ca, omissão de Mg e omissão de S, com o objetivo de: (a) obter sintomas de deficiência dos ma cronutrientes; (b) analisar o crescimento das plantas através da produção de matéria seca; (c) determinar a concentração dos macronutrientes nas folhas e caules das plantas cultivadas nos diversos tratamentos. Os sintomas visuais de deficiência foram identificados e descritos. As plantas foram coletadas e separadas em raiz, caule, folhas e determinaram-se os teores dos macronutrientes minerais neste material. Os resultados obtidos mostram: - os sintomas visuais de deficiência são bem definidos e de fácil caracterização para todos os nutrientes; - só foi possível detectar efeito na produção de matéria seca das folhas e caules para omissão de nitrogênio e para omissão de potássio nos caules; - os níveis de deficiência e adequação obtidos nas folhas foram respectivamente: N% = 1,25 e 2,63; P% = 0,17 e 0,36; K% = 0,46 e 3,55; Ca% = 0,62e 1,78; Mg% = 0,37 e 0,80; s%= 0,19 e 0,23. - os níveis de deficiência e adequação obtidos nos caules foram respectivamente: N% = 0,67 e 0,98; P% = 0,13 e 0,31; K% = 0,73 e 2,67; Ca% = 0,11 e 0,64; Mg% = 0,08 e 0,20; S% = 0,15 e 0,20.

Flora Costaricensis. William Burger, editor. Family #40, Casuarinaceae, Family #41, PIperaceae [by] William Burger.

v.35(1971)

A study of the mammals of Iran: resulting from the Street Expedition of 1962-63 [by] Douglas M. Lay.

v.54(1967)

Exigências térmicas para o desenvolvimento de Palmistichus elaeisis (Hymenoptera, Eulophidae) em pupas de cinco espécies de lepidópteros

The thermal requirements of Palmistichus elaeisis Delvare & LaSalle, 1993 were determined by rearing this pupal parasitoid in the following lepidopteran hosts: Diatraea saccharalis (Fabricius, 1794) (Crambidae), Anticarsia gemmatalis (Hübner, 1818), Heliothis virescens (Fabricius, 1777), Spodoptera frugiperda (J.E. Smith, 1797) (Noctuidae) and Thyrinteina arnobia (Stoll, 1782) (Geometridae). The experiment was set in laboratory conditions (temperatures between 18ºC and 30ºC, RH=70 ± 10% and 14-hour photoperiod). The life cycle (egg-adult) ranged from 40.4 ± 0.63 days (18ºC, H. virescens) to 18.1 ± 0.13 days (28ºC, D. saccharalis). The thermal constant of the egg-adult period ranged from 353.1 (D. saccharalis) to 407.7 degree-days (S. frugiperda). The lowest thermal threshold ranged from 5.0ºC (A. gemmatalis) to 7.5ºC (D. saccharalis). At 30ºC, all prepupae died. These results suggest that P. elaeisis can be reared in laboratory on all the hosts tested.

A vegetação do município de Ilhéus, Estado da Bahia: III - caracterização da vegetação pelo valôr dos índices das espécies

The indices found are analysed as a whole and general conclusions are drawn from them which may be of use in understanding many of the problems offered by the local flora (Ilhéus). The first column of the tables presented indicates the biological form of the species, showing the nature of the flora and the constitution of the climax. A total of 200 species of phanerophyta were found; 69 macrophanerophyta (trees), 54 are mesophanerophyta (treelets) and 77 are nanophanerophyta (shrubs). The macrophanerophyta are consequently considered as dominants and the meso-and nanophanerophyta as codominants (the biological forms: chamaephyta, hemicriptophyta, criptophyta, geophyta, therophyta, epiphyta and hydrophyta are subdominants), the more so as the first cover 80% and the others more or less 50%. This points to a climax of trees and a local vegetation mainly composed of trees also. The smaller forms are left out as they are beyond the present scope of this sort of wort in Brazil. The third column of ecological formulae indicates the reaction of the constituent species to light (C = sciophilous, F = photophilous and I = indifferents), the biological types of vegetation (H = hygrophytes, X = xerophytes and M = mesophytes) and the fidelity of the species to the climax. Of the species studied: 25 are pioneers (P. Table I), 63 are accidentals (A. Table II), 35 are companion species (O. Table III), 19 show preferences (E. Table with vitality Vn), 44 are selective (S. Table V) and 13 exclusive species (L. Table VI). This leads to the conclusion that the vegetation of the region is in full reconstitution. As to the ecological characteristics of the 200 species studied, 89 are either pioneers (a class separated by the author) or accidentals; this means that the devastated zones are being reconstituted in the subsere both with members of the prisere and alien species. Of the remaining species, 54 are companion, or accompanying species, which appear in most subclimax, serclímax and quasiclimax associations, and 57 are real constituents of the local climax. As all the species except the pioneers, selectives and exclusives (xerophytes and mesophytes) may be considered as hygrophytes this type evidently predominantes in the region and may constitute a hygrophilous serclimax and quasiclímax. In regard to light 101 are sciophilous, 32 indiferents and 67 photophilous. This leads to the conclusion that the vegetation comprises mainly tolerant species, showing the hygrophilous and mesophilous character of the region with a vegetation composed mostly of trees. The presence a large number of sciophilous species is easy to understand as the hygrophilous and mesophilous habitats and the dominance of trees favour the germination and growth of tolerant species. The last two columns analyse the percentage of individuals present and the occurrent classes to which they belong: 92 species vary between 1 and 9%; 50 between to 10 and 19%; 36 between 20 and 29%; 14 between 30 and 39%; and 8 between 40 and 49%. Only 8 species belong to occurrence class V; 14 to classe IV; 36 to class III; 50 to class II; and 92 to class I. This leads to the conclusion that the local formation is very unsociable and very complex, though the median coverture is 80% and the number of species is very large. The analysis of the data also shows that the climax is being reconstituted in the subsere with elements drawn from the prisere and alien species introduced either by man (following desvastation) or by other consequent factors (such as brusque changes of microclimates due to total or partial destruction). This modifies the subclimax appreciably and apparently also the climax of the local regional subsere. As a final conclusion it is suggested that as in the subsere the pioneer formation is xerophilous, the prisere also beging as a xerosere; but as there are and probably always were hydrophilous formation evolving in the same climate, the local climax is composed of species with medium exactions, that is of relative mesophites.

Notas de Ixodologia: II - uma nova espécie do gênero Amblyomma e uma nova espécie do gênero Ixodes (Acari Ixodidae)

A new tick, Amblyomma parkeri, n. sp., is described as a parasite of Coendu sp. from S. Paulo, Brazil. Female holotype, nymph and larva are described (Figs. 2 e 3). The n. sp. differs completly from Koch's species Amblyomma longirostre, the common parasite of the Erethizotidae. Standard data for measures of the female dorsal scutum ixodidae are proposed as follows (fig. 1): PA = Antero-posterior; PB = Postero-basal; PM = Postero-median; TT = Transversal; OO = Inter-ocular; OT= Occulo-transversal; SS = Inter-scapular; CC = Cervical; PT = Postero-transversal; ST = Scapulo-transversal; NPT = Normal to the postero-transversal; NST = Normal to the scapulo-transversal. In the female holotype the standard data are as follows: PA = 2.00 mm; PB = 2.26 mm; PM = 1.10 mm; TT = 2.20 mm; OO = 2.26 mm; SS = 0,84 mm; CC = 0.63 mm; SC = 0.12 mm; NPT = 0.20mm; STN = 0.1 mm. Peritrema 0.80 x 0.42 mm with a narrow postero-internal angle and a large, elongated macula. Coxa I with two short spines and all other coxae with only one shorter spine, shortest in coxa IV. Hypostoma spatulated with formula 3/3. Gnathosoma 1.42 mm long and basis 0.63 mm long by 0.84 greatest wide. Palpi with smoth external surface, 1.00 mm long. Type lot No. 4458 from Cotia, S. Paulo, Brazil; in the acarological collection of the Escola Paulista de Medicina, S. Paulo. Ixodes didelphidis, n. sp., differing from Ixodes loricatus Neumann by the shape of the peritremata (figs. 4 a 5) of the male and female and by the number of the punctations in this organ is described form Didelphidae, Muridae and Cavidae. Twenty eight lots were obtained from Anápolis, Goiás, Brasil, where I. loricatus is subtituded by the n. sp. under description. Comparison with NEUMANN'S types of I. loricatus was possible through the courtesy of Prof. A. BRIZARD from Toulouse, who kindly loaned NEUMANN'S material. Female cotypes N° 40 and male allotype N° 531 in the Collection of Ixodidae of the Oswaldo Cruz Institute.

Prevalência da infecção pelo Toxoplasma gondii em animais domésticos, silvestres e grupamentos humanos da Amazônia

Através de Reação de Hemaglutinação Indireta para toxoplasmose foram examinadas amostras de sangue de dez diferentes espécies de animais domésticos e silvestres, de um grupamento humano da cidade de Manaus-Amazonas e de um grupamento humano indígena de área distante, no território de Roraima. Em 108 animais domésticos, o exame sorológico foi reagente em 90,6% dos gatos (Felis catus), 68,4% dos cães (Canis familiaris), 60,0% dos bovinos (Bos sp), 41,2% dos galináceos (Gallus sp) e 40,0% dos palmípedes (Cairina sp). Nos 104 animais silvestres foram reagentes 75,0% dos felídeos (Felis sp), 63,6% dos marsupiais (Didelphis marsupialis e Marmosa sp), 63,3% dos primatas (Saimiri sp) e 61,1% dos roedores (Proechimys). Entre os dois grupos humanos a prevalência foi de 70,6% nos 51 habitantes da área de Manaus, 64,8% nos 37 silvícolas de Roraima. Os autores discutem os resultados obtidos, assim como os diversos aspectos envolvidos na epidemiologia da toxoplasmose e chamam a atenção para a existência de mecanismos de transmissão ainda não esclarecidos, enfatizando a necessidade de maiores estudos dessa zoonose.

In postmenopausal women with osteoporosis, denosumab significantly improved trabecular bone score (TBS), an index of trabecular microarchitecture

Background/Purpose: The trabecular bone score (TBS), a novel graylevel texture index determined from lumbar spine DXA scans, correlates with 3D parameters of trabecular bone microarchitecture known to predict fracture. TBS may enhance the identification of patients at increased risk for vertebral fracture independently of bone mineral density (BMD) (Boutroy JBMR 2010; Hans JBMR 2011). Denosumab treatment for 36 months decreased bone turnover, increased BMD, and reduced new vertebral fractures in postmenopausal women with osteoporosis (Cummings NEJM 2009). We explored the effect of denosumab on TBS over 36 months and evaluated the association between TBS and lumbar spine BMD in women who had DXA scans obtained from eligible scanners for TBS evaluation in FREEDOM. Methods: FREEDOM was a 3-year, randomized, double-blind trial that enrolled postmenopausal women with a lumbar spine or total hip DXA T-score __2.5, but not __4.0 at both sites. Women received placebo or 60 mg denosumab every 6 months. A subset of women in FREEDOM participated in a DXA substudy where lumbar spine DXA scans were obtained at baseline and months 1, 6, 12, 24, and 36. We retrospectively applied, in a blinded-to-treatment manner, a novel software program (TBS iNsightR v1.9, Med-Imaps, Pessac, France) to the standard lumbar spine DXA scans obtained in these women to determine their TBS indices at baseline and months 12, 24, and 36. From previous studies, a TBS _1.35 is considered as normal microarchitecture, a TBS between 1.35 and _1.20 as partially deteriorated, and 1.20 reflects degraded microarchitecture. Results: There were 285 women (128 placebo, 157 denosumab) with a TBS value at baseline and _1 post-baseline visit. Their mean age was 73, their mean lumbar spine BMD T-score was _2.79, and their mean lumbar spine TBS was 1.20. In addition to the robust gains in DXA lumbar spine BMD observed with denosumab (9.8% at month 36), there were consistent, progressive, and significant increases in TBS compared with placebo and baseline (Table & Figure). BMD explained a very small fraction of the variance in TBS at baseline (r2_0.07). In addition, the variance in the TBS change was largely unrelated to BMD change, whether expressed in absolute or percentage changes, regardless of treatment, throughout the study (all r2_0.06); indicating that TBS provides distinct information, independently of BMD. Conclusion: In postmenopausal women with osteoporosis, denosumab significantly improved TBS, an index of lumbar spine trabecular microarchitecture, independently of BMD.