Comparison of ACUITY and CRUSADE Scores in Predicting Major Bleeding during Acute Coronary Syndrome

Background:The ACUITY and CRUSADE scores are validated models for prediction of major bleeding events in acute coronary syndrome (ACS). However, the comparative performances of these scores are not known.Objective:To compare the accuracy of ACUITY and CRUSADE in predicting major bleeding events during ACS.Methods:This study included 519 patients consecutively admitted for unstable angina, non-ST-elevation or ST-elevation myocardial infarction. The scores were calculated based on admission data. We considered major bleeding events during hospitalization and not related to cardiac surgery, according to the Bleeding Academic Research Consortium (BARC) criteria (type 3 or 5: hemodynamic instability, need for transfusion, drop in hemoglobin ≥ 3 g, and intracranial, intraocular or fatal bleeding).Results:Major bleeding was observed in 31 patients (23 caused by femoral puncture, 5 digestive, 3 in other sites), an incidence of 6%. While both scores were associated with bleeding, ACUITY demonstrated better C-statistics (0.73, 95% CI = 0.63 - 0.82) as compared with CRUSADE (0.62, 95% CI = 0.53 - 0.71; p = 0.04). The best performance of ACUITY was also reflected by a net reclassification improvement of + 0.19 (p = 0.02) over CRUSADE’s definition of low or high risk. Exploratory analysis suggested that the presence of the variables ‘age’ and ‘type of ACS’ in ACUITY was the main reason for its superiority.Conclusion:The ACUITY Score is a better predictor of major bleeding when compared with the CRUSADE Score in patients hospitalized for ACS.

One-year Mortality after an Acute Coronary Event and its Clinical Predictors: The ERICO Study

Background:Information about post-acute coronary syndrome (ACS) survival have been mostly short-term findings or based on specialized, cardiology referral centers.Objectives:To describe one-year case-fatality rates in the Strategy of Registry of Acute Coronary Syndrome (ERICO) cohort, and to study baseline characteristics as predictors.Methods:We analyzed data from 964 ERICO participants enrolled from February 2009 to December 2012. We assessed vital status by telephone contact and official death certificate searches. The cause of death was determined according to the official death certificates. We used log-rank tests to compare the probabilities of survival across subgroups. We built crude and adjusted (for age, sex and ACS subtype) Cox regression models to study if the ACS subtype or baseline characteristics were independent predictors of all-cause or cardiovascular mortality.Results:We identified 110 deaths in the cohort (case-fatality rate, 12.0%). Age [Hazard ratio (HR) = 2.04 per 10 year increase; 95% confidence interval (95%CI) = 1.75–2.38], non-ST elevation myocardial infarction (HR = 3.82 ; 95%CI = 2.21–6.60) or ST elevation myocardial infarction (HR = 2.59; 95%CI = 1.38–4.89) diagnoses, and diabetes (HR = 1.78; 95%CI = 1.20‑2.63) were significant risk factors for all-cause mortality in the adjusted models. We found similar results for cardiovascular mortality. A previous coronary artery disease diagnosis was also an independent predictor of all-cause mortality (HR = 1.61; 95%CI = 1.04–2.50), but not for cardiovascular mortality.Conclusion:We found an overall one-year mortality rate of 12.0% in a sample of post-ACS patients in a community, non-specialized hospital in São Paulo, Brazil. Age, ACS subtype, and diabetes were independent predictors of poor one‑year survival for overall and cardiovascular-related causes.

Cardiac Sympathetic Hyperactivity after Chemotherapy: Early Sign of Cardiotoxicity?

Background:Chemotherapy with anthracyclines and trastuzumab can cause cardiotoxicity. Alteration of cardiac adrenergic function assessed by metaiodobenzylguanidine labeled with iodine-123 (123I-mIBG) seems to precede the drop in left ventricular ejection fraction.Objective:To evaluate and to compare the presence of cardiovascular abnormalities among patients with breast cancer undergoing chemotherapy with anthracyclines and trastuzumab, and only with anthracycline.Methods:Patients with breast cancer were analyzed clinical, laboratory, electrocardiographic and echocardiographic and cardiac sympathetic activity. In scintigraphic images, the ratio of 123I-mIBG uptake between the heart and mediastinum, and the washout rate were calculated. The variables were compared between patients who received anthracyclines and trastuzumab (Group 1) and only anthracyclines (Group 2).Results:Twenty patients, with mean age 57 ± 14 years, were studied. The mean left ventricular ejection fraction by echocardiography was 67.8 ± 4.0%. Mean washout rate was 28.39 ± 9.23% and the ratio of 123I-mIBG uptake between the heart and mediastinum was 2.07 ± 0.28. Of the patients, 82% showed an increased in washout rate, and the ratio of 123I-mIBG uptake between the heart and mediastinum decreased in 25%. Concerning the groups, the mean washout rate of Group 1 was 32.68 ± 9.30% and of Group 2 was 24.56 ± 7.72% (p = 0,06). The ratio of 123I-mIBG uptake between the heart and mediastinum was normal in all patients in Group 2, however, the Group 1, showed 50% the ratio of 123I-mIBG uptake between the heart and mediastinum ≤ 1.8 (p = 0.02).Conclusion:In women with breast cancer undergoing chemotherapy, assessment of cardiac sympathetic activity with 123I-mIBG appears to be an early marker of cardiotoxicity. The combination of chemotherapy showed higher risk of cardiac adrenergic hyperactivity.

Acute Coronary Syndrome Treatment Costs from the Perspective of the Supplementary Health System

AbstractBackground:Acute coronary syndrome (ACS) is defined as a “group of clinical symptoms compatible with acute myocardial ischemia”, representing the leading cause of death worldwide, with a high clinical and financial impact. In this sense, the development of economic studies assessing the costs related to the treatment of ACS should be considered.Objective:To evaluate costs and length of hospital stay between groups of patients treated for ACS undergoing angioplasty with or without stent implantation (stent+ / stent-), coronary artery bypass surgery (CABG) and treated only clinically (Clinical) from the perspective of the Brazilian Supplementary Health System (SHS).Methods:A retrospective analysis of medical claims of beneficiaries of health plans was performed considering hospitalization costs and length of hospital stay for management of patients undergoing different types of treatment for ACS, between Jan/2010 and Jun/2012.Results:The average costs per patient were R$ 18,261.77, R$ 30,611.07, R$ 37,454.94 and R$ 40,883.37 in the following groups: Clinical, stent-, stent+ and CABG, respectively. The average costs per day of hospitalization were R$ 1,987.03, R$ 4,024.72, R$ 6,033.40 and R$ 2,663.82, respectively. The average results for length of stay were 9.19 days, 7.61 days, 6.19 days and 15.20 days in these same groups. The differences were significant between all groups except Clinical and stent- and between stent + and CABG groups for cost analysis.Conclusion:Hospitalization costs of SCA are high in the Brazilian SHS, being significantly higher when interventional procedures are required.

Nutrição mineral da seringueira: I - Crescimento e recrutamento de macronutrientes no período de quatro anos pelo clone Fx 3864 na região de Rio Branco, AC

Com o objetivo de obter dados referentes ao crescimento e concentração e acúmulo de macronutrientes em função da idade da planta, foram coleta das amostras de folhas, galhos secos, ponta e base de galhos primários, e ponta, meio e base do tronco de plantas de seringueira clone Fx 3864 com 1,0 a 4,0 anos de idade em plantações situadas sobre Latossol Vermelho-Amarelo textura argilosa na área da BONAL S.A., localizada na região de Rio Branco, AC. Os resultados obtidos mostraram que: - O maior incremento no crescimento ocorreu a partir do terceiro ano. - As maiores concentrações de nutrientes, ocorreram nas folhas. - A extração de nutrientes pela seringueira, por hectare, no quarto ano, foi a seguinte: N - 24, 54 kg, P - 1,82 kg, Ca - 11,07 kg, Mg - 5,29 kg, S - 1,88 kg, - região do Amazonas. - A extração total de macronutrientes pelo sistema, em ordem decrescente: N K Ca Mg S P.

Recuperació i producció sostenible del formatge d'Estahon

Des de la perspectiva ambiental, el projecte s’ha enfocat vers la conservació de la biodiversitat, tant animal com vegetal, mitjançant unes pràctiques ramaderes que prioritzin l’aprofitament dels recursos sense una sobre-explotació d’aquests. D’aquesta manera es pot garantir el manteniment de la biodiversitat vegetal que s’ha aconseguit a través dels anys gràcies a la interacció planta-animal, és a dir, l’adaptació de les plantes al pasturatge per cabres i ovelles i l’adaptació animal a les espècies vegetals pel seu manteniment i creixement. A més a més, s’ha optat per unes races de bestiar autòctones que malgrat no ser les més productives quant a llet, si que són les que estan més adaptades a les condicions orogràfiques i climàtiques d’Estahon. El ramat serà tractat en condicions de pasturatge extensiu sota les bases de la ramaderia ecològica, la qual cosa ens permetrà aconseguir l’elaboració d’uns formatges també ecològics i de qualitat. Pel que fa a la sostenibilitat social, en els darrers temps s’està tendint cap a un món rural cada cop més despoblat i envellit, mentre que les ciutats són cada cop més extenses i densament poblades. És per això que s’hauria d’aconseguir un reequilibri territorial. Una manera de fixar població als petits pobles de muntanya és trobant alternatives que siguin viables econòmicament perquè s’hi pugui viure amb dignitat. Finalment, per assolir una sostenibilitat econòmica, s’ha intentat tancar el cicle productiu dins de l’explotació. D’aquesta manera, a part de reduir el consum pel transport d’aliments, s’aconsegueix no dependre de l’exterior per alimentar el bestiar. Així es redueixen molt els costos en la producció i alimentació del bestiar. Per fer l’anàlisi econòmica s’ha optat per no tenir en compte les subvencions provinents de la Generalitat de Catalunya, ja que aquestes no es mantindran per sempre (i per tant seria insostenible a mitjà termini), però tot i això es poden contemplar per tal d’iniciar l’explotació i tenir un període d’adaptació.

Planificación de aplicaciones best-effort y soft real-time en NOWs

La aparición de nuevos tipos de aplicaciones, como vídeo bajo demanda, realidad virtual y videoconferencias entre otras, caracterizadas por la necesidad de cumplir sus deadlines. Este tipo de aplicaciones, han sido denominadas en la literatura aplicaciones soft-real time (SRT) periódicas. Este trabajo se centra en el problema de la planificación temporal de este nuevo tipo de aplicaciones en clusters no dedicados.

Modelo de pérdida de paquetes para redes híbridas

El objetivo de este proyecto es la predicción de la pérdida de paquete. Para ello necesitaremos el modelado del canal. De esta manera, podremos determinar cuando una transmisión llega con éxito o no. En primer lugar, se han estudiado los algoritmos de adaptación de la tasa. Estos algoritmos mejoran el rendimiento de la comunicación. Por este motivo, el programa de simulación se basa en algunos de estos algoritmos. En paralelo, se han capturado medidas del canal terrestre para realizar el modelado. Finalmente, con un programa mucho más completo se ha simulado el comportamiento de una transmisión con el modelado del canal físico, y se han asumido algunas consideraciones, como las colisiones. Por lo tanto, se ha obtenido un resultado más realista, con el cual se ha analizado teóricamente las posibilidades de un enlace entre el canal terrestre y el canal satélite, para crear una red híbrida.

Eco-epidemiologia de Haemonchus contortus bahienses, ecotipo presente en ovinos de zonas aridas de Venezuela

Haemonchus contortus bahiensis Grisi, 1974 parasita a los ovinos de zonas áridas de Venezuela. En las hembras de dicho ecotipo la distribución de frecuencias por nosotros observada fue de un 15,32% para el morfotipo con lengüeta supravulvar, de un 51,61% para el botonado y de un 33,07% para el liso. Correspondiéndole a dicho ecotipo un índice de diversidad de Shannon-Weaver de 1,44 bits. Las medidas corporales, el tamaño de los huevos y el symlophe son similares en los tres morfotipos. La disposición espacial tanto de los machos como de las hembras en el seno de la población de hospedadores es de tipo contagiosa siendo bien descrita por el parámetro K de la distibución binominal negativa. Se evidenció la existencia de una compleja interacción entre la abundancia, la agregación y la prevalencia de dicho ecotipo y se discute su importancia sobre el equilibrio hospedador-parásito.

“Un fol anar don es en fol venguz”: idas y venidas del desconocido Engles

Investigación elaborada a partir de una estancia en la Facoltà di Lettere e filosofia de la Università degli Studi dell'Aquila entre los meses de octubre del 2006 y marzo del 2007. Engles es uno de los trovadores occitanos de los siglos XII y XIII más misteriosos i desconocidos. Ante la falta de datos históricos o documentales, la única vía que queda es intentar descubrir las posibilidades comunicativas de los textos literarios que mencionan a Engles cuando son leídos en conjunto, como parte de un mismo grupo temático en torno a este personaje enigmático. De hecho, haciendo una lectura de este tipo, resulta evidente que parte de la información que podemos deducir hoy en día de Engles pudo haber sido, en cierto modo, alterada; o, como mínimo, leída erróneamente a lo largo del tiempo. Por ello resultan contradictorias las conclusiones que se derivan de la información que existe de él. Parte del problema es que a la falta de información archivística se suma la escasez del corpus de textos relacionados con Engles; y, sin embargo, a pesar de lo escaso en números, resulta de gran interés informativo. Partiendo del estudio de algunas de estas menciones, el artículo intenta establecer un diálogo coherente entre todos los textos, buscando dilucidar quién fue el misterioso Engles.

Avaluació de set materials representatius del programa didàctic aplicat a les Escoles Bressol Municipals de Mataró dins del projecte de formació del professorat 2006/07

ii. Desprès de finalitzar el primer any d’aplicació del projecte “La música a les Escoles Bressol Municipals de Mataró”, s’inicia la present recerca, en la que participen tots els grups que formen part del projecte, amb l’objectiu de valorar-ho i veure’n la continuïtat. Es detecta que els materials emprats en la proposta didàctica són l’element que ha esdevingut més exitós fins al moment. Definint-ne una mostra de set materials, es procedeix a determinar l’ús que les educadores els atorguen en relació a la proposta didàctica i a avaluar-los

Localization of algebras over coloured operads

We give sufficient conditions for homotopical localization functors to preserve algebras over coloured operads in monoidal model categories. Our approach encompasses a number of previous results about preservation of structures under localizations, such as loop spaces or infinite loop spaces, and provides new results of the same kind. For instance, under suitable assumptions, homotopical localizations preserve ring spectra (in the strict sense, not only up to homotopy), modules over ring spectra, and algebras over commutative ring spectra, as well as ring maps, module maps, and algebra maps. It is principally the treatment of module spectra and their maps that led us to the use of coloured operads (also called enriched multicategories) in this context.

Neoadjuvant chemoradiotherapy with or without panitumumab in patients with wild-type KRAS, locally advanced rectal cancer (LARC): a randomized, multicenter, phase II trial SAKK 41/07.

BACKGROUND: We conducted a randomized, phase II, multicenter study to evaluate the anti-epidermal growth factor receptor (EGFR) mAb panitumumab (P) in combination with chemoradiotherapy (CRT) with standard-dose capecitabine as neoadjuvant treatment for wild-type KRAS locally advanced rectal cancer (LARC). PATIENTS AND METHODS: Patients with wild-type KRAS, T3-4 and/or N+ LARC were randomly assigned to receive CRT with or without P (6 mg/kg). The primary end-point was pathological near-complete or complete tumor response (pNC/CR), defined as grade 3 (pNCR) or 4 (pCR) histological regression by Dworak classification (DC). RESULTS: Forty of 68 patients were randomly assigned to P + CRT and 28 to CRT. pNC/CR was achieved in 21 patients (53%) treated with P + CRT [95% confidence interval (CI) 36%-69%] versus 9 patients (32%) treated with CRT alone (95% CI: 16%-52%). pCR was achieved in 4 (10%) and 5 (18%) patients, and pNCR in 17 (43%) and 4 (14%) patients. In immunohistochemical analysis, most DC 3 cells were not apoptotic. The most common grade ≥3 toxic effects in the P + CRT/CRT arm were diarrhea (10%/6%) and anastomotic leakage (15%/4%). CONCLUSIONS: The addition of panitumumab to neoadjuvant CRT in patients with KRAS wild-type LARC resulted in a high pNC/CR rate, mostly grade 3 DC. The results of both treatment arms exceeded prespecified thresholds. The addition of panitumumab increased toxicity.