Usefulness of heart rate to predict cardiac events in treated patients with high-risk systemic hypertension.

A high heart rate (HR) predicts future cardiovascular events. We explored the predictive value of HR in patients with high-risk hypertension and examined whether blood pressure reduction modifies this association. The participants were 15,193 patients with hypertension enrolled in the Valsartan Antihypertensive Long-term Use Evaluation (VALUE) trial and followed up for 5 years. The HR was assessed from electrocardiographic recordings obtained annually throughout the study period. The primary end point was the interval to cardiac events. After adjustment for confounders, the hazard ratio of the composite cardiac primary end point for a 10-beats/min of the baseline HR increment was 1.16 (95% confidence interval 1.12 to 1.20). Compared to the lowest HR quintile, the adjusted hazard ratio in the highest quintile was 1.73 (95% confidence interval 1.46 to 2.04). Compared to the pooled lower quintiles of baseline HR, the annual incidence of primary end point in the top baseline quintile was greater in each of the 5 study years (all p <0.05). The adjusted hazard ratio for the primary end point in the highest in-trial HR heart rate quintile versus the lowest quintile was 1.53 (95% confidence interval 1.26 to 1.85). The incidence of primary end points in the highest in-trial HR group compared to the pooled 4 lower quintiles was 53% greater in patients with well-controlled blood pressure (p <0.001) and 34% greater in those with uncontrolled blood pressure (p = 0.002). In conclusion, an increased HR is a long-term predictor of cardiovascular events in patients with high-risk hypertension. This effect was not modified by good blood pressure control. It is not yet known whether a therapeutic reduction of HR would improve cardiovascular prognosis.

Tachycardia is a strong predictor of cardiovascular events in the value trial

Objective: Tachycardia is associated with hypertension and is a predictor of cardiovascular events. The predictive effect of tachycardia might reflect its connection with hypertension. In this analysis of 15,245 VALUE study patients we explore whether tachycardia predicts cardiovascular endpoints in high risk hypertension and whether the in-trial blood pressure lowering modified the tachycardia - related risk. Methods: Heart rate from ECG readings at baseline and annually throughout the trial. Results: In the Cox Regression analysis the primary endpoint hazard ratio for a 10 beats per minute increment of baseline heart rate was 1.16 (1.12-1.2) p < 0.0001, 1.17 (1.13-1.22) p < 0.0001 and 1.22 (1.18-1.27) p < 0.0001 unadjusted, adjusted for baseline blood pressure and for blood pressure plus risk factors, respectively. Primary endpoints strikingly increased in the highest quintile of baseline heart rate (=/>79 beats). Primary endpoints in the highest heart rate quintile were 30 % higher in first, 55 % in second, 55 % in third, 52 % in fourth and 46 % in the fifth year of the study. The in-trial heart rate was also a potent predictor. The primary endpoint hazard ratios of highest heart rate quintile versus pooled lower 4 quintiles was (1.34-1.66) p < 0.0001 unadjusted, 1.52 (1.36-1.69) p <0.0001 adjusted for baseline blood pressure and risk factors and 1.52 (1.36-1.69) p < 0.0001 further adjusted for in trial pressure. The increase of primary events in the upper quintile of in-trial heart rate was 68% in the group with good and 63% in the group with inadequate blood pressure control (both p < 0.0001 by log rank test). Conclusions: 1./ Tachycardia is a short term marker and a long term predictor of adverse event in high risk hypertension. 2./ Tachycardia contributes to the residual cardiovascular risk regardless of the degree of BP control. We hypothesize heart rate lowering with appropriate drugs may further decrease the cardiovascular risk in patients with high risk hypertension and tachycardia.

"Tractatus de jure triumphi apud Romanos.

"Antonius Favereau a.d. 1588 perscripsit cum primo Clarom. Ordinis praesset M. Julius Bulengerus"

Genetic variation in GIPR influences the glucose and insulin responses to an oral glucose challenge.

Glucose levels 2 h after an oral glucose challenge are a clinical measure of glucose tolerance used in the diagnosis of type 2 diabetes. We report a meta-analysis of nine genome-wide association studies (n = 15,234 nondiabetic individuals) and a follow-up of 29 independent loci (n = 6,958-30,620). We identify variants at the GIPR locus associated with 2-h glucose level (rs10423928, beta (s.e.m.) = 0.09 (0.01) mmol/l per A allele, P = 2.0 x 10(-15)). The GIPR A-allele carriers also showed decreased insulin secretion (n = 22,492; insulinogenic index, P = 1.0 x 10(-17); ratio of insulin to glucose area under the curve, P = 1.3 x 10(-16)) and diminished incretin effect (n = 804; P = 4.3 x 10(-4)). We also identified variants at ADCY5 (rs2877716, P = 4.2 x 10(-16)), VPS13C (rs17271305, P = 4.1 x 10(-8)), GCKR (rs1260326, P = 7.1 x 10(-11)) and TCF7L2 (rs7903146, P = 4.2 x 10(-10)) associated with 2-h glucose. Of the three newly implicated loci (GIPR, ADCY5 and VPS13C), only ADCY5 was found to be associated with type 2 diabetes in collaborating studies (n = 35,869 cases, 89,798 controls, OR = 1.12, 95% CI 1.09-1.15, P = 4.8 x 10(-18)).

Obispos y gladiadores: El recurso a los profesionales del anfiteatro en disputas por la elección episcopal.

[spa]La costumbre de enrolar a combatientes del anfiteatro (arenarii) como guardia personal en el marco de luchas faccionales sobrevivió durante el siglo IV. Incluso si en la mayor parte de casos este fenómeno se explica por razones políticas, conocemos dos ejemplos en los que los candidatos a obispo recurrieron a gladiadores para triunfar sobre sus oponentes. El primer ejemplo está relacionado con la elección de Silvano (en el 305 o en el 307/308), quien llegó a hacerse elegir obispo de Cirta (actual Constantine)gracias a la ayuda del arenarius Muto. Esta ayuda quedó bien demostrada por el testimonio de diversas personas durante el proceso seguido contra Silvano en el 320, en el que se reconoció su culpabilidad y se le condenó al exilio. El segundo ejemplo es el del papa Dámaso (366), elegido obispo de Roma en la iglesia de Lucina el mismo día en el que el diácono Ursino era escogido en la basílica de Julio. En el conflicto siguiente, Dámaso convocó a arenarii, quadrigari y fossores, quienes acudieron en su ayuda fuertemente armados. Éstos atacaron la basílica en la que se habían refugiado los partidarios de Ursino y el resultado del asalto fue de 137 muertos. [eng]The habit of engaging fighters of the amphitheatre (arenarii) as a personal guard in the factional struggles survived during the 4th century. Although in most cases it was about political causes, we know two examples where the candidates to be bishops turned to gladiators in order to overcome their opponents. The first example is that of election of Silvanus (305 or 307-308), who got the bishopric of Cirta (the modern Constantine) thanks to the help of the arenarius Mutus. This help was proved by the testimony of several witnesses during the trial which was followed against Silvanus in 320, where his guilt was admitted and he was condemned to the exile. The second exemple is that of the the Pope Damasus (366), elected bishop of Rome in the church of Lucina in the same day as the deacon Ursinus was elected in the basilica of Julius. In the conflict that was to follow, Damasus called arenarii, quadrigarii and fossores who came to help him heavily armed. They attacked the basilica where the supporters of Ursinus had taken refuge and as a result of the assault 137 people died.

Nutrição mineral da cana‑de‑açúcar irrigada com efluente de esgoto tratado, em área com aplicação de fosfogesso

O objetivo deste trabalho foi quantificar o aporte e a remoção de nutrientes em sistemas de cultivo de cana‑de‑açúcar irrigados, ou não, com efluente de estação de tratamento de esgoto (EETE), com e sem adição de fosfogesso, bem como avaliar os efeitos desses sistemas de cultivo no estado nutricional das plantas. Foram avaliados tratamentos sem irrigação e com irrigação a 100 e 150% da necessidade hídrica da cultura. Os tratamentos com fosfogesso foram aplicados em área de terceiro corte, irrigada com EETE desde o plantio. As avaliações foram realizadas em duas safras. Os tratamentos não afetaram os rendimentos de colmos. O tratamento com EETE e fosfogesso apresentou efeito sinérgico sobre o conteúdo de nitrogênio e de enxofre nas plantas. O EETE beneficiou a nutrição das plantas quanto ao fósforo, mas não causou melhorias na nutrição com potássio e enxofre. A nutrição com ferro, zinco e manganês não foi influenciada pelo aporte desses micronutrientes pelo EETE. O fósforo e o nitrogênio aportados na irrigação com EETE devem ser considerados na recomendação de adubação. Porém, potássio, enxofre, ferro, zinco e manganês do efluente não são fontes eficientes desses nutrientes para as plantas.

Direct torque control of permanent magnet synchronous machines - analysis and implementation

Thedirect torque control (DTC) has become an accepted vector control method besidethe current vector control. The DTC was first applied to asynchronous machines,and has later been applied also to synchronous machines. This thesis analyses the application of the DTC to permanent magnet synchronous machines (PMSM). In order to take the full advantage of the DTC, the PMSM has to be properly dimensioned. Therefore the effect of the motor parameters is analysed taking the control principle into account. Based on the analysis, a parameter selection procedure is presented. The analysis and the selection procedure utilize nonlinear optimization methods. The key element of a direct torque controlled drive is the estimation of the stator flux linkage. Different estimation methods - a combination of current and voltage models and improved integration methods - are analysed. The effect of an incorrect measured rotor angle in the current model is analysed andan error detection and compensation method is presented. The dynamic performance of an earlier presented sensorless flux estimation method is made better by improving the dynamic performance of the low-pass filter used and by adapting the correction of the flux linkage to torque changes. A method for the estimation ofthe initial angle of the rotor is presented. The method is based on measuring the inductance of the machine in several directions and fitting the measurements into a model. The model is nonlinear with respect to the rotor angle and therefore a nonlinear least squares optimization method is needed in the procedure. A commonly used current vector control scheme is the minimum current control. In the DTC the stator flux linkage reference is usually kept constant. Achieving the minimum current requires the control of the reference. An on-line method to perform the minimization of the current by controlling the stator flux linkage reference is presented. Also, the control of the reference above the base speed is considered. A new estimation flux linkage is introduced for the estimation of the parameters of the machine model. In order to utilize the flux linkage estimates in off-line parameter estimation, the integration methods are improved. An adaptive correction is used in the same way as in the estimation of the controller stator flux linkage. The presented parameter estimation methods are then used in aself-commissioning scheme. The proposed methods are tested with a laboratory drive, which consists of a commercial inverter hardware with a modified software and several prototype PMSMs.