Maligne Hypertonie: Klinische Zeichen von 7 Patienten Malignant Hypertension: Clinical Manifestations of 7 Cases.

Background: Malignant hypertension is defined by marked systemic arterial hypertension with retinal haemorrhages, exudation or papilloedema. Due to the rarity of this disease and due to its non-specific symptoms and lesions, the diagnosis can be challenging. Patients and Methods We investigated the types of symptoms and ocular lesions observed with ocular fundus examination, ocular fundus photography, fluorescein angiography and optical coherence tomography in a small case series of 7 patients with malignant hypertension. Results: Median systolic blood pressure (BP) was 205 mmHg ± 21. Median diastolic BP was 150 mmHg ± 16. Decrease in visual acuity (6/7 patients) and scotoma (5/7) were the main symptoms and Elschnig spot, flamed shaped haemorrhage, serous retinal detachment, cotton wool spots and optic nerve oedema were the five most frequently observed lesions. A regression of lesions was observed after therapy of systemic hypertension. Conclusion: The association of multiple lesions strongly suggests malignant hypertension. However even in cases with only one lesion malignant hypertension should be kept in mind.

3B.01: Performance of targeted screening for the identification of hypertension in children

OBJECTIVE: As universal screening of hypertension performs poorly in childhood, targeted screening to children at higher risk of hypertension has been proposed. Our goal was to assess the performance of combined parental history of hypertension and overweight/obesity to identify children with hypertension. We estimated the sensitivity, specificity, negative and positive predictive values of overweight/obesity and parental history of hypertension for the identification of hypertension in children. DESIGN AND METHOD: We analyzed data from a school-based cross-sectional study including 5207 children aged 10 to 14 years from all public 6th grade classes in the canton of Vaud, Switzerland. Blood pressure was measured with a clinically validated oscillometric automated device over up to three visits separated by one week. Children had hypertension if they had sustained elevated blood pressure over the three visits. Parents were interviewed about their history of hypertension. RESULTS: The prevalence of hypertension was 2.2%. 14% of children were overweight or obese and 20% had a positive history of hypertension in either or both parents. 30% of children had either or both conditions. After accounting for several potential confounding factors, parental history of hypertension (odds ratio (OR): 2.6; 95% confidence interval (CI): 1.8-4.0), overweight excluding obesity (OR: 2.5; 95% CI: 1.5-4.2) and obesity (OR: 10.1; 95% CI: 6.0-17.0) were associated with hypertension in children. Considered in isolation, the sensitivity and positive predictive values of parental history of hypertension (respectively 41% and 5%) or overweight/obesity (respectively 43% and 7%) were relatively low. Nevertheless, considered together, the sensitivity of targeted screening in children with either overweight/obesity or paternal history of hypertension was higher (65%) but the positive predictive value remained low (5%). The negative predictive value was systematically high. CONCLUSIONS: Restricting screening of hypertension to children with either overweight/obesity or with hypertensive parents would substantially limit the proportion of children to screen (30%) and allow the identification of a relatively large proportion (65%) of hypertensive cases. That could be a valuable alternative to universal screening.

Desempenho da tangerineira 'Span Americana' em diferentes porta-enxertos

Este trabalho objetivou avaliar o crescimento vegetativo, a produção e a qualidade de frutos da tangerina 'Span Americana' em diferentes porta-enxertos, nas condições edafoclimáticas de Bebedouro-SP. O plantio foi realizado em junho de 2003, em espaçamento de 6,0 m x 3,0 m, sendo utilizada irrigação por gotejamento a partir de 2006. Os porta-enxertos avaliados foram: citranges [Citrus sinensis (L.) Osbeck × Poncirus trifoliata L. Raf] 'Carrizo' e 'Troyer', tetraploides; trifoliatas (P. trifoliata) 'Davis A' e 'Flying Dragon'; limão Volkameriano Catania 2 (C. volkameriana Tenn. et Pasq.), HRS 849 [(C. aurantium L. cv. 'Smooth Flat Seville' x P. trifoliata cv. 'Argentina')], tangelo 'Orlando' (C. reticulata Blanco × C. paradisi Macf.) e limão 'Cravo' (C. limonia Osbeck). Foram avaliadas a produção acumulada, a eficiência produtiva e a precocidade de entrada em produção, no período de 2007 a 2009. Avaliaram-se, também, as dimensões das plantas e a taxa média de crescimento das plantas no período de 2005 a 2008, além da qualidade dos frutos em 2006 e 2007. Em pomares irrigados de tangerineira 'Span Americana', os porta-enxertos trifoliata 'Davis A' e HRS 849 apresentam desempenho horticultural satisfatório. Para plantio em alta densidade, a melhor performance da tangerineira 'Span Americana' é obtida com a utilização dos porta-enxertos trifoliata 'Flying Dragon' e citranges 'Troyer' e 'Carrizo'.

Qualidade do abacate 'HASS' frigoarmazenado submetido a atmosferas modificadas ativas

O objetivo deste trabalho foi avaliar a conservação do abacate 'Hass'frigoarmazenado submetido a atmosferas modificadas ativas. Os frutos foram acondicionados em embalagem de náilon+polietileno e submetidos à injeção de mistura de gases, constituindo os tratamentos: I - mistura gasosa do ambiente (21,0 kPa de O2+0,03 kPa de CO2); II - 4,0 kPa de O2+5,0kPa de CO2 ; III - 4,0 kPa de O2+6,0 kPa de CO2 ; IV - 4,0 kPa de O2+7,0 kPa de CO2, e V- 4,0 kPa de O2+8,0 kPa de CO2). As embalagens contendo os frutos foram armazenadas em câmara frigorífica, a uma temperatura de 10±1ºC e umidade relativa de 90±5%, durante 25 dias, sendo as análises realizadas a cada 5 dias. As análises realizadas foram perda de massa, atividade respiratória, potencial hidrogeniônico (pH), firmeza, acidez titulável (AT), sólidos solúveis (SS) e atividade das enzimas pectinametilesterase (PME) e poligalacturonase (PG). O tratamento em que os frutos foram submetidos à pressão parcial de 4,0 kPa de O2+7,0 kPa de CO2 foi o mais efetivo na conservação dos frutos, principalmente pela menor perda de massa e baixa produção de CO2.

Magnetoestratigrafía de las sucesiones del Mioceno medio y superior del Vallés occidental (Depresión del Vallés-Penedés, NE España): Implicaciones biocronológicas y cronoestratigráficas.

The magnetostratigraphic analysis of the middle to late Miocene continental deposits from the Valles-Penedes basin, combined with its well-documented fossil mammal record, provides a well-resoluted chronology for the upper basin infill. It is based on the biostratigraphic and magnetostratigraphic cross-correlation of 18 sections throughout the alluvial and transitional/shallow marine sequences in the Western Valles area. The biostratigraphic framework consists of 24 mammal localities of upper Aragonian and Vallesian age. Correlation of the studied sections to the geomagnetic polarity time scale (GPTS) is based on the distinctive pattern of local magnetozones, as well as the radiometric age of the late Vallesian fauna from the Bicorp Basin (9.6 + 0.3 Ma) and the known relationship of the late Vallesian assemblages with marine beds belonging to the planktonic forarninifera N16 zone. It has led to an absolute dating of the fauna1 events and a precise chronostratigraphy of the Vallesian marnrnal stage in its type area. The Hipparion First Appearance Datum (FAD) defines the lower Vallesian boundary and is dated at 11.1 Ma, at the base of chron C5r. ln. It is in good agreement with radiometric ages from the early Hipparion bearing sites in the Vienna Basin (1 1.1 * 0.5 Ma) and the classic Howenegg locality in Germany (10.8 * 0.3 Ma). It also agrees with the age of the turkish localities of Yailacilar (1 1.6 + 0.25 Ma) and Yenieskihisar-2 (1 1.1 * 0.2 Ma) with absence of Hipparion. Al1 these support the isochrony of the dispersa1 of Hipparion throughout the Mediterranean region. A possible isochrony at a larger geographical scale (Old World, Mesogea) must await more reliable ages of the Hipparion FAD in Asia and Africa. The Cricetulodon FAD that defines the MN9a/MN9b boundary occurs at the middle part of C5n. Assuming an on average constant sedimentation rate, this datum has an age of approximately 10.4 Ma. The earlyllate Vallesian boundary is marked by one of the most distinct fauna1 events of the late Neogene: the dispersa1 of the muridae Progonomys into Europe and North Africa, which coincides with an important macromarnmal turnover. The first extensive appearance of Progonomys in Europe (MN9íMN10 boundary) is dated at 9.7 Ma (C4Ar3r), showing a remarkable diachrony with the Himalayan region. F9i d lly, the FAD of Rotundomys bressnnus occurs in the upper part of C4Ar.ln (9.2-9.3 Ma). The Vallesian spans 2.4 Myr, from 11.1 Ma (CSr.ln) to 8.7 Ma (C4An), and correlates to the early Tortonian.

Generic utilities in chronic obstructive pulmonary disease patients stratified according to different staging systems.

Background To determine generic utilities for Spanish chronic obstructive pulmonary disease (COPD) patients stratified by different classifications: GOLD 2007, GOLD 2013, GesEPOC 2012 and BODEx index. Methods Multicentre, observational, cross-sectional study. Patients were aged ≥40 years, with spirometrically confirmed COPD. Utility values were derived from EQ-5D-3 L. Means, standard deviations (SD), medians and interquartile ranges (IQR) were computed based on the different classifications. Differences in median utilities between groups were assessed by non-parametric tests. Results 346 patients were included, of which 85.5% were male with a mean age of 67.9 (SD = 9.7) years and a mean duration of COPD of 7.6 (SD = 5.8) years; 80.3% were ex-smokers and the mean smoking history was 54.2 (SD = 33.2) pack-years. Median utilities (IQR) by GOLD 2007 were 0.87 (0.22) for moderate; 0.80 (0.26) for severe and 0.67 (0.42) for very-severe patients (p < 0.001 for all comparisons). Median utilities by GOLD 2013 were group A: 1.0 (0.09); group B: 0.87 (0.13); group C: 1.0 (0.16); group D: 0.74 (0.29); comparisons were statistically significant (p < 0.001) except A vs C. Median utilities by GesEPOC phenotypes were 0.84 (0.33) for non exacerbator; 0.80 (0.26) for COPD-asthma overlap; 0.71 (0.62) for exacerbator with emphysema; 0.72 (0.57) for exacerbator with chronic bronchitis (p < 0.001). Comparisons between patients with or without exacerbations and between patients with COPD-asthma overlap and exacerbator with chronic bronchitis were statistically-significant (p < 0.001). Median utilities by BODEx index were: group 02: 0.89 (0.20); group 34: 0.80 (0.27); group 56: 0.67 (0.29); group 79: 0.41 (0.31). All comparisons were significant (p < 0.001) except between groups 34 and 56. Conclusion Irrespective of the classification used utilities were associated to disease severity. Some clinical phenotypes were associated with worse utilities, probably related to a higher frequency of exacerbations. GOLD 2007 guidelines and BODEx index better discriminated patients with a worse health status than GOLD 2013 guidelines, while GOLD 2013 guidelines were better able to identify a smaller group of patients with the best health.

Molecular dating of caprines using ancient DNA sequences of Myotragus balearicus, an extinct endemic Balearic mammal

Background: Myotragus balearicus was an endemic bovid from the Balearic Islands (Western Mediterranean) that became extinct around 6,000-4,000 years ago. The Myotragus evolutionary lineage became isolated in the islands most probably at the end of the Messinian crisis, when the desiccation of the Mediterranean ended, in a geological date established at 5.35 Mya. Thus, the sequences of Myotragus could be very valuable for calibrating the mammalian mitochondrial DNA clock and, in particular, the tree of the Caprinae subfamily, to which Myotragus belongs. Results: We have retrieved the complete mitochondrial cytochrome b gene (1,143 base pairs), plus fragments of the mitochondrial 12S gene and the nuclear 28S rDNA multi-copy gene from a well preserved Myotragus subfossil bone. The best resolved phylogenetic trees, obtained with the cytochrome b gene, placed Myotragus in a position basal to the Ovis group. Using the calibration provided by the isolation of Balearic Islands, we calculated that the initial radiation of caprines can be dated at 6.2 ± 0.4 Mya. In addition, alpine and southern chamois, considered until recently the same species, split around 1.6 ± 0.3 Mya, indicating that the two chamois species have been separated much longer than previously thought. Conclusion: Since there are almost no extant endemic mammals in Mediterranean islands, the sequence of the extinct Balearic endemic Myotragus has been crucial for allowing us to use the Messinian crisis calibration point for dating the caprines phylogenetic tree.

A systematic review of ultrasound-guided methods for brachial plexus blockade.

We systematically reviewed 25 randomised controlled trials of ultrasound-guided brachial plexus blockade that recruited 1948 participants: either one approach vs another (axillary, infraclavicular or supraclavicular); or one injection vs multiple injections. There were no differences in the rates of successful blockade with approach, relative risk (95% CI): axillary vs infraclavicular, 1.0 (1.0-1.1), p = 0.97; axillary vs supraclavicular, 1.0 (1.0-1.1), p = 0.68; and infraclavicular vs supraclavicular, 1.0 (1.0-1.1), p = 0.32. There was no difference in the rate of successful blockade with the number of injections, relative risk (95% CI) 1.0 (1.0-1.0), p = 0.69, for one vs multiple injections. The rate of procedural paraesthesia was less with one injection than multiple injections, relative risk (95% CI) 0.6 (0.4-0.9), p = 0.004.

Myocardial perfusion scintigraphy in the detection of silent ischemia in asymptomatic diabetic patients

OBJECTIVE: This study was aimed to evaluate myocardial perfusion in asymptomatic patients with type 1 (DM1) and type 2 diabetes mellitus (DM2) without previous diagnoses of coronary artery disease (CAD) or cerebral infarction. MATERIALS AND METHODS: Fifty-nine consecutive asymptomatic patients (16 DM1, 43 DM2) underwent myocardial perfusion scintigraphy with 99mTc-sestamibi (MPS). They were evaluated for body mass index, metabolic control of DM, type of therapy, systemic arterial hypertension, dyslipidemia, nephropathy, retinopathy, peripheral neuropathy, smoking, and familial history of CAD. RESULTS: MPS was abnormal in 15 patients (25.4%): 12 (20.3%) with perfusion abnormalities, and 3 with isolated left ventricular dysfunction. The strongest predictors for abnormal myocardial perfusion were: age 60 years and above (p = 0.017; odds ratio [OR] = 6.0), peripheral neuropathy (p = 0.028; OR = 6.1), nephropathy (p = 0.031; OR = 5.6), and stress ECG positive for ischemia (p = 0.049; OR = 4.08). CONCLUSION: Silent myocardial ischemia occurs in more than one in five asymptomatic diabetic patients. The strongest predictors of ischemia in this study were: patient age, peripheral neuropathy, nephropathy, retinopathy and a stress ECG positive for ischemia.

AltitudeOmics : Resetting of Cerebrovascular CO2 Reactivity Following Acclimatization to High Altitude.

Previous studies reported enhanced cerebrovascular CO2 reactivity upon ascent to high altitude using linear models. However, there is evidence that this response may be sigmoidal in nature. Moreover, it was speculated that these changes at high altitude are mediated by alterations in acid-base buffering. Accordingly, we reanalyzed previously published data to assess middle cerebral blood flow velocity (MCAv) responses to modified rebreathing at sea level (SL), upon ascent (ALT1) and following 16 days of acclimatization (ALT16) to 5260 m in 21 lowlanders. Using sigmoid curve fitting of the MCAv responses to CO2, we found the amplitude (95 vs. 129%, SL vs. ALT1, 95% confidence intervals (CI) [77, 112], [111, 145], respectively, P = 0.024) and the slope of the sigmoid response (4.5 vs. 7.5%/mmHg, SL vs. ALT1, 95% CIs [3.1, 5.9], [6.0, 9.0], respectively, P = 0.026) to be enhanced at ALT1, which persisted with acclimatization at ALT16 (amplitude: 177, 95% CI [139, 215], P &lt; 0.001; slope: 10.3%/mmHg, 95% CI [8.2, 12.5], P = 0.003) compared to SL. Meanwhile, the sigmoidal response midpoint was unchanged at ALT1 (SL: 36.5 mmHg; ALT1: 35.4 mmHg, 95% CIs [34.0, 39.0], [33.1, 37.7], respectively, P = 0.982), while it was reduced by ~7 mmHg at ALT16 (28.6 mmHg, 95% CI [26.4, 30.8], P = 0.001 vs. SL), indicating leftward shift of the cerebrovascular CO2 response to a lower arterial partial pressure of CO2 (PaCO2) following acclimatization to altitude. Sigmoid fitting revealed a leftward shift in the midpoint of the cerebrovascular response curve which could not be observed with linear fitting. These findings demonstrate that there is resetting of the cerebrovascular CO2 reactivity operating point to a lower PaCO2 following acclimatization to high altitude. This cerebrovascular resetting is likely the result of an altered acid-base buffer status resulting from prolonged exposure to the severe hypocapnia associated with ventilatory acclimatization to high altitude.

Determinação espectrofotométrica por injeção em fluxo de vitamina B6 (piridoxina) em formulações farmacêuticas

A flow injection (FI) spectrophotometric procedure is proposed for the determination of vitamin B6 (pyridoxine hydrochloride) in pharmaceutical preparations. Powdered samples containing from 2.5 to 4.5 mg, were previously dissolved in 0.1 mol L-1 phosphate buffer solution (pH 7.0) and a volume of 500 muL was injected directly into a carrier stream consisting of this same phosphate buffer solution, flowing at 4.4 mL min-1. The stable blue indophenol dye produced in the oxidation of pyridoxine hydrochloride by potassium hexacyanoferrate(III) and N,N-diethyl-p-phenylenediamine solution was directly measured at 684 nm. Vitamin B6 was determined in five pharmaceutical preparations in the 0.5 to 6.0 mg L-1 concentration range (calibration graph: A= -0.00499 + 0.11963 C; r= 0.9991, where A is the absorbance and C is the vitamin B6 concentration in mg L-1), with a detection limit of 0.02 mg L-1 (3 Sblank/slope). The recovery of this vitamin from three samples ranged from 97.5 to 103.3 %. The analytical frequency was 62 h-1 and r.s.d. were less than 2% for solutions containing 1.0 and 3.0 mg L-1 vitamin B6 (n= 10). The results obtained for the determination of vitamin B6 in commercial formulations were in good agreement with those obtained by a spectrophotometric procedure (r=0.9997) and also with the label values (r= 0.9998).

Calcium phosphate glasses: silanation process and effect on the bioactivity behavior of Glass-PMMA composites

This article presents the results of a study of the efficiency of silanation process of calcium phosphate glasses particles and its effect on the bioactivity behavior of glasspoly( methyl methacrylate) (PMMA) composites. Two different calcium phosphate glasses: 44.5CaO-44.5P2O5-11Na2O (BV11) and 44.5CaO-44.5P2O5-6Na2O-5TiO2 (G5) were synthesized and treated with silane coupling agent. The glasses obtained were characterized by Microprobe and BET while the efficiency of silanation process was determined using Fourier Transform Infrared Spectroscopy (FTIR), X-ray Photoelectron Spectroscopy (XPS) and Thermal Analysis (DTA and TG)techniques. The content of coupling agent chemically tightly bond to the silanated glasses ascended to 1.69 6 0.02 wt % for BV11sil glass and 0.93 6 0.01 wt % for G5sil glass. The in vitro bioactivity test carried out in Simulated Body Fluid (SBF) revealed certain bioactive performance with the use of both silanated glasses in a 30% (by weight) as filler of the PMMA composites because of a superficial deposition of an apatite-like layer with low content of CO3 22 and HPO4 22 in its structure after soaking for 30 days occurred. VC 2013 Wiley Periodicals,Inc. J Biomed Mater Res Part B: Appl Biomater 00B: 000-000, 2013.

Metallien talteenotto kloridiliuoksesta

Diplomityön tarkoituksena oli tutkia ja kehittää menetelmä arvometallien kuten kuparin, sinkin, koboltin ja nikkelin talteenottoon metallikloridiliuoksesta. Tavoitteena oli valita taloudellisin ja ympäristöystävällisin menetelmä, jolla saadaan nämä arvometallit myyntituotteiksi. Lisäksi puhdistetun prosessiveden tuli täyttää asetetut tavoitteet. Kirjallisuustyön perusteella laskettiin viidelle eri prosessivaihtoehdolle ainetaseet HSC Sim 6.0 ohjelmalla, joka on HSC Chemistry-pohjainen prosessien simulointi- ja mallinnusohjelma. Kaikissa vaihtoehdoissa oli ensimmäisenä prosessiosana kuparin, sinkin, koboltin ja nikkelin sulfidisaostus ja sakan pesu. Sulfidisaostusta seurasi vaihtoehtoisesti joko 1) hapetus hapella ja hydroksidisaostus, 2) hapetus vetyperoksidilla ja hydroksidisaostus, 3) pelkkä hydroksidisaostus, 4) hapetus SO2/O2-kaasuseoksella ja hydroksidisaostus tai 5) karbonaattisaostus. Taselaskennan perusteella valittiin kokeelliseen osaan tutkittavat prosessivaihtoehdot, jotka olivat sulfidisaostus, hydroksidisaostus, SO2/O2- hapetus ja hydroksidisaostus sekä karbonaattisaostus. Kokeissa arvometallit saatiin talteenotettua sulfidisaostuksella selektiivisimmin lämpötilassa 55 °C ja pH:ssa 4. Näissä olosuhteissa reagenssin kulutus verrattaessa muihin tehtyihin sulfidisaostuksiin oli pienin. Sakka laskeutui ja suotautui hyvin. Loppusakan sisältämien metallien (kupari, sinkki ja koboltti) pitoisuudet olivat korkeimmat. Myös nikkelin määrä oli suuri. Mangaani ja rauta saatiin talteenotettua selektiivisimmin karbonaattisaostuksella lämpötilassa 65 °C. Sakka sisälsi eniten mangaania. Sakka laskeutui ja suotautui hyvin. Tällä menetelmällä puhdistetun prosessiveden laatu täytti asetetut tavoitteet.

A qualitative analysis of immigrant population health practices in the Girona Healthcare Region

The research we present here forms part of a two-phase project - one quantitative and the other qualitative - assessing the use of primary health care services. This paper presents the qualitative phase of said research, which is aimed at ascertaining the needs, beliefs, barriers to access and health practices of the immigrant population in comparison with the native population, as well as the perceptions of healthcare professionals. Moroccan and sub-Saharan were the immigrants to who the qualitative phase was specifically addressed. The aims of this paper are as follows: to analyse any possible implications of family organisation in the health practices of the immigrant population; to ascertain social practices relating to illness; to understand the significances of sexual and reproductive health practices; and to ascertain the ideas and perceptions of immigrants, local people and professionals regarding health and the health system. Methods: qualitative research based on discursive analysis. Data gathering techniques consisted of discussion groups with health system users and semi-structured individual interviews with healthcare professionals. The sample was taken from the Basic Healthcare Areas of Salt and Banyoles (belonging to the Girona Healthcare Region), the discussion groups being comprised of (a) 6 immigrant Moroccan women, (b) 7 immigrant sub-Saharan African women and (c) 6 immigrant and native population men (2 native men, 2 Moroccan men and 2 sub-Saharan men); and the semi-structured interviews being conducted with the following healthcare professionals: (a) 3 gynaecologists, (b) 3 nurses and 1 administrative staff. Results: use of the healthcare system is linked to the perception of not being well, knowledge of the healthcare system, length of time resident in Spain and interiorization of traditional Western medicine as a cure mechanism. The divergences found among the groups of immigrants, local people and healthcare professionals with regard to healthcare education, use of the healthcare service, sexual and reproductive healthcare and reticence with regard to being attended by healthcare personnel of the opposite sex demonstrate a need to work with the immigrant population as a heterogeneous group. Conclusions: the results we have obtained support the idea that feeling unwell is a psycho-social process, as it takes place within a specific socio-cultural situation and spans a range of beliefs, perceptions and ideas regarding symptomology and how to treat it

Caracterização química de extratos de Ocimum basilicum L. obtidos através de extração com CO2 a altas pressões

This work reports extraction yield and chemical characterization of the extracts obtained by high-pressure CO2 extraction of a cultivar of Ocimum basilicum L. The experiments were performed in the temperature range of 20 to 50 °C, from 100 to 250 atm of pressure. Chemical analyses were carried out by gas chromatography coupled to mass spectrometry, permitting to identify 23 compounds that were grouped into five chemical classes. Results showed that temperature and solvent density influenced positively the extraction yield. At 20 °C and 0.41 g cm-3 occurred a rise in the concentration of monoterpenes, oxygenated monoterpenes, sesquiterpenes and oxygenated sesquiterpenes.