The Mont Collon mafic complex (Austroalpine Dent Blanche nappe) : permian evolution of the Western European mantle

Résumé: Le complexe du Mont Collon (nappe de la Dent Blanche, Austroalpin) est l'un des exemples les mieux préservés du magmatisme mafique permien des Alpes occidentales. Il est composé d'affleurements discontinus et d'une stratification magmatique en son centre (Dents de Bertol) et est composé à 95% de roches mafiques cumulatives (gabbros à olivine et/ou cpx, anorthositiques, troctolites, wehrlites et wehrlites à plagioclase) et localement de quelques gabbros pegmatitiques. Ces faciès sont recoupés par de nombreux filons acides (aphtes, pegmatites quartziques, microgranodiorites et filons anorthositiques) et mafiques tardifs (dikes mélanocrates riches en Fe et Ti). Les calculs thermométriques (équilibre olivine-augite) montrent des températures de 1070-1120 ± 6°C, tandis que le thermomètre amphibole-plagioclase indique une température de 740 ± 40°C à 0.5 GPa pour les amphiboles magmatiques tardives. La geobarométrie sur pyroxène donne des pressions moyennes de 0.3-0.6 GPa, indiquant un emplacement dans la croûte moyenne. De plus, les températures obtenues sur des amphiboles coronitiques indiquent des températures de l'ordre de 700 ± 40°C confirmant que les réactions coronitiques apparaissent dans des conditions subsolidus. Les âges concordants U/Pb sur zircons de 284.2 ± 0.6 et 282.9 ± 0.6 Ma obtenus sur un gabbro pegmatitique et une pegmatitique quartzique, sont interprétés comme des âges de cristallisation. Les datations 40Ar/39Ar sur amphiboles des filons mélanocrates donnent un âge plateau de 260.2 ± 0.7 Ma, qui est probablement très proche de l'âge de cristallisation. Ainsi, cet age 40Ar/39Ar indique un second évènement magmatique au sein du complexe. Les compositions des roches totales en éléments majeurs et traces montrent peu de variations, ainsi que le Mg# (75-80). Les éléments traces enregistrent le caractère cumulatif des roches (anomalie positive en Eu) et révèlent des anomalies négatives systématiques en Nb, Ta, Zr, Hf et Ti dans les faciès basiques. Le manque de corrélation entre éléments majeurs et traces est caractéristique d'un processus de cristallisation in situ impliquant une quantité variable de liquide interstitiel (L) entre les phases cumulus. Les distributions des éléments traces dans les minéraux sont homogènes, indiquant une rééquilibration .subsolidus entre cristaux et liquide interstitiel. Un modèle quantitatif basé sur les équations de cristallisation in situ de Langmuir reproduisent correctement les concentrations en terres rares légères des minéraux cumulatifs montrant la présence de 0 à 35% de liquide interstitiel L pour des degrés de différenciation F de 0 à 45%, par rapport au faciès les moins évolués du complexe. En outre, les valeurs de L sont bien corrélées avec les proportions modales d'amphibole interstitielle et les concentrations en éléments incompatibles des roches (Zr, Nb). Le liquide parental calculé des cumulats du Mont Collon est caractérisé par un enrichissement relatif en terres rares légères et Th, un appauvrissement en terres rares lourdes typique d'une affinité transitionnelle (T-MORB) et une forte anomalie négative en Nb-Ta. Les roches cumulatives montrent des compositions isotopiques en Nd-Sr proches de la terre globale silicatée (BSE), soit 0.6<εNdi<+3.2, 0.7045<87Sr/86Sri<0.7056. Les rapports initiaux en Pb indiquent une source dans le manteau enrichi subcontinental lithosphérique, préalablement contaminé par des sédiments océaniques. Les dikes mélanocrates Fe-Ti sont représentatifs de liquides et ont des spectres de terres rares enrichis, une anomalie positive en Nb-Ta et des εNdi de +7, des 87Sr/86Sri de 0.703 et des rapports initiaux en Pb, similaires à ceux des basaltes d'île océanique, indiquant une source asthénosphérique modérément appauvrie. Ainsi, la fusion partielle du manteau lithosphérique subcontinental est induite par l'amincissement post-orogénique et la remontée de l'asthénosphère. Les filons mélanocrates proviennent, après délamination du manteau lithosphérique, de la fusion de l'asthénosphère. Abstract The early Permian Mont Collon mafic complex (Dent Blanche nappe, Austroalpine nappe system) is one of the best preserved examples of the Permian mafic magmatism in the Western Alps. It is composed of discontinuous exposures and a well-preserved magmatic layering (the Dents de Bertol cliff) crops out in the center part of the complex. It mainly consists of cumulative mafic rocks, which represent 95 vol-% of the mafic complex (ol- and cpx-bearing gabbros and rare anorthositic layers, troctolites, wehrlites and plagioclase-wehrlites) and locally pegmatitic gabbros. All these facies are crosscut by widespread acidic (aplites, quartz-rich pegmatites, microgranodiorites) and late mafic Fe-Ti melanocratic dikes. Olivine-augite thermometric calculations yield a range of 1070-1120 ± 6°C, while amphibole-plagioclase thermometer yields a temperature of 740 ± 40°C at 0.5 GPa. Pyroxene geobarometry points to a pressure of 0.3-0.6 GPa, indicating a middle crustal level of emplacement. Moreover, temperature calculations on the Mont Conon coronitic amphiboles indicate temperatures of 700 ± 40°C, close to those calculated for magmatic amphiboles. These temperatures confirm that coronitic reactions occurred at subsolidus conditions. ID-TIMS U/Pb zircon ages of 284.2 ± 0.6 and 282.9 ± 0.6 Ma obtained on a pegmatitic gabbro and a quartz-pegmatitic dike, respectively, were interpreted as the crystallization ages of these rocks. 40Ar/39Ar dating on amphiboles from Fe-Ti melanocratic dikes yields a plateau age of 260.2 ± 0.7 Ma, which is probably very close to the crystallization age. Consequently, this 40Ar/P39Ar age indicates a second magmatic event. Whole-rock major- and trace-element compositions show little variation across the whole intrusion and Mg-number stays within a narrow range (75-80). Trace-element concentrations record the cumulative nature of the rocks (e.g. positive Eu anomaly) and reveal systematic Nb, Ta, Zr, Hf and Ti negative anomalies for all basic facies. The lack of correlation between major and trace elements is characteristic of an in situ crystallization process involving variable amounts of interstitial liquid (L) trapped between the cumulus mineral phases. LA-ICPMS measurements show that trace-element distributions in minerals are homogeneous, pointing to subsolidus re-equilibration between crystals and interstitial melts. A quantitative modeling based on Langmuir's in situ crystallization equation successfully reproduced the Rare Earth Element (REE) concentrations in cumulitic minerals. The calculated amounts of interstitial liquid L vary between 0 and 35% for degrees of differentiation F of 0 to 45%, relative to the least evolved facies of the intrusion. Furthermore, L values are well correlated with the modal proportions of interstitial amphibole and whole-rock incompatible trace-element concentrations (e.g. Zr, Nb) of the tested samples. The calculated parental melt of the Mont Collon cumulates is characterized by a relative enrichment in Light REE and Th, a depletion in Heavy REE, typical of a transitional affinity (T-MORB), and strong negative Nb-Ta anomaly. Cumulative rocks display Nd-Sr isotopic compositions close to the BSE (-0.6 < εNdi < +3.2, 0.7045 < 87Sr/86Sri < 0.7056). Initial Pb ratios point to an origin from the melting of an enriched subcontinental lithospheric mantle source, previously contaminated at the source by oceanic sediments. The contrasted alkaline Fe-Ti melanocratic dikes are representative of liquids. They display enriched fractionated REE patterns, a positive Nb-Ta anomaly and εNdi of +7, 87Sr/86Sri of 0.703 and initial Pb ratios, all reminiscent of Ocean Island Basalt-type rocks, pointing to a moderately

Antecipação da colheita de caqui 'Costata' através da quebra de dormência com cianamida hidrogenada e óleo mineral

No município de Araponga, Estado de Minas Gerais, foi estudada a possibilidade de antecipar a colheita do caquizeiro 'Costata', e obter preços mais elevados no mercado através da quebra de dormência artificial. A cianamida hidrogenada nas doses de 2,4; 7,3; 12,2 mLL-1 , combinadas com 8,0 mLL-1 de óleo mineral, foi aplicada em 9-6, 30-6, 21-7 e 11-8-1999, quando as gemas se encontravam dormentes. Quando comparada com as plantas-testemunha, a aplicação de 7,3 a 12,2 mLL-1 de cianamida hidrogenada e 8,0 mLL-1 de óleo mineral, no período de 9-6 a 16-6, antecipou a brotação, o florescimento e a colheita em 12; 10 e 10 semanas, respectivamente. Desse modo, a colheita pôde ser realizada a partir de dezembro. A fixação dos frutos foi maior com o aumento da concentração e a aplicação realizada entre 7-7 e 11-8, a maior massa dos frutos foi obtida com a aplicação de 0,1 a 2,9 mLL-1, no período de 26-7 a 11-8, o teor de sólidos solúveis aumentou, a acidez titulável diminuiu e a firmeza da polpa não foi alterada.

Incidencia, etiología y epidemiología de la brucelosis en una área rural de la província de Lleida

Fundamentos: Este estudio investiga, de forma prospectiva, la incidencia, la etiología y el perfil epidemiológico de la brucelosis humana en las comarcas del Pallars Jussà y Sobirà (Lleida), durante el período 1995-1998. Métodos: Fueron estudiados 55 pacientes diagnosticados de brucelosis. Se registró información sobre el sexo, edad, municipio de residencia, riesgo ocupacional, contacto con animales y consumo de productos lácticos no higienizados, y se obtuvieron muestras de sangre para hemocultivo. Resultados: Se registraron 10, 14, 15 y 16 casos para los años 1995, 1996, 1997 y 1998 respectivamente, y las tasas medias acumuladas fueron de 52 en el Pallars Jussà y de 129 en el Pallars Sobirà. El número de casos fue cuatro veces superior en hombres (81,8%) que en mujeres (18,2%) (RR: 4,4; IC95% 2,2-8,7). La incidencia máxima se produjo en los meses de Marzo-Abril y la mínima en los meses de verano. El 71% de los pacientes desarrollaba una actividad profesional de riesgo y hubo un claro predominio del mecanismo de contagio directo (71%). La especie animal más frecuentemente considerada fuente de infección fue la ovina (65%), seguida de la bovina (47%) y de la caprina (25%). En el Pallars Jussà hubo predominio ovino (OR: 0,3; IC95% 0,1 - 0,9) y en el Pallars Sobirà de bovino (OR: 6,6; IC95% 1,8 - 26,2). Se aislaron 27 cepas de Brucella sp, correspondiendo todas ellas a la especie melitensis. Conclusiones: La incidencia de la zoonosis en las comarcas estudiadas ha aumentado durante el período 1995-1998. Los resultados del estudio configuran un perfil epidemiológico característico de enfermedad profesional. El agente etiológico ha sido Brucella melitensis con claro predominio de la biovariedad 1.

Tratamentos pós-colheita com 1-metilciclopropeno em manga 'Tommy Atkins': efeito de doses e número de aplicações

Foram conduzidos dois experimentos com o objetivo de avaliar a eficiência de tratamentos com 1-MCP sobre a conservação da manga 'Tommy Atkins', reconhecendo doses e número de aplicações. Os frutos foram colhidos no estádio de maturação 2, em pomar comercial localizado em Petrolina, Pernambuco. No primeiro experimento, foram testados: 1. doses (0; 600; 1.200 e 2.400 nL L-1), aplicadas a 25ºC; e 2. tempo de armazenamento (0; 2; 4; 7; 9; 10 e 11 dias), em temperatura ambiente (26,7±2,0ºC). O delineamento experimental foi o inteiramente casualizado, em fatorial 4 x 7 (doses de 1-MCP x tempo de armazenamento), com 4 repetições. No segundo experimento, foram estudados: 1. doses e número de aplicações (controle, uma aplicação de 900 nL L-1, uma aplicação de 1.200 nL L-1 e duas aplicações de 900 nL L-1); e 2. tempo de armazenamento (0; 7; 15; 18; 20; 22; 25 e 26 dias), sendo os frutos mantidos refrigerados (11,0±1,6ºC e 88±7% UR) até o 15º dia e, então, transferidos para temperatura ambiente (26,3±2,1ºC e 44±6% UR). Neste experimento, o delineamento foi inteiramente casualizado, em fatorial 4 x 8 (dose e número de aplicações de 1-MCP x tempo de armazenamento), com 4 repetições. A primeira ou única aplicação ocorreu no dia da colheita e a segunda, no 14º dia. O 1-MCP afetou essencialmente a firmeza da polpa, sendo 1.200 nL L-1 a dose mais eficiente no retardo do amaciamento. A realização de uma aplicação de 1.200 nL L-1 ou duas de 900 nL L-1, sob refrigeração, resultou em efeitos praticamente equivalentes. Porém, as alterações logísticas promovidas por uma única aplicação são menores.

Produção da laranjeira-de-umbigo 'Monte Parnaso' com incisão anelar de ramos e uso de reguladores vegetais

A laranjeira-de-umbigo 'Monte Parnaso' (Citrus sinensis [L.] Osbeck) tem produtividade inferior a 10 kg de frutos/planta, em função de baixa fixação e/ou retenção de frutos. Com o propósito de solucionar esse problema, no ano agrícola de 2001-2002, plantas com 11 anos de idade, enxertadas sobre Poncirus trifoliata (L.) Raf., em Butiá, Rio Grande do Sul, foram submetidas aos seguintes tratamentos: 1) Testemunha: sem anelagem e sem reguladores vegetais; 2) Incisão anelar da casca dos ramos principais, 10 dias após a queda das pétalas (02-10-2001); 3) Incisão anelar da casca dos ramos no final da queda natural de frutos (08-11-2001); 4) Pulverização com 5 mg.L-1 de ácido giberélico (AG3), 10 dias após a queda das pétalas (02-10-2001); 5) Pulverização com 15 mg.L-1 de ácido 2,4 diclorofenoxiacético (2,4-D), no final da queda natural dos frutos (08-11-2001); 6) Pulverização com 50 mg.L-1 de ácido diclorofenoxipropiônico (2,4-DP), no final da queda natural dos frutos (08-11-2001); 7) Pulverização com 10 mg.L-1 de AG3 + 15 mg.L-1 de 2,4-D, em maio (14-05-2001 e 11-05-2002); 8) Tratamentos 2 + 3, e 9) Tratamentos 2 + 3 + 7. O delineamento experimental adotado foi em blocos ao acaso, com 5 repetições, usando 3 plantas úteis por parcela. A pulverização com 5 mg.L-1 de AG3, 10 dias após a queda das pétalas, aumenta a produção, mas diminui a massa média dos frutos em relação a outros tratamentos que aumentam a produção, e a pulverização no final da queda natural com 15 mg.L-1 de 2,4-D diminui o teor de suco dos frutos. Para aumentar a produção de frutos, basta adotar-se um dos seguintes procedimentos: em novembro, após a queda natural dos frutos, fazer a incisão anelar da casca dos ramos, ou pulverizar as plantas com 15 mg.L-1 de 2,4-D, ou pulverizar as plantas com 50 mg.L-1 de 2,4-DP; ou em maio, pulverizar as plantas com 10 mg.L-1 de AG3 + 15 mg.L-1 de 2,4-D.

Increasing prehospital emergency medical service interventions for nursing home residents.

QUESTION: In the ageing European population, the proportion of interventions by the emergency medical services (EMS) for elderly patients is increasing, but little is known about the recent trend of EMS interventions in nursing homes. The aim of this analysis was to describe the evolution of the incidence of requests for prehospital EMS interventions for nursing home residents aged 65 years and over between 2004 and 2013. METHODS: A prospective population-based register of routinely collected data for each EMS intervention in the Canton of Vaud. Linear time trends of incidence of requests to the EMS in nursing homes were calculated and stratified by age categories. RESULTS: The number of ambulance interventions in nursing homes for people aged 65 years and over (65+) increased by 68.9% (1124‒1898) between 2004 and 2013. A significant linear increase of the annual incidence of requests to EMS per 1,000 nursing home residents was found for people aged 65-79 (10.2, 95% confidence interval [CI] 6.2-14.2), 80-89 (16.5, 95% CI 14.0-19.0) and over 90 (12.1, 95% CI 5.8-18.4). EMS interventions in nursing home residents who required an emergency physician increased during the same period by 205.6% (from 106 to 324), representing an increase from 2% to 7% of all emergency physician interventions in the Canton. CONCLUSIONS: Our results confirmed an important increase in the incidence of EMS interventions in nursing homes during the last decade, far exceeding the actual increase of the nursing home population during the same period. This evolution represents an important opportunity to reconsider the EMS missions in the context of an ageing society.

Percutaneous coronary interventions prior to coronary artery bypass surgery.

BACKGROUND AND AIM OF THE STUDY: Percutaneous coronary interventions (PCI) are frequently performed before coronary artery bypass graft (CABG) surgery. This study sought to evaluate postoperative outcomes, and incidence of recurrent target ischemia in vessels with prior PCI in patients who had PCI prior to CABG compared to only CABG patients. METHODS: A review included CABG patients operated from 2000 to 2012. PCI prior to CABG patients were compared with patients having had CABG on native coronary arteries. Demographic and risk factors, including hospital morbidity, mortality, and recurrent target vessel ischemia at follow-up (FU), were compared. Major end-points were statistical differences of postoperative morbidity and reintervention rates due to symptomatic graft failure or target vessel ischemia during FU. RESULTS: Twenty-four percent of 1669 isolated CABG patients had PCI prior to CABG, with an increasing percentage during recent years. Demographics, risk factors, comorbidities and mortality rates were similar. Incidence of postoperative hemorrhage (OR 1.9; 95% CI 1.1-3.2; p = 0.02), perioperative myocardial infarction rate (p = 0.02), neurological deficits (OR 3.5; 95% CI 1.2-9.7; p = 0.02) and re-intervention rate for symptomatic graft or target vessel occlusion were higher in pretreated patients (OR 1.8; 95% CI 1.1-3.0; p = 0.01). CONCLUSIONS: PCI prior to CABG increases the risk for postoperative morbidity. Increased postoperative hemorrhage could be attributed to ongoing double anti-platelet therapy. doi: 10.1111/jocs.12514 (J Card Surg 2015;30:313-318).

N. H. Pinello

Lyijykynäpiirroksen alla musteella kirjoitettu teksti: "Tutto il mondo è fatto come la nostra famiglia. N. H. v. Pinello." - Z. Topeliuksen kokoelman kuva.

Physico-chemical characterization and oxidative reactivity evaluation of aged brake wear particles

Brake wear dust is a significant component of traffic emissions and has been linked to adverse health effects. Previous research found a strong oxidative stress response in cells exposed to freshly generated brake wear dust. We characterized aged dust collected from passenger vehicles, using microscopy and elemental analyses. Reactive oxygen species (ROS) generation was measured with acellular and cellular assays using 2′7-dichlorodihydrofluorescein dye. Microscopy analyses revealed samples to be heterogeneous particle mixtures with few nanoparticles detected. Several metals, primarily iron and copper, were identified. High oxygen concentrations suggested that the elements were oxidized. ROS were detected in the cell-free fluorescent test, while exposed cells were not dramatically activated by the concentrations used. The fact that aged brake wear samples have lower oxidative stress potential than fresh ones may relate to the highly oxidized or aged state of these particles, as well as their larger size and smaller reactive surface area.

Effects of CPAP on oxidative stress and nitrate efficiency in sleep apnoea: a randomised trial.

Background: Previous studies have presented contradictory data concerning obstructive sleep apnoea syndrome (OSAS), lipid oxidation and nitric oxide (NO) bioavailability. This study was undertaken to (1) compare the concentration of 8-isoprostane and total nitrate and nitrite (NOx) in plasma of middle-aged men with OSAS and no other known co-morbidity and healthy controls of the same age, gender and body mass index; and (2) test the hypothesis that nasal continuous positive airway pressure (CPAP) therapy attenuates oxidative stress and nitrate deficiency. Methods: A prospective, randomised, placebo controlled, double-blind, crossover study was performed in 31 consecutive middle-aged men with newly diagnosed OSAS and 15 healthy control subjects. Patients with OSAS were randomised to receive sham CPAP or effective CPAP for 12 weeks. Blood pressure, urinary catecholamine levels and plasma 8-isoprostane and NOx concentrations were obtained before and after both treatment modalities. Results: Patients with OSAS had significantly higher 8-isoprostane levels (median (IQR) 42.5 (29.2-78.2) vs 20.0 (12.5-52.5) pg/ml, p = 0.041, Mann-Whitney test) and lower NOx levels (264 (165-650) vs 590 (251- 1465) mmol/l, p = 0.022) than healthy subjects. Body mass index, blood pressure and urinary catecholamines were unchanged by CPAP therapy, but 8-isoprostane concentrations decreased (38.5 (24.2-58.7) pg/ml at baseline vs 22.5 (16.2-35.3) pg/ml on CPAP, p = 0.0001) and NOx levels increased (280 (177-707) vs 1373 (981-1517) mmol/l, p = 0.0001) after CPAP. Conclusions: OSAS is associated with an increase in oxidative stress and a decrease in NOx that is normalised

Clear Cell Papillary Renal Cell Carcinoma and Renal Angiomyoadenomatous Tumor: Two Variants of a Morphologic, Immunohistochemical, and Genetic Distinct Entity of Renal Cell Carcinoma.

Clear cell papillary renal cell carcinoma (ccpRCC) and renal angiomyoadenomatous tumor (RAT) share morphologic similarities with clear cell (ccRCC) and papillary RCC (pRCC). It is a matter of controversy whether their morphologic, immunophenotypic, and molecular features allow the definition of a separate renal carcinoma entity. The aim of our project was to investigate specific renal immunohistochemical biomarkers involved in the hypoxia-inducible factor pathway and mutations in the VHL gene to clarify the relationship between ccpRCC and RAT. We investigated 28 ccpRCC and 9 RAT samples by immunohistochemistry using 25 markers. VHL gene mutations and allele losses were investigated by Sanger sequencing and fluorescence in situ hybridization. Clinical follow-up data were obtained for a subset of the patients. No tumor recurrence or tumor-related death was observed in any of the patients. Immunohistochemistry and molecular analyses led to the reclassification of 3 tumors as ccRCC and TFE3 translocation carcinomas. The immunohistochemical profile of ccpRCC and RAT samples was very similar but not identical, differing from both ccRCC and pRCC. Especially, the parafibromin and hKIM-1 expression exhibited differences in ccpRCC/RAT compared with ccRCC and pRCC. Genetic analysis revealed VHL mutations in 2/27 (7%) and 1/7 (14%) ccpRCC and RAT samples, respectively. Fluorescence in situ hybridization analysis disclosed a 3p loss in 2/20 (10%) ccpRCC samples. ccpRCC and RAT have a specific morphologic and immunohistochemical profile, but they share similarities with the more aggressive renal tumors. On the basis of our results, we regard ccpRCC/RAT as a distinct entity of RCCs.

Five-year outcome of catheter ablation of persistent atrial fibrillation using termination of atrial fibrillation as a procedural endpoint.

BACKGROUND: This study aimed to determine 5-year efficacy of catheter ablation for persistent atrial fibrillation (AF) using AF termination as a procedural end point. METHODS AND RESULTS: One hundred fifty patients (57±10 years) underwent persistent AF ablation using a stepwise ablation approach (pulmonary vein isolation, electrogram-guided, and linear ablation) with the desired procedural end point being AF termination. Repeat ablation was performed for recurrent AF or atrial tachycardia. AF was terminated by ablation in 120 patients (80%). Arrhythmia-free survival rates after a single procedure were 35.3%±3.9%, 28.0%±3.7%, and 16.8%±3.2% at 1, 2, and 5 years, respectively. Arrhythmia-free survival rates after the last procedure (mean 2.1±1.0 procedures) were 89.7%±2.5%, 79.8%±3.4%, and 62.9%±4.5%, at 1, 2, and 5 years, respectively. During a median follow-up of 58 (interquartile range, 43-73) months after the last ablation procedure, 97 of 150 (64.7%) patients remained in sinus rhythm without antiarrhythmic drugs. Another 14 (9.3%) patients maintained sinus rhythm after reinitiation of antiarrhythmic drugs, and an additional 15 (10.0%) patients regressed to paroxysmal recurrences only. Failure to terminate AF during the index procedure (hazard ratio 3.831; 95% confidence interval, 2.070-7.143; P<0.001), left atrial diameter ≥50 mm (hazard ratio 2.083; 95% confidence interval, 1.078-4.016; P=0.03), continuous AF duration ≥18 months (hazard ratio 1.984; 95% confidence interval, 1.024-3.846; P<0.04), and structural heart disease (hazard ratio 1.874; 95% confidence interval, 1.037-3.388; P=0.04) predicted arrhythmia recurrence. CONCLUSIONS: In patients with persistent AF, an ablation strategy aiming at AF termination is associated with freedom from arrhythmia recurrence in the majority of patients over a 5-year follow-up period. Procedural AF nontermination and specific baseline factors predict long-term outcome after ablation.

Predictability of refraction following immediate sequential bilateral cataract surgery (ISBCS) performed under general anesthesia

Abstract Background: To evaluate the predictability of refraction following immediate sequential bilateral cataract surgery (ISBCS) performed under general anaesthesia. Methods: This is a retrospective review of all ISBCS performed at Kantonsspital Winterthur, Switzerland, between April 2000 and September 2013. The case notes of 250 patients were reviewed. Patients having full refraction reported (110 patients/220 eyes) were included. 210 (95 %) eyes had a straight forward phacoemulsification with posterior chamber intraocular lens implantation, seven eyes had a planned extracapsular cataract extraction (ECCE); three eyes had an intracapsular cataract extraction. Results: Both eyes of 110 patients (64 women, 46 men) with a mean age of 79.0 years, standard deviation (SD) ±11.4 (range 26 to 97 years) were included. Median preoperative best corrected visual acuity (BCVA) was 0.5 LogMAR in the first eye, the interquartile range (IQR) was [0.4, 1.2]; 0.7 LogMAR in the second eye with IQR [0.4, 1.8]. At one month, the median BCVA was 0.2 LogMAR, IQR [0.1, 0.3] in the first eye, median BCVA was 0.1 LogMAR and IQR [0.0, 0.5] in the second eye. There were 3 eyes (3 %) that lost 3 lines or more in BCVA at one month (control vs. pre-operatively). In all three cases, poor visual acuity had been recorded pre-operatively (>1 LogMAR). Achieved refraction was within ±1.0 D of the target in 83 % of eyes. There were only 5 % (n = 6) of cases where if delayed sequential bilateral extraction had been performed could potentially intraocular lens (IOL) choice have been adjusted, in four of these cases, target refraction was within ±1.0 D in the second eye. Conclusions: ISBCS performed under general anaesthesia achieves target refraction in 83 % of eyes after consideration of complications, ocular co-morbidities and systemic restrictions. In the majority of cases where IOL power calculation could be considered, the achieved refraction of the second surgical eye was within ±1.0 D of intended refraction. This undermines the utility of IOL power adjustments in the second surgical eye. Keywords: Cataract, Cataract surgery, Immediate sequential bilateral cataract surgery

Estudo comparativo das seqüências rápidas ponderadas em T2, utilizando-se sincronização respiratória, apnéia, supressão de gordura, bobina de corpo e bobina de sinergia para a avaliação do fígado pela ressonância magnética

OBJETIVO: Comparar, qualitativa e quantitativamente, as imagens de ressonância magnética do fígado, ponderadas em T2, utilizando-se seqüências rápidas, diferenciadas pela técnica de controle respiratório, pela utilização de supressão de gordura e pelo tipo de bobina de radiofreqüência. MATERIAIS E MÉTODOS: Estudo prospectivo em 71 pacientes consecutivos, sendo realizadas seis seqüências para comparação: 1) supressão de gordura com sincronização respiratória e bobina de corpo; 2) supressão de gordura em apnéia e bobina de corpo; 3) sem supressão de gordura com sincronização respiratória e bobina de corpo; 4) sem supressão de gordura em apnéia e bobina de corpo; 5) com supressão de gordura com sincronização respiratória e bobina de sinergia; 6) com supressão de gordura em apnéia e bobina de sinergia. A avaliação qualitativa foi baseada em três critérios: detecção de determinadas estruturas anatômicas do fígado, definição dos contornos hepáticos, e presença de artefatos de respiração. A análise quantitativa foi obtida através da relação das intensidades de sinal do fígado e do ruído de fundo. RESULTADOS: O valor médio dos índices globais de qualidade de imagem para cada uma das seis seqüências supracitadas foi de 7,8, 4,6, 7,9, 5,2, 6,7 e 4,6, respectivamente. As seqüências obtidas com sincronização respiratória apresentaram melhor qualidade de imagem e relação sinal/ruído superiores às seqüências com apnéia (p < 0,001). As seqüências realizadas com e sem supressão de gordura apresentaram qualidade de imagem e relação sinal/ruído semelhantes (p > 0,05). As seqüências obtidas com bobina de sinergia apresentaram qualidade de imagem semelhante (p > 0,05) e relação sinal/ruído inferior àquelas com bobina de corpo (p < 0,001). CONCLUSÃO: Associando-se as análises qualitativa e quantitativa das imagens, as melhores seqüências foram aquelas obtidas com sincronização respiratória e bobina de corpo, utilizando-se ou não supressão de gordura.