Gene-environment interactions of selected pharmacogenes in arterial hypertension.

Hypertension affects approximately 1 billion people worldwide. Owing to population aging, hypertension-related cardiovascular burden is expected to rise in the near future. In addition to genetic variants influencing the blood pressure response to antihypertensive drugs, several genes encoding for drug-metabolizing or -transporting enzymes have been associated with blood pressure and/or hypertension in humans (e.g., ACE, CYP1A2, CYP3A5, ABCB1 and MTHFR) regardless of drug treatment. These genes are also involved in the metabolism and transport of endogenous substances and their effects may be modified by selected environmental factors, such as diet or lifestyle. However, little is currently known on the complex interplay between environmental factors, endogenous factors, genetic variants and drugs on blood pressure control. This review will discuss the respective role of population-based primary prevention and personalized medicine for arterial hypertension, taking a pharmacogenomics' perspective focusing on selected pharmacogenes.

Audit report on applying agreed-upon procedures for the City of Linden’s compliance with road use tax requirements for the period July 1, 1999 through June 30, 2004

Audit report on applying agreed-upon procedures for the City of Linden’s compliance with road use tax requirements for the period July 1, 1999 through June 30, 2004

Floating arterial thrombus related stroke treated by intravenous thrombolysis.

BACKGROUND: The effects of intravenous thrombolysis on floating thrombi in cervical and intracranial arteries of acute ischemic stroke patients are unknown. Similarly, the best prevention methods of early recurrences remain controversial. This study aimed to describe the clinical and radiological outcome of thrombolyzed strokes with floating thrombi. METHODS: We retrospectively analyzed all thrombolyzed stroke patients in our institution between 2003 and 2010 with floating thrombi on acute CT-angiography before the intravenous thrombolysis. The floating thrombus was diagnosed if an elongated thrombus of at least 5 mm length, completely surrounded by contrast on supra-aortic neck or intracerebral arteries, was present on CT-angiography. Demographics, vascular risk factors, and comorbidities were recorded and stroke etiology was determined after a standardized workup. Repeat arterial imaging was performed by CTA at 24 h or before if clinical worsening was noted and then by Doppler and MRA during the first week and at four months. RESULTS: Of 409 thrombolyzed stroke patients undergoing acute CT Angiography, seven (1.7%) had a floating thrombus; of these seven, six had it in the anterior circulation. Demographics, risk factors and stroke severity of these patients were comparable to the other thrombolyzed patients. After intravenous thrombolysis, the floating thrombi resolved completely at 24 h in four of the patients, whereas one had an early recurrent stroke and one developed progressive worsening. One patient developed early occlusion of the carotid artery with floating thrombus and subsequently a TIA. The two patients with a stable floating thrombus had no clinical recurrences. In the literature, only one of four reported cases were found to have a thrombolysis-related early recurrence. CONCLUSIONS: Long-term outcome seemed similar in thrombolyzed patients with floating thrombus, despite a possible increase of very early recurrence. It remains to be established whether acute mechanical thrombectomy could be a safer and more effective treatment to prevent early recurrence. However, intravenous thrombolysis should not be withheld in eligible stroke patients.

Promoção do Auto-cuidado em utentes com Hipertensão Arterial

O presente estudo faz uma abordagem geral em termos bibliográficos sobre a hipertensão arterial dado a sua importância epidemiológica a nível mundial, centrada na óptica da enfermagem, utilizando o modelo teórico de Dorohteia Orem – Teoria de Deficit de Auto-cuidado, mostrando a sua aplicação prática juntos dos utentes hipertensos de Lagoa – Rª das Patas. Tratando-se de uma comunidade com carências várias, procuramos estabelecer relações entre esses factores e a hipertensão. Fizemos um levantamento geral em termos demográficos da pequena povoação; ficamos a saber da distribuição populacional por faixa etária, identificando a população alvo do nosso trabalho (hipertensos dos 45 a 85 anos); conhecer o comportamento dos utentes perante os factores de riscos; identificar os deficits de auto-cuidado, promover o auto-cuidado através de visitas domiciliárias, interagindo com o hipertenso no seu meio familiar, no intuito de satisfazer a sua necessidade no que concerne ao tratamento e controle do nível da pressão arterial, proporcionando-lhe um atendimento personalizado, contribuindo assim, para melhoria da sua qualidade de vida.

Hipertensão arterial na gravidez

Para a maioria das mulheres, a gravidez é um fenómeno fisiológico, mas, em alguns casos pode ocorrer agravos durante sua evolução, colocando em risco a saúde da mãe e do feto. De entre esses agravos, que podem ser chamados de doenças maternas, ocorrem nesse período, à hipertensão na gravidez que é considerada uma das que mais provocam problemas no organismo materno, fetal e neonatal. Ela constitui um dos problemas de grande morbi - mortalidade tanto materno como fetal, o que leva a atribuir ênfase a essa situação. Daí surgiu o interesse de desenvolver o trabalho cujo tema é “ Hipertensão Arterial na Gravidez: Como os cuidados de Enfermagem podem contribuir para a melhoria da qualidade de vida das Grávidas Hipertensas. Tendo como objectivo entender o contributo do enfermeiro na prevenção e diminuição da mesma, da importância das intervenções de enfermagem nessas gestantes, compreender a problemática em estudo e dessa forma enriquecer o conhecimento em relação a temática. Através de revisões bibliográficas, foi possível constatar que a Hipertensão na Gravidez tem sido uma das patologias mais comuns, por vezes evoluindo para outras complicações da mesma. A revisão da literatura foi focalizada em alguns artigos Científicos disponibilizados através de revistas, sites de internet e analisando os dados da Entrevista feita no Sector da Maternidade do Hospital Baptista de Sousa. Após uma reflexão sobre os diferentes métodos existentes e os objectivos para o estudo, optou - se pelo método qualitativo para a compreensão absoluta e ampla do fenómeno em estudo. O tema em estudo é importante pela sua pertinência e também para aperceber do papel fundamental do Enfermeiro para que as gestantes tenham um acompanhamento eficaz e eficiente, tentando ao máximo prevenir esta patologia, bem como outros que podem surgir durante a gestação, construindo assim um laço entre Enfermeiro/Utente para a melhoria das intervenções de Enfermagem.

Archaeology on the Road, July 2008

Team Archaeology is excited to be riding with you this year! We hope to make our participation an annual opportunity to share the story of Iowa’s amazing past. As you ride across the state you will be passing by the locations of hundreds of known archaeological sites and an as yet unknown number of new discoveries waiting to be made. These archaeological sites, and the artifacts they contain, tell the history of the first people to travel this landscape and the stories of each generation that has contributed to what we know of ourselves today. As you travel through our beautiful state, you too are now a part of that story, making history for the future to learn and wonder about! The Office of the State Archaeologist serves a unique dual role in Iowa as both a designated research unit of The University of Iowa and as a state agency. The larger mission of the OSA is to develop, disseminate, and preserve knowledge of Iowa’s human past through Midwestern and Plains archaeological research, scientific discovery, public stewardship, service, and education. It is our goal to provide all Iowans the opportunity to learn about their past. I see this as an investment in the preservation of a nonrenewable resource—the archaeological record of Iowa. Look for the Team Archeology members as you ride and be sure to ask them about Iowa archeology. Please help yourself to free materials about our shared past from our information tables at each overnight town and get one of the free Iowa Archeology wrist bands. There will also be free public talks by local archaeologists each afternoon, as well as flintknapping and other demonstrations of archaeological interest, so keep this booklet as your guide to the week’s activities. Most of all, ride smart, be safe, and when you get home tell your friends and neighbors about Iowa archaeology!

Road Use Tax/Fund Primary Road Fund Budget: Reversions, September 11, 2008

Pursuant to Iowa Code Section 307.46(2) - This is the Iowa Department of Transportation's report on the use of reversions.

Final Report, Secondary Road Fund Distribution Advisory Committee, 2002-2005

This report presents the findings and recommendations of the Secondary Road Fund Distribution Advisory Committee (SRFDAC) established by SF 2192 of the 2002 Iowa Acts.

A Assistência de Enfermagem Prestada ao Idoso com Hipertensão Arterial

O presente trabalho é o resultado da nossa investigação desenvolvida com base no tema “A Assistência de Enfermagem Prestada ao Idoso com Hipertensão Arterial”, através da análise de entrevistas realizadas aos enfermeiros do Centro de Saúde de Fonte Inês, e cujo objectivo central é avaliar a importância dos cuidados de enfermagem para dar resposta às necessidades dos idosos com hipertensão arterial. O estudo foi realizado com base numa abordagem qualitativa, e os dados foram colhidos através de entrevistas com perguntas abertas, respeitando o anonimato dos entrevistados. Deste estudo participaram cinco enfermeiros. Factores vários são identificados como causa da hipertensão, destacando-se entre eles o histórico familiar. Contudo, o consumo de sal, a obesidade, a diabete, o abuso do álcool, a vida sedentária e o fumo, são “factores de risco” a se ter em conta. Fala-se também hoje em dia numa maior “expectativa de vida”. Efectivamente, com a idade aumenta a vulnerabilidade do ser humano no tocante ao desenvolvimento de enfermidades, nomeadamente doenças crónicas como a hipertensão arterial. Assim sendo, achamos pertinente estudar este tema, mormente considerando que a maioria dos utentes que procuram os nossos centros de saúde são pessoas Idosas com esta patologia. Pudemos constatar e destacar o papel preponderante do enfermeiro no que concerne ao cuidado, e neste sentido para, prestar cuidados aos idosos, os enfermeiros devem ter conhecimento do processo de envelhecimento. É também destacada a importância de um serviço de saúde de qualidade, que vá de encontro às expectativas e necessidades do Idoso, proporcionando ao mesmo tempo uma vida digna, saudável e duradoura. A análise dos resultados demonstra que os enfermeiros estão conscientes das dificuldades que afectam o bom funcionamento dessa estrutura de saúde, e apontam a necessidade de se identificar estratégias que visam colmatar as insuficiências.

On ignoring scientific evidence: The bumpy road to enlightenment

It is well accepted that people resist evidence that contradicts their beliefs.Moreover, despite their training, many scientists reject results that are inconsistent withtheir theories. This phenomenon is discussed in relation to the field of judgment anddecision making by describing four case studies. These concern findings that clinical judgment is less predictive than actuarial models; simple methods have proven superiorto more theoretically correct methods in times series forecasting; equal weighting ofvariables is often more accurate than using differential weights; and decisions cansometimes be improved by discarding relevant information. All findings relate to theapparently difficult-to-accept idea that simple models can predict complex phenomenabetter than complex ones. It is true that there is a scientific market place for ideas.However, like its economic counterpart, it is subject to inefficiencies (e.g., thinness,asymmetric information, and speculative bubbles). Unfortunately, the market is only correct in the long-run. The road to enlightenment is bumpy.

Continuous arterial spin labeling of mouse cerebral blood flow using an actively-detuned two-coil system at 9.4T.

Among numerous magnetic resonance imaging (MRI) techniques, perfusion MRI provides insight into the passage of blood through the brain's vascular network non-invasively. Studying disease models and transgenic mice would intrinsically help understanding the underlying brain functions, cerebrovascular disease and brain disorders. This study evaluates the feasibility of performing continuous arterial spin labeling (CASL) on all cranial arteries for mapping murine cerebral blood flow at 9.4 T. We showed that with an active-detuned two-coil system, a labeling efficiency of 0.82 ± 0.03 was achieved with minimal magnetization transfer residuals in brain. The resulting cerebral blood flow of healthy mouse was 99 ± 26 mL/100g/min, in excellent agreement with other techniques. In conclusion, high magnetic fields deliver high sensitivity and allowing not only CASL but also other MR techniques, i.e. (1)H MRS and diffusion MRI etc, in studying murine brains.

Neurally adjusted ventilatory assist can improve arterial oxygenation

INTRODUCTION. Neurally Adjusted Ventilatory Assist (NAVA) [1] is a new spontaneousassisted ventilatory mode which uses the diaphragmatic electrical activity (Eadi) to pilot the ventilator. Eadi is used to initiate the ventilator's pressurization and cycling off. Delivered inspiratory assistance is proportional to Eadi. NAVA can improve patient-ventilator synchrony [2] compared to pressure support (PS), but little is known about its effect on minute ventilation and oxygenation. OBJECTIVES. To compare the effects of NAVA and PS on minute ventilation and oxygenation and to analyze potential determinant factors for oxygenation. METHODS. Comparison between two 20-min periods under NAVA and PS. NAVA gain (proportionality factor between Eadi and delivered pressure) set as to obtain the same peak pressure as in PS. FIO2 and positive end-expiratory pressure (PEEP) were the same in NAVA and PS. Blood gas analyses were performed at the end of both recording periods. Statistical analysis: groups were compared with paired t tests or non parametric Wilcoxon signed-rank tests. p\0.05 was considered significant. RESULTS. [Mean ± SD]: 22 patients (age 66 ± 12 year, 7 M/15F, BMI 23.4 ± 3.1 kg/m2), 8 patients with COPD. Initial settings: PS 13 ± 3 cmH2O, PEEP 7 ± 2 cmH2O, NAVA gain 2.2 ± 1.8. Minute ventilation and PaCO2 were the same with both modes (p = 0.296 and 0.848, respectively). Tidal volume was lower with NAVA (427 ± 102 vs. 477 ± 102 ml, p\0.001). In contrast respiratory rate was higher with NAVA (25.6 ± 9.5 vs. 22.3 ± 8.9 cycles/min). Arterial oxygenation was improved with NAVA (PaO2 85.1 ± 28.9 vs. 75.8 ± 11.9 mmHg, p = 0.017, PaO2/FIO2 210 ± 53 vs. 195 ± 58 mmHg, p = 0.019). Neural inspiratory time (Tin) was comparable between NAVA and PS (p = 0.566). Among potential determinant factors for oxygenation, mean airway pressure (Pmean) was lower with NAVA (10.6 ± 2.6 vs. 11.1 ± 2.4 cmH2O, p = 0.006), as was the pressure time product (PTP) (6.8 ± 3.0 vs. 9.2 ± 3.5 cmH2O 9 s, p = 0.004). There were less asynchrony events with NAVA (2.3 ± 2.0 vs. 4.4 ± 3.8, p = 0.009).Tidal volume variability was higher with NAVA (variation coefficient: 30 ± 19.5 vs. 13.5 ± 8.6, p\0.001). Inspiratory time in excess (Tiex) was lower with NAVA (56 ± 23 vs. 202 ± 200 ms, p = 0.001). CONCLUSION. Despite lower Pmean and PTP in NAVA, arterial oxygenation was improved compared to PS. As asynchronies may be associated with an increased work of breathing and a higher oxygen consumption, their decrease in number with NAVA could be an explanation for oxygenation improvement. Another explanation could be the increase in VT variability. Further studies should now be performed to confirm the potential of NAVA in improving arterial oxygenation and explore the underlying mechanisms.