Retinal and systemic vascular function in health and disease: the effect of smoking and coronary artery disease

The purpose of the following studies was to explore the effect of systemic vascular and endothelial dysfunction upon the ocular circulation and functionality of the retina. There are 6 principal sections to the present work. Retinal vessel activity in smokers and non-smokers: the principal findings of this work were: chronic smoking affects retinal vessel motion at baseline and during stimulation with flickering light; chronic smoking leads to a vaso-constrictory shift in retinal arteriolar reactivity to flicker; retinal arteriolar elasticity is decreased in chronic smokers. The effect of acute smoking on retinal vessel dynamics in smokers and non-smokers: the principal finding of this work was that retinal reactivity in chronic smokers is blunted when exposed to clicker light provocation immediately after smoking one cigarette. Ocular blood flow in coronary artery disease: The principal findings of this work were: retrobulbar and retinal blood flow is preserved in CAD patients, despite a change pulse wave transmission; arterial retinal response to flickering light provocation is significantly delayed in CAD patients; retinal venular diameters are significantly dilated in CAD patients. Autonomic nervous system function and peripheral circulation in CAD: The principal findings in this work were: CAD patients demonstrate a sympathetic overdrive during a 24 period; a delay in peripheral vascular reactivity (nail-fold capillaries) as observed in patients suffering from CAD could be caused by either arteriosclerotic changes of the vascular walls or due to systemic haemodynamic changes. Visual function in CAD: The principal findings in this work were: overall visual function in CAD patients is preserved, despite a decrease in contrast sensitivity; applying a filtering technique selecting those with greater coefficient of variance which in turn represents a decrease in reliability, some patients appear to have an impaired visual function as assessed using FDT visual field evaluation. Multiple functional, structural and biochemical vascular endothelial dysfunctions in patients suffering from CAD: relationships and possible implications: The principal findings of this work were: BMI significantly correlated with vWF (a marker of endothelial function) in CAD patients. Retinal vascular reactivity showed a significant correlation with peripheral reactivity parameters in controls which lacked in the CAD group and could reflect a loss in vascular endothelial integrity; visual field parameters as assessed by frequency doubling technology were strongly related with systemic vascular elasticity (ambulatory arterial stiffness index) in controls but not CAD patients.

Immigrant dislocated identities:Rachid Nini’s Diario de un ilegal

This article describes the process through which the subjectivity of the illegal immigrant is deconstructed and later reconstructed, as revealed by the Moroccan journalist and intellectual Rachid Nini in his book Diario de un ilegal/Diary of an Illegal Immigrant (2002), an account of the author's perils as an illegal immigrant in Spain. The analysis focuses firstly on the narrative form that Nini employs to give an account of his story, and secondly on the spatial displacement to which the subject and his subjectivity are exposed, which leads to the obliteration of his identity. The abrupt changes that the subject faces in a new location are paramount and impel him to a constant quest for self-definition and of negotiation with the new Other. Thus, the privileges that Nini enjoyed while in Morocco, those of a male journalist, poet, translator and intellectual with a university degree, disappear altogether once his plane has landed on the Canary Islands. In this new location, the place of origin and/or race are now what define his identity; he is now simply a moro - a Moor - he is not considered as an individual but, as will be shown, as a member of a homogenizing category which resists definition. The article finishes by addressing how Nini, in his quest to destroy homogenizing stereotypes, employs other stereotypes as though this were the only escape from the schizophrenic state the illegal immigrant identity had been forced into.

Interactions entre le thromboxane A₂, le facteur d'activation plaquettaire et le monoxyde d'azote dans la rétinopathie induite par l'oxygène chez le rat nouveau-né : implications dans la rétinopathie du prématuré

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal.

Non-Pharmacological Approaches for Pain Management in Sickle Cell Disease: Development of a Mindfulness-Based Intervention

Background: Sickle Cell Disease (SCD) is a genetic hematological disorder that affects more than 7 million people globally (NHLBI, 2009). It is estimated that 50% of adults with SCD experience pain on most days, with 1/3 experiencing chronic pain daily (Smith et al., 2008). Persons with SCD also experience higher levels of pain catastrophizing (feelings of helplessness, pain rumination and magnification) than other chronic pain conditions, which is associated with increases in pain intensity, pain behavior, analgesic consumption, frequency and duration of hospital visits, and with reduced daily activities (Sullivan, Bishop, & Pivik, 1995; Keefe et al., 2000; Gil et al., 1992 & 1993). Therefore effective interventions are needed that can successfully be used manage pain and pain-related outcomes (e.g., pain catastrophizing) in persons with SCD. A review of the literature demonstrated limited information regarding the feasibility and efficacy of non-pharmacological approaches for pain in persons with SCD, finding an average effect size of .33 on pain reduction across measurable non-pharmacological studies. Second, a prospective study on persons with SCD that received care for a vaso-occlusive crisis (VOC; N = 95) found: (1) high levels of patient reported depression (29%) and anxiety (34%), and (2) that unemployment was significantly associated with increased frequency of acute care encounters and hospital admissions per person. Research suggests that one promising category of non-pharmacological interventions for managing both physical and affective components of pain are Mindfulness-based Interventions (MBIs; Thompson et al., 2010; Cox et al., 2013). The primary goal of this dissertation was thus to develop and test the feasibility, acceptability, and efficacy of a telephonic MBI for pain catastrophizing in persons with SCD and chronic pain.

Methods: First, a telephonic MBI was developed through an informal process that involved iterative feedback from patients, clinical experts in SCD and pain management, social workers, psychologists, and mindfulness clinicians. Through this process, relevant topics and skills were selected to adapt in each MBI session. Second, a pilot randomized controlled trial was conducted to test the feasibility, acceptability, and efficacy of the telephonic MBI for pain catastrophizing in persons with SCD and chronic pain. Acceptability and feasibility were determined by assessment of recruitment, attrition, dropout, and refusal rates (including refusal reasons), along with semi-structured interviews with nine randomly selected patients at the end of study. Participants completed assessments at baseline, Week 1, 3, and 6 to assess efficacy of the intervention on decreasing pain catastrophizing and other pain-related outcomes.

Results: A telephonic MBI is feasible and acceptable for persons with SCD and chronic pain. Seventy-eight patients with SCD and chronic pain were approached, and 76% (N = 60) were enrolled and randomized. The MBI attendance rate, approximately 57% of participants completing at least four mindfulness sessions, was deemed acceptable, and participants that received the telephonic MBI described it as acceptable, easy to access, and consume in post-intervention interviews. The amount of missing data was undesirable (MBI condition, 40%; control condition, 25%), but fell within the range of expected missing outcome data for a RCT with multiple follow-up assessments. Efficacy of the MBI on pain catastrophizing could not be determined due to small sample size and degree of missing data, but trajectory analyses conducted for the MBI condition only trended in the right direction and pain catastrophizing approached statistically significance.

Conclusion: Overall results showed that at telephonic group-based MBI is acceptable and feasible for persons with SCD and chronic pain. Though the study was not able to determine treatment efficacy nor powered to detect a statistically significant difference between conditions, participants (1) described the intervention as acceptable, and (2) the observed effect sizes for the MBI condition demonstrated large effects of the MBI on pain catastrophizing, mental health, and physical health. Replication of this MBI study with a larger sample size, active control group, and additional assessments at the end of each week (e.g., Week 1 through Week 6) is needed to determine treatment efficacy. Many lessons were learned that will guide the development of future studies including which MBI strategies were most helpful, methods to encourage continued participation, and how to improve data capture.

Interactions entre le thromboxane A₂, le facteur d'activation plaquettaire et le monoxyde d'azote dans la rétinopathie induite par l'oxygène chez le rat nouveau-né : implications dans la rétinopathie du prématuré

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal.

(Figure 2) Stratigraphic distribution of Schizosphaerella in DSDP Hole 79-547B

The Jurassic (hemi)pelagic continental margin deposits drilled at Hole 547B, off the Moroccan coast, reveal striking Tethyan affinity. Analogies concern not only types and gross vertical evolution of facies, but also composition and textures of the fine sediment and the pattern of diagenetic alteration. In this context, the occurrence of the nanno-organism Schizosphaerella Deflandre and Dangeard (sometimes as a conspicuous portion of the fine-grained carbonate fraction) is of particular interest. Schizosphaerella, an incertae sedis taxon, has been widely recorded as a sediment contributor from Tethyan Jurassic deeper-water carbonate facies exposed on land. Because of its extremely long range (Hettangian to early Kimmeridgian), the genus Schizosphaerella (two species currently described, S. punctulata Deflandre and Dangeard and S. astrea Moshkovitz) is obviously not of great biostratigraphic interest. However, it is of interest in sedimentology and petrology. Specifically, Schizosphaerella was often the only component of the initial fine-grained fraction of a sediment that was able to resist diagenetic obliteration. However, alteration of the original skeletal structure did occur to various degrees. Crystal habit and mineralogy of the fundamental skeletal elements, as well as their mode of mutual arrangement in the test wall with the implied high initial porosity of the skeleton (60-70%), appear to be responsible for this outstanding resistance. Moreover, the ability to concentrate within and, in the case of the species S. punctulata, around the skeleton, large amounts of diagenetic calcite also contributed to the resistance. In both species of Schizosphaerella, occlusion of the original skeletal void space during diagenesis appears to have proceeded in an analogous manner, with an initial slight uniform syntaxial enlargement of the basic lamellar skeletal crystallites followed, upon mutual impingement, by uneven accretion of overgrowth cement in the remaining skeletal voids. However, distinctive fabrics are evident according to the different primary test wall architecture. In S. punctulata, intraskeletal cementation is usually followed by the growth of a radially structured crust of bladed to fibrous calcite around the valves. These crusts are interpreted as a product of aggrading neomorphism, associated with mineralogic stabilization of the original, presumably polyphase, sediment. Data from Hole 547B, along with inferences, drawn from the fabric relationships, suggest that the crusts formed and (inferentially) mineralogic stabilization occurred at a relatively early time in the diagenetic history in the shallow burial realm. An enhanced rate of lithification at relatively shallow burial depths and thus the chance for neomorphism to significantly influence the textural evolution of the buried sediment may be related to a lower Mg/Ca concentration ratio in the oceanic system and, hence, in marine pore waters in pre-Late Jurassic times.

The Neolithic of El Niño cave (Ayna, Albacete) in the Sierra del Segura context

Since its excavation in the summer of 1973, El Niño cave has been considered a key site to understand the process of production economy and pottery technology introduction in South-eastern Iberian Peninsula, and especially to approach how such process could have affected people already settled in the Segura mountains. However, data from El Niño cave was very fragmentary, due to the lack of a broad study of Neolithic occupations of the site. In this paper, we present the analysis of pottery, lithic industry and faunal remains, as well as the existing dates from the site´s Holocene levels. The review of different evidence from the site allows suggesting that El Niño cave would have probably acted as a hunting and shepherding station, being a logistical site of larger places. However, limitations due to the fact that we are dealing with a 40- year-old excavation, prevent specifying how the process of Neolithic introduction in the Segura Mountains occurred.

Los ungüentarios de alabastro en el Mediterráneo. Primer Milenio a. C.

A partir del hallazgo de un tipo particular de envases: ungüentarios y perfumarios en una nueva tumba en el territorio de Arados/Amrit, observamos cómo se incrementa la presencia de estos envases en tumbas de incineración e inhumación durante el primer milenio antes de Cristo en la cuenca mediterránea. Hemos elaborado una serie de análisis y discusiones sobre su distribución, cronología, significado y uso social, tratando de establecer una periodización de sus usos y una contextualización cultural y social dentro del ritual funerario y del uso de determinadas materias primas empleadas para su elaboración.

Cova dels Jurats at Calescoves (Alaior, Minorca). A Cave Shrine in the Talayotic context?

Excavations carried out in the Cova dels Jurats between 2010 and 2012 served to establish that, unlike the rest of the caves Calescoves, this one functioned as a sanctuary, with two different phases. The first one corresponds to the Final Talayotic Period, as the first cave shrine documented in the Talayotic culture. In Roman times, the place was still used as a sanctuary, but with a totally different ritual, linked to the inscriptions discovered at the entrance of the cave.

HPLC Determination of Angiotensin-Converting Enzyme Activity on Toyopearl HW-40S Column

Angiotensin-converting enzyme (EC3.4.15. I; ACE), isa membrane-bounddipeptidyl carboxypeptidase that mediates the cleavage of the C-terminal dipeptide His-Leu of the decapeptide angiotensin, generating the most powerful endogenous vaso-constricting angiotensin.
Some ACE inhibitors, such as Captopril, have been used as anti-hypertensive drugs. Moreover in recent years, large quantities of ACE inhibitors have been identijied and isolated from peptides derivedfrom food material such as casein, soy protein, jish protein and so on. Functional food with hypotensive effect has been developed on the basis of these works.
Typicalprocedures for screening hypotensive peptides offood origins are separationof products of peptic and tryptic digestion of proteins followed by inhibitory activitydetermination of each fraction. A method developed by Cushman has been the mostwidely used, in which ACE activity is determined by the amount of hippuric acid
generated as a product of enzymatic reaction of ACE with tripeptide of hippuryl-Lhistidyl-L-leucine. Hippuric acid is determined spectrophotometrically at 228 nm after its isolation from the reaction system by ethylacetate extraction, which not only requires alarge quantity of reagent but also results in large error.
An improved method based on Cushman ’s method is proposed in this paper. In this method, an enzymatic reaction system is based on Cushman’s method, while isolation and determination of hippuric acid is performed by medium perjormance gel chromatography on a Toyopearl HW-40s column. Due to the size exclusion nature of the column with somewhat hydrophobic properties, complete separation of four existing fractions in the reaction system is obtained within a smallfraction of the time necessary in Cushman’s method, with ideal reproducibility.

Tratamento Endovascular de Patologia da Aorta Torácica: Experiência Institucional

Introdução: O tratamento endovascular da aorta torácica (TEVAR) é uma modalidade terapêutica emergente que tem vindo a revolucionar a abordagem de diferentes tipos de patologia da aorta na sua localização torácica. Objetivos: Avaliação da experiência institucional do serviço de angiologia e cirurgia vascular. Métodos: Análise retrospetiva da série consecutiva de todos os doentes com patologia da aorta torácica e/ou toracoabdominal submetidos a TEVAR na nossa instituição. Foram excluídos aqueles com uso concomitante de endopróteses fenestradas/ramificadas abdominais. Resultados: Desde abril de 2005 até abril de 2014, 79 doentes foram submetidos a TEVAR, com idade média de 66 ± 12,83 anos (máx: 86; mín: 14). As indicações incluíram: 46 aneurismas (58%), 17 dissecções aórticas clássicas tipo B (22%), 13 no contexto de outras síndromes aórticas agudas (16%), 2 por ateroembolismo (3%) e um por fístula aortoesofágica (1%). Na patologia aneurismática, a distribuição anatómica da doença foi a seguinte: 5 na aorta ascendente e arco aórtico (11%), 35 na aorta torácica descendente (76%) e 6 toracoabdominal (13%). O diâmetro médio das dilatações aneurimáticas foi de 69,64 mm (máx: 150 mm). A rotura foi uma apresentação da patologia em 21,5% dos doentes (n = 17); 20,9% dos doentes tinham antecedentes de cirurgia aórtica prévia. A dissecção aórtica tipo B complicada foi a segunda indicação mais comum, sendo de apresentação aguda em 13 (76%) e crónica em 4 (24%). As complicações na base da intervenção foram dilatação aneurismática em 35% (n = 6), malperfusão com isquemia de órgão alvo 47% (n = 8), desconhecida em 18% (n = 3). Foi realizada extensão distal com stent descoberto (Petticoat) em 9 casos (41,2%) e foram realizados procedimentos adjuvantes em 18% (stenting renal n = 2; stenting ilíaco n = 1). Dentro das outras síndromes aórticas agudas, o TEVAR foi realizado no contexto de úlcera aórtica penetrante (n = 4), hematoma intramural (n = 4) e os restantes por rotura/pseudoaneurisma (n = 5). As endopróteses utilizadas foram: 32 Valiant Medtronic®, 15 TAG Gore®, 25 Zenith TX2 Cook®, 2 Zenith TX1 Cook®, uma Relay Plus®, 3 Talent Medtronic® e outras em 1%. A mediana de dias de cuidados intensivos foi 2 (intervalo 0-42) e a mediana de suporte tranfusional foi de 2 UCE. A taxa de mortalidade aos 30 dias ou intra-hospital foi de 18% (n = 14). Atendendo ao timing da cirurgia, a taxa de mortalidade aferida nos casos electivos foi de 8% (4/50) e nos urgentes atinge os 35% (10/29). Intraoperatoriamente foram tratadas 7 complicações relacionadas com vaso de acesso membro, 2 casos de dissecção aórtica iatrogénica, um caso de trombose arterial inferior e um endoleak tipo IA. A taxa de reintervenções foi de 17%, com as seguintes indicações: 9 endoleaks, 2 isquemias mesentéricas e 2 fístulas aortoesofágicas. Conclusões: A série apresentada traduz uma experiência institucional favorável com resultados reprodutíveis e que o TEVAR é um procedimento seguro e eficaz para o tratamento de diferentes patologias da aorta torácica, quando comparado com o tratamento cirúrgico aberto.

Chirurgia mini-invasiva : tecniche di intervento in presenza di malattie vascolari

Il mio elaborato tratta le tecniche e le problematiche affrontate nella chirurgia mini invasiva in presenza di malattie vascolari; si parla di mini-invasiva in quanto la procedura d'intervento,come dice la parola stessa, non consiste in un vero e proprio intervento chirurgico ma bensi', nella maggior parte dei casi , si svolge in day- hospital. Dopo aver descritto cosa si intende per malattie vascolari e i fattori che portano alla loro comparsa all'interno del nostro organismo, mi focalizzo sulle tecniche utilizzate in fase di diagnosi da parte del cardiologo emodinamista per stabilire quale tipo di patologia è stata riscontrata sul paziente e la sua gravità e,successivamente, sulle tecniche d'intervento. Proprio per quel che riguarda le tecniche procedurali, descrivo quelle principalmente utilizzate nel campo della chirurgia mini-invasiva mettendo a confronto la classica tecnica dell'angioplastica, ormai utilizzata da anni, con quella dell'aterectomia che, in base al sistema di funzionamento e al tipo d'intervento da eseguire, si divide in due grosse branche: aterectomia direzionale e aterectomia rotazionale. Dopo aver illustrato il principio tecnologico e di funzionamento di ogni tecnica, in riferimento a studi eseguiti da parte di svariate equipe su un ampio range di pazienti, ho messo a confronto l'angioplastica con l'aterectomia per cercare di stabilire quale tra le due tecniche porta a risultati migliori, soprattutto a lungo termine, in modo tale da ridurre il rischio di restenosi nel paziente(ovvero un ulteriore restringimento nella zona del vaso dove si è intervenuti )

God and War: the Church of England and Armed Conflict in the Twentieth Century

Despite narratives of secularization, it appears that the British public persistently pay attention to clerical opinion and continually resort to popular expressions of religious faith, not least in time of war. From the throngs of men who gathered to hear the Bishop of London preach recruiting sermons during the First World War, to the attention paid to Archbishop Williams' words of conscience on Iraq, clerical rhetoric remains resonant. For the countless numbers who attended National Days of Prayer during the Second World War, and for the many who continue to find the Remembrance Day service a meaningful ritual, civil religious events provide a source of meaningful ceremony and a focus of national unity. War and religion have been linked throughout the twentieth century and this book explores these links: taking the perspective of the 'home front' rather than the battlefield. Exploring the views and accounts of Anglican clerics on the issue of warfare and international conflict across the century, the authors explore the church's stance on the causes, morality and conduct of warfare; issues of pacifism, obliteration bombing, nuclear possession and deterrence, retribution, forgiveness and reconciliation, and the spiritual opportunities presented by conflict. This book offers invaluable insights into how far the Church influenced public appraisal of war whilst illuminating the changing role of the Church across the twentieth century.

Multiple Myeloma Presenting with Distal Limb Gangrene: An Odd Case Report

Multiple myeloma (MM) is a plasmocytic malignant proliferation of a single clone resulting in an overabundance of monoclonal immunoglobulins. MM commonly presents with bone disorders, renal failure, anaemia and hypercalcaemia. Hyperviscosity syndrome is rare, as are vaso-occlusive symptoms. The authors report a dramatic case of an 80-year-old woman admitted to the emergency department with full-blown distal gangrene. The culprit turned out to be a MM, unusually presenting with symptomatic hyperviscosity and peripheral occlusive ischaemia. This catastrophic and particularly dramatic presentation is almost unprecedented, with only a few cases reported worldwide.

Interação de microorganismos na solubilização de fósforo e potássio de rochas para produção de biofertilizantes

he present model of agriculture is based on intensive use of industrial inputs, due to its rapid response, but it brings harmful consequences to the environment, and it is necessary the use of modern inputs. And an alternative is the use of rock biofertilizers in agriculture, a product easy to use, with higher residual effect and does not harm the environment. The objective of study was to evaluate the inoculation and co-inoculation of different microorganisms in the solubilization of rock phosphate and potash ground microbial evaluating the best performance in the production of biofertilizers comparing with rocks pure in soil chemical properties and, verify effect of inoculation of the bacterium Paenibacillus polymyxa in the absorption of minerals dissolved in the development of cowpea (Vigna unguiculata [L.] Walp.). The first bioassay was conducted in Laboratory (UFRN) for 72 days in Petri dishes, where the rock powder was increased by 10% and sulfur co-inoculated and inoculated with bacterial suspension of Paenibacillus polymyxa grown in medium tryptone soy broth, Ralstonia solanacearum in medium Kelman, Cromobacterium violaceum in medium Luria-Bertani and Acidithiobacillus thiooxidans in medium Tuovinen and Kelly,and fungi Trichoderma humatum and Penicillium fellutanum in malt extract. Every 12 days, samples were removed in order to build up the release curve of minerals. The second bioassay was conducted in a greenhouse of the Agricultural Research Corporation of Rio Grande do Norte in experimental delineation in randomized block designs, was used 10 kg of an Yellow Argissolo Dystrophic per pot with the addition of treatments super phosphate simple (SS), potassium chloride (KCl), pure rock, biofertilizers in doses 40, 70, 100 and 200% of the recommendation for SS and KCl, and a control, or not inoculated with bacteria P. polymyxa. Were used seeds of cowpea BRS Potiguar and co-inoculated with the bacterial suspension of Bradyrhizobium japonicum and P. polymyxa. The first crop was harvested 45 days after planting, were evaluated in the dry matter (ADM), macronutrients (N, P, K, Ca, Mg) and micronutrients (Zn, Fe, Mn) in ADM. And the second at 75 days assessing levels of macro end micronutrients in plants and soil, and the maximum adsorption capacity of P in soil. The results showed synergism in co-inoculations with P. polymyxa+R. solanacearum and, P. polymyxa+C. violaceum solubilizations providing higher P and K, respectively, and better solubilization time at 36 days. The pH was lower in biofertilizers higher doses, but there was better with their addition to P at the highest dose. Significant reduction of maximum adsorption capacity of phosphorus with increasing dose of biofertilizer. For K and Ca was better with SS+KCl, and Mg to pure rock. There was an effect of fertilization on the absorption, with better results for P, K and ADM with SS+KCL, and N, Ca and Mg for biofertilizers. Generally, the P. polymyxa not influence the absorption of the elements in the plant. In treatments with the uninoculated P. polymyxa chemical fertilizer had an average significantly higher for weight and number of grains. And in the presence of the bacteria, biofertilizers and chemical fertilizers had positive values in relation to rock and control. The data show that the rocks and biofertilizers could meet the need of nutrients the plants revealed as potential for sustainable agriculture