Dramatic effect of early clopidogrel administration in reducing mortality and MACE rates in ACS patients. Data from the Swiss registry AMIS-Plus.

BACKGROUND: Patients who have acute coronary syndromes with or without ST-segment elevation have high rates of major vascular events. We evaluated the efficacy of early clopidogrel administration (300 mg) (<24 hours) when given with aspirin in such patients. METHODS: We included 30,243 patients who had an acute coronary syndrome with or without ST segment elevation. Data on early clopidogrel administration were available for 24,463 (81%). Some 15,525 (51%) of the total cohort were administrated clopidogrel within 24h of admission. RESULTS: In-hospital death occurred in 2.9% of the patients in the early clopidogrel group treated with primary PCI and in 11.4% of the patients in the other group without primary percutaneous coronary intervention (PCI) and no early clopidogrel. The unadjusted clopidogrel odds ratio (OR) for mortality was 0.31 (95% confidence interval 0.27-0.34; p <0.001). Incidence of major adverse cardiac death (MACE) was 4.1% in the early clopidogrel group treated with 1°PCI and 13.5% in the other group without primary PCI and no early clopidogrel (OR 0.35, confidence interval 0.32-0.39, p <0.001). Early clopidogrel administration and PCI were the only treatment lowering mortality as shown by mutlivariate analysis. CONCLUSIONS: The early administration of the anti-platelet agent clopidogrel in patients with acute coronary syndromes with or without ST-segment elevation has a beneficial effect on mortality and major adverse cardiac events. The lower mortality rate and incidence of MACE emerged with a combination of primary PCI and early clopidogrel administration.

Matematiikka ja tietotekniikka

Kirjoitus perustuu Pekka Orposen virkaanastujaiesitelmään Jyväskylän yliopistossa 27.11.96.

Exposure of the Swiss population to computed tomography.

BACKGROUND: The frequency of CT procedures has registered a significant increase over the last decade, which led at the international level to an increasing concern on the radiological risk associated with the use of CT especially in paediatrics. This work aimed at investigating the use of computed tomography in Switzerland, following the evolution of CT frequency and dose data over a decade and comparing it to data reported in other countries. METHODS: The frequency and dose data related to CT are obtained by means of a nationwide survey. National frequencies were established by projecting the collected data, using the ratio of the number of CT units belonging to the respondents to the total number of CT units in the country. The effective doses per examination were collected during an auditing campaign. RESULTS: In 2008 about 0.8 Million CT procedures (~ 100 CT examinations / 1000 population) were performed in the country, leading to a collective effective dose of more than 6000 man.Sv (0.8 mSv/caput). In a decade the frequency of CT examinations averaged over the population and the associated average effective dose per caput increased by a factor of 2.2 and 2.9 respectively. CONCLUSIONS: Although the contribution of CT to the total medical X-rays is 6% in terms of the frequency, it represents 68% in terms of the collective effective dose. These results are comparable to those reported in a number of countries in Europe and America with similar health level.

Respostas nutricionais de cafeeiros Catuaí e Icatu a doses de calcário em subsuperfície

O aprofundamento do sistema radicular no solo é condicionado por relações Ca/Al adequadas, podendo a calagem subsuperficial apresentar efeito positivo no crescimento das raízes e na absorção de nutrientes. Assim sendo, foi realizado um experimento em colunas de solo, em casa de vegetação, no qual se avaliou a absorção de Al, Ca, Mg e P por duas variedades de cafeeiros (Catuaí e Icatu), uma sensível e outra tolerante ao Al, respectivamente, em função da aplicação em subsuperfície de sete doses de calcário (0,0; 0,49; 1,7; 2,9; 4,1; 6,6 e 9,3 t ha-1). Cultivaram-se as plantas até 6,5 meses de idade, em solo acondicionado em colunas de PVC, subdivididas em três anéis. O anel superior recebeu calcário e fertilização. Nos dois anéis inferiores, as saturações por Al (m %) variaram de 0 a 93 %. A aplicação de calcário na subsuperfície aumentou os teores de Ca e Mg na parte aérea e nas raízes e o teor de P nas folhas superiores de ambas as variedades. A eficiência de utilização de Ca na parte aérea e em raízes decresceu com a aplicação do calcário em subsuperfície para ambas as variedades, enquanto a eficiência de utilização de P diminuiu somente para a parte aérea da var. Icatu. A aplicação do calcário na subsuperfície reduziu o teor de Al na parte aérea da var. Icatu e em raízes da var. Catuaí. Os teores de P, Ca e Mg nas folhas foram adequados às variedades, independentemente da quantidade de calcário aplicada ao solo, indicando que a adubação e a correção da acidez da camada superficial do solo foram eficientes para manter a planta nutrida, independentemente do teor de Al na subsuperfície do solo.

A vaccine against nicotine for smoking cessation: a randomized controlled trial.

BACKGROUND: Tobacco dependence is the leading cause of preventable death and disabilities worldwide and nicotine is the main substance responsible for the addiction to tobacco. A vaccine against nicotine was tested in a 6-month randomized, double blind phase II smoking cessation study in 341 smokers with a subsequent 6-month follow-up period. METHODOLOGY/PRINCIPAL FINDINGS: 229 subjects were randomized to receive five intramuscular injections of the nicotine vaccine and 112 to receive placebo at monthly intervals. All subjects received individual behavioral smoking cessation counseling. The vaccine was safe, generally well tolerated and highly immunogenic, inducing a 100% antibody responder rate after the first injection. Point prevalence of abstinence at month 2 showed a statistically significant difference between subjects treated with Nicotine-Qbeta (47.2%) and placebo (35.1%) (P = 0.036), but continuous abstinence between months 2 and 6 was not significantly different. However, in subgroup analysis of the per-protocol population, the third of subjects with highest antibody levels showed higher continuous abstinence from month 2 until month 6 (56.6%) than placebo treated participants (31.3%) (OR 2.9; P = 0.004) while medium and low antibody levels did not increase abstinence rates. After 12 month, the difference in continuous abstinence rate between subjects on placebo and those with high antibody response was maintained (difference 20.2%, P = 0.012). CONCLUSIONS: Whereas Nicotine-Qbeta did not significantly increase continuous abstinence rates in the intention-to-treat population, subgroup analyses of the per-protocol population suggest that such a vaccination against nicotine can significantly increase continuous abstinence rates in smokers when sufficiently high antibody levels are achieved. Immunotherapy might open a new avenue to the treatment of nicotine addiction. TRIAL REGISTRATION: Swiss Medical Registry 2003DR2327; ClinicalTrials.gov NCT00369616.

Mineralogia de partículas envolvidas na formação de gradiente textural em um argissolo subtropical

A presença de gradiente textural é comum e marcante em Argissolos. O objetivo do trabalho foi estudar a mineralogia das partículas envolvidas no processo de formação de gradiente textural em um solo subtropical do Rio Grande do Sul. Amostras de um Argissolo Vermelho-Amarelo distrófico abrúptico, material parental sedimentar, foram coletadas em duas trincheiras localizadas em distintas posições no relevo da área do departamento de solos da Universidade Federal de Santa Maria. No perfil 1, sob campo nativo e posicionado na meia encosta de uma colina com 9 % declividade, amostras foram coletadas nos horizontes A1, A2, AB e Bt. No perfil 2, sob vegetação espontânea e localizado no topo plano da colina, amostras foram coletadas nos horizontes A1, A2, E e Bt. Atributos químicos foram avaliados sobre a fração de solo menor que 2 mm. Amostras de argila dispersa em NaOH, após serem extraídas, foram submetidas à difração laser, discriminando a distribuição do tamanho de partícula envolvida no processo. A fração menor que 0,2 μm foi extraída, saturada com Ca2+ e submetida à difração de raios X sob os seguintes tratamentos: normal, à temperatura ambiente (N); depois de saturada com etilenoglicol (EG), depois de aquecida a 300 e 550 ºC. Os difratogramas de raios X (N) foram submetidos à modelagem matemática com DecompRX. Ambos os perfis apresentaram gradiente textural. Os teores de argila no horizonte Bt foram 2,9 e 4,4 vezes maiores no perfil 1 e 2 que nos seus respectivos horizontes mais arenosos. Os diagramas de difração laser mostraram enriquecimento no horizonte Bt em partículas de tamanho modal de 0,09 e 0,2 μm. A mineralogia dessa fração apresentou incremento nos horizontes Bt de interestratificados caulinita-esmectita (C-E) em detrimento das fases vermiculita hidróxi-Al entrecamada (VHE) e ilita-esmectita (I-E). Dessa forma, infere-se que o gradiente textural observado no solo está associado ao processo de migração de C-E com partículas de tamanho modal de 0,09 e 0,2 μm. Entretanto, o perfil 2 apresenta indícios de descontinuidade litológica, indicando que o processo de migração de partículas não é o único responsável pela formação de gradiente textural.

Factors influencing emergency delays in acute stroke management.

Early admission to hospital with minimum delay is a prerequisite for successful management of acute stroke. We sought to determine our local pre- and in-hospital factors influencing this delay. Time from onset of symptoms to admission (admission time) was prospectively documented during a 6-month period (December 2004 to May 2005) in patients consecutively admitted for an acute focal neurological deficit presented at arrival and of presumed vascular origin. Mode of transportation, patient's knowledge and correct recognition of stroke symptoms were assessed. Physicians contacted by the patients or their relatives were interviewed. The influence of referral patterns on in-hospital delays was further evaluated. Overall, 331 patients were included, 249 had an ischaemic and 37 a haemorrhagic stroke. Forty-five patients had a TIA with neurological symptoms subsiding within the first hours after admission. Median admission time was 3 hours 20 minutes. Transportation by ambulance significantly shortened admission delays in comparison with the patient's own means (HR 2.4, 95% CI 1.6-3.7). The only other factor associated with reduced delays was awareness of stroke (HR 1.9, 95% CI 1.3-2.9). Early in-hospital delays, specifically time to request CT-scan and time to call the neurologist, were shorter when the patient was referred by his family or to a lesser extent by an emergency physician than by the family physician (p < 0.04 and p < 0.01, respectively) and were shorter when he was transported by ambulance than by his own means (p < 0.01). Transportation by ambulance and referral by the patient or family significantly improved admission delays and early in-hospital management. Correct recognition of stroke symptoms further contributed to significant shortening of admission time. Educational programmes should take these findings into account.