Active mitral ring for post-surgical remote correction of residual mitral regurgitation on the beating heart.

OBJECTIVES: Residual mitral regurgitation after valve repair worsens patients' clinical outcome. Postimplant adjustable mitral rings potentially address this issue, allowing the reshaping of the annulus on the beating heart under echocardiography control. We developed an original mitral ring allowing valve geometry remodelling after the implantation and designed an animal study to assess device effectiveness in correcting residual mitral regurgitation. METHODS: The device consists of two concentric rings: one internal and flexible, sutured to the mitral annulus and a second external and rigid. A third conic element slides between the two rings, modifying the shape of the flexible ring. This sliding element is remotely activated with a rotating tool. Animal model: in adult swine, under cardio pulmonary bypass and cardiac arrest, we shortened the primary chordae of P2 segment to reproduce Type III regurgitation and implanted the active ring. We used intracardiac ultrasound to assess mitral regurgitation and the efficacy of the active ring to correct it. RESULTS: Severe mitral regurgitation (3+ and 4+) was induced in eight animals, 54 ± 6 kg in weight. Vena contracta width decreased from 0.8 ± 0.2 to 0.1 cm; proximal isovelocity surface area radius decreased from 0.8 ± 0.2 to 0.1 cm and effective regurgitant orifice area decreased from 0.50 ± 0.1 to 0.1 ± 0.1 cm(2). Six animals had a reversal of systolic pulmonary flow that normalized following the activation of the device. All corrections were reversible. CONCLUSIONS: Postimplant adjustable mitral ring corrects severe mitral regurgitation through the reversible modification of the annulus geometry on the beating heart. It addresses the frequent and morbid issue of recurrent mitral valve regurgitation.

Association of the presence of residual anti-Toxoplasma gondii IgM in pregnant women and their respective family groups in Miracema, Northwest Rio de Janeiro, Brazil

The seroprevalence of toxoplasmosis in 832 pregnant women in Miracema, Rio de Janeiro, was determined and 75.1% (625) and 2.0% (17) were anti-Toxoplasma gondii IgG and IgM positive, respectively. Out of the 17 IgM positive pregnant women, only one had low avidity IgG corresponding to the acute phase of the infection. All the other women presented with high avidity IgG and also presented with residual IgM anti-T. gondii. Of this sample, 106 received home visits (this includes 11 family nuclei of pregnant women with residual IgM anti-T. gondii, 68 nuclei of only IgG positive pregnant women and 27 nuclei of pregnant women with no antibodies to anti-T. gondii), resulting in 267 individuals visited. Out of these 267 individuals, 21 were positive for IgG and IgM anti-T. gondii and were candidates for the IgG avidity test. All of them presented with high avidity IgG and residual IgM. Five of these IgM+ individuals were (5/238; 2.1%) relatives of IgM negative pregnant women. The other 16 (16/29; 55.2%) were relatives of IgM+ pregnant women who were positive for residual IgM anti-T. gondii. This association was statistically significant (p = 0.0000). The analysis presented herein raises questions regarding the presence of residual IgM anti-T. gondii such as genetic determinants or even constant antigenic stimuli for the same family cluster.

The residual efficacy of a cypermethrin pour-on formulation applied on goats on the mortality and blood intake of Triatoma infestans

Triatoma infestans is the main vector of Trypanosoma cruzi, the aetiological agent of Chagas disease in the Gran Chaco region of South America. As a frequent blood meal source for triatomine bugs, domestic goats play a key role in the eco-epidemiology of Chagas disease. The aim of this study was to evaluate the mortality and blood intake of T. infestans fed on goats that had been treated with different doses of pour-on insecticide. Third-instar nymphs were fed on goats that had been treated with 0 cc, 5 cc, 10 cc or 15 cc of a pour-on formulation of cypermethrin. The exposure of T. infestans to animals treated at different post-application intervals revealed a residual activity of the insecticide. The mortality rate in the treated groups was higher than in the control groups until 30 days post-insecticide application (p = 0.03), except in the group treated with 5 cc, in which no mortality was detected after seven days of insecticide application. Rainfall affected the triatomicide effect, reducing the time of residual activity. The cypermethrin pour-on treatment decreased the blood intake of T. infestans. Thirty days after the cypermethrin application, nymph mortality was 16% (± 13) with both doses (10 cc and 15 cc). The 15 cc dose did not result in higher insect mortality or increased persistence compared to the 10 cc dose.

Residual antimalarials in malaria patients from Tanzania--implications on drug efficacy assessment and spread of parasite resistance.

Repeated antimalarial treatment for febrile episodes and self-treatment are common in malaria-endemic areas. The intake of antimalarials prior to participating in an in vivo study may alter treatment outcome and affect the interpretation of both efficacy and safety outcomes. We report the findings from baseline plasma sampling of malaria patients prior to inclusion into an in vivo study in Tanzania and discuss the implications of residual concentrations of antimalarials in this setting. In an in vivo study conducted in a rural area of Tanzania in 2008, baseline plasma samples from patients reporting no antimalarial intake within the last 28 days were screened for the presence of 14 antimalarials (parent drugs or metabolites) using liquid chromatography-tandem mass spectrometry. Among the 148 patients enrolled, 110 (74.3%) had at least one antimalarial in their plasma: 80 (54.1%) had lumefantrine above the lower limit of calibration (LLC = 4 ng/mL), 7 (4.7%) desbutyl-lumefantrine (4 ng/mL), 77 (52.0%) sulfadoxine (0.5 ng/mL), 15 (10.1%) pyrimethamine (0.5 ng/mL), 16 (10.8%) quinine (2.5 ng/mL) and none chloroquine (2.5 ng/mL). The proportion of patients with detectable antimalarial drug levels prior to enrollment into the study is worrying. Indeed artemether-lumefantrine was supposed to be available only at government health facilities. Although sulfadoxine-pyrimethamine is only recommended for intermittent preventive treatment in pregnancy (IPTp), it was still widely used in public and private health facilities and sold in drug shops. Self-reporting of previous drug intake is unreliable and thus screening for the presence of antimalarial drug levels should be considered in future in vivo studies to allow for accurate assessment of treatment outcome. Furthermore, persisting sub-therapeutic drug levels of antimalarials in a population could promote the spread of drug resistance. The knowledge on drug pressure in a given population is important to monitor standard treatment policy implementation.

Nutrientes y renovación del agua en aiguamolls de l’Empordà. (NE de la península Ibérica). Uso potencial de agua residual para la inundación de zonas húmedas

The monitoring of the ecological water quality of 'Aiguamolls de l’Empordà' Natural Park was carried out between September 1996 to August 1997. The aim was to evaluate the impact of effluent from a nearby wastewater treatment plant, on the flooding of marshes in the Natural Park. In this paper we present physical and chemical data together nutrient concentrations and its changes in the lentic system of the 'Aiguamolls de l’Empordà'. The ultimate aim was to evaluate the effect of reclaimed wastewater on the salt marsh system. Seasonal variation in nutrients concentrations and their relationship to turnover and source of water were analysed. Significant variation in the N/P ratio was related to water turnover. Confined systems presented lower values for this ratio. Taking into account the nutrient concentrations of the reclaimed water, which is rich in nitrogen, it is recommended flooding applied in zones with high water turnover and higher N/P ratios

Disponibilidade de fósforo para o arroz inundado sob efeito residual de calcário, gesso e esterco de curral aplicados na cultura do feijão

Foram realizados simultaneamente quatro experimentos em vasos com os solos Neossolo Flúvico (RU), Gleissolo Háplico (GX), Gleissolo Melânico (GM) e Organossolo Mésico (OY) artificialmente drenado, com objetivo de avaliar a influência de calcário, gesso e esterco de curral curtido - aplicados em cultivo prévio de feijoeiro, na eficiência de diferentes extratores e da fosfatase ácida, usados em amostra de solos aerados, antes da inundação; na predição da disponibilidade do P para a cultura após a inundação e na produção de arroz inundado. Após a colheita do feijoeiro, cinco repetições correspondentes a cada tratamento em cada solo foram misturadas entre si e colocadas em vasos de 5 dm³ (3,2 dm³ de solo) onde foi conduzido o experimento de arroz inundado. Nessa época, colheram-se subamostras para as determinações de P por Mehlich-1, Resina, Bray-1, P remanescente e atividade da fosfatase ácida no solo. O delineamento experimental utilizado foi o inteiramente casualizado, em esquema fatorial 3 x 2, sendo: três tratamentos de solo (calcário, gesso e sem aplicação de calcário e gesso) e dois níveis de esterco de curral curtido (com e sem) com quatro repetições. Os solos dos vasos permaneceram em inundação com uma lâmina de água de 3 cm sobre a superfície do solo. Após 60 dias de inundação, foram transplantadas plântulas de arroz e cultivadas até à maturação dos grãos. Durante o período experimental, o arroz recebeu adubação nitrogenada e potássica em cobertura. Os extratores de P e a atividade da fosfatase ácida, nas amostras dos solos aerados, antes do cultivo, não foram eficientes para predizer P disponível para o arroz inundado. A aplicação de esterco de curral curtido proporcionou maior disponibilidade de P, maiores produções de matéria seca de grãos e parte aérea, teores foliares e acúmulo de P nas plantas de arroz. Os solos apresentaram respostas variadas à aplicação de calcário e gesso.

Fitorremediação de solo contaminado com picloram por capim-pé-de-galinha-gigante (Eleusine coracana)

O longo efeito residual do herbicida picloram no solo aumenta o risco de lixiviação e de fitotoxicidade em culturas sucedâneas; sua presença no solo pode ser abreviada com o uso da fitorremediação. O objetivo deste trabalho foi avaliar a influência da densidade populacional de capim-pé-de-galinha-gigante (Eleusine coracana) sobre a fitorremediação de solo contaminado com o herbicida picloram. O experimento foi realizado em casa de vegetação localizada no município de Rio Verde-GO, no período de setembro de 2006 a fevereiro de 2007. Os tratamentos foram compostos pela combinação entre quatro densidades populacionais da espécie vegetal Eleusine coracana (capim-pé-de-galinha-gigante) (0, 7, 14 e 21 plantas por vaso, correspondendo a 0, 172, 344 e 516 plantas m-2, respectivamente) e três doses do picloram (0, 80 e 160 g ha-1 - aplicadas diretamente nos vasos, simulando níveis de contaminação do solo). Após o cultivo da espécie vegetal fitorremediadora no substrato por 100 dias, efetuou-se, no próprio vaso, a semeadura da soja (Glycine max L.), espécie utilizada como bioindicadora da presença do picloram. A espécie Eleusine coracana mostrou ter capacidade de remediar solos contaminados com o herbicida picloram. A partir de 172 plantas m-2, aumentos na densidade populacional da espécie fitorremediadora não proporcionaram redução de carryover do herbicida picloram sobre a cultura da soja semeada em sucessão.

Influência de esterco bovino e calcário sobre o efeito residual da adubação fosfatada para a Brachiaria brizantha cultivada após o feijoeiro

A deficiência de P é uma das limitações mais generalizadas ao estabelecimento e à manutenção de pastagens nas regiões tropicais. Essa deficiência é devida, principalmente, ao baixo teor e aos processos de adsorção/precipitação do P nos solos. Com o objetivo de avaliar a influência da calagem e da adubação orgânica sobre o efeito residual do P, aplicado ao feijoeiro, na nutrição fosfatada e no rendimento do braquiarão cultivado em sucessão, foram conduzidos, em casa de vegetação, quatro experimentos inteiramente ao acaso, em esquema fatorial 4 x 5 e três repetições. Cada unidade experimental foi constituída por um vaso contendo 4 dm³ dos solos: Latossolo Vermelho distrófico textura muito argilosa, Latossolo Vermelho-Amarelo distrófico textura argilosa, Latossolo Vermelho-Amarelo distrófico textura média e Neossolo Quartzarênico órtico textura arenosa. Cada solo, representando um experimento, recebeu os tratamentos constituídos de quatro doses de calcário (0,0; 0,5; 1,0; e 2,0 vezes a dose recomendada para elevar a saturação por bases a 60 %) e cinco doses de esterco bovino (0,0; 2,5; 5,0; 7,5; e 10,0 % do volume de solo). Os vasos foram cultivados com feijoeiro e, após a colheita deste, cultivaram-se três plantas de braquiarão, as quais foram submetidas a cortes consecutivos aos 70, 160 e 290 dias após a emergência. As produções totais de matéria seca e o acúmulo de P na parte aérea do braquiarão foram positivamente influenciados pela adubação orgânica e pela calagem. Esses tratamentos também influenciaram positivamente o efeito residual da adubação fosfatada, aplicada ao feijoeiro, na nutrição fosfatada e no rendimento do braquiarão.

Absence of residual Hodgkin's disease demonstrated by PET/CT in a deceased organ donor.

With the current limited availability of organs for transplantation, it is important to consider marginal donor candidates, including survivors of potentially curable malignancies such as lymphoma. The absence of refractory/recurrent residual disease at the time of brain death can be difficult to establish. Therefore, it is critical to have objective data to decide whether to proceed or not with organ procurement and transplantation. We report a unique situation in which (18)F-fluorodeoxyglucose positron emission tomography (PET) was used to rule out Hodgkin's lymphoma recurrence in a 33-year-old, heart-beating, brain-dead, potential donor with a past history of Hodgkin's disease and a persistent mediastinal mass. PET showed no significant uptake in the mass, allowing organ donation and transplantation to occur. We present a new means of evaluating potential brain-dead donors with a past history of some lymphoma, whereby PET may help transplant physicians by optimizing donation safety while rationalizing the inclusion of marginal donors.

Influence of liming on residual soil respiration and chemical properties in a tropical no-tillage system

Because of the climate changes occurring across the planet, especially global warming, the different forms of agricultural soil use have attracted researchers´ attention. Changes in soil management may influence soil respiration and, consequently, C sequestration. The objectives of this study were to evaluate the long-term influence of liming on soil respiration and correlate it with soil chemical properties after two years of liming in a no-tillage system. A randomized complete block design was used with six replications. The experimental treatments consisted of four lime rates and a control treatment without lime. Two years after liming, soil CO2 emission was measured and the soil sampled (layers 0-5, 5-10, 10-20, and 20-30 cm). The P, Ca2+ e Mg2+ soil contents and pH and base saturation were determined. CO2 emission from soil limed at the recommended rate was 24.1 % higher, and at twice the recommended rate, 47.4 % higher than from unlimed soil. Liming improved the chemical properties, and the linear increase in soil respiration rate correlated positively with the P, Ca2+ and Mg2+ soil contents, pH and base saturation, and negatively with H + Al and Al3+ contents. The correlation coefficient between soil respiration rate and chemical properties was highest in the 10-20 cm layer.

Year-round poultry litter decomposition and N, P, K and Ca release

Poultry litter is an important nutrient source in agriculture, although little information is available regarding its decomposition rate and nutrient release. To evaluate these processes, poultry litter (PL) was applied to the soil to supply 100, 200 and 300 kg ha-1 N contained in 4,953, 9,907 and 14,860 kg ha-1 PL, respectively. The litter bag technique was used to monitor the process of decomposition and nutrient release from the litter. These bags were left on the soil surface and collected periodically (after 15, 30, 60, 90, 120, 150, 180, 210, 240, 270, 300, 330, and 365 days). The dry matter (DM) loss was highest (35 %) after the first 30 days of field incubation. The highest nutrient release occurred in the first 60 days on the field, when 40, 34, 91, and 39 %, respectively, of N, P, K, and Ca of the initial PL dry matter (4,860 kg ha-1) was already released to the soil. In absolute terms, these percentages represent 40, 23, 134, and 69 kg ha-1 of N, P, K, and Ca and these values doubled and tripled as the PL fertilization rates increased to 9,907 and 14,860 kg ha-1, respectively. After one year of field incubation, the residual contents in the litter were 27, 15, 18 and 30 % of the initial DM , and N, P and Ca, respectively. The release rate of K was the fastest and 91 % of the K had been released from the PL after 30 days of field incubation.

Efeito residual da adubação da batata sobre a produção do milho-verde em cultivo sucessivo

Este trabalho foi realizado em áreas da Fazenda Experimental da Empresa de Pesquisa Agropecuária de Minas Gerais (Epamig), no Município de Três Pontas, MG. O objetivo foi analisar o efeito residual da adubação aplicada no solo, por ocasião do plantio da batata (Solanum tuberosum L.), em subseqüente cultivo de milho-verde (Zea mays L.). A batata, cv. Achat, plantada no espaçamento 0,80 m x 0,40 m, foi adubada nas doses: 0, 2 e 4 t ha-1 da fórmula 4-16-8. Após a colheita da batata, o milho-verde, híbrido AG162, foi semeado no delineamento experimental de blocos casualizados, com quatro repetições, e no esquema de parcelas subdivididas, a saber: nas parcelas, a adubação de plantio da batata, e nas subparcelas, a adubação de plantio do milho-verde (adubado e não adubado). As características analisadas foram: altura média da planta, número de espigas/parcela, produção de espiga com e sem palhas, e concentrações P, K+, Ca2+ e Mg2+. O aumento das doses da adubação mineral da batata aumentou os teores de P, K e Ca trocáveis no solo, os quais podem melhorar a produção do milho-verde em cultivo subseqüente.

Efeito residual da adubação com composto orgânico sobre o crescimento e produção de alface

Este trabalho teve como objetivo avaliar o efeito residual do composto orgânico sobre o crescimento e a produção da alface. Plantas da cultivar Babá foram adubadas com cinco doses de composto orgânico (0,0, 22,8, 45,6, 68,4 e 91,2 t/ha de matéria seca), na presença e na ausência de adubo mineral (643 kg/ha de 4-14-8 e duas aplicações de 30 kg/ha de N em cobertura). O efeito residual foi avaliado em um segundo cultivo nas mesmas parcelas, sem adição de adubos. Doses crescentes de composto orgânico aumentaram a produção da cultura até 27.367 kg/ha de matéria fresca, obtida na dose mais elevada em plantas cultivadas entre 80 e 110 dias após a aplicação do composto. A aplicação de adubo mineral não apresentou efeito residual. Os efeitos residuais do composto orgânico expressaram-se também pelo aumento linear dos teores de bases trocáveis, de P e da capacidade efetiva de troca de cátions, (CTC) do solo, que atingiram valores de 10,77 cmol c/dm³, 461 mg/dm³ e 11,08 cmol c/dm³, respectivamente.

Residual venous obstruction, alone and in combination with D-dimer, as a risk factor for recurrence after anticoagulation withdrawal following a first idiopathic deep vein thrombosis in the prolong study.

OBJECTIVE: This study aims to assess the predictive value of residual venous obstruction (RVO) for recurrent venous thrombo-embolism (VTE) in a study using D-dimer to predict outcome. DESIGN: This is a multicentre randomised open-label study. METHODS: Patients with a first episode of idiopathic VTE were enrolled on the day of anticoagulation discontinuation when RVO was determined by compression ultrasonography in those with proximal deep vein thrombosis (DVT) of the lower limbs. D-dimer was measured after 1 month. Patients with normal D-dimer did not resume anticoagulation while patients with abnormal D-dimer were randomised to resume anticoagulation or not. The primary outcome measure was recurrent VTE over an 18-month follow-up. RESULTS: A total of 490 DVT patients were analysed (after excluding 19 for different reasons and 118 for isolated pulmonary embolism (PE)). Recurrent DVT occurred in 19% (19/99) of patients with abnormal D-dimer who did not resume anticoagulation and 10% (31/310) in subjects with normal D-dimer (adjusted hazard ratio: 2.1; p = 0.02). Recurrences were similar in subjects either with (11%, 17/151) or without RVO (13%, 32/246). Recurrent DVT rates were also similar for normal D-dimer, with or without RVO, and for abnormal D-dimer, with or without RVO. CONCLUSIONS: Elevated D-dimer at 1 month after anticoagulation withdrawal is a risk factor for recurrence, while RVO at the time of anticoagulation withdrawal is not.