Fatores associados a óbito e hospitalizações em uma clínica de insuficiência cardíaca

Trata-se de um estudo descritivo, retrospectivo, com abordagem quantitativa cujo objetivo geral foi descrever e analisar o perfil epidemiológico dos pacientes com Insuficiência Cardíaca atendidos pela Clinica de IC de um Hospital Universitário. Os objetivos específicos orientam-se para:(a)Caracterizar os casos de Insuficiência Cardíaca segundo variáveis demográficas, variáveis clínicas, de diagnóstico e co morbidades;(b)Comparar as características clínicas e demográficas dos pacientes conforme grupos etiológicos identificados e fração de ejeção;(c)Determinar a taxa de mortalidade e hospitalização dos pacientes acompanhados pela clínica. Os dados analisados neste estudo são oriundos de um banco de dados onde são alocadas informações dos pacientes em atendimento ambulatorial da referida clinica.Para a análise dos dados foi utilizada a estatística descritiva, freqüências e porcentagens assim como tabelas e gráficos para a demonstração dos dados levantados.Os mesmos foram analisados através do software SPSS v.18.0, no qual se utilizou a estatística multivariada e curvas de sobrevida de Kaplan-Meyer.Os resultados apontam para uma predominância masculina de 60,1%, com idade de 63,5 anos. Na caracterização quanto à classe funcional observa-se que a predominante é a classe funcional I e II com 73,6% do total. Os pacientes assistidos apresentam uma média de 42% da fração de ejeção do ventrículo esquerdo e 61,7% possuem etiologia não isquêmica. Em nosso estudo, descrevemos 71,8% de portadores de disfunção sistólica. Os pacientes com etiologia isquêmica tinham predomínio do sexo masculino(70,7%), e a etiologia não isquêmica com uma prevalência maior do sexo feminino(45,5%vs 29,3%;p<0,001). Além disso, os pacientes isquêmicos eram mais idosos (p<0,001), com historia familiar de DAC(p<0,041), presença de diabetes (p<0,001). A disfunção sistólica(FE<50%) era predominante no grupo de pacientes isquêmicos(77%vs 69%; p=0,048).As classes funcionais mais avançadas(III e IV) foram menos predominantes nos indivíduos isquêmicos(32,5%) em relação aos não isquêmicos(41,3%;p=0,041).O paciente de etiologia isquêmica recebeu tratamento farmacológico semelhante ao não isquêmico com exceção do uso de AAS(p<0,001).Esses indivíduos cursaram com maior numero de internações por outras causas exceto IC(p<0,001) e maior numero de óbitos(p=0,007).Em relação à fração de ejeção, observou-se que indivíduos com FE>50% tinham predomínio do sexo feminino(p=0,006),mais idosos(p<0,001),de etiologia não isquêmica(p=0,048) e classes funcionais I e II(p=0,025).Indivíduos com FE<50% eram mais graves, apresentando maior número de internações por IC(37,8%vs20%;p<0,001), e internações por outras causas(27,2%vs17,5%;p=0,018) e maior número de óbitos (18%vs8,4%;p=0,005) do que os com fração de ejeção preservada. O resultado desse estudo teve como finalidade o conhecimento do perfil de uma população própria, com o objetivo de aprimorar a assistência prestada a ela. Os enfermeiros de Clínicas de IC, juntos com os profissionais da equipe multidisciplinar, desempenham papel fundamental no acompanhamento, orientação e educação desses pacientes.

水生植物凤眼莲的种内基因型差异与入侵模式

原产于亚马逊河流域的水生植物凤眼莲（Eichhornia crassipes）在花部结构上有三种花型（L、M和S），故其配殖系统（mating system）为典型的三型花柱（tristyly）。但在入侵地区，它却常只有M和L两种花型，其中尤以M型占据绝对优势，使有性繁殖水平大为下降。为了解释凤眼莲在入侵过程中，花型频率为何发生变化以及该变化对其在入侵地的适应性进化上有何影响，作者在中国西南的两个居群中连续两年开展了野外生长和人工授粉实验，对比分析水面和泥地两类不同生境中M和L在克隆生长、生物量积累以及有性繁殖水平等方面的异同，并利用RAPD、 ISSR片段比较了具M型和L型花植物个体间的遗传变异水平。对三型花柱这一长期引人注目的遗传模式的分子位点也尝试了连锁片段的克隆和测序。 克隆生长的对比实验发现，在2004年，漂浮生长的M个体平均克隆分株数为25.37，L为21.20，前者显示较强的克隆生长能力（t＝2.252， P< 0.05）;2005年的实验再次证实M（每个个体19.83个分株）比L（每个个体15.53分株）表现出了显著较强的克隆优势（t＝2.631，P<0.001）。M较L多产生克隆约24%。 但在岸边泥地上固着生长时，2004年L个体平均克隆分株为16.20，M 为10.17个分株。L表现出了更强的克隆生长能力（t＝4.788，p<0.001），与漂浮生长状况下的情形恰恰相反，暗示M与L个体可能存在一定的生态位分化。这种分化可能是在入侵过程中形成的，也可能反映了原产地亚马孙流域旱涝交替造成的固着生长与漂浮生长交替发生的种内适应性。 生物量（干重）的对比分析发现，M个体在漂浮生长和固着生长的情况下都比L有着更高的生物量积累（漂浮生长实验：t＝6.173，p<0.005（2004年）;t＝6.99，p<0.001（2005年）。固着生长实验：t＝4.029，p<0.001）。生物量对凤眼莲的竞争和过冬有着一定的作用，因此较大的生物量积累可能是M个体在当地气候和环境中逐渐适应的一个结果。 有性繁殖的实验包括了实验个体的花序数与花朵数、自交与异交人工授粉的结实情况以及种子萌发率等方面的对比分析。结果表明，虽然M和L个体在花序数和花朵数上不存在显著差异，但是M个体在自交和异交的种子产量上比L略高，尤其是自交的种子产量，M显著高于L（M平均每个蒴果的自交种子产量为139.8，L为76.2）。以各100粒种子进行萌发实验，发现两花型之间在种子萌发率上不存在显著差异。对于M而言，其自交种子产量远大于异交种子产量 （139.8 vs. 93.3），且种子萌发率也略大于异交的种子萌发率（自交种子萌发率45.47％，异交种子萌发率 30.73％）。结合以上的实验结果，本文认为M基因型优势的形成可能与M个体与当地环境长期适应导致的生长与繁殖 上的优势有关。M的本地适应性是建立在特定的遗传背景上时，异交反而会破坏这种遗传组合，造成远交衰退。 对40个M和30个L个体进行20个RAPD引物和20个ISSR引物的遗传分析时发现，所有个体在RAPD表型上没有区别，但是在M中出现了3个ISSR表型，在L中出现了2个ISSR表型。本文还尝试利用RAPD技术扫描与三型花柱的遗传位点连锁的DNA片段。在146个RAPD随机引物中，初步发现两个候选片段，一个750bp，另一个2 000bp;已对它们进行了克隆、测序。 这些初步实验表明凤眼莲在我国的入侵可能伴随着基因型的差异表现和居群遗传分化，这种基因型的差异表现对该植物的成功入侵具有作用。其中，花型为M的个体的优势生长解释了该花型在中国分布区内的主导地位。推测该生长优势的遗传基础可能来源于基因组内较高的杂合子水平和在入侵地较长的适应历史，但最终结论尚有待进一步的实验证据。

Change in Pacific Northwest coastal ecosystems. Proceedings of the Pacific Northwest Coastal Ecosystems Regional Study Workshop, August 73-14, 1996, Troutdale, Oregon

Over the past one hundred and fifty years, the landscape and ecosystems of the Pacific Northwest coastal region, already subject to many variable natural forces, have been profoundly affected by human activities. In virtually every coastal watershed from the Strait of Juan de Fuca to Cape Mendocino, settlement, exploitation and development of resou?-ces have altered natural ecosystems. Vast, complex forests that once covered the region have been largely replaced by tree plantations or converted to non-forest conditions. Narrow coastal valleys, once filled with wetlands and braided streams that tempered storm runoff and provided salmon habitat, were drained, filled, or have otherwise been altered to create land for agriculture and other uses. Tideflats and saltmarshes in both large and small estuaries were filled for industrial, commercial, and other urban uses. Many estuaries, including that of the Columbia River, have been channeled, deepened, and jettied to provide for safe, reliable navigation. The prodigious rainfall in the region, once buffered by dense vegetation and complex river and stream habitat, now surges down sirfiplified stream channels laden with increased burdens of sediment and debris. Although these and many other changes have occurred incrementally over time and in widely separated areas, their sum can now be seen to have significantly affected the natural productivity of the region and, as a consequence, changed the economic structure of its human communities. This activity has taken place in a region already shaped by many interacting and dynamic natural forces. Large-scale ocean circulation patterns, which vary over long time periods, determine the strength and location of currents along the coast, and thus affect conditions in the nearshore ocean and estuaries throughout the region. Periodic seasonal differences in the weather and ocean act on shorter time scales; winters are typically wet with storms from the southwest while summers tend to be dry with winds from the northwest. Some phenomena are episodic, such as El Nifio events, which alter weather, marine habitats, and the distribution and survival of marine organisms. Other oceanic and atmospheric changes operate more slowly; over time scales of decades, centuries, and longer. Episodic geologic events also punctuate the region, such as volcanic eruptions that discharge widespread blankets of ash, frequent minor earthquakes, and major subduction zone earthquakes each 300 to 500 years that release accumulated tectonic strain, dropping stretches of ocean shoreline, inundating estuaries and coastal valleys, and triggering landslides that reshape stream profiles. While these many natural processes have altered, sometimes dramatically, the Pacific Northwest coastal region, these same processes have formed productive marine and coastal ecosystems, and many of the species in these systems have adapted to the variable environmental conditions of the region to ensure their long-term survival.

The Effects of Visual Object Size in The Depth Perception in KM Mouse

Whether mice perceive the depth of space dependent on the visual size of object targets was explored when visual cues such as perspective and partial occlusion in space were excluded. A mouse was placed on a platform the height of which is adjustable. The platform located inside a box in which all other walls were dark exception its bottom through that light was projected as a sole visual cue. The visual object cue was composed of 4x4 grids to allow a mouse estimating the distance of the platform relative to the grids. Three sizes of grids reduced in a proportion of 2/3 and seven distances with an equal interval between the platform and the grids at the bottom were applied in the experiments. The duration of a mouse staying on the platform at each height was recorded when the different sizes of the grids were presented randomly to test whether the Judgment of the mouse for the depth of the platform from the bottom was affected by the size information of the visual target. The results from all conditions of three object sizes show that time of mice staying on the platform became longer with the increase in height. In distance of 20 similar to 30 cm, the mice did not use the size information of a target to judge the depth, while mainly used the information of binocular disparity. In distance less than 20 cm or more than 30 cm, however, especially in much higher distance 50 cm, 60 cm and 70 cm, the mice were able to use the size information to do so in order to compensate the lack of binocular disparity information from both eyes. Because the mice have only 1/3 of the visual field that is binocular. This behavioral paradigm established in the current study is a useful model and can be applied to the experiments using transgenic mouse as an animal model to investigate the relationships between behaviors and gene functions.

Anomalous Pressure Behavior of N-Cluster Emissions in GaAs0.973Sb0.022N0.005

Photoluminescence of GaAs0.973Sb0.022N0.005 is investigated at different temperatures and pressures. Both the alloy band edge and the N-related emissions, which show different temperature and pressure dependences, are observed. The pressure coefficients obtained in the pressure range 0-1.4GPa for the band edge and N-related emissions are 67 and 45 meV/GPa, respectively. The N-related emissions shift to a higher energy in the lower pressure range and then begin to redshift at about 8.5 GPa. This redshift is possibly caused by the increase of the X-valley component in the N-related states with increasing pressure.

MnSi similar to 1.73 grown on silicon with mass-analyzed low energy dual ion beam epitaxy technique

Semiconducting manganese silicide, Mn27Si47 and Mn15Si26, were obtained using mass-analyzed low energy dual ion beam epitaxy technique, Auger electron spectroscopy depth profiles showed that some of the Mn ions were deposited on single-crystal silicon substrate and formed a 37.5 nm thick Mn film, and the other Mn ions were successfully implanted into the Si substrate with the implantation depth of 618 nm. Some samples were annealed in the atmosphere of flowing N-2 at 840 degreesC. X-ray diffraction measurements showed that the annealing was beneficial to the formation of Mn27Si47 and Mn15Si26 (C) 2001 Published by Elsevier Science B.V.

Development of expressed sequence tags from the bay scallop, Argopecten irradians irradians

The bay scallop, Argopecten irradians irradians, introduced from North America, has become one of the most important aquaculture species in China. Inan effort to identify scallop genes involved in host defense, a high-quality cDNA library was constructed from whole body tissues of the bay scallop. A total of 5828 successful sequencing reactions yielded 4995 expressed sequence tags (ESTs) longer than 100 bp. Cluster and assembly analyses of the ESTs identified 637 contigs (consisting of 2853 sequences) and 2142 singletons, totaling 2779 unique sequences. Basic Local Alignment Search Tool (BLAST) analysis showed that the majority (73%) of the unique sequences had no significant homology (E-value >= 0.005) to sequences in GenBank. Among the 748 sequences with significant GenBank matches, 160 (21.4%) were for genes related to metabolism, 131 (17.5%) for cell/organism defense, 124 (16.6%) for gene/protein expression, 83 (11.1%) for cell structure/motility, 70 (9.4%) for cell signaling/communication, 17 (2.3%) for cell division, and 163 (21.8%) matched to genes of unknown functions. The list of host-defense genes included many genes with known and important roles in innate defense such as lectins, defensins, proteases, protease inhibitors, heat shock proteins, antioxidants, and Toll-like receptors. The study provides a significant number of ESTs for gene discovery and candidate genes for studying host defense in scallops and other molluscs.

Atitudes dos médicos dentistas no tratamento médico-dentário de pacientes com deficiência mental

Monografia apresentada à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciada em Medicina Dentária

Estudo da prevalência da discrepância anterior de Bolton numa população ortodôntica portuguesa

Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Medicina Dentária

Body image and body satisfaction differ by race in overweight postpartum mothers.

BACKGROUND: Body image (BI) and body satisfaction may be important in understanding weight loss behaviors, particularly during the postpartum period. We assessed these constructs among African American and white overweight postpartum women. METHODS: The sample included 162 women (73 African American and 89 white) in the intervention arm 6 months into the Active Mothers Postpartum (AMP) Study, a nutritional and physical activity weight loss intervention. BIs, self-reported using the Stunkard figure rating scale, were compared assessing mean values by race. Body satisfaction was measured using body discrepancy (BD), calculated as perceived current image minus ideal image (BD<0: desire to be heavier; BD>0: desire to be lighter). BD was assessed by race for: BD(Ideal) (current image minus the ideal image) and BD(Ideal Mother) (current image minus ideal mother image). RESULTS: Compared with white women, African American women were younger and were less likely to report being married, having any college education, or residing in households with annual incomes >$30,000 (all p < 0.01). They also had a higher mean body mass index (BMI) (p = 0.04), although perceived current BI did not differ by race (p = 0.21). African Americans had higher mean ideal (p = 0.07) and ideal mother (p = 0.001) BIs compared with whites. African Americans' mean BDs (adjusting for age, BMI, education, income, marital status, and interaction terms) were significantly lower than those of whites, indicating greater body satisfaction among African Americans (BD(Ideal): 1.7 vs. 2.3, p = 0.005; BD(Ideal Mother): 1.1 vs. 1.8, p = 0.0002). CONCLUSIONS: Racial differences exist in postpartum weight, ideal images, and body satisfaction. Healthcare providers should consider tailored messaging that accounts for these racially different perceptions and factors when designing weight loss programs for overweight mothers.

A functional polymorphism in the 5HTR2C gene associated with stress responses also predicts incident cardiovascular events.

Previously we have shown that a functional nonsynonymous single nucleotide polymorphism (rs6318) of the 5HTR2C gene located on the X-chromosome is associated with hypothalamic-pituitary-adrenal axis response to a stress recall task, and with endophenotypes associated with cardiovascular disease (CVD). These findings suggest that individuals carrying the rs6318 Ser23 C allele will be at higher risk for CVD compared to Cys23 G allele carriers. The present study examined allelic variation in rs6318 as a predictor of coronary artery disease (CAD) severity and a composite endpoint of all-cause mortality or myocardial infarction (MI) among Caucasian participants consecutively recruited through the cardiac catheterization laboratory at Duke University Hospital (Durham, NC) as part of the CATHGEN biorepository. Study population consisted of 6,126 Caucasian participants (4,036 [65.9%] males and 2,090 [34.1%] females). A total of 1,769 events occurred (1,544 deaths and 225 MIs; median follow-up time = 5.3 years, interquartile range = 3.3-8.2). Unadjusted Cox time-to-event regression models showed, compared to Cys23 G carriers, males hemizygous for Ser23 C and females homozygous for Ser23C were at increased risk for the composite endpoint of all-cause death or MI: Hazard Ratio (HR) = 1.47, 95% confidence interval (CI) = 1.17, 1.84, p = .0008. Adjusting for age, rs6318 genotype was not related to body mass index, diabetes, hypertension, dyslipidemia, smoking history, number of diseased coronary arteries, or left ventricular ejection fraction in either males or females. After adjustment for these covariates the estimate for the two Ser23 C groups was modestly attenuated, but remained statistically significant: HR = 1.38, 95% CI = 1.10, 1.73, p = .005. These findings suggest that this functional polymorphism of the 5HTR2C gene is associated with increased risk for CVD mortality and morbidity, but this association is apparently not explained by the association of rs6318 with traditional risk factors or conventional markers of atherosclerotic disease.

Functional Variants in Notch Pathway Genes NCOR2, NCSTN, and MAML2 Predict Survival of Patients with Cutaneous Melanoma.

BACKGROUND: The Notch signaling pathway is constitutively activated in human cutaneous melanoma to promote growth and aggressive metastatic potential of primary melanoma cells. Therefore, genetic variants in Notch pathway genes may affect the prognosis of cutaneous melanoma patients. METHODS: We identified 6,256 SNPs in 48 Notch genes in 858 cutaneous melanoma patients included in a previously published cutaneous melanoma genome-wide association study dataset. Multivariate and stepwise Cox proportional hazards regression and false-positive report probability corrections were performed to evaluate associations between putative functional SNPs and cutaneous melanoma disease-specific survival. Receiver operating characteristic curve was constructed, and area under the curve was used to assess the classification performance of the model. RESULTS: Four putative functional SNPs of Notch pathway genes had independent and joint predictive roles in survival of cutaneous melanoma patients. The most significant variant was NCOR2 rs2342924 T>C (adjusted HR, 2.71; 95% confidence interval, 1.73-4.23; Ptrend = 9.62 × 10(-7)), followed by NCSTN rs1124379 G>A, NCOR2 rs10846684 G>A, and MAML2 rs7953425 G>A (Ptrend = 0.005, 0.005, and 0.013, respectively). The receiver operating characteristic analysis revealed that area under the curve was significantly increased after adding the combined unfavorable genotype score to the model containing the known clinicopathologic factors. CONCLUSIONS: Our results suggest that SNPs in Notch pathway genes may be predictors of cutaneous melanoma disease-specific survival. IMPACT: Our discovery offers a translational potential for using genetic variants in Notch pathway genes as a genotype score of biomarkers for developing an improved prognostic assessment and personalized management of cutaneous melanoma patients.