Tracheostomy in children.

We reviewed the records of 108 patients who had a tracheostomy performed over a 10-year period from July 1979 to April 1989. Median age at tracheostomy was 6 months (1 week-15 years). Indications for surgery were acquired subglottic stenosis (31.4%), bilateral vocal cord paralysis (22.2%), congenital airway malformations (22.2%) and tumours (11.1%). No epiglottis and no emergency situation had to be managed by tracheostomy. Operation was uneventful in all, but 8 patients (7.4%) developed a pneumothorax in the postoperative period. Twenty-one (19.5%) had severe complications during the cannulation period (tube obstruction in 11 patients with cardiorespiratory arrest in 4; dislocation of the tube in 6 patients). Fifteen patients (13.8%) had severe complications after decannulation (2 had a cardiorespiratory arrest); all 15 had to be recannulated. At the end of the study period 85 patients (78.7%) were successfully decannulated with a median period of tracheostomy of 486 days (8 days-6.6 years). The median hospital stay was 159 days (13 days-2.7 years). All patients could be discharged. Eight patients (7.4%) died but no death was related to tracheostomy. In summary the mortality rate is lower than reported in previous reviews and tracheostomy is a safe operation even in small children but cannula-related complications may lead to life-threatening events. The management of tracheostomized small children and infants in a highly staffed and monitored intensive care unit has allowed better handling of complications and has resulted in a reduction in cannula-related deaths.

Produção e sobrevivência de miniestacas e minicepas de erva-mate cultivadas em sistema semi-hidropônico

O objetivo deste trabalho foi avaliar a viabilidade técnica do sistema semi-hidropônico para condução de minicepas de erva-mate e a resposta destas a soluções nutritivas de diferentes diluições nas sucessivas coletas, bem como, a sobrevivência das miniestacas produzidas neste sistema, após enraizamento. Depois de onze coletas, obteve-se 95,6% de sobrevivência das minicepas e média de 291 miniestacas m-2 de minijardim. As mudas obtidas por miniestaquia apresentaram média de 85,6% de sobrevivência, sem variação significativa entre as soluções testadas e número da coleta. O sistema adotado é tecnicamente viável, e recomenda-se a utilização de solução nutritiva menos concentrada.

L"herbari de la Institució Catalana d"Història Natural.

El herbario de la Institució Catalana d"Història Natural En este trabajo presentamos un estudio sobre el herbario de la Institució Catalana d"Història Natural. Mostramos estadísticas sobre los recolectores, los años y las localidades de recolección, las familias y los grupos taxonómicos representados, así como un listado de pliegos tipo y otros ejemplares de interés taxonómico. El herbario consta, actualmente, de 1.202 pliegos. Está constituido, casi en su totalidad, por plantas cedidas por la familia de Frederic Trèmols y por parte de la exsiccata «Plantes d"Espagne» del hermano Sennen. Los materiales proceden principalmente de Cataluña (532 pliegos, un 44 %), del resto del Estado Español (218, un 18 %) y del continente europeo (125, un 10 %), e incluyen una proporción de crucíferas poco habitual en nuestros herbarios (253, un 21 %). Por otra parte, de los 112 pliegos tipos presentes en el herbario, muy pocos taxones son reconocidos en floras actuales, como la Achillea millefolium L. subsp. ceretanica (Sennen) O. Bolòs & Vigo o el Eryngium × chevalieri Sennen. Sin embargo, el interés científico de esta colección resulta limitado, dado que una gran parte de los pliegos son duplicados de otras colecciones depositadas también en el Instituto Botánico de Barcelona.

The ADVANCE trial: clarifying the role of perindopril/indapamide fixed-dose combination in the reduction of cardiovascular and renal events in patients with diabetes mellitus.

Patients with type 2 diabetes mellitus exhibit a marked increase in cardiovascular and renal risk. A number of interventional trials have shown that these patients benefit greatly from aggressive BP lowering, especially when the drug regimen comprises an inhibitor of the renin-angiotensin system. The results of the placebo-controlled ADVANCE (Action in Diabetes and Vascular disease: PreterAx and DiamicroN MR Controlled Evaluation) trial, conducted in patients with type 2 diabetes, are exemplary in this respect. The systematic use of a fixed-dose combination containing the ACE inhibitor perindopril and the diuretic indapamide afforded substantial protection against cardiovascular mortality and myocardial infarction, while providing important renoprotection, reducing the development of micro- and macroalbuminuria, and allowing regression of nephropathy. The beneficial effects were obtained regardless of baseline BP and whether or not the patients were receiving antihypertensive therapy.

Crònica (il·lustrada) d’un viatge al paradís: expedició a les Illes Salvatges

Entre l’11 i el 27 de març va tenir lloc l’expedició “Savage Islands Botanical Expedition 2013 – Expedição Botânica Ilhas Selvagens 2013”, que va constituir un dels moments més àlgids i alhora emocionants del projecte “Conservation of the critically endangered endemic flora of the Selvagens Islands, Atlantic Ocean”, finançat per The Mohammed bin Zayed Species Conservation Fund (http://www.speciesconservation.org/). Aquest projecte se centra en l’estudi de tres endemismes exclusius de l’arxipèlag de les Salvatges greument amenaçats, amb l’objectiu final d’implementar mesures efectives per a la seva conservació (vegeu http://www.speciesconservation.org/case‐studies‐projects//1651 per a més informació). Aquests tres endemismes (Euphorbia anachoreta, Asparagus nesiotes subsp. nesiotes i Argyranthemum thalassophilum) compten amb molts pocs efectius (abans de l’expedició s’estimava una mida poblacional inferior a la cinquantena per als dos primers, i de menys de 250 per al darrer) i tenen un gran interès des del punt de vista biogeogràfic atesos l’aïllament de l’arxipèlag (el territori terrestre més proper són les Illes Canàries, situades a uns 165 quilòmetres al sud) i la seva antiguitat geològica (prop de 30 milions d’anys, essent l’arxipèlag més antic de tota la Macaronèsia; Geldmacher et al., 2001).

Effectiveness of neutral RAPD markers to detect genetic divergence between the subspecies uncinata and mugo of Pinus mugo Turra

Abstract

Temozolomide versus standard 6-week radiotherapy versus hypofractionated radiotherapy in patients older than 60 years with glioblastoma: the Nordic randomised, phase 3 trial.

BACKGROUND: Most patients with glioblastoma are older than 60 years, but treatment guidelines are based on trials in patients aged only up to 70 years. We did a randomised trial to assess the optimum palliative treatment in patients aged 60 years and older with glioblastoma. METHODS: Patients with newly diagnosed glioblastoma were recruited from Austria, Denmark, France, Norway, Sweden, Switzerland, and Turkey. They were assigned by a computer-generated randomisation schedule, stratified by centre, to receive temozolomide (200 mg/m(2) on days 1-5 of every 28 days for up to six cycles), hypofractionated radiotherapy (34·0 Gy administered in 3·4 Gy fractions over 2 weeks), or standard radiotherapy (60·0 Gy administered in 2·0 Gy fractions over 6 weeks). Patients and study staff were aware of treatment assignment. The primary endpoint was overall survival. Analyses were done by intention to treat. This trial is registered, number ISRCTN81470623. FINDINGS: 342 patients were enrolled, of whom 291 were randomised across three treatment groups (temozolomide n=93, hypofractionated radiotherapy n=98, standard radiotherapy n=100) and 51 of whom were randomised across only two groups (temozolomide n=26, hypofractionated radiotherapy n=25). In the three-group randomisation, in comparison with standard radiotherapy, median overall survival was significantly longer with temozolomide (8·3 months [95% CI 7·1-9·5; n=93] vs 6·0 months [95% CI 5·1-6·8; n=100], hazard ratio [HR] 0·70; 95% CI 0·52-0·93, p=0·01), but not with hypofractionated radiotherapy (7·5 months [6·5-8·6; n=98], HR 0·85 [0·64-1·12], p=0·24). For all patients who received temozolomide or hypofractionated radiotherapy (n=242) overall survival was similar (8·4 months [7·3-9·4; n=119] vs 7·4 months [6·4-8·4; n=123]; HR 0·82, 95% CI 0·63-1·06; p=0·12). For age older than 70 years, survival was better with temozolomide and with hypofractionated radiotherapy than with standard radiotherapy (HR for temozolomide vs standard radiotherapy 0·35 [0·21-0·56], p<0·0001; HR for hypofractionated vs standard radiotherapy 0·59 [95% CI 0·37-0·93], p=0·02). Patients treated with temozolomide who had tumour MGMT promoter methylation had significantly longer survival than those without MGMT promoter methylation (9·7 months [95% CI 8·0-11·4] vs 6·8 months [5·9-7·7]; HR 0·56 [95% CI 0·34-0·93], p=0·02), but no difference was noted between those with methylated and unmethylated MGMT promoter treated with radiotherapy (HR 0·97 [95% CI 0·69-1·38]; p=0·81). As expected, the most common grade 3-4 adverse events in the temozolomide group were neutropenia (n=12) and thrombocytopenia (n=18). Grade 3-5 infections in all randomisation groups were reported in 18 patients. Two patients had fatal infections (one in the temozolomide group and one in the standard radiotherapy group) and one in the temozolomide group with grade 2 thrombocytopenia died from complications after surgery for a gastrointestinal bleed. INTERPRETATION: Standard radiotherapy was associated with poor outcomes, especially in patients older than 70 years. Both temozolomide and hypofractionated radiotherapy should be considered as standard treatment options in elderly patients with glioblastoma. MGMT promoter methylation status might be a useful predictive marker for benefit from temozolomide. FUNDING: Merck, Lion's Cancer Research Foundation, University of Umeå, and the Swedish Cancer Society.

Produtividade e rendimento do cafeeiro submetido a lâminas de irrigação

O objetivo deste trabalho foi avaliar a produtividade e o rendimento das quatro primeiras safras de cafeeiro (Coffea arabica L.), cultivado sob lâminas de irrigação. O experimento foi conduzido na Fazenda Experimental do Glória, Uberlândia, MG. O delineamento experimental foi o de blocos ao acaso, com quatro repetições e oito tratamentos constituídos das lâminas de irrigação equivalentes a 0 (sem irrigação), 30, 60, 90, 120, 150, 180 e 210% da evaporação em tanque Classe A (ECA). O plantio foi realizado em janeiro de 2001, no espaçamento de 3,5x0,7 m. As parcelas foram constituídas por três linhas com oito plantas cada. Foi utilizado o sistema de irrigação por gotejamento, com emissores autocompensantes de vazão 3,5 L h-1. A produtividade máxima foi de 115 sacas ha-1, obtida com a lâmina de 164,1% da ECA. A reposição de 143% da ECA propiciou rendimento ótimo de 291,8 L de "café da roça" por saca beneficiada. O efeito das lâminas de irrigação sobre a produtividade e o rendimento depende do ano. A irrigação não ameniza a bienalidade da produção do cafeeiro, em relação às plantas cultivadas em sequeiro.

Désensibilisation: vers de nouvelles perspectives [Allergen specific immunotherapy: review of new perspectives].

Allergic diseases constitute a health problem worldwide. More than just a treatment option, the classical desensitization (SIT--Specific immunotherapy) by subcutaneous injection has profiled over time as a unique approach, able to attenuate the immune response to allergic stimuli proved. For a long time conservative, desensitization has now progressed in the knowledge of allergens, in the understanding of the mechanisms involved in immune response and in production techniques. From recombinants to alternative routes of allergen delivery, this article gives an overview of new perspectives and assesses SIT in order to provide guidance to the general physician before choosing to initiate such treatment or not in patients with respiratory allergy.

Iowa Child Advocacy Board Annual Report, 2012

The Iowa Child Advocacy Board (ICAB) is an independent board composed of nine members appointed by the Governor of Iowa and confirmed by the Iowa Senate. ICAB establishes policies and procedures for two volunteer child advocacy programs: the Court Appointed Special Advocate (CASA) program and the Iowa Citizen Foster Care Review Boards programs.

Antagonismo direto e biocontrole da podridão-mole-do-tomateiro pelo uso de procariotas

O objetivo deste trabalho foi avaliar procariotas quanto ao potencial de antagonismo direto para o biocontrole da podridão-mole-do-tomateiro (Pectobacterium carotovorum subsp. carotovorum). Avaliaram-se 45 isolados bacterianos pelo teste de antibiose contra o patógeno. Foram feitos dois ensaios em que sementes de tomate (Lycopersicon esculentum Mill.) cv. Santa Clara foram infectadas com isolados antagônicos. As mudas foram transplantadas para solos infestados com suspensões de propágulos P. carotovorum com OD540 de 0,45 e 0,65. Os antagonistas UFV-0005, UFV-043, UFV-BF112 e UFV-0006 foram eficientes em proteger plantas de tomateiro contra a podridão-mole.

Physiological analysis of leaf senescence of two rice cultivars with different yield potential

The objective of this work was to evaluate the physiological changes that occur in different leaves during the early and late grain-filling stages of two rice genotypes (Oryza sativa subsp. indica , BRS Pelota cultivar, and O. sativa subsp. japonica , BRS Firmeza cultivar), which present differences in grain yield potential. The plants were cultivated in greenhouse. Pigment content, chlorophyll fluorescence, electron transport and oxygen evolution rate were determined in the grain-filling stage, from the first to the forth leaf (top to bottom). Pigment content, photochemical efficiency of photosystem II and electron transport decreased significantly according to the position of leaves in 'BRS Pelota'. The BRS Firmeza cultivar shows higher pigment content and higher activity of the photosynthetic apparatus in comparison to 'BRS Pelota' during the grain-filling stage.

Histoire ecclésiastique des Francs. Suivie d'un sommaire de ses autres ouvrages, et précédée de sa vie écrite au Xe siècle. Tome 2 / par saint Grégoire,... ; par Odon,... ; traduction nouvelle, par Henri Bordier

[Historia Francorum (français). 1859-1862]

Histoire ecclésiastique des Francs. Suivie d'un sommaire de ses autres ouvrages, et précédée de sa vie écrite au Xe siècle. Tome 1 / par saint Grégoire,... ; par Odon,... ; traduction nouvelle, par Henri Bordier

[Historia Francorum (français). 1859-1862]

Histoire ecclésiastique des Francs. Suivie d'un sommaire de ses autres ouvrages, et précédée de sa vie écrite au Xe siècle. Tome 2 / par saint Grégoire,... ; par Odon,... ; traduction nouvelle, par Henri Bordier

[Historia Francorum (français). 1859-1862]