Determinants of antithrombotic choice for patent foramen ovale in cryptogenic stroke.

OBJECTIVE: We examined the influence of clinical, radiologic, and echocardiographic characteristics on antithrombotic choice in patients with cryptogenic stroke (CS) and patent foramen ovale (PFO), hypothesizing that features suggestive of paradoxical embolism might lead to greater use of anticoagulation. METHODS: The Risk of Paradoxical Embolism Study combined 12 databases to create the largest dataset of patients with CS and known PFO status. We used generalized linear mixed models with a random effect of component study to explore whether anticoagulation was preferentially selected based on the following: (1) younger age and absence of vascular risk factors, (2) "high-risk" echocardiographic features, and (3) neuroradiologic findings. RESULTS: A total of 1,132 patients with CS and PFO treated with anticoagulation or antiplatelets were included. Overall, 438 participants (39%) were treated with anticoagulation with a range (by database) of 22% to 54%. Treatment choice was not influenced by age or vascular risk factors. However, neuroradiologic findings (superficial or multiple infarcts) and high-risk echocardiographic features (large shunts, shunt at rest, and septal hypermobility) were predictors of anticoagulation use. CONCLUSION: Both antithrombotic regimens are widely used for secondary stroke prevention in patients with CS and PFO. Radiologic and echocardiographic features were strongly associated with treatment choice, whereas conventional vascular risk factors were not. Prior observational studies are likely to be biased by confounding by indication.

Aprender Creativamente a Cooperar: La Inteligencia Espiritual

Es preciso, una cooperación que sea capaz de tener permanentemente en cuenta la visión, la nueva mirada, hacia el otro. Un pequeño paso dado, por muchos, constituye un gran salto. En esta comunicación quisiera presentar cómo a través del cultivo de la inteligencia espiritual podría aprenderse creativamente a cooperar.

Networks of noisy oscillators with correlated degree and frequency dispersion

We investigate how correlations between the diversity of the connectivity of networks and the dynamics at their nodes affect the macroscopic behavior. In particular, we study the synchronization transition of coupled stochastic phase oscillators that represent the node dynamics. Crucially in our work, the variability in the number of connections of the nodes is correlated with the width of the frequency distribution of the oscillators. By numerical simulations on Erdös-Rényi networks, where the frequencies of the oscillators are Gaussian distributed, we make the counterintuitive observation that an increase in the strength of the correlation is accompanied by an increase in the critical coupling strength for the onset of synchronization. We further observe that the critical coupling can solely depend on the average number of connections or even completely lose its dependence on the network connectivity. Only beyond this state, a weighted mean-field approximation breaks down. If noise is present, the correlations have to be stronger to yield similar observations.

Successful embolization of a delayed splenic rupture following trauma in a child.

Delayed rupture of the spleen following trauma is an exceedingly rare phenomenon in children. In the case we have experienced, arterial embolization was successfully performed, surgery was avoided, and functional splenic tissue was preserved. Embolization is of value in the management of blunt splenic injuries in hemodynamically stable children, even after delayed rupture. The exact criteria for its use remain to be established.

Pode a gestação influenciar a evolução de nódulo tireoidiano maligno?

Os autores descrevem um nódulo tireoidiano com padrões ultrassonográfico e citopatológico benignos que diminuiu mais de 50% em três anos e se modificou durante a gestação, constatando-se que era carcinoma papilífero. Conclui-se que a gestação pode aumentar o risco de malignização ou acelerar o crescimento de nódulo tireoidiano maligno preexistente, corroborando dados da literatura.

Étude de faisabilité pour une mesure fiable de la mobilité après fracture du membre inférieur chez l'enfant

Introduction : Les fractures du membre inférieur (MI) de l'enfant traitées par immobilisation plâtrée engendrent une modification significative de la mobilité exacerbée en cas d'obésité. L'accéléromètre est un outil d'évaluation du degré d'activité physique (AP) de l'enfant scientifiquement validé. Il n'a jamais fait l'objet d'étude chez un enfant ayant souffert d'une fracture du MI. Le but de ce travail était d'identifier les problèmes dans l'utilisation d'un accéléromètre comme moyen de mesure de l'AP après fracture nécessitant une décharge du MI. Une adaptation de la réhabilitation post-traumatique en fonction du BMI pourrait alors être proposée. Méthode : Identification d'enfants âgés de 8 et 15 ans, victimes d'une fracture du membre inférieur, consultant aux urgences de l'Hôpital de l'Enfance d'octobre 2013 à mai 2014 et nécessitant une décharge post-traumatique. Etaient exclus les enfants polytraumatisés ou souffrants d'un déficit mental. Données pré-requises des patients: âge, poids, taille, sexe, mécanisme de l'accident, type de fracture et traitement. Proposition de port d'un Actiwatch® Spectrum au poignet et cheville pour la période de remobilisation en décharge. Identification des avantages et problèmes liés à l'usage de l'appareil durant les premiers 30 jours de la période de réhabilitation. Importance : L'absence totale d'étude sur la mobilité post-fracture, la complexité des problèmes liés à la marche en décharge, les contraintes de l'immobilisation plâtrée et la prévalence grandissante de l'obésité pédiatrique justifient la recherche d'un moyen fiable pour quantifier la mobilité d'un enfant en décharge après traumatisme du MI. Résultats : Sur 43 fractures du MI traitées à l'HEL durant la période de l'étude, 13 enfants identifiés, dont 1 exclu pour maladie psychiatrique, 1 refus de participation, 2 transferts immédiats, 2 non inclus pour causes pratiques. Sept garçons âgés de 11 à 16 ans ont accepté le port de l'Actiwatch® pour une durée variant entre 7 et 27 jours (moyenne 15). Nombre d'activités (NA) médians de 5 enfants: 171,79 ±105,37 [cpm]* à J1 et 219,48 ±145,52 [cpm] à J5. NA totales médianes sur 24h : 114'072±44'791 [cpm] à J1 et 234'452 ±134'775 [cpm] à J5. Une dynamique de regain de mobilité est mise en évidence avec intensités maximales et minimales du nombre d'activités pour chacun. La médiane du temps de sommeil des 5 enfants était de 716± 45,5 [mn]. Les problèmes rencontrés ont été d'ordre mécanique (Un Actiwatch® fut défectueux), d'ordre pratique (un perdu et rendu tardivement, un port intermittent, une réaction allergique au bracelet à 4j de port). Conclusions La compliance à l'utilisation de l'Actiwatch® sur toute la durée de la décharge n'était pas optimale. La mobilité moyenne des enfants était objectivable de par leur dynamique, leur intensité maximale et minimale et comparables vis-à-vis de certaines études. Une différence avec les sujets en surpoids est observable. La durée de sommeil de chaque enfant suggère que l'antalgie administrée en cours de traitement est suffisante. Utiliser ce capteur de manière prolongée et sur un grand collectif d'enfants serait un moyen fiable et simple d'objectiver la dynamique de reprise de l'activité physique chez ces patients. Profil de l'étude : observation de cas.

El atletismo a debate podológico

En este comentario pretendo exponer tres modalidades deportivas, dentro de la amplia gama del atletismo, que por sus características y esfuenos, a los que deben someterse los atletas, presentan lesiones que caen dentro del campo de la Podología. Empezamos por comentar el Sprint deporte de velocidad pura, seguiremos con las carreras de Fondo, para acabar con el Salto.

Biofouling e biodeterioração química de argamassa de cimento portland em reservatório de usina hidroelétrica

Last decade Brazilian rivers experimented progressive biofouling of Limnoperna fortunei communities and Cordylophora caspia hydroids. The microhabitat is so favorable that in around 1.5 years L. fortunei increased from 0.39 to nearby 149,000 units/m². Ten Portland cement mortar samples were produced with 1: 3.5: 0.4 dosages and installed for 1 year at Salto Caxias Brazilian Power Plant reservoir in 0.5 m and 1.0 m deep to investigate the biofouling influence on hydraulic civil structures. SEM, EDS, visual investigation and XRF results indicate none direct chemical interrelationships between L. fortunei and the mortar samples. However C. caspia diminished the mortar surface resistance and caused cement paste leaching.

Produção de poli(3-hidroxibutirato) por Cupriavidus Necator em meio hidrolisado de amido de arroz com suplementação de óleo de soja em diferentes temperaturas

Poly (3-hydroxybutyrate) (P(3HB)) is a biopolymer, completely biodegradable, which has similar properties to fuel-based polymers. However to make it economically competitive it is necessary the study of cheap sources of substrate. The influence of hydrolyzed rice starch supplemented with soybean oil at different temperatures (30, 35 and 40 °C) was studied in the production of P(3HB) by C. necator. The percentage of P(3HB) produced in the cultures at 30, 35 °C was 30, 39% and 35, 43% without and with supplementation of oil, respectively. The culture at 40 °C showed no production phase due to a possible oxygen limitation. These results demonstrate that hydrolyzed rice starch supplemented with soybean oil increases the yield of P(3HB) and temperature of 35 ºC is the most favorable for biopolymer production.

Maijani kanssa

Sottiisi.

Turun polkka

Kansansävelmä.

Fotossíntese, condutância estomática e produtividade de clones de Eucalyptus sob diferentes condições edafoclimáticas

O objetivo deste trabalho foi avaliar a fotossíntese, condutância estomática e produtividade de clones de Eucalyptus em duas áreas distintas: uma no Município de Eunápolis, Sul da Bahia, com precipitação bem distribuída ao longo do ano (área úmida); e outra em Salto da Divisa, Leste de Minas Gerais, com precipitação concentrada nos meses quentes do ano (área seca). Foram estudados quatro clones, avaliando-se o crescimento, através do inventário das árvores; e as variáveis fotossintéticas, medidas com o aparelho Infrared Gas Analyser (IRGA). Dentro de cada área só houve diferença significativa entre clones na área úmida quanto à variável volume de madeira. A produtividade dos clones na área úmida foi 3,3 vezes superior à produtividade da área seca. Na área úmida, todos os clones diminuíram a condutância estomática com o aumento do déficit de pressão de vapor, com queda de 0,16 mol m² s-1 para cada 1 kPa de aumento no DPV e taxa fotossintética máxima variando de 12,5 a 16,4 µmol m² s-1. A comparação entre os clones da área úmida resultou em diferença significativa do clone A, que apresentou fotossíntese máxima superior à dos demais. Na área seca não houve relação entre condutância estomática e DPV e não se observou diferença na fotossíntese entre os clones, que variou de 1,2 a 3,4 µmol m² s-1. Verificou-se relação linear entre a fotossíntese máxima e a produtividade dos clones, evidenciando que a taxa fotossintética foi um dos fatores responsáveis pela maior produtividade do Eucalyptus na área úmida.