906 resultados para MITRAL VALVE REGURGITATION


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Polymerase chain reaction techniques were developed and applied to identify DNA from .40 species of prey contained in fecal (scat) soft-part matrix collected at terrestrial sites used by Steller sea lions (Eumetopias jubatus) in British Columbia and the eastern Aleutian Islands, Alaska. Sixty percent more fish and cephalopod prey were identified by morphological analyses of hard parts compared with DNA analysis of soft parts (hard parts identified higher relative proportions of Ammodytes sp., Cottidae, and certain Gadidae). DNA identified 213 prey occurrences, of which 75 (35%) were undetected by hard parts (mainly Salmonidae, Pleuronectidae, Elasmobranchii, and Cephalopoda), and thereby increased species occurrences by 22% overall and species richness in 44% of cases (when comparing 110 scats that amplified prey DNA). Prey composition was identical within only 20% of scats. Overall, diet composition derived from both identification techniques combined did not differ significantly from hard-part identification alone, suggesting that past scat-based diet studies have not missed major dietary components. However, significant differences in relative diet contributions across scats (as identified using the two techniques separately) reflect passage rate differences between hard and soft digesta material and highlight certain hypothesized limitations in conventional morphological-based methods (e.g., differences in resistance to digestion, hard part regurgitation, partial and secondary prey consumption), as well as potential technical issues (e.g., resolution of primer efficiency and sensitivity and scat subsampling protocols). DNA analysis of salmon occurrence (from scat soft-part matrix and 238 archived salmon hard parts) provided species-level taxonomic resolution that could not be obtained by morphological identification and showed that Steller sea lions were primarily consuming pink (Oncorhynchus gorbuscha) and chum (Oncorhynchus keta) salmon. Notably, DNA from Atlantic salmon (Salmo salar) that likely originated from a distant fish farm was also detected in two scats from one site in the eastern Aleutian Islands. Overall, molecular techniques are valuable for identifying prey in the fecal remains of marine predators. Combining DNA and hard-part identification will effectively alleviate certain predicted biases and will ultimately enhance measures of diet richness, fisheries interactions (especially salmon-related ones), and the ecological role of pinnipeds and other marine predators, to the benefit of marine wildlife conservationists and fisheries managers.

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Three new centric diatom species assigned to a new genus are described from Miocene lacustrine deposits of Idaho. Species of the new genus, Mesodictyon, have the areola cribrum in the middle of the loculus, strutted processes and radiating, non-fasciculated striae. The strutted processes of M. magnum (diameter 60-150 μm) have long (2-3 μm) tubular extensions. The strutted processes of M. fovis (diameter 14-80 μm) are in distinct pits near the junction of the face and mantle. The valve face of M. undulatum (diameter 10-44 μm) is weakly tangentially undulate. Preliminary evidence indicates that Mesodictyon has a wide geographic distribution and may be a useful biostratigraphic marker.

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The adaptation of a commercially available ice machine for autonomous photovoltaic operation without batteries is presented. In this adaptation a 1040 W(p) photovoltaic array directly feeds a variable-speed drive and a 24 V(dc) source. The drive runs an induction motor coupled by belt-and-pulley to an open reciprocating compressor, while the dc source supplies a solenoid valve and the control electronics. Motor speed and refrigerant evaporation pressure are set aiming at continuously matching system power demand to photovoltaic power availability. The resulting system is a simple integration of robust, standard, readily available parts. It produces 27 kg of ice in a clear-sky day and has ice production costs around US$0.30/kg. Although a few machine features might be specific to Brazil, its technical and economical guidelines are applicable elsewhere. Copyright (C); 2010 John Wiley & Sons, Ltd.

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A taxonomic survey of the diatom Pseudo-nitzschia H. Peragallo was carried out in the Parana and Santa Catarina coasts, Southern Brazil. Samples were taken in various localities along the coastline using vertical hauls from the bottom to the surface. Electron microscopy revealed five species: the potentially toxic P. australis Frenguelli, P calliantha Lundholm, Moestrup & Has le, P multiseries (Has le) Has le and P pungens (Grunow ex Cleve) Has le (plus P pungens var. cingulata Villac), and the non-toxic P linea Lundholm, Has le & G. A. Fryxell. Southern Brazilian strains of P. calliantha and P multiseries have previously been shown to be toxic, raising concerns about a potential contamination of mussels and oysters being commercially grounded in the region. High morphological variability was observed in valve characters of P calliantha and P pungens, in some cases confirmed in the literature. In P calliantha there was a conspicuous differentiation in two morphotypes separated from each other by the width and the shape of the valve, and the density of the poroids. P linea has not previously been found in Brazilian waters, and P pungens var. cingulata is a new record in Western Atlantic waters. Future investigations using molecular techniques will elucidate whether the genetic variability corresponds to the morphological variation and unveil the possible existence of semicryptic species of Pseudo-nitzschia inhabiting the South Brazilian coast.

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Plicatulostrea onca, a new genus and species of Plicatulidae, is described based on shell and anatomy. The samples were collected under intertidal rocks at Kungkrabaen Bay, Thailand. Plicatulostrea differs from other plicatulids mainly in lacking undulations or shell sculpture, by long projections of the hinge teeth of the right valve and extreme body compression. Plicatulostrea onca has a radially arranged spots at the shell surface and typical plicatulid anatomy, differing mainly by the richness of papillae on the mantle edge and by invasion of the gonad along the mantle lobes. Some comments on the anatomy of the family are also provided.

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A revision of the deep-water verticordiid genus Spinosipella is provided, based on conchological and anatomical characters. The genus is considered distinct from Verticordia (of which it was considered a subgenus) based on the strong ribs, prickly surface, reduction of lunula, relative large size, weakly spiral valve shape, and other characters. The following species are considered in the genus: (1) Spinosipella agnes new species, ranging from Florida, USA, to Rio de Janeiro, Brazil, and also including the Porcupine Abyssal Plain in the North Atlantic; (2) S. tinga new species, occurring from Rio de Janeiro to Rio Grande do Sul, Brazil; (3) S. acuticostata (Philippi, 1844), a Pliocene fossil from southern Italy; (4) S. deshayesiana (Fischer, 1862), from south and central Indo-Pacific (S. ericia Hedley, 1911, the type species of the genus, was revealed to be a new synonym of S. deshayesiana); and (5) S. costeminens (Poutiers, 1981), from the tropical west Pacific. The five species differ mainly in conchological details of the number and size of ribs, of the prickly sculpture, shape of the shell, of the hinge and the degree of convexity. Anatomical description is also provided for the two Pacific species, which differ among themselves mainly by the size of the pair of renal folds. From the standpoint of anatomical characters, the more significant are: the wide lithodesma; the elongation of the auricles, crossing the roof of pallial cavity; a tall digital fold in posterior region of supraseptal chamber; the low but wide palps; the muscular, gizzard-like stomach; the complete separation of both constituents of the hermaphroditic gonad (a ventro-posterior testicle and a centro-dorsal ovary), and a complete fusion of the visceral ganglia.

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FUNDAMENTO: Penicilina G benzatina a cada 3 semanas é o protocolo padrão para a profilaxia secundária para febre reumática recorrente. OBJETIVO: Avaliar o efeito da penicilina G benzatina em Streptococcus sanguinis e Streptococcus oralis em pacientes com doença valvular cardíaca, devido à febre reumática com recebimento de profilaxia secundária. MÉTODOS: Estreptococos orais foram avaliados antes (momento basal) e após 7 dias (7º dia) iniciando-se com penicilina G benzatina em 100 pacientes que receberam profilaxia secundária da febre reumática. Amostras de saliva foram avaliadas para verificar a contagem de colônias e presença de S. sanguinis e S. oralis. Amostras de saliva estimulada pela mastigação foram serialmente diluídas e semeadas em placas sobre agar-sangue de ovelhas seletivo e não seletivo a 5% contendo penicilina G. A identificação da espécie foi realizada com testes bioquímicos convencionais. Concentrações inibitórias mínimas foram determinadas com o Etest. RESULTADOS: Não foram encontradas diferenças estatísticas da presença de S. sanguinis comparando-se o momento basal e o 7º dia (p = 0,62). No entanto, o número existente de culturas positivas de S. oralis no 7º dia após a Penicilina G benzatina apresentou um aumento significativo em relação ao valor basal (p = 0,04). Não houve diferença estatística existente entre o momento basal e o 7º dia sobre o número de S. sanguinis ou S. oralis UFC/mL e concentrações inibitórias medianas. CONCLUSÃO: O presente estudo mostrou que a Penicilina G benzatina a cada 3 semanas não alterou a colonização por S. sanguinis, mas aumentou a colonização de S. oralis no 7º dia de administração. Portanto, a susceptibilidade do Streptococcus sanguinis e Streptococcus oralis à penicilina G não foi modificada durante a rotina de profilaxia secundária da febre reumática utilizando a penicilina G.

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Hunter syndrome (MPSII) is a rare X-linked lysosomal storage disorder that can affect multiple systems but primarily affects the heart. We report the case of a previously asymptomatic 23-year-old patient who had an attenuated form of MPSII and presented with refractory heart failure that required a heart transplant. The diagnosis was confirmed by detection of an increase in urinary excretion of glycosaminoglycans, a deficiency in enzymatic activity, and molecular analysis. A myocardial biopsy revealed hypertrophic cardiomyocytes, mild fibrosis, and lysosomal storage in interstitial cells. Molecular analysis identified a novel mutation in the iduronate-2-sulfatase gene. Although the clinical outcome was not favorable, we believe that this approach may be valid in end-stage heart failure. (C) 2012 Elsevier Inc. All rights reserved.

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Objective: Optimal surgical treatment of patients with transposition of the great arteries (TGA), ventricular septal defect (VSD), and pulmonary stenosis (PS) remains a matter of debate. This study evaluated the clinical outcome and right ventricle outflow tract performance in the long-term follow-up of patients subjected to pulmonary root translocation (PRT) as part of their surgical repair. Methods: From April 1994 to December 2010, we operated on 44 consecutive patients (median age, 11 months). All had malposition of the great arteries as follows: TGA with VSD and PS (n = 33); double-outlet right ventricle with subpulmonary VSD (n = 7); double-outlet right ventricle with atrioventricular septal defect (n = 1); and congenitally corrected TGA with VSD and PS (n 3). The surgical technique consisted of PRT from the left ventricle to the right ventricle after construction of an intraventricular tunnel that diverted blood flow from the left ventricle to the aorta. Results: The mean follow-up time was 72 +/- 52.1 months. There were 3 (6.8%) early deaths and 1 (2.3%) late death. Kaplan-Meier survival was 92.8% and reintervention-free survival was 82.9% at 12 years. Repeat echocardiographic data showed nonlinear growth of the pulmonary root and good performance of the valve at 10 years. Only 4 patients required reinterventions owing to right ventricular outflow tract problems. Conclusions: PRT is a good surgical alternative for treatment of patients with TGA complexes, VSD, and PS, with acceptable operative risk, high long-term survivals, and few reinterventions. Most patients had adequate pulmonary root growth and performance. (J Thorac Cardiovasc Surg 2012;143:1292-8)

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Background: In the presence of turbinate dysfunction, an inferior turbinectomy for persistent hypertrophy of bone and/or mucosa may be performed. We sought to explore anatomic feasibility of a transoral turbinectomy. Methods: After transoral inferior turbinectomy in 12 cadavers, average distances from the external nasal valve to inferior turbinate and from pyriform aperture to inferior turbinate were compared. Average "area of access" was calculated. Preoperative and postoperative nasal length, tip projection, and alar-base width were also compared. Results: Average distance from external nasal valve to inferior turbinate was 32.4 mm. Average distance from aperture to inferior turbinate was 2.4 mm (P < 0.0001). Average "areas of access" to nasal vault through the external nasal valve and mouth were 183.9 mm(2) and 243.6 mm(2) (P = 0.07), respectively. Conclusions: The transoral approach provides a larger "area of access" to the turbinate, a statistically significant reduction of distance to target, no postoperative changes in nasal soft tissue, and easier instrumentation.

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PURPOSE: Describe a modified technique to increase nostril cross-sectional area using rib and septal cartilage graft over alar nasal cartilages. METHODS: A modified surgical technique was used to obtain, carve and insert cartilage grafts over alar nasal cartilages. This study used standardized pictures and measured 90 cadaveric nostril cross-sectional area using Autocad (c); 30 were taken before any procedure and 60 were taken after grafts over lateral crura (30 using costal cartilage and 30 using septal cartilage). Statistical analysis were assessed using a model for repeated measures and ANOVA (Analysis of Variance) for the variable "area". RESULTS: There's statistical evidence that rib cartilage graft is more effective than septal cartilage graft. The mean area after the insertion of septal cartilage graft is smaller than the mean area under rib graft treatment (no confidence interval for mean difference contains the zero value and all P-values are below the significance level of 5%). CONCLUSIONS: The technique presented is applicable to increase nostril cross section area in cadavers. This modified technique revealed to enhance more nostril cross section area with costal cartilage graft over lateral crura rather than by septal graft.

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Objective: To validate the 2000 Bernstein Parsonnet (2000BP) and additive EuroSCORE (ES) to predict mortality in patients who underwent coronary bypass surgery and/or heart valve surgery at the Heart Institute, University of Sao Paulo (InCor/HC-FMUSP). Methods:A prospective observational design. We analyzed 3000 consecutive patients who underwent coronary bypass surgery and/or heart valve surgery, between May 2007 and July 2009 at the InCor/HC-FMUSP. Mortality was calculated with the 2000BP and ES models. The correlation between estimated mortality and observed mortality was validated by calibration and discrimination tests. Results: There were significant differences in the prevalence of risk factors between the study population, 2000BP and ES. Patients were stratified into five groups for 2000BP and three for the ES. In the validation of models, the ES showed good calibration (P = 0396), however, the 2000BP (P = 0.047) proved inadequate. In discrimination, the area under the ROC curve proved to be good for models, ES (0.79) and 2000BP (0.80). Conclusion: In the validation, 2000BP proved questionable and ES appropriate to predict mortality in patients who underwent coronary bypass surgery and/or heart valve surgery at the InCor/HC-FMUSP.

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INTRODUÇÃO: A esternotomia mediana longitudinal é a via de acesso mais utilizada no tratamento das doenças cardíacas. As infecções profundas da ferida operatória no pós-operatório das cirurgias cardiovasculares são uma complicação séria, com alto custo durante o tratamento. Diferentes estudos têm encontrado fatores de risco para o desenvolvimento de mediastinite e as variáveis pré-operatórias têm tido especial destaque. OBJETIVO: O objetivo deste estudo é identificar fatores de risco pré-operatórios para o desenvolvimento de mediastinite em pacientes submetidos a revascularização do miocárdio e a substituição valvar. MÉTODOS: Este estudo observacional representa uma coorte de 2768 pacientes operados consecutivamente. O período considerado para análise foi de maio de 2007 a maio de 2009 e não houve critérios de exclusão. Foi realizada análise univariada e multivariada pelo modelo de regressão logística das 38 variáveis pré-operatórias eleitas. RESULTADOS: Nesta série, 35 (1,3%) pacientes evoluíram com mediastinite e 19 (0,7%) com osteomielite associada. A idade média dos pacientes foi de 59,9 ± 13,5 anos e o EuroSCORE de 4,5 ± 3,6. A mortalidade hospitalar foi de 42,8%. Na análise multivariada, foram identificadas três variáveis como preditoras independentes de mediastinite: balão intra-aórtico (OR 5,41, 95% IC [1,83 -16,01], P=0,002), hemodiálise (OR 4,87, 95% IC [1,41 - 16,86], P=0,012) e intervenção vascular extracardíaca (OR 4,39, 95% IC [1,64 - 11,76], P=0,003). CONCLUSÃO: O presente estudo demonstrou que necessidade do suporte hemodinâmico pré-operatório com balão intra-aórtico, hemodiálise e intervenção vascular extracardíaca são fatores de risco para o desenvolvimento de mediastinite após cirurgia cardíaca.