Femoral versus Radial Access in Primary Angioplasty. Analysis of the ACCEPT Registry

Background:The radial access provides a lower risk of bleeding and vascular complications related to the puncture site in comparison to the femoral access. Recent studies have suggested a reduction in mortality associated with the radial access in patients with acute myocardial infarction undergoing percutaneous coronary intervention.Objective:To compare the occurrence of adverse cardiovascular ischemic and hemorrhagic events in patients undergoing primary angioplasty according to the type of arterial access route.Methods:From August 2010 to December 2011, 588 patients undergoing primary percutaneous coronary intervention during acute ST-segment elevation myocardial infarction were assessed; they were recruited from 47 centers participating in the ACCEPT registry. Patients were grouped and compared according to the arterial access used for the procedure.Results:The mean age was 61.8 years; 75% were males and 24% had diabetes mellitus. There was no difference between groups as regards the procedure success rate, as well as regards the occurrence of death, reinfarction, or stroke at six months of follow-up. Severe bleeding was reported in 1.1% of the sample analyzed, with no statistical difference related to the access used.Conclusions:The femoral and radial accesses are equally safe and effective for the performance of primary percutaneous coronary intervention. The low rate of cardiovascular events and of hemorrhagic complications reflects the quality of the participating centers and the operators expertise with the use of both techniques.

Diabetes Mellitus and Glucose as Predictors of Mortality in Primary Coronary Percutaneous Intervention

Background: Diabetes mellitus and admission blood glucose are important risk factors for mortality in ST segment elevation myocardial infarction patients, but their relative and individual role remains on debate. Objective: To analyze the influence of diabetes mellitus and admission blood glucose on the mortality of ST segment elevation myocardial infarction patients submitted to primary coronary percutaneous intervention. Methods: Prospective cohort study including every ST segment elevation myocardial infarction patient submitted to primary coronary percutaneous intervention in a tertiary cardiology center from December 2010 to May 2012. We collected clinical, angiographic and laboratory data during hospital stay, and performed a clinical follow-up 30 days after the ST segment elevation myocardial infarction. We adjusted the multivariate analysis of the studied risk factors using the variables from the GRACE score. Results: Among the 740 patients included, reported diabetes mellitus prevalence was 18%. On the univariate analysis, both diabetes mellitus and admission blood glucose were predictors of death in 30 days. However, after adjusting for potential confounders in the multivariate analysis, the diabetes mellitus relative risk was no longer significant (relative risk: 2.41, 95% confidence interval: 0.76 - 7.59; p-value: 0.13), whereas admission blood glucose remained and independent predictor of death in 30 days (relative risk: 1.05, 95% confidence interval: 1.02 - 1.09; p-value ≤ 0.01). Conclusion: In ST segment elevation myocardial infarction patients submitted to primary coronary percutaneous intervention, the admission blood glucose was a more accurate and robust independent predictor of death than the previous diagnosis of diabetes. This reinforces the important role of inflammation on the outcomes of this group of patients.

Experience of ECMO in Primary Graft Dysfunction after Orthotopic Heart Transplantation

Background:Primary graft dysfunction is the main cause of early mortality after heart transplantation. Mechanical circulatory support has been used to treat this syndrome.Objective:Describe the experience with extracorporeal membrane oxygenation to treat post-transplant primary cardiac graft dysfunction.Methods:Between January 2007 and December 2013, a total of 71 orthotopic heart transplantations were performed in patients with advanced heart failure. Eleven (15.5%) of these patients who presented primary graft dysfunction constituted the population of this study. Primary graft dysfunction manifested in our population as failure to wean from cardiopulmonary bypass in six (54.5%) patients, severe hemodynamic instability in the immediate postoperative period with severe cardiac dysfunction in three (27.3%), and cardiac arrest (18.2%). The average ischemia time was 151 ± 82 minutes. Once the diagnosis of primary graft dysfunction was established, we installed a mechanical circulatory support to stabilize the severe hemodynamic condition of the patients and followed their progression longitudinally.Results:The average duration of extracorporeal membrane oxygenation support was 76 ± 47.4 hours (range 32 to 144 hours). Weaning with cardiac recovery was successful in nine (81.8%) patients. However, two patients who presented cardiac recovery did not survive to hospital discharge.Conclusion:Mechanical circulatory support with central extracorporeal membrane oxygenation promoted cardiac recovery within a few days in most patients.

Serial High-Sensitivity Troponin T in Post-Primary Angioplasty Exercise Test

Abstract Background: The kinetics of high-sensitivity troponin T (hscTnT) release should be studied in different situations, including functional tests with transient ischemic abnormalities. Objective: To evaluate the release of hscTnT by serial measurements after exercise testing (ET), and to correlate hscTnT elevations with abnormalities suggestive of ischemia. Methods: Patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary angioplasty were referred for ET 3 months after infarction. Blood samples were collected to measure basal hscTnT immediately before (TnT0h), 2 (TnT2h), 5 (TnT5h), and 8 hours (TnT8h) after ET. The outcomes were peak hscTnT, TnT5h/TnT0h ratio, and the area under the blood concentration-time curve (AUC) for hscTnT levels. Log-transformation was performed on hscTnT values, and comparisons were assessed with the geometric mean ratio, along with their 95% confidence intervals. Statistical significance was assessed by analysis of covariance with no adjustment, and then, adjusted for TnT0h, age and sex, followed by additional variables (metabolic equivalents, maximum heart rate achieved, anterior wall STEMI, and creatinine clearance). Results: This study included 95 patients. The highest geometric means were observed at 5 hours (TnT5h). After adjustments, peak hscTnT, TnT5h/TnT0h and AUC were 59% (p = 0.002), 59% (p = 0.003) and 45% (p = 0.003) higher, respectively, in patients with an abnormal ET as compared to those with normal tests. Conclusion: Higher elevations of hscTnT may occur after an abnormal ET as compared to a normal ET in patients with STEMI.

Prevalence of Risk for Obstructive Sleep Apnea Syndrome and Association With Risk Factors in Primary Care

Abstract Background: Obstructive sleep apnea syndrome (OSAS) is a chronic, progressive disease with high morbidity and mortality. It is underdiagnosed, especially among women. Objective: To study the prevalence of high risk for OSAS globally and for the Berlin Questionnaire (BQ) categories, and to evaluate the reliability of the BQ use in the population studied. Methods: Observational, cross-sectional study with individuals from the Niterói Family Doctor Program, randomly selected, aged between 45 and 99 years. The visits occurred between August/2011 and December/2012. Variables associated with each BQ category and with high risk for OSAS (global) were included in logistic regression models (p < 0.05). Results: Of the total (616), 403 individuals (65.4%) reported snoring. The prevalence of high risk for OSA was 42.4%, being 49.7% for category I, 10.2% for category II and 77.6% for category III. Conclusion: BQ showed an acceptable reliability after excluding the questions Has anyone noticed that you stop breathing during your sleep? and Have you ever dozed off or fallen asleep while driving?. This should be tested in further studies with samples mostly comprised of women and low educational level individuals. Given the burden of OSAS-related diseases and risks, studies should be conducted to validate new tools and to adapt BQ to better screen OSAS.

Estudos químico-agrícolas sôbre o enxofre

1. Analyses of soluble sulphates in 2 N ammonium chloride extracts of 24 samples of soils of the state of São Paulo, Brazil, S. A., showed a sulphur content varying from 0,0013 g per 100 g (found in the b layer of a genuine "terra roxa") to 0,007 g per 100 g of soil (b layer of a soil of depression without definite characteristics). (The results are expressed as elemental sulphur). Determinations of total sulphur in 56 samples of soils of the same state using the method of fusion with sodium carbonate and sodium nitrate revealed 0.007 g of elemental S per 100 g of soil as the lowest value (found in several soil types) and 0.096 g as the highest one (found in the b layer of an ar-quean soil). Apparently soluble sulphates accumulate in the upper layers and total sulphur does the opposite. It was found a strong correlation between total S and carbon content. 2. Under laboratory conditions, in a compost of fresh soil, powdered sulphur and apatite, it was verified after a three months period of incubation that the pH value lowered from 6.30 to 3.23; the citric acid solubility of apatite increased to 271.1 per cent of the original one. Lupinus sp. grown in soil manured with sulphur and apatite has showed fresh and dry weights higher than the plants in control pots; the results are significant at 5% level of probability; phosphorus content is also higher in the manured plants. It was observed a net influence of the apatite plus sulphur treatment on the weight of root nodosities that was four times greater than in the control plants. 3. Nearly five hundred determinations of S, N and P were carried out in 35 species of plants cultivated in the state of São Paulo. A great variation in the amounts of these elements was observed. As a general rule, the leaves contain more sulphur than the stems and roots show the lowest percentages. The conjunct roots and stem of guar (Cyamopsis psoraloides) revealed only 0.019 per cent sulphur; the leaves of kale showed the highest sulphur content, i. e., 2.114%. Apparently there is no correlation between the amounts of S, N and P. The ratio S/N increases from 0.006 (guar) to 0.485 (kale). The ratio S/P, always higher than the corresponding S/N, increases from 0.082 (guar) to 6.381 (older leaves of tomato plants). It is interesting to mention that several among the most important crops in the state of São Paulo namely, cotton, rice, coffee and sugar cane contain more sulphur than phosphorus. 4. Tomato plants cultivated in nutrient solution lacking sulphur showed the following visual symptons of deficiency : chlorosis first in the younger leaves and afterwards in all the leaves; anthocyanin pigments in the petioles and stems; absence of fruits; primary roots stunted and secondary ones longer than in the control plants; stems slender, hard, woody. The histological study of petioles suffering from sulphur deficiency revealed anthocyanin in the parenchyme layer instead of clo-rophyll pigments observed in normal petioles; in the chlorotic leaves the large chloroplasts present only the stroma but the small ones have a little amount of green pigments. Chemical analysis revealed in the abnormal plants : less sulphur and an increased proportion of phosphorus; older leaves contain more sulphur and less phosphorus than the younger ones probably due to physiological difficulties in translocation of sulphur bearing material; increased amount of total N attributed to accumulation of nitrates; marked decrease in ash, sugars and starch; increased proportion of crude fiber and dry material. In the plants suffering from sulphur deficiency photosyntetic rate decreased 34 per cent. 5. Tomato plants were succesfully cultivated in nutrient solution in absence of mineral sulphur but in presence of cysteine. The plants absorbed sulphur, under that form and were able to grow up quite well; the fruiting was normal. In this way rested cleary demonstrated the possibility of absorption of organic sulphur without previous mineralization and its utilization in the building up of protein molecules.

O problema técnico-econômico da adubação

The authors discuss from the economic point of view the use of a few functions intended to represent the yield y corresponding to a level xof the nutrient. They point out that under conditions of scarce capital what is actually most important is not to obtain the highest profit per hectare but the highest return per cruzeiro spent, so that we should maximize the function z = _R - C_ = _R_ - 1 , C C where R is the gross income and C the cost of production (fixed plus variable, both per hectare). Being C = M + rx, with r the unit price of the nutrient and Af the fixed cost of the crop, wo are led to the equation (M + rx)R' - rR = 0. With R = k + sx + tx², this gives a solution Xo = - Mt - √ M²t² - r t(Ms - Kr)- _____________________ rt on the other hand, with R = PyA [1 - 10-c(x + b)], x0 will be the root of equation (M + rx)cL 10 + r 10c(x + b) = 0 (12). Another solution, pointed out by PESEK and HEADY, is to maximize the function z = sx + tx² _________ m + rx where the numerator is the additional income due to the nutrient, and m is the fixed cost of fertilization. This leads to a solution x+ = - mt - √m²t² - mrst (13) _________________ rt However, we must have x+< _r_-_s_ I if we want to satisfy t _dy_ > r. dx This condition is satisfied only if we have m < _(s__-__r)² (14), - 4 t a restriction apparently not perceived by PESEK and HEADY. A similar reasoning using Mitscherlich's law leads to equation (mcL 10 + r) + cr(L 10)x - r 10cx = 0 (15), with a similar restriction. As an example, data of VIEGAS referring to fertilization of corn (maize) gave the equation y - 1534 + 22.99 x - 0. 1069 x², with x in kg/ha of the cereal. With the prices of Cr$ 5.00 per kilo of maize, Cr$ 26.00 per kilo of P2O3,. and M = Cr$ 5,000.00, we obtain x0 = 61 kg/ha of P(2)0(5). A similar reasoning using Mitscherlich's law leads to x0 = 53 kg/ha. Now, if we take in account only the fixed cost of fertilization m = Cr$ 600.00 per hectare, we obtain from (13) x+ = 51 kg/ha of P2O5, while (14) gives x+ - 41 kg/ha. Note that if m = Cr$ 5,000.00, we obtain by formula (13) x+ = 88 kg/ha of P2O5, a solution which is not valid, since condition (14) is not satisfied.

Motor and cognitive development of selected Egyptian and German primary school aged children : a cross-cultural study

Magdeburg, Univ., Fak. für Humanwiss., Diss., 2013

The induction of root and shoot morphogenesis in Phaseolus vulgaris tissue cultures

Exogenous concentrations of bean seed extract prepared from seeds pretreated in aerated water, homogenized in Veliky and Martin's 67-V salt solution, filtered, and added to the culture medium at proper concentrations promote callus proliferation, root morphogenesis, and shoot morphogenesis in leaf explains of Phaseolus vulgaris var. Bico de Ouro. The activity of the bean seed factor is dependent upon the period of pretreatment in aerated water.

Host plants of root-knot nematodes

Root-knot nematodes were found attacking Coffea spp. and also roots of a few weed species usually found in the coffee orchards in São Paulo. C. arabica cv. Catuaí, C. arabica cv. Mundo Novo, Timor Hybrid and a few plants of C. racemosa showed to be susceptible to Meloidogyne exigua. Roots of Ageratum conyzoides, Amaranthus viridis, Bidens pilosa, Coffea arabica cv. Mundo Novo, Coffea racemosa, Commelina virginica, Digitaria sanguinalis, Galinsoga parviflora, Gnaphalium spathulatum, Porophyllum ruderale, Portulaca oleracea, Pterocaulon virgatum and Solanum americanum were disfigured by M. incognita M. arenaria was found attacking roots of Eleusine indica and Gnaphalium spathulatum, and the presence of an unidentified Meloidogyne species was verified in roots of the following species: Vernonia ferruginea, C. arabica x C. canephora, Eupatorium pauciflorum, Coffea canephora cv. Kouillou, Coffea eugenioides, Coffea racemosa, Coffea stenophylla, Euphorbia pilullifera, Solanum americanum, Ageratum conyzoides, Phyllanthus corcovadensis, and Emilia sagittata.

Non root feeding with two sources of zinc on Coffea arábica L. 'mundo novo'(B.Rodr.) Choussy

A trial was carried out on an eight old coffee plantation with visible zinc problems. The plantation was situated nearly the city of Jaú (22º30'S, 48º30'W). State of São Paulo, Brazil. The soil is classified as medium texture Oxisol of low base saturation (Latossol Vermelho Amarelo - fase arenosa). The pulverization program started in november 1977, followed in march and July 1978 (heavy harvest) and ended in march and July 1979 (light harvest). Is should be mentioned that a well reconized characteristic of arábica coffe is its habit of biennial bearing, a very heavy harvest is most often followed by a light load the next year. The following treatments and amounts of chemicals per cova hole (4 trees) were tested in accordance with a random block design: 1. 1 g of zinc (zinc sulphate, 0.5%) 2. 3 g of nitrogen (urea, 1.3%) 3. 1 g of zinc + 3 g of nitrogen (zinc sulphate 0.5% + urea 1.3%) 4. 0.25 g, 0.50 g, 1.00 g, 2.00 g of zinc plus 0.75 g, 1.50 g, 3.00 g and 6.00 of nitrogen (correspondent to NZN* 15-0-0-5 as 0.75%, 1-5%, 3.0% and 6.0% by v/v). Foliar absorption data were obtained by collecting the 3rd and 4th pairs of the coffee leaves and analysed them for N, P, K, Ca, Mg, S, B, Cu, Fe, Mn, and Zn. The main results may be summarized as follows: 1. The maximum calculated yields of clean coffee were obtained by the applications of 5.84 1 of NZN (1.13%) per hectare. 2. The applications of zinc sulphate (0.5%) and urea (1.3%) together or separate did not affected the coffee bean production. 3. The applications of 15.0 1 of NZN per hectare reduced the coffee yields. 4. Leaf damages and burning symptoms were observed by the applications of urea (1.3%) plus zinc sulphate (0.5%) and larger doses than 7.5 1 of NZN per hectare. 5. Leaf tissue analysis show that the concentrations of the elements were affecred by the age of the leaves and by the yields of the coffee trees. 6. The applications of increasing doses of NZN causes an increase in the concentration of zinc, manganese and boron in the leaves and decreased the concentration in calcium and potassium the leaves. 7. The concentration of zinc in the leaves associated with the heavy harvest, in July, was 70.0 ppm.