Impact of extracardiac findings during cardiac MR on patient management and outcome.

BACKGROUND: Cardiac magnetic resonance (CMR) is increasingly used to assess heart diseases. Relevant non-cardiac diseases may also be incidentally found on CMR images. The aim of this study was to determine the prevalence and nature of incidental extra-cardiac findings (IEF) and their clinical impact in non-selected patients referred for CMR. MATERIAL/METHODS: MR images of 762 consecutive patients (515 men, age: 56±18 years) referred for CMR were prospectively interpreted by 2 radiologists blinded for any previous imaging study. IEFs were classified as major when requiring treatment, follow-up, or further investigation. Clinical follow-up was performed by checking hospital information records and by calling referring physicians. The 2 endpoints were: 1) non-cardiac death and new treatment related to major IEFs, and 2) hospitalization related to major IEFs during follow-up. RESULTS: Major IEFs were proven in 129 patients (18.6% of the study population), 14% of those being unknown before CMR. During 15±6 month follow-up, treatment of confirmed major IEFs was initiated in 1.4%, and no non-cardiac deaths occurred. Hospitalization occurred in 8 patients (1.0% of the study population) with confirmed major IEFs and none occurred in the remaining 110 patients with unconfirmed/unexplored major IEFs (p<0.001). CONCLUSIONS: Screening for major IEFs in a population referred for routine CMR changed management in 1.4% of patients. Major IEFs unknown before CMR but without further exploration, however, carried a favorable prognosis over a follow-up period of 15 months.

Fire management, climate change and their interacting effects on birds in complex Mediterranean landscapes: dynamic distribution modelling of an early-successional species - the near-threatened Dartford Warbler (Sylvia undata)

The current challenge in a context of major environmental changes is to anticipate the responses of species to future landscape and climate scenarios. In the Mediterranean basin, climate change is one the most powerful driving forces of fire dynamics, with fire frequency and impact having markedly increased in recent years. Species distribution modelling plays a fundamental role in this challenge, but better integration of available ecological knowledge is needed to adequately guide conservation efforts. Here, we quantified changes in habitat suitability of an early-succession bird in Catalonia, the Dartford Warbler (Sylvia undata) ― globally evaluated as Near Threatened in the IUCN Red List. We assessed potential changes in species distributions between 2000 and 2050 under different fire management and climate change scenarios and described landscape dynamics using a spatially-explicit fire-succession model that simulates fire impacts in the landscape and post-fire regeneration (MEDFIRE model). Dartford Warbler occurrence data were acquired at two different spatial scales from: 1) the Atlas of European Breeding Birds (EBCC) and 2) Catalan Breeding Bird Atlas (CBBA). Habitat suitability was modelled using five widely-used modelling techniques in an ensemble forecasting framework. Our results indicated considerable habitat suitability losses (ranging between 47% and 57% in baseline scenarios), which were modulated to a large extent by fire regime changes derived from fire management policies and climate changes. Such result highlighted the need for taking the spatial interaction between climate changes, fire-mediated landscape dynamics and fire management policies into account for coherently anticipating habitat suitability changes of early succession bird species. We conclude that fire management programs need to be integrated into conservation plans to effectively preserve sparsely forested and early succession habitats and their associated species in the face of global environmental change.

Variabilidade genética de cajuzinho-do-cerrado (Anacardium humile St. Hill.) por meio de marcadores rapd

Nativo do Cerrado brasileiro e com alta variabilidade morfológica, o cajuzinho-do-cerrado (Anacardium humile St. Hill.) apresenta frutos de grande aceitação pelas populações locais, os quais atraem por suas características peculiares, como tamanho, sabor único e potencial para uso sustentável por produtores e pela indústria. A produção de sementes limitada, acarretada pela baixa polinização e pela alta predação por animais e insetos, dificulta a propagação da espécie. O conhecimento da variabilidade genética do cajuzinho-do-cerrado é importante para maximizar o uso de seus recursos genéticos para futuros programas de melhoramento e de conservação da espécie. No presente trabalho, a variabilidade genética de 122 acessos de A. humile procedentes de 11 municípios (procedências) do Cerrado de Goiás e Mato Grosso, foi estimada por meio de marcadores RAPD. As similaridades genéticas foram estimadas a partir da matriz binária, tendo sido processadas análises de agrupamento e de dispersão gráfica a partir da matriz de distâncias. Os iniciadores com maior expressão foram OPA11 e 08. Os dez iniciadores utilizados geraram 157 bandas, sendo 156 polimórficas (99 %), com média de 15,6 bandas/ iniciadores. Grande variabilidade dentro de municípios foi detectada, sendo o polimorfismo superior a 90 %, exceto da procedência de Jataí-GO. A distância entre acessos variou de 0,138 a 0,561, com média de 0,370, sendo os menores valores registrados entre os acessos de Mineiros-GO, e Serranópolis-GO. Os acessos de Caiapônia-GO, e Santo Antônio do Descoberto-GO, foram os mais distantes geneticamente. A dissimilaridade total entre acessos variou de 0,103 a 0,796, com médias de 0,390. Os acessos 87 e 114 de Serranópolis-GO, e Santo Antônio do Descoberto-GO, respectivamente, foram os mais distantes geneticamente, demonstrando a importância dessas procedências no enriquecendo do banco de germoplasma da espécie.

Chronic nonbacterial osteomyelitis in children: a retrospective multicenter study.

BACKGROUND: To determine the clinical presentation, current treatment and outcome of children with nonbacterial inflammatory bone disease. METHODS: Retrospective multicenter study of patients entered into the Swiss Pediatric Rheumatology Working Group registry with a diagnosis of chronic nonbacterial osteomyelitis (CNO) and synovitis acne pustulosis hyperostosis osteitis (SAPHO) syndrome. The charts were reviewed for informations about disease presentation, treatment, course and outcome. RESULTS: Forty-one children (31 girls and 10 boys) from 6 pediatric hospitals in Switzerland diagnosed between 1995 and 2010 were included in the study. The diagnosis was multifocal CNO (n = 33), unifocal CNO (n = 4) and SAPHO syndrome (n = 4). Mean age at onset of CNO was 9.5 years (range 1.4-15.6) and mean follow-up time was 52 months (range 6-156 months). Most patients (n = 27) had a chronic persistent disease course (>6 months), 8 patients had a course with one or more relapses and 6 patients had only one episode of CNO. Forty nine percent had received at least one course of antibiotics. In 57% treatment with nonsteroidal anti-inflammatory drugs (NSAID) was sufficient to control the disease. Twelve out of 16 children with NSAID failure subsequently received corticosteroids, methotrexate, TNF α inhibitors, bisphosphonates or a combination of these drugs. CONCLUSIONS: In a multicenter cohort of 41 children 22% started with unifocal lesion with a significant diagnostic delay. A higher proportion presented with chronic persistent disease than with a recurrent form. An osteomyelitis in the pelvic region is significantly associated with other features of juvenile spondylarthritis.

TAMANHO ÓTIMO DE AMOSTRAS DE FRUTOS E DE SEMENTES PARA DETERMINAÇÃO DA POLIEMBRIONIA EM CITROS

RESUMOPoliembrionia e apomixia nucelar são atributos importantes, tanto no melhoramento e seleção de porta-enxertos de citros, como para sua multiplicação comercial. Avaliou-se a poliembrionia e estimouse o tamanho ótimo de amostras de frutos e de sementes de genótipos de citros para determinar o número de sementes por fruto, número de embriões por semente e taxa de poliembrionia. As plantas-matrizes que forneceram os frutos e sementes estão instaladas na Embrapa Mandioca e Fruticultura, em Cruz das Almas, Bahia. Avaliaram-se: tangerineiras ‘Sunki Tropical’, ‘Sunki Maravilha’, ‘Sunki da Flórida’, ‘Sunki Comum’, ‘Dancy’ e ‘Cleópatra’; limoeiros ‘RugosoJambhiri’, ‘Rugoso da Flórida’, ‘Rugoso Comum’, ‘Volkameriano Lagoa Grande’ e ‘Cravo Santa Cruz’; e os híbridos limoeiro ‘Cravo’ x tangerineira ‘Sunki Maravilha’, tangerineira ‘Sunki da Flórida’ x citrangequat ‘Thomasville’ e híbrido de limeira-ácida ‘Tahiti’ obtido por polinização aberta. Os resultados foram submetidos à análise estatística descritiva, estimando-se equações de máxima curvatura para determinação de tamanho ótimo de amostras de frutos e de sementes a partir de 20 ou 100 frutos e de 156 sementes por variedade, respectivamente. A produção de sementes e a poliembrionia variaram expressivamente entre os genótipos avaliados, podendo estes serem classificados em cinco grupos de produção de sementes e de taxa de poliembrionia, respectivamente, compreendendo os intervalos de 2 a 28 sementes e de 12 a 100%. O tamanho ótimo estimado para as amostras foi de nove frutos uniformes, dez e 23 sementes, para determinar, respectivamente, o número médio de sementes por fruto, o número médio de embriões por semente e a taxa de poliembrionia por contagem direta, pois esses valores representam os tamanhos ótimos que atendem a todos os grupos de variedades estudadas.

DIETARY FIBRE CONTENT, PHENOLIC COMPOUNDS AND ANTIOXIDANT ACTIVITY IN SOURSOPS (Annona muricata L.)

ABSTRACT Healthy eating is associated with the consumption of fruits, which are notable for their beneficial effects on human health. The aim of this study was to evaluate the proximate composition, composition of fibers and components with antioxidant activity in soursops varieties Crioula, Lisa and Morada of physiological maturity (PM) and mature (M). The protein, lipid and moisture contents did not differ between soursop varieties, but the ash contents were higher in the Morada-PM (0.56%±0.03) and the Morada-M (0.82%±0.10) varieties. The Crioula-M variety showed higher levels of total dietary fibre (5.76%±0.12). The Lisa-M variety showed higher levels of insoluble dietary fibre (4.46%±0.00). The Lisa-M variety also showed a higher level of phenolic compounds (284.25 mg gallic acid/100 g of soursop pulp), differing significantly (p <0.05) from the Crioula-PM soursop (154.40 mg of gallic acid/100 g of soursop pulp). Under the DPPH• system, the soursops that showed highest antioxidant activity were the Crioula-M (EC50 of 156.40 g.g DPPH-1) and the Crioula-PM (EC50 of 162.41 g.g DPPH-1), which differed significantly from the Morada soursops. The results suggest that the consumption of soursops is useful for increasing concentrations of bioactive compounds and dietary fibre.

European Stroke Organisation (ESO) guidelines for the management of temperature in patients with acute ischemic stroke.

BACKGROUND: Hyperthermia is a frequent complication in patients with acute ischemic stroke. On the other hand, therapeutically induced hypothermia has shown promising potential in animal models of focal cerebral ischemia. This Guideline Document presents the European Stroke Organisation guidelines for the management of temperature in patients with acute ischemic stroke. METHODS: A multidisciplinary group identified related questions and developed its recommendations based on evidence from randomized controlled trials elaborating the Grading of Recommendations Assessment, Development, and Evaluation approach. This Guideline Document was reviewed within the European Stroke Organisation and externally and was approved by the European Stroke Organisation Guidelines Committee and the European Stroke Organisation Executive Committee. RESULTS: We found low-quality evidence, and therefore, we cannot make any recommendation for treating hyperthermia as a means to improve functional outcome and/or survival in patients with acute ischemic stroke and hyperthermia; moderate evidence to suggest against routine prevention of hyperthermia with antipyretics as a means to improve functional outcome and/or survival in patients with acute ischemic stroke and normothermia; very low-quality evidence to suggest against routine induction of hypothermia as a means to improve functional outcome and/or survival in patients with acute ischemic stroke. CONCLUSIONS: The currently available data about the management of temperature in patients with acute ischemic stroke are limited, and the strengths of the recommendations are therefore weak. We call for new randomized controlled trials as well as recruitment of eligible patients to ongoing randomized controlled trials to allow for better-informed recommendations in the future.