A comparison between diuretics and angiotensin-receptor blocker agents in patients with stage I hypertension (PREVER-treatment trial): study protocol for a randomized double-blind controlled trial

Abstract Background Cardiovascular disease is the leading cause of death in Brazil, and hypertension is its major risk factor. The benefit of its drug treatment to prevent major cardiovascular events was consistently demonstrated. Angiotensin-receptor blockers (ARB) have been the preferential drugs in the management of hypertension worldwide, despite the absence of any consistent evidence of advantage over older agents, and the concern that they may be associated with lower renal protection and risk for cancer. Diuretics are as efficacious as other agents, are well tolerated, have longer duration of action and low cost, but have been scarcely compared with ARBs. A study comparing diuretic and ARB is therefore warranted. Methods/design This is a randomized, double-blind, clinical trial, comparing the association of chlorthalidone and amiloride with losartan as first drug option in patients aged 30 to 70 years, with stage I hypertension. The primary outcomes will be variation of blood pressure by time, adverse events and development or worsening of microalbuminuria and of left ventricular hypertrophy in the EKG. The secondary outcomes will be fatal or non-fatal cardiovascular events: myocardial infarction, stroke, heart failure, evidence of new subclinical atherosclerosis and sudden death. The study will last 18 months. The sample size will be of 1200 participants for group in order to confer enough power to test for all primary outcomes. The project was approved by the Ethics committee of each participating institution. Discussion The putative pleiotropic effects of ARB agents, particularly renal protection, have been disputed, and they have been scarcely compared with diuretics in large clinical trials, despite that they have been at least as efficacious as newer agents in managing hypertension. Even if the null hypothesis is not rejected, the information will be useful for health care policy to treat hypertension in Brazil. Clinical trials registration number ClinicalTrials.gov: NCT00971165

Meiotic segregation and interchromosomal effect in the sperm of a double translocation carrier: a case report

Abstract Background Infertility is a natural mechanism of selection intended to prevent the delivery of a child with malformations or mental retardation. Male infertility is closely related to chromosomal abnormalities. This study was focused on the analysis of meiotic segregation involving a Robertsonian translocation, 45,XY,der(13;13) [56]/45,XY,der(13;14) [44] and the evaluation of possible interchromosomal effects. Results Hybridisation with LSI 13q14 and subtelomere 14q probes and WCP13 SpectrumGreen and WCP14 SpectrumOrange probes showed a high proportion of unbalanced gametes, corresponding to 71.2% of the spermatozoa. The disomic frequencies of the sexual chromosomes and chromosome 18 of the patient were higher (5.28% and 2.55%, respectively) than those of the control (0.6% and 0.59%, respectively). Conclusion Meiotic segregation studies in sperm are an important tool for genetic counselling of chromosomal aberrations, allowing for a prediction of the risks and consequent implications for the reproductive life. The patient with this rare translocation exhibited meiotic segregation fidelity, and a high rate of unbalanced gametes with disomic spermatozoa.

Association of a probiotic to a Helicobacter pylori eradication regimen does not increase efficacy or decreases the adverse effects of the treatment: a prospective, randomized, double-blind, placebo-controlled study

Abstract Background The treatment for the eradication of Helicobacter pylori (H. pylori) is complex; full effectiveness is rarely achieved and it has many adverse effects. In developing countries, increased resistance to antibiotics and its cost make eradication more difficult. Probiotics can reduce adverse effects and improve the infection treatment efficacy. If the first-line therapy fails a second-line treatment using tetracycline, furazolidone and proton-pump inhibitors has been effective and low cost in Brazil; however it implies in a lot of adverse effects. The aim of this study was to minimize the adverse effects and increase the eradication rate applying the association of a probiotic compound to second-line therapy regimen. Methods Patients with peptic ulcer or functional dyspepsia infected by H. pylori were randomized to treatment with the furazolidone, tetracycline and lansoprazole regimen, twice a day for 7 days. In a double-blind study, patients received placebo or a probiotic compound (Lactobacillus acidophilus, Lactobacillus rhamnosus, Bifidobacterium bifidum and Streptococcus faecium) in capsules, twice a day for 30 days. A symptom questionnaire was administered in day zero, after completion of antibiotic therapy, after the probiotic use and eight weeks after the end of the treatment. Upper digestive endoscopy, histological assessment, rapid urease test and breath test were performed before and eight weeks after eradication treatment. Results One hundred and seven patients were enrolled: 21 men with active probiotic and 19 with placebo plus 34 women with active probiotic and 33 with placebo comprising a total of 55 patients with active probiotic and 52 with placebo. Fifty-one patients had peptic ulcer and 56 were diagnosed as functional dyspepsia. The per-protocol eradication rate with active probiotic was 89.8% and with placebo, 85.1% (p = 0.49); per intention to treat, 81.8% and 79.6%, respectively (p = 0.53). The rate of adverse effects at 7 days with the active probiotic was 59.3% and 71.2% with placebo (p = 0.20). At 30 days, it was 44.9% and 60.4%, respectively (p = 0.08). Conclusions The use of this probiotic compound compared to placebo in the proposed regimen in Brazilian patients with peptic ulcer or functional dyspepsia showed no significant difference in efficacy or adverse effects. Trial registration Current Controlled Trials ISRCTN04714018

The double task of preventing malnutrition and overweight: a quasi-experimental community-based trial

Background: The Maternal-Child Pastoral is a volunteer-based community organization of the Dominican Republic that works with families to improve child survival and development. A program that promotes key practices of maternal and child care through meetings with pregnant women and home visits to promote child growth and development was designed and implemented. This study aims to evaluate the impact of the program on nutritional status indicators of children in the first two years of age. Methods: A quasi-experimental design was used, with groups paired according to a socioeconomic index, comparing eight geographical areas of intervention with eight control areas. The intervention was carried out by lay health volunteers. Mothers in the intervention areas received home visits each month and participated in a group activity held biweekly during pregnancy and monthly after birth. The primary outcomes were length and body mass index for age. Statistical analyses were based on linear and logistic regression models. Results: 196 children in the intervention group and 263 in the control group were evaluated. The intervention did not show statistically significant effects on length, but point estimates found were in the desired direction: mean difference 0.21 (95%CI −0.02; 0.44) for length-for-age Z-score and OR 0.50 (95%CI 0.22; 1.10) for stunting. Significant reductions of BMI-for-age Z-score (−0.31, 95%CI −0.49; -0.12) and of BMI-for-age > 85th percentile (0.43, 95%CI 0.23; 0.77) were observed. The intervention showed positive effects in some indicators of intermediary factors such as growth monitoring, health promotion activities, micronutrient supplementation, exclusive breastfeeding and complementary feeding. Conclusions: Despite finding effect measures pointing to effects in the desired direction related to malnutrition, we could only detect a reduction in the risk of overweight attributable to the intervention. The findings related to obesity prevention may be of interest in the context of the nutritional transition. Given the size of this study, the results are encouraging and we believe a larger study is warranted.

Double shunt technique for hybrid palliation of hypoplastic left heart syndrome: a case report

We report a technique to palliate hypoplastic left heart syndrome, with no PDA stenting, but with double polytetrafluoroethylene shunt from pulmonary artery to ascending and descending aorta by combined thoracotomies. A 30-day-old female was operated with this technique. Five months after first operation, the child was submitted to Norwood/Glenn operation. Good hemodinamic recovery and initial clinical evolution was observed. The child was extubated in 8th post operatory day and reentubated in the next day due to pulmonary infection. Despite antibiotic treatment, the child died after systemic infectious complications.

Theoretical and experimental study of the excitonic binding energy in GaAs/AlGaAs single and coupled double quantum wells

This paper discusses the theoretical and experimental results obtained for the excitonic binding energy (Eb) in a set of single and coupled double quantum wells (SQWs and CDQWs) of GaAs/AlGaAs with different Al concentrations (Al%) and inter-well barrier thicknesses. To obtain the theoretical Eb the method proposed by Mathieu, Lefebvre and Christol (MLC) was used, which is based on the idea of fractional-dimension space, together with the approach proposed by Zhao et al., which extends the MLC method for application in CDQWs. Through magnetophotoluminescence (MPL) measurements performed at 4 K with magnetic fields ranging from 0 T to 12 T, the diamagnetic shift curves were plotted and adjusted using two expressions: one appropriate to fit the curve in the range of low intensity fields and another for the range of high intensity fields, providing the experimental Eb values. The effects of increasing the Al% and the inter-well barrier thickness on Eb are discussed. The Eb reduction when going from the SQW to the CDQW with 5 Å inter-well barrier is clearly observed experimentally for 35% Al concentration and this trend can be noticed even for concentrations as low as 25% and 15%, although the Eb variations in these latter cases are within the error bars. As the Zhao's approach is unable to describe this effect, the wave functions and the probability densities for electrons and holes were calculated, allowing us to explain this effect as being due to a decrease in the spatial superposition of the wave functions caused by the thin inter-well barrier.

A phase I randomized, double-blind, controlled trial of 2009 influenza A (H1N1) inactivated monovalent vaccines with different adjuvant systems

Methods We conducted a phase I, multicenter, randomized, double-blind, placebo-controlled, multi-arm (10) parallel study involving healthy adults to evaluate the safety and immunogenicity of influenza A (H1N1) 2009 non-adjuvanted and adjuvanted candidate vaccines. Subjects received two intramuscular injections of one of the candidate vaccines administered 21 days apart. Antibody responses were measured by means of hemagglutination-inhibition assay before and 21 days after each vaccination. The three co-primary immunogenicity end points were the proportion of seroprotection >70%, seroconversion >40%, and the factor increase in the geometric mean titer >2.5. Results A total of 266 participants were enrolled into the study. No deaths or serious adverse events were reported. The most commonly solicited local and systemic adverse events were injection-site pain and headache, respectively. Only three subjects (1.1%) reported severe injection-site pain. Four 2009 influenza A (H1N1) inactivated monovalent candidate vaccines that met the three requirements to evaluate influenza protection, after a single dose, were identified: 15 μg of hemagglutinin antigen without adjuvant; 7.5 μg of hemagglutinin antigen with aluminum hydroxide, MPL and squalene; 3.75 μg of hemagglutinin antigen with aluminum hydroxide and MPL; and 3.75 μg of hemagglutinin antigen with aluminum hydroxide and squalene. Conclusions Adjuvant systems can be safely used in influenza vaccines, including the adjuvant monophosphoryl lipid A (MPL) derived from Bordetella pertussis with squalene and aluminum hydroxide, MPL with aluminum hydroxide, and squalene and aluminum hydroxide.

Experimental Investigation of Three-Dimensional Single and Double optical Lattices

A complete laser cooling setup was built, with focus on threedimensional near-resonant optical lattices for cesium. These consist of regularly ordered micropotentials, created by the interference of four laser beams. One key feature of optical lattices is an inherent ”Sisyphus cooling” process. It efficiently extracts kinetic energy from the atoms, leading to equilibrium temperatures of a few µK. The corresponding kinetic energy is lower than the depth of the potential wells, so that atoms can be trapped. We performed detailed studies of the cooling processes in optical lattices by using the time-of-flight and absorption-imaging techniques. We investigated the dependence of the equilibrium temperature on the optical lattice parameters, such as detuning, optical potential and lattice geometry. The presence of neighbouring transitions in the cesium hyperfine level structure was used to break symmetries in order to identify, which role “red” and “blue” transitions play in the cooling. We also examined the limits for the cooling process in optical lattices, and the possible difference in steady-state velocity distributions for different directions. Moreover, in collaboration with ´Ecole Normale Sup´erieure in Paris, numerical simulations were performed in order to get more insight in the cooling dynamics of optical lattices. Optical lattices can keep atoms almost perfectly isolated from the environment and have therefore been suggested as a platform for a host of possible experiments aimed at coherent quantum manipulations, such as spin-squeezing and the implementation of quantum logic-gates. We developed a novel way to trap two different cesium ground states in two distinct, interpenetrating optical lattices, and to change the distance between sites of one lattice relative to sites of the other lattice. This is a first step towards the implementation of quantum simulation schemes in optical lattices.

Molecular architecture of fur binding to iron-induced and - repressed genes in Helicobacter pylori

The ferric uptake regulator protein Fur regulates iron-dependent gene expression in bacteria. In the human pathogen Helicobacter pylori, Fur has been shown to regulate iron-induced and iron-repressed genes. Herein we investigate the molecular mechanisms that control this differential iron-responsive Fur regulation. Hydroxyl radical footprinting showed that Fur has different binding architectures, which characterize distinct operator typologies. On operators recognized with higher affinity by holo-Fur, the protein binds to a continuous AT-rich stretch of about 20 bp, displaying an extended protection pattern. This is indicative of protein wrapping around the DNA helix. DNA binding interference assays with the minor groove binding drug distamycin A, point out that the recognition of the holo-operators occurs through the minor groove of the DNA. By contrast, on the apo-operators, Fur binds primarily to thymine dimers within a newly identified TCATTn10TT consensus element, indicative of Fur binding to one side of the DNA, in the major groove of the double helix. Reconstitution of the TCATTn10TT motif within a holo-operator results in a feature binding swap from an holo-Fur- to an apo-Fur-recognized operator, affecting both affinity and binding architecture of Fur, and conferring apo-Fur repression features in vivo. Size exclusion chromatography indicated that Fur is a dimer in solution. However, in the presence of divalent metal ions the protein is able to multimerize. Accordingly, apo-Fur binds DNA as a dimer in gel shift assays, while in presence of iron, higher order complexes are formed. Stoichiometric Ferguson analysis indicates that these complexes correspond to one or two Fur tetramers, each bound to an operator element. Together these data suggest that the apo- and holo-Fur repression mechanisms apparently rely on two distinctive modes of operator-recognition, involving respectively the readout of a specific nucleotide consensus motif in the major groove for apo-operators, and the recognition of AT-rich stretches in the minor groove for holo-operators, whereas the iron-responsive binding affinity is controlled through metal-dependent shaping of the protein structure in order to match preferentially the major or the minor groove.

Spin polarized transport in manganese oxide double-perovskite thin films

Gegenstand dieser Arbeit war die Untersuchung von metallischen gemischtvalenten Manganaten und magnetischen Doppelperowskiten. Aufgrund ihres großen negativen Magnetowiderstandes (MW) sind diese halbmetallischen Oxide interessant für mögliche technische Anwendungen, z.B. als Leseköpfe in Festplatten. Es wurden die kristallographischen, elektronischen und magnetischen Eigenschaften von epitaktischen Dünnschichten und polykristallinen Pulverproben bestimmt.Epitaktische Dünnschichten der Verbindungen La_0.67Ca_0.33MnO₃ und La_0.67Sr_0.33MnO₃ wurdenmit Kaltkathodenzerstäubung und Laserablation auf einkristallinen Substraten wie SrTiO₃abgeschieden. Mit Hall-Effekt Messungen wurde ein Zusammenbruch der Ladungsträgerdichte bei der Curie-Temperatur T_C beobachtet.Mit dem Wechsel des Dotierungsatoms A von Ca (T_C=232 K) zu Sr (T_C=345 K)in La_0.67A_0.33MnO₃ konnte die Feldsensitivität des Widerstandes bei Raumtemperatur gesteigert werden. Um die Sensitivität weiter zu erhöhen wurde die hohe Spinpolarisation von nahezu 100% in Tunnelexperimenten ausgenutzt. Dazu wurden biepitaktische La_0.67Ca_0.33MnO₃ Schichten auf SrTiO₃ Bikristallsubstraten hergestellt. Die Abhängigkeit des Tunnelmagnetowiderstandes (TMW) vom magnetischen Feld, Temperatur und Strum war ein Schwerpunkt der Untersuchung. Mittels spinpolarisierten Tunnelns durch die künstliche Korngrenze konnte ein hysteretischer TMW von 70% bei 4 K in kleinen Magnetfeldern von 120 Oe gemessen werden. Eine weitere magnetische Oxidverbindung, der Doppelperowskit Sr₂FeMoO₆ miteine Curie-Temperatur oberhalb 400 K und einem großen MW wurde mittels Laserablation hergestellt. Die Proben zeigten erstmals das Sättigunsmoment, welches von einer idealen ferrimagnetischen Anordnung der Fe und Mo Ionen erwartet wird. Mit Hilfe von Magnetotransportmessungen und Röntgendiffraktometrie konnte eine Abhängigkeit zwischen Kristallstruktur (Ordnung oder Unordnung im Fe, Mo Untergitter) und elektronischem Transport (metallisch oder halbleitend) aufgedeckt werden.Eine zweiter Doppelperowskit Ca₂FeReO₆ wurde im Detail als Pulverprobe untersucht. Diese Verbindung besitzt die höchste Curie-Temperatur von 540 K, die bis jetzt in magnetischen Perowskiten gefunden wurde. Mit Neutronenstreuung wurde eine verzerrte monoklinische Struktur und eine Phasenseparation aufgedeckt.

La via Emilia tra Rimini e Forlì. Ruolo e immagine della strada

Abstract Il tema delle infrastrutture, intese come parte dell’architettura dello spazio urbano e del territorio, assume un ruolo centrale in molti progetti contemporanei e costituisce la ragione di questa ricerca. E’ preso in esame, in particolare, il tracciato extraurbano della via Emilia, antica strada consolare romana la cui definizione risale al II sec. a.C., nel tratto compreso tra le città di Rimini e Forlì. Studiare la strada nel suo rapporto con il territorio locale ha significato in primo luogo prendere in considerazione la via Emilia in quanto manufatto, ma anche in quanto percorso che si compie nel tempo. Si è dunque cercato di mostrare come, in parallelo all’evoluzione della sua sezione e della geometria del suo tracciato, sia cambiata anche la sua fruizione, e come si sia evoluto il modo in cui la strada viene “misurata”, denominata e gestita. All’interno di una riflessione critica sulla forma e sul ruolo della strada nel corso dei secoli la Tesi rilegge il territorio nella sua dimensione di “palinsesto”, riconoscendo e isolando alcuni momenti in cui la via Emilia ha assunto un valore “simbolico” che rimanda alla Roma imperiale. La perdita del significato via Emilia, intesa come elemento di “costruzione” del territorio, ha origine con il processo di urbanizzazione diffusa che ha investito il territorio extraurbano a partire dalla fine della seconda guerra mondiale. La condizione attuale della strada, sempre più congestionata dal traffico veicolare, costituisce la premesse per una riflessione sul futuro della sua forma e degli insediamenti che attraversa. La strategia proposta dagli Enti locali che prevede il raddoppio della strada, con la costruzione della via Emilia Bis, non garantisce solo un potenziamento infrastrutturale ma rappresenta l’occasione per sottrarre al tracciato attuale la funzione di principale asse di comunicazione extraurbana. La via Emilia potrebbe così recuperare il ruolo di itinerario narrativo, attraverso la configurazione dei suoi spazi collettivi, l’architettura dei suoi edifici, il significato dei suoi monumenti, e diventare spazio privilegiato di relazione e di aggregazione. The theme of urban infrastructures, thought as part of the design of urban space and territory, has a central role in several contemporary projects and is the reason of this research. The object of the study is the extra urban route of the via Emilia, an ancient roman road which has been defined in the II century b. C., in its stretch between the cities of Rimini and Forlì. Studying the road in its relationship with the local environment has meant first of all considering the via Emilia as an “artefact” but also as a path that takes place over time. The aim of this research was also to demonstrate how its fruition has changed together with the evolution of the section and geometry of the route, and how the road itself is measured, named and managed. Within a critical approach on the shape and on the role played by the road through the centuries, this Essay reinterprets the territory in its dimension of “palimpsest”, identifying and isolating some periods of time when the via Emilia assumed a symbolic value which recalls the Imperial Rome. The loss of the meaning of the via Emilia, intended as an element that “constitutes” the territory originates from a process of diffused urbanization, which spread in the extra urban environment from the end of the second world war. The actual condition of the road, more and more congested by traffic, is the premise of a reflection about the future of its shape and of the settlements alongside. The strategy proposed by the local authorities, that foresees to double the size of the road, building the via Emilia Bis, not only guarantees an infrastructural enhancement but also it represents an opportunity to take off from the road itself the current function of being the principal axis of extra urban connection. In this way the via Emilia could regain its role as a narrative itinerary, through the configuration of its public spaces, the architecture of its buildings, the meaning of its monuments, and then become a privileged space of relationship and aggregation.

Double-stimulus sensitive (temperature and pH) self-assemblable polymers

The rheological properties of block co-polymers in water solution at different pH have been investigated. The block copolymers are based on different architectures containing poly(ethylene glycol), poly(propylene glycol) and different blocks of polymer that change their hydrophobic/hydrophilic behavior as a function of pH. The polymer chains of the starting material were extended at their functional ends with the pH-sensitive units using ATRP; this mechanism of controlled radical polymerization was chosen because of the need to minimize polydispersity and avoid transfer reactions possibly leading to homopolymeric inpurities. The starting material were modified in order to use them as macroinitiator for ATRP. The kinetic of each ATRP reaction has been investigated, in order to be able to synthesize polymers with different degree of polymerization, stopping the reaction when the desired polymers chain length has been reached. We will use polymer chains with different basicity and degree of polymerization to link any possible effect of their presence to the conditions under which they become hydrophobic. It has been shown that the rate of polymerization changes changing the type of macroinitiator and the type of monomer synthesized. The slowest rate of polymerization is the one with the most hindered monomer synthesized using the macroinitiator with the highest molecular weight. The water solubility of the synthesized polymers changes depending on the pH of the solution and on the structure of the polymers. It has been shown using 1H-NMR that some of the synthesized polymers are capable to self-aggregation in water solution. The self-aggregation and the type of aggregation is influenced from the structure of the polymer and from the pH of the solution. Changing the structure of the polymers and the pH it is possible to obtain different type of aggregates in solution. This aggregates differ for the volume occupied from them, and for their hardness. Rheological measurements have been demonstrated that the synthesized polymers are capable to form gel phases. The gelation temperature changes changing the structure of the aggregates in solution and it is possible to correlate the changing in the gelation temperature with the changing in the structure of the polymer.

Color/kinematic duality, double copies and scalar matrix models

In questa tesi presentiamo una descrizione autoconsistente della dualità Colore/Cinematica nelle teorie di gauge e al processo di Double Copy. Particolare attenzione viene data all'approccio alla dualità con il formalismo di cono-luce, in quanto semplifica notevolmente sia il calcolo sia l'interpretazione fisica: vengono indagati i settori duale e self-duale per poi passare al modello di Chalmers e Siegel per l'estensione alla teoria generale. Proponiamo quindi uno Scalar Matrix Model, che può essere un buon modello per generare ampiezze ottenibili da una Double Copy `inversa', e ne studiamo un'eventuale dualità a la Colore/Cinematica. Vengono illustrati alcuni casi particolari di rottura spontanea di simmetria. In appendice riportiamo un notebook di Mathematica per il calcolo di ampiezze tree level di puro gauge, utile per i calcoli necessari allo studio della dualità.