Predictors of Conversion from Radial Into Femoral Access in Cardiac Catheterization

Background: Fewer bleeding complications and early ambulation make radial access a privileged route for cardiac catheterization. However, transradial (TR) approach is not always successful, requiring its conversion into femoral access. Objectives: To evaluate the rate of conversion from radial into femoral access in cardiac catheterization and to identify its predictors. Methods: Prospective dual-center registry, including 7632 consecutive patients undergoing catheterization via the radial access between Jan/2009 and Oct/2012. We evaluated the incidence of conversion into femoral access and its predictors by logistic regression analysis. Results: The patients’ mean age was 66 ± 11 years, and 32% were women. A total of 2969 procedures (38.4%) were percutaneous coronary interventions (PCI), and the most used first intention arterial access was the right radial artery (97.6%). Radial access failure rate was 5.8%. Independent predictors of conversion from radial into femoral access were the use of short introducer sheaths (OR 3.047, CI: 2.380-3.902; p < 0.001), PCI (OR 1.729, CI: 1.375-2.173; p < 0.001), female sex (OR 1.569, CI: 1.234-1.996; p < 0.001), multivessel disease (OR 1.457, CI: 1.167-1.819; p = 0.001), body surface area (BSA) ≤ 1.938 (OR 1.448, CI: 1.120-1.871; p = 0.005) and age > 66 years (OR 1.354, CI: 1.088-1.684; p = 0.007). Conclusion: Transradial approach for cardiac catheterization has a high success rate and the need for its conversion into femoral access in this cohort was low. Female sex, older age, smaller BSA, the use of short introducer sheaths, multivessel disease and PCI were independent predictors of conversion into femoral access.

Dous phyllopodos, observados no Rio Grande do Norte

Le 19 juillet 1928 l'auteur trouva près de Natal, capitale de l'État de Rio Grande do Norte, a 5º 47' au sud de l'équateur, un nouveau Dendrocephalus qui portera le nom ornatus, dû a ses appendices caudales teints d'écarlate brillant. La femelle (Pl.1) atteint 12 mm. de longueur e contient des oeufs noirs dans sa cavité d'incubation. Le mâle, beaucoup plus robuste, atteint 16 mm. et montre, outre les caracteres sexuels, une modification extrémement compliquée des deuxièmes antennes (qui dans la planche II sont vues devant les premières). L'espèce est plus petite que les deux autres décrites de l'Amérique du Sud et se distingue facilement par les antennes du mâle. Elle fut trouvée au bord de la route dans une flaque large et profonde d'eau de pluie argileuse. Les exemplares rapportés moururent en quelques jours et la mare, lors d'une seconde visite, fut trouvé sèche. L'autre espèce, observée en 9. 7. 28 dans un étang naturel tout-près de la capitale, avait déjà été observée á Matto Grosso et en Paraguay et déterminée comme Cyclestheria hislopi BAIRD. THIELE pense que les individus de l'Amérique du Sud, pour cause de quelques petites différences, pour-raient nien former une autre espèce qu'il propose d'appeler sarsiana, mais la comparaison des desseins et descriptions avec mes exemplaires ne parait pas soutenir cette idée. Tout-de-mème la répartition connue de cette espèce est extrêmement curieuse et peut-être unique en zoologie. Elle a été signalée à Nagpur (Hindoustan), Ceylon, Queensland (Australie), Célèbes, Afrique orientale et Sansibar; seulement le premier lieu se trouve bien au nord de l'équateur, mais encore dans la zone tropicale, comme toutes les autres localités. L'explication de cette extension sur les deux mondes est tout ce qu'il a de plus difficile, puisque entre les localisations il n'y a pas seulement d'énormes distances sur terre (que l'on pourrait expliquer par un défaut d'observations), mais des espaces tres étendus, occupés par la mer. L'intervention de l'homme ne saurait expliquer ces faits et le transport par les oiseaux aquatiques ne pourrait être qu'un fait tout-a-fait excepcionnel pour les grands trajets océaniques. Le recours aux terres hypothétiques, qui formaient des ponts intercontinentaux dans des périodes géologiques extrêmement reculées, recontre des objections évidentes. En tous les cas on ne peut qu'admirer la constance avec laquelle le type de l'espèce s'est maintenu durant d'innombrales générations et a travers de telles distances quand les autres phyllopodes ont formé non seulement des variétés, mais même un grand nombre de genre et de familles.

Estudos sôbre a excitação química da córtex cerebral (Ação da acetilcolina)

The author has studied the influence of acetylcholine solutions directly applied on the motor cortex of dogs, cats monkeys and rabbits. For this purpose small squares of filter paper were soaked in the acetylcholine solution and soon afterwards laid on the motor cortex. Solutions varying from 0,2 to 10 per cent have been experimented. It has been shown that local application of the solutions on the motor points, previously localized by induction coil, produced motor reactions. It has been found, in the dogs that 10 per cent acetylcholine solutions cause localized muscular twitchings (clonus) in almost all the animals experimented. Generalised epileptiform convulsions were obtained in44,4% of the dogs. Convulsions were also obtained by employing 1 per cent solution of acetylcholine. Definite response has been obtained with 0,2 per cent solution. Failure of motor action, pointed out by other authors, has been related to the use of anesthetics. Convulsions were easily produced by rapid light mechanical stimulations of the skin covering the muscles in conection with the excited motor point, and the application on the motor point of acetylcholine. The results on monkeys can be summarized as follows. Two species of monkeys were experimented: Cebus capucinus and Macaca mulata. In the monkeys C. capucinus generalised convulsive reactions were induced with actylcholine solutions in a concentration as low as 0,5 per cent. Motor reaction or convulsive seizeres were obtained in seven of the eight monkeys used. Three monkeys M. mulata were stimulated with 10 per cent acetylcholine solution but only localized muscular contraction hae been observed. Similar results has been obtained on the motor cortex of cats and rabbits. One of the three cats employed has shown epileptiform convulsions and the remaining only localized muscular contractions. In the rabbits muscular twitchings have been also induced. The sensitizing power of eserine on the action of acetylcholine has been also searched. The results indicate that a previous application of eserine solution on the motor center, potentiates the action of acetylcholine. The intensity of the muscular twitchings is greater than the obtained before the application of the eserine solution. Generalised epileptiform convulsions sometimes appeared following the use of lower concentrations of acetylcholine than those previously employed. Experiments have been carried out by injecting eserine and prostigmine by parenteral route. A dosis dufficient for induce small muscular tremors did not enhance obviously the motor effects produced by the application of the acetylcholine solutions on the motor cortex. From seven dogs experimented, all previously tested for convulsive seiruzes by application of 1 and 10 per cent acetylcholine solution with negative results, only one has shown epileptiform convulsions after the injection of prostigmine. Morphine has also been tested as facilitating substance for convulsions induced by acetylcholine. Six from the nine dogs submitted to the experiments, developed epileptiform seizures after injection of morphine and stimulation of the motor cortex with acetylcholine. (Table IV). In another series of experiments atropine and nicotine have been studied as for to their action on the motor effects of acetylcholine. Nicotine has a strong convulsant action, even when employed in very high concentration. Since a depressant effect has not appeared even by the applications of high concentrations of nicotine in the motor corteõ of dogs, unlike the classical observations for the autonomus nervous system, it was not possible to verify the action of acetylcholine on a motor center paralised by nicotine. It is important to not that the motor phenomena observed after the first aplication of acetylcholine, can desappear by the renewal of the pieces of filter paper soaked in the acetylcholine solution. Atropine, either applied on the motor point in low concentration, or injected in sufficient amount for inhibiting the “muscarinic effects” of acetylcholine on the autonomous nervous system, did not prevent the motor reactions of acetylcholine on the cerebral cortex.

Factors influencing the development of Plasmodium gallinaceum in Aedes fluviatilis

Aedes fluviatilis is susceptible to infection by Plasmodium gallinaceum and is a convenient insect host for the malaria parasite in countries where Aedees aegypti cannot be maintained in laboratories. In South America, for instance, the rearing of A. aegypti the main vector of urban yellow fever, is not advaisable because of the potential health hazard it represents. Our results of the comparative studies carried out between the sporogonic cycle produced with two lines of P. gallinaceum parasites into A. fuviatilis were as follows. As proved for A. aegypti, mosquito infection rates were variable when A. fluviatilis blood-fed on chicks infected with and old syringe-passaged strain of P. gallinaceum. Oocysts developed in 41% of those mosquitos and the mean peak of oocyst production was 56 per stomach. Salivary gland infections developed in about 6% of the mosquitos. The course of sporogony was unrelated to the size of the inoculum administered to chicks or to the route by which the birds were infected. The development of infected salivary glands was unrelated to oocyst production. Sporogony of P. gallinaceum was more uniform when mosquitos blood-fed on chicks infected with a sporozoite-passaged strain. Oocysts developed in about 50% of those mosquitoes and the mean peak of oocyst production was 138 per stomach, with some individuals having as many as 600-800 oocysts. Infected salivary glands developed in a mean of 27% of the mosquitos but, in some batches, was a high as 50%. Patterns of salivary gland parasitism were similar to those of oocyst production. The course of sporogony of P. gallinaceum in A. fluviatilis is analized in relation to degree of parasitemia and gametocytemia in the vertebrate host.

Studies on Trypanosoma rangeli Tejera, 1920: V - Developmental pattern in the alimentary canal of Rhodnius prolixus

The morphological sequence of Trypanosoma rangeli development in the alimentary canal of Rhodnius prolixus, is described, with observation made in dissected guts from 6 hours to 45 days post-infection. No metacyclic-forms are produced in the digestive tract at any time, and transmission by the contaminative route must be considered atypical. Amastigotes appear to be an essential stage in the development of T. rangeli in the gut of R. prolixus. The epidemiological importance of the developmental pattern of T. rangeli in the vector´s gut is discussed, and its usefulness for aging infection is considered.

Evolution of sarcoma 180 in mice treated with hyperchlorinated water

Mice treated with hyperchlorinated water (50 ppm of chlorine) and control mice, drinking tap water (1-3 ppm of chlorine) were inoculated with 2.5 x 10 [raised to the power of 6] sarcoma 180 cells, by intraperitoneal route. Tumor evolution was measured by enumeration of tumor cells in peritoneal cavity and by evaluation of weight gain at different time intervals after tumor implantation. In mice treated with excessive amounts of chlorine there was enhancement of tumor growth demonstrated by: (a) shorter incubation period and increased weight gain (ascites formation) after tumor implantation; (b) increased number of tumor cells in the peritoneal cavity 2, 3 and 4 days after tumor challenge. The number of peritoneal cells exsudated after tumor implantation was lower in mice treated with hyperchlorinated water than in controls. The tumor enhancement observed after excessive chlorine ingestion would be due to: (a) reduction of the number of peritoneal macrophages that migrate to the peritoneal cavity and (b) reduction of the tumoricidal capacity of peritonela macrophages induced by the direct effect of chlorine or by the reduction of the amount of endogenous endotoxins due to the bactericidal effect of chlorine.

Evolution of sarcoma 180 in mice infected with Trypanosoma cruzi

Mice infected with Trypanosoma cruzi were challenged with 2x10[raised to the power of 6] cells of sarcoma 180 (ascite tumor) by i.p. route, on day seven post infection. Tumor development was followed by evaluation of weight gain, by measurement of ascitic fluid produced and enumeration of tumor cells in ascitic fluid. Infected mice were more resitant to tumor development as demonstrated by reduction in ascites formation and by reduction in the number of tumor cells in ascitic fluid, at different time intervals after tumor challenge. The number of peritoneal cells exsudated after tumor inoculation was greater in infected mice than in controls. This increased resitance of mice infected with T. cruzi to tumor development could be due to the action of macrophages activated by the infection and by the action of endotoxins absorbed from the gut or produced by the own parasite.

Disseny d'itineraris d'educació ambiental en ambients de fons de vall

L’anàlisi de l’estat actual dels equipaments i activitats d’educació ambiental (EA) en l’àmbit del Parc Natural de l’Alt Pirineu (PNAP) ha detectat un grau de desenvolupament molt baix d’aquesta disciplina. Per aquest motiu, s’elabora una nova eina, amb l’objectiu d’establir unes pautes per a l’elaboració d’una activitat d’EA concreta: els itineraris d’EA; i així ampliar l’escassa oferta actual. El protocol per al disseny d’itineraris d’EA, dóna unes directrius per a estandarditzar la descripció i l’anàlisi de la zona proposada. La finalitat del qual és facilitar i agilitar la implantació d’itineraris que presentin unes condicions mínimes establertes. La eficiència d’aquesta eina, queda verificada amb els resultats obtinguts en la realització de dues proves pilot en dues zones amb possibilitats de desenvolupar-hi itineraris d’EA. Una de les zones ha quedat descartada, per l’incompliment d’un dels criteris que s’ha definit en el protocol com a imprescindibles pel bon desenvolupament de l’activitat que es planteja. Mentre que en l’altre zona, el compliment de totes aquestes condicions o criteris, fan viable la implantació de l’itinerari d’EA, duent a terme així el seu posterior disseny. Malgrat l’estudi es centri en un espai natural protegit concret, és una eina que pretén ser extrapolable en d’altres espais d’aquesta categoria.

Itinerari d'educació ambiental: petjades a Comes de Rubió

El Parc Natural de l’Alt Pirineu (PNAP) va ser creat l’any 2003. A causa de la seva recent creació, manca el desenvolupament de moltes de les seves àrees. Actualment, el parc està creant una xarxa d’itineraris d’Educació Ambiental (EA). Per aquesta raó, és interessant dedicar aquest treball al disseny d’un itinerari d’EA a la zona de Comes de Rubió, situada dins l’àmbit territorial del PNAP. L’objectiu principal del present projecte és l’elaboració d’aquest itinerari amb els recursos necessaris per tal que sigui implementable d’una manera immediata. Per tal d’analitzar la viabilitat de l’itinerari s’ha aplicat el protocol de valoració dissenyat pel grup Edukamb. La puntuació que s’ha obtingut ha estat 61 sobre 100, fet que indica que l’itinerari és viable tot i que compta amb algunes mancances. S’ha constatat que les condicions de l’itinerari són idònies per poder ser visitat pel públic en general, entre altres coses per la forma circular de l’itinerari, per tenir 3 km de recorregut i per disposar d’una gran varietat d’aspectes d’interès. En el disseny de l’itinerari s’ha definit el recorregut, s’han determinat els elements d’interès, s’han proposat 5 parades, s’han dissenyat els materials pedagògics, s’ha definit la situació de la senyalització i s’han proposat correccions per a les mancances detectades en el protocol, entre altres, una millora en l’accessibilitat al punt d’inici i la construcció de passeres en els punts potencialment erosionables. Les principals pautes a seguir a l’hora d’elaborar el material pedagògic han estat la integració de l’aspecte social amb el natural i la promoció de la sensibilització envers el medi ambient.

Els camins "verd" i "daurat" cap a l'accés obert: arguments a favor de combinar i relacionar

Els debats recents sobre l'accés obert (OA) han tendit a tractar les revistes d'OA i l'auto-arxiu com dues rutes diferents. Alguns partidaris de l'auto-arxiu fins i tot han suggerit que per si sol aquest pot conduir a l'accés obert complet de la literatura científica mundial. En aquest article es discuteix que, de fet, cada camí correspon a una fase del moviment cap a l'accés obert; que amb el simple fet de l’auto-arxiu no n'hi ha prou, i que cal que els dipòsits proporcionin alguna capacitat de crear marques. De totes maneres, fer això desembocaria, finalment, en la creació d'overlay journals (o bases de dades). Per tant, els dos camins es fusionarien per crear un paisatge d'OA madur.

Anatomical landmarks for transnasal endoscopic skull base surgery.

Resection of midline skull base lesions involve approaches needing extensive neurovascular manipulation. Transnasal endoscopic approach (TEA) is minimally invasive and ideal for certain selected lesions of the anterior skull base. A thorough knowledge of endonasal endoscopic anatomy is essential to be well versed with its surgical applications and this is possible only by dedicated cadaveric dissections. The goal in this study was to understand endoscopic anatomy of the orbital apex, petrous apex and the pterygopalatine fossa. Six cadaveric heads (3 injected and 3 non injected) and 12 sides, were dissected using a TEA outlining systematically, the steps of surgical dissection and the landmarks encountered. Dissection done by the "2 nostril, 4 hands" technique, allows better transnasal instrumentation with two surgeons working in unison with each other. The main surgical landmarks for the orbital apex are the carotid artery protuberance in the lateral sphenoid wall, optic nerve canal, lateral optico-carotid recess, optic strut and the V2 nerve. Orbital apex includes structures passing through the superior and inferior orbital fissure and the optic nerve canal. Vidian nerve canal and the V2 are important landmarks for the petrous apex. Identification of the sphenopalatine artery, V2 and foramen rotundum are important during dissection of the pterygopalatine fossa. In conclusion, the major potential advantage of TEA to the skull base is that it provides a direct anatomical route to the lesion without traversing any major neurovascular structures, as against the open transcranial approaches which involve more neurovascular manipulation and brain retraction. Obviously, these approaches require close cooperation and collaboration between otorhinolaryngologists and neurosurgeons.

CD8 kinetically promotes ligand binding to the T-cell antigen receptor.

The mechanism of CD8 cooperation with the TCR in antigen recognition was studied on live T cells. Fluorescence correlation measurements yielded evidence of the presence of two TCR and CD8 subpopulations with different lateral diffusion rate constants. Independently, evidence for two subpopulations was derived from the experimentally observed two distinct association phases of cognate peptide bound to class I MHC (pMHC) tetramers and the T cells. The fast phase rate constant ((1.7 +/- 0.2) x 10(5) M(-1) s(-1)) was independent of examined cell type or MHC-bound peptides' structure. Its value was much faster than that of the association of soluble pMHC and TCR ((7.0 +/- 0.3) x 10(3) M(-1) s(-1)), and close to that of the association of soluble pMHC with CD8 ((1-2) x 10(5) M(-1) s(-1)). The fast binding phase disappeared when CD8-pMHC interaction was blocked by a CD8-specific mAb. The latter rate constant was slowed down approximately 10-fold after cells treatment with methyl-beta-cyclodextrin. These results suggest that the most efficient pMHC-cell association route corresponds to a fast tetramer binding to a colocalized CD8-TCR subpopulation, which apparently resides within membrane rafts: the reaction starts by pMHC association with the CD8. This markedly faster step significantly increases the probability of pMHC-TCR encounters and thereby promotes pMHC association with CD8-proximal TCR. The slow binding phase is assigned to pMHC association with a noncolocalized CD8-TCR subpopulation. Taken together with results of cytotoxicity assays, our data suggest that the colocalized, raft-associated CD8-TCR subpopulation is the one capable of inducing T-cell activation.

L'autoetnografia com a memòria de trànsit

Projecte realitzat en el Departament de dibuix de la Facultat de Belles Arts, a la Universitat de Barcelona, durant el segon curs de Doctorat, en el seminari que a càrrec de Fernando Hernandez on treballem l’ Autoetnografia Narrativa. Aquesta és una investigació que no té un caràcter individual marcat tan sols per la meva veu, sinó que més aviat la configuren també tots els companys de Seminari, amb ells i a través d’ells he aconseguit aprendre molts factors que intento quedin reflectits en el texte que presento i que treballo des de l’Educació Artística i la Cultura Visual. Durant aquest any me n’he adonat de què l’aprenentatge es realitza i té molt a veure amb les vivències que cada un de nosaltres construeix en societat, en elles centro les següents pàgines que per mí són l’inici d’un recorregut cap a un nou coneixement. Intento en tot moment tenir present el grup amb el qual he tingut la possibilitat de treballar durant aquest any i des del qual he pogut treballar-me com a subjecte educadora. D’aquesta manera i des de mí presento la meva contribució a n’aquest construir aprenentatge en societat, a partir de la següent narració.

Evaluation of the rabbit as a model for chagas' disease: I. Parasitological studies

In order to investigate the value of the rabbit as an experimental model for Chagas' disease, 72 animals have been inoculated by intraperitoneal and conjunctival route with bloodstream forms, vector-derived metacyclic trypomastigotes and tissue culture trypomastigotes of Trypanosoma cruzi strains Y, CL and Ernane. In 95.6% of the animals trypomastigotes had been detected at the early stages of infection by fresh blood examination. The course of parasitemia at the acute phase was strongly influenced by the parasite strain and route of inoculation. At the chronic phase parasites had been recovered by xenodiagnosis and/or hemoculture in 40% of the examined animals. The xenodiagnosis studies have shown selective interactions between the T. cruzi strains and the four species of vectors used, inducing significant variability in the results. The data herein present are consistent with the parasitological requirements established for a suitable model for chronic Chagas' disease.