Association between valvular surgery and mortality among patients with infective endocarditis complicated by heart failure.

Context Heart failure (HF) is the most common complication of infective endocarditis. However, clinical characteristics of HF in patients with infective endocarditis, use of surgical therapy, and their associations with patient outcome are not well described.Objectives To determine the clinical, echocardiographic, and microbiological variables associated with HF in patients with definite infective endocarditis and to examine variables independently associated with in-hospital and 1-year mortality for patients with infective endocarditis and HF, including the use and association of surgery with outcome.Design, Setting, and Patients The International Collaboration on Endocarditis-Prospective Cohort Study, a prospective, multicenter study enrolling 4166 patients with definite native- or prosthetic-valve infective endocarditis from 61 centers in 28 countries between June 2000 and December 2006.Main Outcome Measures In-hospital and 1-year mortality.Results Of 4075 patients with infective endocarditis and known HF status enrolled, 1359 (33.4% [95% CI, 31.9%-34.8%]) had HF, and 906 (66.7% [95% CI, 64.2%-69.2%]) were classified as having New York Heart Association class III or IV symptom status. Within the subset with HF, 839 (61.7% [95% CI, 59.2%-64.3%]) underwent valvular surgery during the index hospitalization. In-hospital mortality was 29.7% (95% CI, 27.2%-32.1%) for the entire HF cohort, with lower mortality observed in patients undergoing valvular surgery compared with medical therapy alone (20.6% [95% CI, 17.9%-23.4%] vs 44.8% [95% CI, 40.4%-49.0%], respectively; P < .001). One-year mortality was 29.1% (95% CI, 26.0%-32.2%) in patients undergoing valvular surgery vs 58.4% (95% CI, 54.1%-62.6%) in those not undergoing surgery (P < .001). Cox proportional hazards modeling with propensity score adjustment for surgery showed that advanced age, diabetes mellitus, health care-associated infection, causative microorganism (Staphylococcus aureus or fungi), severe HF (New York Heart Association class III or IV), stroke, and paravalvular complications were independently associated with 1-year mortality, whereas valvular surgery during the initial hospitalization was associated with lower mortality.Conclusion In this cohort of patients with infective endocarditis complicated by HF, severity of HF was strongly associated with surgical therapy and subsequent mortality, whereas valvular surgery was associated with lower in-hospital and 1-year mortality.

Subclinical thyroid dysfunction, cardiac function, and the risk of heart failure. The Cardiovascular Health study.

OBJECTIVES: The goal of this study was to determine whether subclinical thyroid dysfunction was associated with incident heart failure (HF) and echocardiogram abnormalities. BACKGROUND: Subclinical hypothyroidism and hyperthyroidism have been associated with cardiac dysfunction. However, long-term data on the risk of HF are limited. METHODS: We studied 3,044 adults>or=65 years of age who initially were free of HF in the Cardiovascular Health Study. We compared adjudicated HF events over a mean 12-year follow-up and changes in cardiac function over the course of 5 years among euthyroid participants, those with subclinical hypothyroidism (subdivided by thyroid-stimulating hormone [TSH] levels: 4.5 to 9.9, >or=10.0 mU/l), and those with subclinical hyperthyroidism. RESULTS: Over the course of 12 years, 736 participants developed HF events. Participants with TSH>or=10.0 mU/l had a greater incidence of HF compared with euthyroid participants (41.7 vs. 22.9 per 1,000 person years, p=0.01; adjusted hazard ratio: 1.88; 95% confidence interval: 1.05 to 3.34). Baseline peak E velocity, which is an echocardiographic measurement of diastolic function associated with incident HF in the CHS cohort, was greater in those patients with TSH>or=10.0 mU/l compared with euthyroid participants (0.80 m/s vs. 0.72 m/s, p=0.002). Over the course of 5 years, left ventricular mass increased among those with TSH>or=10.0 mU/l, but other echocardiographic measurements were unchanged. Those patients with TSH 4.5 to 9.9 mU/l or with subclinical hyperthyroidism had no increase in risk of HF. CONCLUSIONS: Compared with euthyroid older adults, those adults with TSH>or=10.0 mU/l have a moderately increased risk of HF and alterations in cardiac function but not older adults with TSH<10.0 mU/l. Clinical trials should assess whether the risk of HF might be ameliorated by thyroxine replacement in individuals with TSH>or=10.0 mU/l.

Fluoriditasetarkastelu ja päästöjen hallinta ferrokromi- ja terästeollisuudessa

Työn alkuosassa kartoitettiin AvestaPolarit –yhtiöiden Tornion tehtaiden keskeiset fluoridilähteet kuten fluspaatti, valukuonat, valupulverit ja fluorivetyhappo. Valupulverien ja kuonien haihtumis- ja liukoisuuskäyttäytymistä valaistiin kotimaisten ja kansainvälisten tutkimusten avulla. Tutkimustuloksia sovellettiin pääpiirteittäin Tornion tehtaiden tilanteeseen ottamalla huomioon tekijät, jotka saattoivat lieventää tai vahvistaa fluoridien vaikutusta ympäristöön. Yleisesti fluoridien ympäristö- ja terveysvaikutukset arvioitiin vähäisiksi. Työn kokeellisessa osassa määritettiin Tornion tehtaiden ferrokromitehtaan, terässulaton, kuumavalssaamon ja kylmävalssaamon fluoriditaseet. Jokaisen osastojen syötteiden fluoridipitoisuudet selvitettiin tuottajien ilmoittamien tuotekoostumuksien, spesifikaatioiden ja fluoridianalyysien perusteella. Fluoridien kokonaismäärät laskettiin jokaiselle syötteelle ja ne suhteutettiin kunkin osaston vuoden 2001 tuotantotasoon. Tasetarkastelussa suurimpina fluoridisyötteinä nousivat odotetusti esiin terässulaton käyttämä kuonanmuodostaja-aine fluspaatti (CaF2) ja kylmävalssaamon peittaushappo, 70 prosenttinen fluorivetyhappo (HF). Lisäksi muita merkittäviä syötteitä olivat kylmävalssaamon käyttämä kalkkipitoinen sekakuona ja ferrokromitehtaan sulatuskoksi. Tuotoksien eli päästöjen fluoridipitoisuudet saatiin selville päästömittauksin. Jätevesistä otettiin pääosin viikoittaisia kokoomanäytteitä, jotka analysoitiin tehtaan laboratoriossa. Kaasumaiset tuotokset oli määritetty kertamittauksien perusteella. Kiinteiden tuotoksien eli sakkojen ja kuonien fluoridimittaukset suoritettiin 3 sulatuksen kuonanäytteistä ja sakan vuosinäytteestä. Tuotoksista suurimmat ominaispäästökertoimet olivat juuri terässulaton AOD-konvertterin ja senkkauunin kuonilla ja kylmävalssaamon neutraloidulla regenerointisakalla ja neutralointisakoilla. Näistä ei aiheutunut varsinaista päästöä lähiympäristöön, koska sakat ja kuonat loppusijoitetaan tehtaan kaatopaikalle tai niitä käytetään liukenemattomassa muodossa. Tornion tehtaiden fluoridisyötteiden ja -tuotoksien mittausepätarkkuudet vaikuttivat fluoriditaseeseen. Ferrokromitehtaan fluoridisyötteet olivat kokonaismäärältään selvästi suurempia kuin tuotokset. Terässulaton fluoriditaseen tuotokset olivat suurempia kuin syötteet ja kylmävalssaamon syötteet sekä tuotokset olivat karkeasti arvioiden samaa suuruusluokkaa. Kuumavalssaamon fluoridisyötteet ja -tuotokset olivat mitättömiä. Fluoriditaseen epävarmuustekijöitä voidaan vähentää suorittamalla esimerkiksi useita fluoridimittauksia kaasumaisista päästöistä.

Étude de la sensibilité baroréceptive en sommeil et à l’éveil dans l’insomnie primaire chronique

L’insomnie, une condition fréquemment retrouvée dans la population, se caractérise d’abord par une difficulté à initier ou à maintenir le sommeil et/ou par des éveils précoces le matin ou encore par un sommeil non-réparateur. Lorsqu’elle n’est pas accompagnée par des troubles psychiatriques ou médicaux ou un autre trouble de sommeil et qu’elle perdure plus de 6 mois on parle alors d’insomnie primaire chronique. Selon certains, cette condition serait associée à un état d’hyperéveil caractérisé par une augmentation de l’activité autonome sympathique durant le sommeil et l’éveil. Le baroréflexe est un important mécanisme de contrôle à court terme des fluctuations de la tension artérielle (TA) et de la fréquence cardiaque agissant sur le cœur et les vaisseaux sanguins par l’entremise du système nerveux autonome. On appelle sensibilité baroréceptive (SBR) la capacité du baroréflexe de réagir et de contrôler les fluctuations de TA en modulant le rythme cardiaque. De manière générale, la SBR serait augmentée durant la nuit par rapport à la journée. Aussi, il semblerait que le baroréflexe soit impliqué dans le phénomène de baisse physiologique de la TA pendant la nuit. Or, des données de notre laboratoire ont démontré une augmentation de la TA systolique au cours de la nuit ainsi qu’une atténuation de la baisse nocturne de TA systolique chez des sujets avec insomnie primaire chronique comparé à des témoins bons dormeurs. De plus, il a été démontré que le baroréflexe était altéré de façon précoce dans plusieurs troubles cardiovasculaires et dans l’hypertension artérielle. Or, il semblerait que l’insomnie soit accompagnée d’un risque accru de développement de l’hypertension artérielle. Ces études semblent aller dans le sens d’une altération des mécanismes de régulation de la TA dans l’insomnie. Par ailleurs, une réduction de la SBR serait aussi impliquée dans des états associés à une augmentation de l’activité autonome sympathique. Ainsi, nous nous sommes demandé si le baroréflexe pouvait constituer un des mécanismes de contrôle de la TA qui serait altéré dans l’insomnie et pourrait être impliqué dans l’augmentation de l’activité sympathique qui semble accompagner l’insomnie. Jusqu’à présent, le baroréflexe reste inexploré dans l’insomnie. L’objectif principal de ce mémoire était d’évaluer de façon non-invasive la SBR à l’éveil et en sommeil chez 11 sujets atteints d’insomnie primaire chronique comparé à 11 témoins bons dormeurs. L’évaluation du baroréflexe a été effectuée de façon spontanée par la méthode de l’analyse en séquence et par le calcul du coefficient alpha obtenu par l’analyse spectrale croisée de l’intervalle RR et de la TA systolique. De façon concomitante, les paramètres de la variabilité de l’intervalle RR en sommeil et à l’éveil ont aussi été comparés chez ces mêmes sujets. Aucune différence significative n’a été notée au niveau des index de la SBR entre le groupe d’insomniaques et celui des bons dormeurs, à l’éveil ou en sommeil. Cependant, on observe des valeurs légèrement plus faibles de la SBR chez les insomniaques ayant mal dormi (efficacité de sommeil (ES) < 85%) comparés aux insomniaques ayant bien dormi (ES≥ 85%) à la nuit expérimentale durant l’éveil et en sommeil. Par ailleurs, aucune différence n’a été notée entre le groupe d’insomniaques et celui des bons dormeurs au niveau des paramètres de la variabilité RR considérés (intervalle RR, PNN50, LF et HF en valeurs normalisées). En effet, les insomniaques tout comme les bons dormeurs semblent présenter une variation normale de l’activité autonome en sommeil, telle que représentée par les paramètres de la variabilité RR. Ces résultats préliminaires semblent suggérer que les mécanismes du baroréflexe sont préservés chez les sujets atteints d’insomnie primaire chronique tels que diagnostiqués de manière subjective. Cependant, il est possible qu’une altération des mécanismes du baroréflexe ne se révèle chez les insomniaques que lorsque les critères objectifs d’une mauvaise nuit de sommeil sont présents.

Cádmio, cromo, chumbo e zinco em plantas de milho e em latossolo após nove aplicações anuais de lodo de esgoto

As maiores limitações para o uso do lodo de esgoto em áreas agrícolas são os riscos de contaminação do solo com metais pesados e sua possível transferência para a cadeia alimentar. Objetivou-se, com este estudo, avaliar os teores de Cd, Cr, Pb e Zn no solo, utilizando-se dois métodos de extração (HNO3 + H2O2 + HCl e HClO4 + HF), o acúmulo destes elementos em plantas de milho cultivadas em Latossolo Vermelho eutroférrico no nono ano de aplicação de lodo de esgoto, bem como seus efeitos na produção de matéria seca e na produtividade de grãos. O experimento foi instalado em condições de campo em Jaboticabal-SP, no delineamento em blocos casualizados, com quatro tratamentos e cinco repetições. Os tratamentos corresponderam a doses acumuladas por nove anos consecutivos de lodo de esgoto (45,0; 90,0 e 127,5 t ha-1, base seca) e um tratamento testemunha que recebeu fertilização mineral com base na análise de solo. O lodo de esgoto foi aplicado manualmente e incorporado ao solo com grade a 0,1 m de profundidade antes da semeadura do milho. Os teores médios de Cd no solo não variaram em função das doses de lodo e dos métodos de extração. Por outro lado, os teores médios de Cr, Pb e Zn no solo obtidos pela digestão com HClO4 + HF foram de 72,4; 31,8 e 62,3 %, respectivamente, superiores àqueles encontrados pela digestão que empregou HNO3 + H2O2 + HCl. Contudo, quando se avaliou apenas o efeito das doses de lodo no solo, em ambos os métodos de extração, verificou-se diferença entre os tratamentos apenas para a concentração de Zn no solo. Exceto o Cd, que não foi detectado, de modo geral, os teores e os acúmulos de Cr, Pb e Zn nas partes das plantas de milho aumentaram com as aplicações de lodo de esgoto. Os teores de Cr, Pb e Zn nos grãos, quando detectados, permaneceram abaixo dos limites máximos estabelecidos para o consumo humano conforme a legislação brasileira. A adição de lodo de esgoto e a fertilização mineral, por longo período, apresentaram efeitos semelhantes na produção de matéria seca e na produtividade de grãos de milho.

Evolução geodinâmica e condicionamento estrutural dos terrenos Piancó-Alto Brígida e Alto Pajeú, domínio da zona transversal, NE do Brasil

This thesis aims to advance in the geological knowledge of the region comprising the Piancó-Alto Brígida (TPAB) and Alto pajeú (TAP) terranes, in the Transversal Zone Domain (Borborema Province, NE Brazil), with the main objective of understanding the geodynamic evolution and the structural framework of these units. To reach this objective, and besides field work and interpretation of traditional aerial photographs, other tools were employed like of remote sensing products (Landsat 7 ETM+, aeroradiometrics, aeromagnetics and topographical images), lithogeochemical (whole rock) analyses and geochronological dating (U-Pb in zircon), besides integration with literature data. In the area, several precambrian geological units outcrop, represented in the TAP by the paleoproterozoic Serra Talhada and Afogados da Ingazeira complexes, Riacho Gravatá Complex (metavolcano-sedimentary sequence of Stenian-Tonian age) and Cariris Velhos orthogneisses (of Tonian age). The TPAB comprises the Santana do Garrote (lower unit) and Serra do Olho d'Água (upper unit) formations of the Cachoeirinha Group (Neoproterozoic III), besides the Piancó orthogneisses and Bom Jesus paragneisses; the latter correspond to an older (basement ?) block and a possible high grade equivalent of the Cachoeirinha Group (or Seridó Group ?), respectively. Several Brasiliano-age plutons occur in both terranes.The aeromagnetic data show the continuity, at depth, of the main shear zones mapped in the region. The Patos, Pernambuco, Boqueirão dos Cochos, Serra do Caboclo, Afogados da Ingazeira/Jabitacá and Congo-Cruzeiro do Nordeste shear zones reach depths greater than to 6-16 km. The aeromagnetic signature of other shear zones, like the Juru one, suggests that these structures correspond to shallower crustal features. The satellite images (Landsat 7 ETM+) and aerogamaspectrometric images discriminate different geological units, contributing to the mapping of the structural framework of the region. The Serra do Caboclo Shear Zone was characterized as the boundary/suture between the TPAB and TAP. This structure is an outstanding, pervasive feature that separates contrasting geological units, such as the Neoproterozoic III Cachoeirinha Group in the TPAB and the Riacho Gravatá Complex and the Cariris Velhos metaplutonics, of Stenian-Tonian age, in the TAP. Occupying different blocks, these units are not found in authoctonous relations, like unconformities and intrusive contacts. Concerning the Cariris Velhos (ca. 1,0 Ga old) event is recorded by radiometric ages of the Riacho Gravatá Complex metavolcanics and intrusive augen and orthogneisses, all of them displaying geochemical affinities of arc or collisional settings. A structural signature of this event was not recorded in the region, possibly due to its low grade/low strain style, obliterated by the overprinting of younger, higher grade/high strain Brasiliano-age fabrics.The first tectonic event (D1) observed in the Cariris Velhos lithotypes presents contractional kinematics with transport to the NW. Neoproterozoic III geochronologic dates, obtained in late-D1 granitoids, imply a Brasiliano age (ca. 610-600 Ma) for this deformation event. The second tectonic event (D2) characterized in the region corresponds to the Brasiliano transcurrent kinematics of the outstanding shear zones and associated granitoid plutons. The geochronological (U-Pb in zircon) data obtained during this thesis also confirms the occurrence of the Cariris Velhos magmatic suite in the TAP, as well as the Neoproterozoic III age to the Cachoeirinha Group in the TPAB. The TAP (Riacho Gravatá Complex, augen and orthogneisses) is interpreted as a continental arc possibly accreted to a microcontinent during the Cariris Velhos (Stenian-Tonian) event. Later on, this terrane collided with the TPAB at the beginning of the Brasiliano orogeny (D1 contractional deformation), and both domins were reworked by the transcurrent shear deformation of the D2 event

Isotopic characterization of the metabasites and amphibolites of the Acungui and Setuva Groups of the Ribeira Belt

Pb, Rb, Sr, Sm and Nd isotope analyses were carried out on amphibolitic rocks from Campo Largo (PR), Rio Branco do Sul (PR) and Adrianópolis (PR) and for the metabasite from Adrianópolis and Apiai (SP), all belonging to the Açungui and Setuva Groups, southern portion of the Ribeira Belt. These occurrences were chosen because each exhibits geochemical data indicative of a mantle source, having different signatures. Geochronologic determinations are available only for the Apiai metagabbro with Neoproterozoic ages of 617 ± 4 Ma (U/Pb in zircon) and 839 ± 85 Ma (Rb/Sr, whole rock). Age determinations by Sm/Nd mineral isochron using whole rock, plagioclase and pyroxene yield values of 885 ± 53 Ma for the Apiai metagabbro and 820 ± 84 Ma for the Adrianópolis metabasite. These results agree within error with the Rb/Sr isochron of 839 ± 85 Ma may possibly be interpreted as the time of extraction of the magma from the mantle, as suggested by positive εNd(850) values (+2,76) from an Adrianópolis sample. An εNd values versus 87Sr/86Sr diagram shows that each studied occurrence plots in a different position, following approximately the mantle array trend, the most primitive being the metabasite of Adrian-acopolis, near the MORB field, and the most enriched being the amphibolite from the same region, near the enriched mantle and or crustal contamination field. The distinct difference in isotopic signatures between the amphibolite and metabasite suggests derivation from different mantle sources, as supported by available geochemical data. Nevertheless, some of the samples show isotopic evidence of the action of metamorphism, crustal contamination and weathering.

Molecular Dynamics simulations of track formation at different ensembles

A series of Molecular Dynamics simulations of thermal spikes has been run in zircon. For two different ensembles: microcanonical one and a combination of microcanonical one acting on the simulation core with Langevin one on the side walls of simulation. Depending on the used ensemble, different track-formation threshold energies were found. When the combined ensemble is carried out, the total energy of the simulations varies with the temperature which can influence how annealing fission-track models should deal with the lattice recovery. A fission-track annealing model is tested with the simulation results. © 2012 Elsevier Ltd. All rights reserved.

Zinco, cádmio e chumbo em plantas de milho e em latossolo tratado com lodo de esgoto por nove anos consecutivos

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Método de traços de fissão em zircão: estudos geocronológicos no grupo Bauru

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Efeito do bloqueio da aldosterona na remodelação cardíaca de ratos espontaneamente hipertensos

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Evolução metamórfica (P-T-t) de granulitos e migmatitos do Complexo Guaxupé na região de São João da Boa Vista, SP

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Efeitos do estresse induzido por polietileno glicol (PEG 6000) em feijoeiro (Phaseolus vulgaris L.)

Pós-graduação em Agronomia (Agricultura) - FCA

A articulação das culturas humanísticas e científica por meio do estudo histórico-sociocultural dos trabalhos de James Prescott Joule: contribuições para a formação de professores universitários em uma perspectiva transformadora

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Cerro Porã Batholith: post-orogenic A-type granite from the Amoguijá Magmatic Arc - Rio ApaTerrane - South of the Amazonian Craton

O Batólito Cerro Porã é um corpo de aproximadamente 30 por 4 km de extensão, localizado na região de Porto Murtinho, Mato Grosso do Sul. Situa-se nos domínios do Terreno Rio Apa, porção sul do Cráton Amazônico. Constitui-se pela Fácies sienogranítica rosa e Fácies monzogranítica cinza. A primeira é caracterizada por textura equi a, essencialmente, inequigranular xenomórfica e pela presença constante de intercrescimentos gráfico e granofíric; constitui-se por feldspatos alcalinos, quartzo e plagioclásio, tendo biotita como único máfico primário. A Fácies monzogranítica cinza apresenta textura porfirítica, com uma matriz de granulação fina gráfica a granofírica e consiste de quartzo, plagioclásio, feldspatos alcalinos e agregados máficos (biotita e anfibólio). Ambas foram metamorfizadas na fácies xisto verde e a Fácies sienogranítica rosa mostra-se milonitizada quando em zonas de cisalhamento. Foi identificado um evento deformacional dúctil-rúptil originado em regime compressivo, responsável pela geração de xistosidade e lineação de estiramento mineral. A Zona de Cisalhamento Esperança relaciona-se a esta fase e reflete a história cinemática convergente, reversa a de cavalgamento, com transporte de topo para NWW. Quimicamente, esses litotipos classificam-se como granitoides do tipo A2 da série alcalina potássica saturada em sílica. Determinação geocronológica obtida pelo método U-Pb (SHRIMP) em zircão, forneceu idade de 1749 ±45 Ma para sua cristalização. Do ponto vista geotectônico, admite-se que o Granito Cerro Porã corresponda a um magmatismo associado a um arco vulcânico desenvolvido no Estateriano e que sua colocação se deu no estágio tardi a pós-orogênico.