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

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. © 2011 Fuchs et al; licensee BioMed Central Ltd.

Prevention of hypertension in patients with pre-hypertension: Protocol for the PREVER-prevention trial

Background: Blood pressure (BP) within pre-hypertensive levels confers higher cardiovascular risk and is an intermediate stage for full hypertension, which develops in an annual rate of 7 out of 100 individuals with 40 to 50 years of age. Non-drug interventions to prevent hypertension have had low effectiveness. In individuals with previous cardiovascular disease or diabetes, the use of BP-lowering agents reduces the incidence of major cardiovascular events. In the absence of higher baseline risk, the use of BP agents reduces the incidence of hypertension. The PREVER-prevention trial aims to investigate the efficacy, safety and feasibility of a population-based intervention to prevent the incidence of hypertension and the development of target-organ damage.Methods: This is a randomized, double-blind, placebo-controlled clinical trial, with participants aged 30 to 70 years, with pre-hypertension. The trial arms will be chlorthalidone 12.5 mg plus amiloride 2.5 mg or identical placebo. The primary outcomes will be the incidence of hypertension, 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 sub-clinical atherosclerosis, and sudden death. The study will last 18 months. The sample size was calculated on the basis of an incidence of hypertension of 14% in the control group, a size effect of 40%, power of 85% and P alpha of 5%, resulting in 625 participants per group. The project was approved by the Ethics committee of each participating institution.Discussion: The early use of blood pressure-lowering drugs, particularly diuretics, which act on the main mechanism of blood pressure rising with age, may prevent cardiovascular events and the incidence of hypertension in individuals with hypertension. If this intervention shows to be effective and safe in a population-based perspective, it could be the basis for an innovative public health program to prevent hypertension in Brazil.Trial Registration: Clinical Trials NCT00970931. © 2011 Fuchs et al; licensee BioMed Central Ltd.

Instantaneously measured traits may detect non-plastic ecophysiological performances in response to drought, explaining distributions of Styrax species in the Cerrado

We analyzed the differences between irrigated and non-irrigated plants of three congeneric Styrax species that present distinct distribution patterns in the physiognomies of the Cerrado vegetation in Brazil. Styrax ferrugineus showed a stomatal conductance (gs) unresponsive to soil water deficit in potted plants. This may explain the high gas exchange and photochemical efficiency found in this species, which is well adapted to the Cerrado sensu stricto (s. str.), a savanna-type vegetation. S. camporum, which is widely distributed in the Cerrado sensu lato (s. l.) areas, was the only species that exhibited increased intrinsic water use efficiency on the days of maximum water deficit. This result distinguishes S. camporum from S. pohlii, which is a forest species, since the gs of both species decreased during the days of maximum water stress. In contrast to other studies, we propose that instantaneously measured traits, such as leaf gas exchange rates and chlorophyll fluorescence, may be used to detect non-plastic performances in response to environmental stress, helping explain distinct geographical distributions of congeneric species in the Cerrado vegetation. © 2013 Springer-Verlag Berlin Heidelberg.

Revisão sistemática e biogeografia da espécie politípica campylorhamphus procurvoides

A última revisão do gênero Campylorhamphus (realizada por Zimmer em 1934), definiu a espécie politípica C. procurvoides como constituída pelos seguintes táxons de diagnose tradicionalmente difícil, feita principalmente com base em caracteres de plumagem: C. p. procurvoides, C. p multostriatus, C. p. probatus, C. p. sanus e C. p. successor. O objetivo do presente estudo foi revisar a sistemática desta espécie politípica através da descrição da variação geográfica e análise crítica da validade dos táxons atualmente reconhecidos, utilizando-se caracteres morfológicos e moleculares. A análise molecular indicou com forte apoio estatístico que a espécie politípica de C. procurvoides é polifilética, uma vez que os táxons nela agrupados se encontram distribuídos em três clados distintos e não proximamente relacionado dentro do gênero Campylorhamphus. Uma análise combinada dos caracteres morfológicos e genéticos possibilitou a diagnose objetiva dos táxons procurvoides, ultostriatus, probatus e sanus, mas não de successor, que foi sinonimizada com um táxon agrupado numa outra espécie politípica (C. t. notabilis); esta mesma análise indicou a existência de dois táxons distintos previamente não reconhecidos e que aqui são diagnosticados e referidos como taxon novum 1 e táxon novum 2. Com base nas suas relações fologenéticas e diagnose consistente, os táxons considerados válidos nesta revisão e tradicionalmente tratados como subespécies de C. procurvoides, são aqui elevados ao nível de espécie com base no Conceito Filético Geral de Espécie.

Balanced anesthesia with sevoflurane does not alter redox status in patients undergoing surgical procedures

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

SURFACE ROUGHNESS AND CANDIDA ALBICANS BIOFILM FORMATION ON A RELINE RESIN AFTER LONG-TERM CHEMICAL DISINFECTION AND TOOTHBRUSHING

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Short-term CO2-C emissions from soil prior to sugarcane (Saccharum spp.) replanting in southern Brazil

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Comparison between noninvasive mechanical ventilation and standard oxygen therapy in children up to 3 years old with respiratory failure after extubation: a pilot prospective randomized clinical study

Objectives: The effectiveness of noninvasive positive-pressure ventilation in preventing reintubation due to respiratory failure in children remains uncertain. A pilot study was designed to evaluate the frequency of extubation failure, develop a randomization approach, and analyze the feasibility of a powered randomized trial to compare noninvasive positive-pressure ventilation and standard oxygen therapy post extubation for preventing reintubation within 48 hours in children with respiratory failure.Design: Prospective pilot study.Setting: PICU at a university-affiliated hospital.Patients: Children aged between 28 days and 3 years undergoing invasive mechanical ventilation for greater than or equal to 48 hours with respiratory failure after programmed extubation.Interventions: Patients were prospectively enrolled and randomly assigned into noninvasive positive-pressure ventilation group and inhaled oxygen group after programmed extubation from May 2012 to May 2013.Measurements and Main Results: Length of stay in PICU and hospital, oxygenation index, blood gas before and after tracheal extubation, failure and reason for tracheal extubation, complications, mechanical ventilation variables before tracheal extubation, arterial blood gas, and respiratory and heart rates before and 1 hour after tracheal extubation were analyzed. One hundred eight patients were included (noninvasive positive-pressure ventilation group, n = 55 and inhaled oxygen group, n = 53), with 66 exclusions. Groups did not significantly differ for gender, age, disease severity, Pediatric Risk of Mortality at admission, tracheal intubation, and mechanical ventilation indications. There was no statistically significant difference in reintubation rate (noninvasive positive-pressure ventilation group, 9.1%; inhaled oxygen group, 11.3%; p > 0.05) and length of stay (days) in PICU (noninvasive positive-pressure ventilation group, 3 [116]; inhaled oxygen group, 2 [1-25]; p > 0.05) or hospital (noninvasive positive-pressure ventilation group, 19 [7-141]; inhaled oxygen group, 17 [8-80]).Conclusions: The study indicates that a larger randomized trial comparing noninvasive positive-pressure ventilation and standard oxygen therapy in children with respiratory failure is feasible, providing a basis for a future trial in this setting. No differences were seen between groups. The number of excluded patients was high.

How wild bearded capuchin monkeys select stones and nuts to minimize the number of strikes per nut cracked

Wild bearded capuchin monkeys, Cebus libidinosus, use stone tools to crack palm nuts to obtain the kernel. In five experiments, we gave 10 monkeys from one wild group of bearded capuchins a choice of two nuts differing in resistance and size and/or two manufactured stones of the same shape, volume and composition but different mass. Monkeys consistently selected the nut that was easier to crack and the heavier stone. When choosing between two stones differing in mass by a ratio of 1.3:1, monkeys frequently touched the stones or tapped them with their fingers or with a nut. They showed these behaviours more frequently before making their first selection of a stone than afterward. These results suggest that capuchins discriminate between nuts and between stones, selecting materials that allow them to crack nuts with fewer strikes, and generate exploratory behaviours to discriminate stones of varying mass. In the final experiment, humans effectively discriminated the mass of stones using the same tapping and handling behaviours as capuchins. Capuchins explore objects in ways that allow them to perceive invariant properties (e.g. mass) of objects, enabling selection of objects for specific uses. We predict that species that use tools will generate behaviours that reveal invariant properties of objects such as mass; species that do not use tools are less likely to explore objects in this way. The precision with which individuals can judge invariant properties may differ considerably, and this also should predict prevalence of tool use across species. (C) 2010 The Association for the Study of Animal Behaviour. Published by Elsevier Ltd. All rights reserved.

The Enhanced Tool-Kit of Two Groups of Wild Bearded Capuchin Monkeys in the Caatinga: Tool Making, Associative Use, and Secondary Tools

The use of stones to crack open encapsulated fruit is widespread among wild bearded capuchin monkeys (Cebus libidinosus) inhabiting savanna-like environments. Some populations in Serra da Capivara National Park (Piaui, Brazil), though, exhibit a seemingly broader toolkit, using wooden sticks as probes, and employing stone tools for a variety of purposes. Over the course of 701.5 hr of visual contact of two wild capuchin groups we recorded 677 tool use episodes. Five hundred and seventeen of these involved the use of stones, and 160 involved the use of sticks (or other plant parts) as probes to access water, arthropods, or the contents of insects` nests. Stones were mostly used as ""hammers""-not only to open fruit or seeds, or smash other food items, but also to break dead wood, conglomerate rock, or cement in search of arthropods, to dislodge bigger stones, and to pulverize embedded quartz pebbles (licking, sniffing, or rubbing the body with the powder produced). Stones also were used in a ""hammer-like"" fashion to loosen the soil for digging out roots and arthropods, and sometimes as ""hoes"" to pull the loosened soil. In a few cases, we observed the re-utilization of stone tools for different purposes (N = 3), or the combined use of two tools-stones and sticks (N = 4) or two stones (N = 5), as sequential or associative tools. On three occasions, the monkeys used smaller stones to loosen bigger quartz pebbles embedded in conglomerate rock, which were subsequently used as tools. These could be considered the first reports of secondary tool use by wild capuchin monkeys. Am. J. Primatol. 71:242-251, 2009. (c) 2008 Wiley-Liss, Inc.

Means to an end: Neotropical parrots manage to pull strings to meet their goals

Although parrots share with corvids and primates many of the traits believed to be associated with advanced cognitive processing, knowledge of parrot cognition is still limited to a few species, none of which are Neotropical. Here we examine the ability of three Neotropical parrot species (Blue-Fronted Amazons, Hyacinth and Lear`s macaws) to spontaneously solve a novel physical problem: the string-pulling test. The ability to pull up a string to obtain out-of-reach food has been often considered a cognitively complex task, as it requires the use of a sequence of actions never previously assembled, along with the ability to continuously monitor string, food and certain body movements. We presented subjects with pulling tasks where we varied the spatial relationship between the strings, the presence of a reward and the physical contact between the string and reward to determine whether (1) string-pulling is goal-oriented in these parrots, (2) whether the string is recognized as a means to obtain the reward and (3) whether subjects can visually determine the continuity between the string and the reward, selecting only those strings for which no physical gaps between string and reward were present. Our results show that some individuals of all species were able to use the string as a means to reach a specific goal, in this case, the retrieval of the food treat. Also, subjects from both macaw species were able to visually determine the presence of physical continuity between the string and reward, making their choices consistently with the recognition that no gaps should be present between the string and the reward. Our findings highlight the potential of this taxonomic group for the understanding of the underpinnings of cognition in evolutionarily distant groups such as birds and primates.

Ontogeny of manipulative behavior and nut-cracking in young tufted capuchin monkeys (Cebus apella): a Perception-action perspective

How do capuchin monkeys learn to use stones to crack open nuts? Perception-action theory posits that individuals explore producing varying spatial and force relations among objects and surfaces, thereby learning about affordances of such relations and how to produce them. Such learning supports the discovery of tool use. We present longitudinal developmental data from semifree-ranging tufted capuchin monkeys (Cebus apella) to evaluate predictions arising from Perception-action theory linking manipulative development and the onset of tool-using. Percussive actions bringing an object into contact with a surface appeared within the first year of life. Most infants readily struck nuts and other objects against stones or other surfaces from 6 months of age, but percussive actions alone were not sufficient to produce nut-cracking sequences. Placing the nut on the anvil surface and then releasing it, so that it could be struck with a stone, was the last element necessary for nut-cracking to appear in capuchins. Young chimpanzees may face a different challenge in learning to crack nuts: they readily place objects on surfaces and release them, but rarely vigorously strike objects against surfaces or other objects. Thus the challenges facing the two species in developing the same behavior (nut-cracking using a stone hammer and an anvil) may be quite different. Capuchins must inhibit a strong bias to hold nuts so that they can release them; chimpanzees must generate a percussive action rather than a gentle placing action. Generating the right actions may be as challenging as achieving the right sequence of actions in both species. Our analysis suggests a new direction for studies of social influence on young primates learning sequences of actions involving manipulation of objects in relation to surfaces.

Learning generalization in problem solving by a blue-fronted parrot (Amazona aestiva)

Pepperberg (The Alex studies: cognitive and communicative abilities of gray parrots. Harvard University Press, Cambridge;1999) showed that some of the complex cognitive capabilities found in primates are also present in psittacine birds. Through the replication of an experiment performed with cotton-top tamarins (Saguinus oedipus oedipus) by Hauser et al. (Anim Behav 57:565-582; 1999), we examined a blue-fronted parrot`s (Amazona aestiva) ability to generalize the solution of a particular problem in new but similar cases. Our results show that, at least when it comes to solving this particular problem, our parrot subject exhibited learning generalization capabilities resembling the tamarins`.

Capuchin monkey tool use: Overview and implications

Nutcracking capuchins are mentioned in reports dating as far back as the sixteenth century,(1,2) as well as in Brazilian folklore.(3) However, it was barely a decade ago that primatologists ""discovered"" the spontaneous use of stones to crack nuts in a semi-free ranging group of tufted capuchin monkeys. Since then, we have found several more capuchin populations in savanna-like environments which(5-7) employ this form of tool use. The evidence so far only weakly supports geneti cally based behavioral differences between populations and does not suggest that dietary pressures in poor environments are proximate determinants of the likelihood of tool use. Instead, tool use within these capuchin populations seems to be a behavioral tradition that is socially learned and is primarily associated with more terrestrial habits. However, differences in the diversity of ""tool kits"" between populations remain to be understood.