Assessment of regional long-axis function during dobutamine echocardiography

Echocardiographic analysis of regional left ventricular function is based upon the assessment of radial motion. Long-axis motion is an important contributor to overall function. but has been difficult to evaluate clinically until the recent development of tissue Doppler techniques. We sought to compare the standard visual assessment of radial motion with quantitative tissue Doppler measurement of peak systolic velocity. timing and strain rate (SRI) in 104 patients with known or suspected coronary artery disease undergoing dobutamine stress echocardiography (DbE). A standard DbE protocol was used with colour tissue Doppler images acquired in digital cine-loop format. peak systolic velocity (PSV), time to peak velocity (TPV) and SRI were assessed off-line by an independent operator. Wall motion was assessed by an experienced reader. Mean PSV, TPV and SRI values were compared with wall motion and the presence of coronary artery disease by angiography. A further analysis included assessing the extent of jeopardized myocardium by comparing average values of PSV, TPV and SRI against the previously validated angiographic score. Segments identified as having normal and abnormal radial wall motion showed significant differences in mean PSV (7.9 +/- 3.8 and 5.9 +/- 3.3 cm/s respectively; P < 0.001), TPV (84 40 and 95 +/- 48 ms respectively; P = 0.005) and SRI (- 1.45 +/- 0.5 and - 1.1 +/- 0.9 s(-1) respectively; P < 0.001). The presence of a stenosed subtending coronary artery was also associated with significant differences from normally perfused segments for mean PSV (8.1 3.4 compared with 5.7 +/- 3.7 cm/s; P < 0.001), TPV (78 50 compared with 92 +/- 45 ms; P < 0.001) and SRI (- 1.35 0.5 compared with - 1.20 +/- 0.4 s(-1); P = 0.05). PSV, TPV and SRI also varied significantly according to the extent of jeopardized myocardium within a vascular territory. These results suggest that peak systolic velocity, timing of contraction and SRI reflect the underlying physiological characteristics of the regional myocardium during DbE, and may potentially allow objective analysis of wall motion.

Recurrent gains and losses of large (84-109 bp) repeats in the rDNA internal transcribed spacer 2 (ITS2) of rhipicephaline ticks

We studied the internal transcribed spacer 2 (ITS2) in twenty-two spp. of ticks from the subfamily Rhipicephalinae. A 104-109 base pair (bp) region was Imperfectly repeated In most ticks studied. Mapping the number of repeat copies on to a phylogeny from the ITS2 showed that there have been many Independent gains and losses of repeats. Comparison of the sequences of the repeat copies Indicated that in most taxa concerted evolution had played little if any role in the evolution of these regions, as the copies clustered by sequence position rather than species, In our putative secondary structure, each repeat copy can fold into a distinct and almost identical stem-loop complex; a gain or loss of a repeat copy apparently does not impair the function of the ITS2 in these ticks.

Determination of reference values for glucose tolerance, insulin tolerance, and insulin sensitivity tests in clinically normal cats

Objective-To determine reference values and test variability for glucose tolerance tests (GTT), insulin tolerance tests (ITT), and insulin sensitivity tests (IST) in cats, Animals-32 clinically normal cats. Procedure-GTT, ITT, and IST were performed on consecutive days. Tolerance intervals tie, reference values) were calculated as means +/- 2.397 SD for plasma glucose and insulin concentrations, half-life of glucose (T-1/2glucose), rate constants for glucose disappearance (K-glucose and K-itt), and insulin sensitivity index (S-l). Tests were repeated after 6 weeks in 8 cats to determine test variability. Results-Reference values for T-1/2glucose, K-glucose, and fasting plasma glucose and insulin concentrations during GTT were 45 to 74 minutes, 0.93 to 1.54 %/min, 37 to 104 mg/dl, and 2.8 to 20.6 muU/ml, respectively. Mean values did not differ between the 2 tests. Coefficients of variation for T-1/2glucose, K-glucose, and fasting plasma glucose and insulin concentrations were 20, 20, 11, and 23%, respectively. Reference values for K-itt were 1.14 to 7.3%/min, and for S-l were 0.57 to 10.99 x 10(-4) min/muU/ml. Mean values did not differ between the 2 tests performed 6 weeks apart, Coefficients of variation for K-itt and S-l were 60 and 47%, respectively. Conclusions and Clinical Relevance-GTT, ITT, and IST can be performed in cats, using standard protocols. Knowledge of reference values and test variability will enable researchers to better interpret test results for assessment of glucose tolerance, pancreatic beta -cell function, and insulin sensitivity in cats.

Comparison of measured sleeping metabolic rate and predicted basal metabolic rate during the first year of life: evidence of a bias changing with increasing metabolic rate

Objective: To compare measurements of sleeping metabolic rate (SMR) in infancy with predicted basal metabolic rate (BMR) estimated by the equations of Schofield. Methods: Some 104 serial measurements of SMR by indirect calorimetry were performed in 43 healthy infants at 1.5, 3, 6, 9 and 12 months of age. Predicted BMR was calculated using the weight only (BMR-wo) and weight and height (BMR-wh) equations of Schofield for 0-3-y-olds. Measured SMR values were compared with both predictive values by means of the Bland-Altman statistical test. Results: The mean measured SMR was 1.48 MJ/day. The mean predicted BMR values were 1.66 and 1.47 MJ/day for the weight only and weight and height equations, respectively. The Bland-Altman analysis showed that BMR-wo equation on average overestimated SMR by 0.18 MJ/day (11%) and the BMR-wh equation underestimated SMR by 0.01 MJ/day (1%). However the 95% limits of agreement were wide: - 0.64 to - 0.28MJ/day (28%) for the former equation and - 0.39 to +0.41 MJ/day (27%) for the latter equation. Moreover there was a significant correlation between the mean of the measured and predicted metabolic rate and the difference between them. Conclusions: The wide variation seen in the difference between measured and predicted metabolic rate and the bias probably with age indicates there is a need to measure actual metabolic rate for individual clinical care in this age group.

Diving behaviour of two Australian bimodally respiring turtles, Rheodytes leukops and Emydura macquarii, in a natural setting

Time-depth recorders were used to investigate the diving performance and behaviour of two bimodally respiring turtle species, Rheodytes leukops and Emydura niacquarii, known to have a high and low reliance on aquatic respiration, respectively. Significant differences in diving performance between R. leukops and E. macquarii were observed in the number of dives/day (39.3 +/- 5.38 vs 112.2 +/- 11.73 dives/day; mean +/- SE), mean dive length (33.1 +/- 7.33 min vs 9.6 +/- 2.26 min) and maximum dive length (623 +/- 104.74 min vs 67.1 +/- 8.14 min), respectively. Differences in diving performance between R. leukops and E macquarii are attributed to the species' reliance (or lack thereof) upon aquatic respiration. Rheodytes leukops displayed a weak bimodal pattern of increased surfacing frequency in the early morning (05:00-07:00) and late afternoon (14:00-18:00), while E. macquarii displayed a strong bimodal pattern of elevated surfacing frequency over similar time periods. Daily patterns of increased surfacing frequency for both species failed to correlate with fluctuating aquatic Po-2 levels or water temperature, and may instead be explained by the heightened activity levels of both species during twilight.

Use of stress echocardiography to predict mortality in patients with diabetes and known or suspected coronary artery disease

OBJECTIVE - This study sought to determine whether stress echocardiography using exercise (when feasible) or dobutamine echo could be used to predict mortality in patients with diabetes. RESEARCH DESIGN AND METHODS - Stress echo was performed in 937 patients with diabetes (aged 59 +/- 13 years, 529 men) for symptom evaluation (42%) and follow-up of known coronary artery disease (CAD) (58%). Stress echocardiography using exercise was performed in 333 patients able to exercise maximally, and dobutamine echo using a standard dobutamine stress was used in 604 patients. Patients were followed for less than or equal to9 years (mean 3.9 +/- 2.3) for all-cause mortality. RESULTS - Normal studies were obtained in 567 (60%) patients; 29% had resting left ventricular (LV) dysfunction, and 25% had ischemia. Abnormalities were confined to one territory in 183 (20%) patients and to multiple territories in 187 (20%) patients. Death (in 275 [29%] patients) was predicted by referral for pharmacologic stress (hazard ratio [HR] 3.94, P < 0.0001), ischemia (1.77, P <0.0001), age (1.02, P = 0.002), and heart failure (1.54, P = 0.01). The risk of death in patients With a normal scan was 4% per year, and this was associated with age and selection for pharmacologic stress testing. In stepwise models replicating the sequence of clinical evaluation, the predictive power of independent clinical predictors (age, selection for pharmacologic stress, previous infarction, and heart failure; model chi(2) = 104.8) was significantly enhanced by addition of stress echo data (model chi(2) = 122.9). CONCLUSIONS - The results of stress echo are independent predictors of death in diabetic patients with known or suspected CAD.. Ischemia adds risk that is incremental to clinical risks and LV dysfunction.

Copper transfer from the Cu(I) chaperone, CopZ, to the repressor, Zn(II)CopY: Metal coordination environments and protein interactions

Extracellular copper regulates the DNA binding activity of the CopY repressor of Enterococcus hirae and thereby controls expression of the copper homeostatic genes encoded by the cop operon. CopY has a CxCxxxxCxC metal binding motif. CopZ, a copper chaperone belonging to a family of metallochaperones characterized by a MxCxxC metal binding motif, transfers copper to CopY. The copper binding stoichiometries of CopZ and CopY were determined by in vitro metal reconstitutions. The stoichiometries were found to be one copper(l) per CopZ and two copper(l) per CopY monomer. X-ray absorption studies suggested a mixture of two- and three-coordinate copper in Cu(1)CopZ, but a purely three-coordinate copper coordination with a Cu-Cu interaction for Cu(1)(2)CopY. The latter coordination is consistent with the formation of a compact binuclear Cu(l)-thiolate core in the CxCxxxxCxC binding motif of CopY. Displacement of zinc, by copper. from CopY was monitored with 2,4-pyridylazoresorcinol. Two copper(l) ions were required to release the single zinc(II) ion bound per CopY monomer. The specificity of copper transfer between CopZ and CopY was dependent on electrostatic interactions. Relative copper binding affinities of the proteins were investigated using the chelator, diethyldithiocarbamic acid (DDC). These data suggest that CopY has a higher affinity for copper than CopZ. However, this affinity difference is not the sole factor in the copper exchange: a charge-based interaction between the two proteins is required for the transfer reaction to proceed. Gain-of-function mutation of a CopZ homologue demonstrated the necessity of four lysine residues on the chaperone for the interaction with CopY. Taken together, these results suggest a mechanism for copper exchange between CopZ and CopY.

Single-nucleotide polymorphism in the CD14 promoter and periodontal disease expression in a Japanese population

It has been reported that there is a relationship between a single-nucleotide polymorphism (SNP) in the promoter region of the CD 14 gene at position -159 (C-->T) and infectious diseases. The aim of the present study was to test the hypthesis that expression of this SNP correlates with periodontal disease in a Japanese population. The CD14 genotype was determined in 163 subjects with periodontitis and in 104 age- and gender-matched control subjects without periodontitis. The genotype distribution and allele frequency within the periodontitis patients were not significantly different from those of control subjects. There was, however, a significant difference in the genotype distribution between young patients (< 35 yrs) and older patients (greater than or equal to 35 yrs). These findings suggest that CD14-159C/T polymorphism is not related to the development of periodontitis in a Japanese population, but that, within the periodontitis subjects, expression of the SNP may be related to early disease activity.

Log??stica de distribui????o e entrega dos objetos do Programa Nacional do Livro Did??tico (PNLD)

O Programa Nacional do Livro Did??tico ??? PNLD, administrado pelo Fundo Nacional de Desenvolvimento da Educa????o ??? FNDE, utiliza, desde 1994, os servi??os da Empresa Brasileira de Correios e Tel??grafos - ECT, para levar ??s escolas p??blicas mais de uma centena de milh??es de livros did??ticos. V??rios eram os problemas a serem resolvidos. Antes de a ECT assumir os servi??os, somente 25% dos livros eram entregues antes do in??cio do ano letivo e o restante entregue durante ano, prejudicando de uma sobre maneira, n??o s?? alunos e professores, mas todo o planejamento de ensino. A aus??ncia de um controle efetivo da entrega dos livros, aliado ao endere??amento incorreto, gerava um de alto ??ndice de reclama????o quanto ao n??o recebimento dos objetos. Com as a????es descritas nesse relato, foi poss??vel aumentar o n??mero de crian??as/adolescentes estudantes de escolas p??blicas, com cobertura de todos os munic??pios brasileiros, os quais s??o na realidade os grandes clientes de todo o processo. Certamente que o sucesso da opera????o envolve a FNDE e a ECT, sendo que nesta ??ltima ?? imprescind??vel a perfeita sintonia entre todas as ??reas

Centro de Inform??tica, Cidadania e Produ????o Cultural para Minorias: CIPRO

O Centro de Inform??tica, Cidadania e Produ????o Cultural Para Minorias (CIPRO) ?? um projeto articulado pela Delegacia Regional do Trabalho do Rio de Janeiro (DRT/RJ) e administrado conjuntamente com diversas Organiza????es N??o Governamentais, entre elas o Comit?? Pela Democratiza????o da Inform??tica (CDI), o Grupo Cultural Afro Reggae (comunidade de Vig??rio Geral), o Grupo Pela Vidda (portadores do HIV) dentre outras. O CIPRO oferece n??o s?? cursos de qualifica????o profissional, mas tamb??m uma infra-estrutura que permita aos alunos praticarem aquilo que aprenderam. Nossa clientela ?? de pessoas que procuram a DRT/RJ para receberem seu seguro desemprego. Tamb??m s??o atendidas pessoas discriminadas ou sem seguro desemprego. O projeto foi oficialmente lan??ado em 28/05/99. Apesar de n??o possuir quaisquer recursos financeiros, treinou em seu primeiro ano de atividade mais de 180 alunos em inform??tica, produ????o cultural e gest??o social. O CIPRO ?? um projeto social constru??do a partir do n??o paternalismo: instrutores s??o ex-alunos e coordenadores s??o ex-administradores, todos entendendo que sua inser????o no mercado de trabalho somente se dar?? a partir do seu esfor??o pessoal e de sua compet??ncia profissional

ENAP 20 anos: caminhos de uma escola de governo

Apresenta????o da trajet??ria da ENAP Escola Nacional de Administra????o P??blica desde sua funda????o, em 1996. Pe??a importante na forma????o de um servi??o p??blico competente, a ENAP tem sua atua????o focada no desenvolvimento de compet??ncias dos servidores para aumentar a capacidade de governo na gest??o de pol??ticas p??blicas

Disciplina 1.2: democracia e cidadania no Brasil

A disciplina teve como conte??dos: conceitos de cidadania, sociedade civil e democracia no pensamento pol??tico contempor??neo e mapeamento de suas diferentes interpreta????es. As principais experi??ncias de participa????o social em curso no Brasil: or??amentos participativos e conselhos de pol??ticas

Prevbarcos: estrat??gia de inclus??o pela Previd??ncia Social

Este estudo de caso faz an??lise do programa Prevbarco, Unidade M??vel Flutuante da Previd??ncia Social, no qual barcos navegam pelos rios da bacia amaz??nica, prestando servi??os previdenci??rios para as comunidades locais - ribeirinhas, quilombolas, extrativistas, ind??genas entre outras - que n??o t??m acesso adequado aos servi??os oferecidos pelas unidades fixas da Previd??ncia Social localizadas nas ??reas urbanas. Faz-se a descri????o do tipo de servi??o prestado pelos Prevbarcos, que desenvolve a inclus??o social e cidadania da popula????o assistida, assim como identifica dificuldades nessa presta????o que se caracteriza desde a contrata????o dos servidores que se voluntariam para os longos percursos de barco, passando pela falta de conhecimento da popula????o sobre cidadania e seus direitos previdenci??rios. A partir deste caso, espera-se reflex??o dos servidores sobre motiva????o para pr??ticas inovadoras e, pelo estudo em quest??o, releva-se a necessidade de pensar e formular pol??ticas p??blicas que atendam, de fato, ??s necessidades de benefici??rios e cidad??os

Burocracia, efici??ncia e modelos de gest??o p??blica: um ensaio

Este artigo apresenta diferentes vis??es sobre burocracia e efici??ncia, fazendo o contraponto com alguns modelos de gest??o p??blica, tais como o tradicional ou ortodoxo, o liberal e o chamado empreendedorismo estatal. Discute o relacionamento entre burocracia e efici??ncia, com um exemplo extra??do do gerencialismo brit??nico, orientador de reformas administrativas em diversos pa??ses. Elenca algumas quest??es recorrentes, que norteiam diversos modelos de gest??o p??blica em sua busca por efici??ncia e que t??m indiscut??vel import??ncia no ??mbito da administra????o p??blica.

Resposta da pressão arterial ao esforço em adolescentes: influência do sobrepeso e obesidade

Artigo original Ergoespirometria