Life expectancy for community-based patients with heart failure from time of diagnosis

AIMS: Heart failure has been demonstrated in previous studies to have a dismal prognosis. However, the modern-day prognosis of patients with new onset heart failure diagnosed in the community managed within a disease management programme is not known. The purpose of this study is to report on prognosis of patients presenting with new onset heart failure in the community who are subsequently followed in a disease management program.

METHODS AND RESULTS: A review of patients referred to a rapid access heart failure diagnostic clinic between 2002 and 2012 was undertaken. Details of diagnosis, demographics, medical history, medications, investigations and mortality data were analysed. A total of 733 patients were seen in Rapid Access Clinic for potential new diagnosis of incident of heart failure. 38.9% (n=285) were diagnosed with heart failure, 40.7% (n=116) with HF-REF and 59.3% (n=169) with HF-PEF. There were 84 (29.5%) deaths in the group of patients diagnosed with heart failure; 41 deaths (35.3%) occurred in patients with HF-REF and 43 deaths (25.4%) occurred in patients with HF-PEF. In patients with heart failure, 52.4% (n=44) died from cardiovascular causes. 63.8% of HF patients were alive after 5 years resulting on average in a month per year loss of life expectancy over that period compared with aged matched simulated population.

CONCLUSIONS: In this community-based cohort, the prognosis of heart failure was better than reported in previous studies. This is likely due to the impact of prompt diagnosis, the improvement in therapies and care within a disease management structure.

Self-refraction, ready-made glasses and quality of life among rural myopic Chinese children: a non-inferiority randomized trial.

PURPOSE: To study, for the first time, the effect of wearing ready-made glasses and glasses with power determined by self-refraction on children's quality of life. METHODS: This is a randomized, double-masked non-inferiority trial. Children in grades 7 and 8 (age 12-15 years) in nine Chinese secondary schools, with presenting visual acuity (VA) ≤6/12 improved with refraction to ≥6/7.5 bilaterally, refractive error ≤-1.0 D and <2.0 D of anisometropia and astigmatism bilaterally, were randomized to receive ready-made spectacles (RM) or identical-appearing spectacles with power determined by: subjective cycloplegic retinoscopy by a university optometrist (U), a rural refractionist (R) or non-cycloplegic self-refraction (SR). Main study outcome was global score on the National Eye Institute Refractive Error Quality of Life-42 (NEI-RQL-42) after 2 months of wearing study glasses, comparing other groups with the U group, adjusting for baseline score. RESULTS: Only one child (0.18%) was excluded for anisometropia or astigmatism. A total of 426 eligible subjects (mean age 14.2 years, 84.5% without glasses at baseline) were allocated to U [103 (24.2%)], RM [113 (26.5%)], R [108 (25.4%)] and SR [102 (23.9%)] groups, respectively. Baseline and endline score data were available for 398 (93.4%) of subjects. In multiple regression models adjusting for baseline score, older age (p = 0.003) and baseline spectacle wear (p = 0.016), but not study group assignment, were significantly associated with lower final score. CONCLUSION: Quality of life wearing ready-mades or glasses based on self-refraction did not differ from that with cycloplegic refraction by an experienced optometrist in this non-inferiority trial.

Iowa Highway Program, Finances and Progress, 1954

(a) Iowa has a total of 101,451 miles of rural roads, both primary and secondary. (b) On January 1, l954, a total of 77,024 miles of these rural roads were surfaced - mostly with gravel and crushed stone. This is 5,53l miles greater than on January l, 1952. (c) Additional roads are being surfaced at the rate of 2766 miles per year. (d) Iowa's highway program provides for a surfaced road to every reasonably located rural home and a paved or other type of dustless surface on all primary roads. (e) Iowa's highway funds come 25.4 per cent from property taxes and special taxes......................................$29,708,546.67 63.7 per cent from road use taxes.......... 74,581,080.30 10.6 per cent from Federal Aid (1952 Act).. 12,424,000.00 0.3 per cent from miscellaneous receipts.. 287,922.86 ---- ------------- 100.0 $117,001,549.83 (f) Annual income under present laws, available for highway construction, is approximately, For primary roads $29,420,000.00 For secondary roads $44,328,000.00 In 19_3, $7,299,000 of secondary road construction funds was transferred to the maintenance fund. (g) Iowa's highway improvements are being paid for as built. No new bonds are being issued.

Impact of different solvents on the recovery of bioactive compounds and antioxidant properties from lemon (Citrus limon L.) pomace waste

The effects of different solvents on the recovery of (i) extractable solids (ES), (ii) total phenolic compounds (TPC), (iii) total flavonoid content (TFC), (iv) vitamin C, and (v) antioxidant activity from lemon pomace waste were investigated. The results revealed that solvents significantly affected the recovery of ES, TPC, TFC, and antioxidant properties. Absolute methanol and 50% acetone resulted in the highest extraction yields of TPC, whereas absolute methanol resulted in the highest extraction of TFC, and water had the highest recovery of vitamin C. 50% ethanol, and 50% acetone had higher extraction yields for TPC, and TFC, as well as higher antioxidant activity compared with their absolute solvents and water. TPC and TFC were shown to be the major components contributing to the antioxidant activity of lemon pomace.

Some parameters that affect CDMA capacity analysis. Results using GIS based simulation

In previous papers we describe a model for capacity analysis in CDMA systems using DC-Cell, a GIS based planning tool developed at Universidad Politecnica de Valencia, and MATLAB. We show some initial results of that model, and now, we are exploring different parameters like cell size, proximity between cells, number of cells in the system and “clustering” CDMA in order to improve the planning process for third generation systems. In this paper we show the results for variations of some of these parameters, specifically the cell size and number of cells. In CDMA systems is quite common to suppose only one carrier frequency for capacity estimation, and it is intuitive to think that for more base stations, mean more users. However the multiple access interference problem in CDMA systems could establish a limit for that supposition in a similar way that occurs in FDMA and TDMA systems.

The declining state of the gillnet fishery in Lake Victoria, Uganda

Lake Victoria had a multi-species fishery dominated until the 1970s by the tilapiine and the haplochromine cichlids (Kudhongania and Cordone, 1974). From about 1930 to 1960, the fisheries of Lake Victoria were managed by controlling the mesh size of gill nets. Gill nets of stretched mesh sizes less than 127 mm (5 inches) were prohibited as they cropped immature Oreochromis esculentus (Ngege), the most important commercial species on the lake (Graham, 1929). The catch per night in the legal 127 mm mesh nets was over 30 fish of O. esculentus prior to 1921 but dropped to 6 and 1.5 fish in 1928 and 1954, respectively, (Beauchamp, 1955), indicating overfishing of the stocks. The overall aim of the survey was to determine the available fish stocks being harvested by the gill net fishery. The specific objectives included the determination of the species composition and catch levels. Gill nets of mesh sizes from 25.4 mm (1 inch) to 228.6 mm (9 inches) were used.

Hidrolisados protéicos de anchoita (engraulis anchoita): obtenção, atividade antioxidante e aplicação em embutido emulsionado

Uma alternativa para pescados subaproveitados e subprodutos da industrialização de pescado é o desenvolvimento de processos para recuperação e/ou alteração das proteínas musculares de pescados. O objetivo deste trabalho foi a obtenção de hidrolisados protéicos de carne mecanicamente separada (CMS) de anchoita (Engraulis anchoita) e a avaliação da sua atividade antioxidante, aplicando-os bem embutido preparado com o surimi de anchoita. Foram produzidos diferentes hidrolisados com as enzimas microbianas Alcalase, Flavourzyme e Protamex, fixando a concentração de substrato e de enzima e os parâmetros pH e temperatura foram variados. Os hidrolisados foram efetivos contra a inibição da peroxidação lipídica (43,8±0,2%) e no poder redutor, onde o hidrolisado com a enzima Flavourzyme em 1 hora de reação mostrou-se mais efetivo. No seqüestro de radicais livres, como o DPPH, o hidrolisado com a enzima Flavourzyme, obtido em tempo de hidrólise de 5 horas, alcançou valores acima de 45,0% em concentração de 5 mg/mL. Na produção de surimi foram testadas lavagens da CMS de anchoita com soluções de bicarbonato de sódio 0,5%, ácido fosfórico 0,05% e cloreto de sódio 0,3%. O maior rendimento (90,5%) e uma coloração mais clara (W= 50,24±1,81) foram encontrados no surimi obtido por lavagens com bicarbonato de sódio e cloreto de sódio (BS), em comparação ao surimi que se utilizou água, ácido fosfórico e cloreto de sódio (AF) ou com soluções de cloreto de sódio, ácido fosfórico e bicarbonato de sódio (AB). Na força de gel o surimi AF (1154,25 ± 4,37 g.mm) obteve maior valor, sendo utilizado para a produção de salsichas. Foram analisadas diferentes concentrações de surimi (70, 75 e 80%) em salsichas, que foram submetidas às análises de cor e textura. Não houve influência da concentração de surimi nas características tecnológicas da salsicha, exceto nos valores de luminosidade. A salsicha com 75% de surimi de anchoita foi caracterizada pela composição proximal, valor energético total (VET) e conteúdo de sódio. A salsicha com surimi e comercial apresentou composição semelhante. O produto com surimi apresentou menor VET (193,7Kcal/100g) e conteúdo de sódio (520 mg/100g) que a salsicha comercial. Nas condições de estudo, no embutido emulsionado, não foi verificada ação antioxidante de hidrolisados, porém houve efeito sobre a CMS de anchoita.

Effects of early nutrition on the wnt and bone morphogenic protein pathways in the developing intestine

Infant formula is consumed by the majority of infants in the United States for at least part of the first year of life. Infant formula lacks many of the bioactive compounds that are naturally occurring in breast milk. Because of this, there has been an increased interest by the companies that manufacture infant formula to include additives that would potentially allow formula to more closely mimic breast milk activity. One such ingredient currently being added to infant formula is prebiotics. Prebiotics are non-digestible food ingredients that beneficially affect the host by selectively stimulating the growth of specific healthful bacteria in the colon. It is speculated that prebiotics replicate the activity of breast milk oligosaccharides, which through the production of butyrate by intestinal microbiota, may interact with the Wnt/BMP pathways. The Wnt/BMP pathways regulate intestinal stem cells, which determine the growth, development and maintenance of the intestine. Therefore, the objective of this study was to explore the effects that the addition of prebiotics to formula have on the regulation of the Wnt/BMP pathways when fed to neonatal piglets, a model commonly used in the study of infant nutrition. Piglets (n=5) were randomized into sow-reared (SR), fed control formula (F), or fed formula with added prebiotics (F+P). Fructooligosaccharides (FOS) (2 g/L) and polydextrose (PDX) (2 g/L) were chosen as the prebiotics for this study, because this combination had been less studied than other combinations. Ileum and ascending colon were collected at 7 and 14 days-of-age. Dry matter content, pH, and short chain fatty acid (SCFA) content was measured. The mRNA expression of β-catenin, sFRP3, sFRP4, frizzled 6, DKK1 (Wnt pathway), gremlin (BMP pathway), TNF-a, HNF-4α and osteopontin (OPN) was measured by RT-qPCR. Piglets fed the F+P diet had greater acetate concentration and lower pH in the ileum at day 14 and in the colon at day 7 and day 14 than F piglets. Butyrate concentrations were highest in SR with F+P not differing from F in ileum at day 14 and colon at day 7 and day 14. Effects of age were seen in all genes, with the exception of OPN, sFRP-3 and sFRP-4. On day 7, no effect of diet was observed in the ileum, however, mRNA expression of DKK1 and frizzled 6 were greater in F+P than SR (p≤0.05). On day 14, gremlin expression was lower and OPN was greater in the ileum of SR piglets compared to F and F+P. Also on day 14, HNF-4α mRNA expression was greater in both ileum and colon of F+P piglets and sFRP3 mRNA expression was greater in the colon than F or SR . In summary, differences were observed between gene expression of F+P and SR piglet intestines, but the supplementation of 2 g/L scFOS and 2 g/L PDX to formula did not shift expression of genes in the Wnt/BMP pathways to be more similar to SR than F. As the Wnt/BMP pathway is known to exist in a gradient along the crypt-villus axis, with Wnt expression dominating in the crypt region and BMP expression dominating in the villi, it was possible that pooling whole tissue reduced our ability to detect treatment effects that would be concentrated in either region. A method was therefore developed to remove intestinal epithelial cells along the villus-to-crypt axis. Twenty-five-day-old F and SR piglets were euthanized and ileal tissue was collected and placed in a dissociation buffer in a shaking water bath. Exfoliated cells were removed at increasing time points from 5 to 100 minutes in order to remove cells along the villus-to-crypt axis. After the final incubation, remaining mucosal tissue was removed using a sterile glass microscope slide and pooled with the final exfoliated cell isolation. After each cell collection, a section of tissue was fixed in formalin for histomorphological examination. Expression of genes in the Wnt/BMP pathways, along with crypt marker genes (CDK5 and v-myb), were measured in both whole ileal tissue, pooled epithelial cells, and separate epithelial cell isolations from the same piglet. The expression of β-catenin, HNF-4α, TNF-α, TGF-β and the crypt marker v-myb matched the expected villus-to-crypt pattern in cells collected after 10 (incubation 1), 30 (incubation 2) and 60 (incubation 3) minutes. However, expression of expression in cells collected after 100 minutes (incubation 4) was variable, which may be due to the fact that crypt cells were not efficiently removed and the presence of unwanted non-epithelial tissue. Gremlin, OPN, DKK1, sFRP3 and sFRP4 expression was not statistically different along the villus-to-crypt axis. Frizzled 6 and CDK5 did not express as we had predicted, with expression highest towards the villi. In summary, the epithelial cell collection method used was not entirely successful. While much of the gene data suggests that cells were removed along the villus-to-crypt axis through the first three incubations, the last incubation, which involved scraping the tissue, removed non-epithelial components of the mucosa, while leaving the crypts intact. In conclusion, the addition of 2 g/L PDX and 2 g/L scFOS did not cause gene expression of the Wnt/BMP pathways to mirror either F or SR expression. New isolation methods to extract cells along the crypt-villus axis should be considered, including the use of a laser capture microdissection. While this combination of prebiotics did not yield the intended effects, future research should be done on other combinations, such as the inclusion of galactooligosaccharides (GOS), which is commonly added to food products including infant formula.

Violência no namoro em contexto académico

1.º Congresso Internacional de Educação, Psicologia e Neurociências: Sinapses, Educar no Século XXI. Vila Franca do Campo: 30 de março e 1 de abril.

Vandetanib for the Treatment of Advanced Medullary Thyroid Cancer Outside a Clinical Trial: Results from a French Cohort

International audience

Segmentos anátomo-cirúrgicos arteriais do rim de cutia (Dasyprocta prymnolopha)

Foram estudados 20 pares de rins decutias (Dasyprocta prymnolopha Wagler, 1831), com o objetivo de descrever os segmentos anátomo-cirúrgicos arteriais. As artérias renais foram injetadas com solução de Vinilite corada, e os rins foram submetidos à corrosão ácida para a obtenção dos moldes vasculares. Observou-se que as artérias renais da cutia, sempre únicas, dividiram-se em artéria setorial ventral e artéria setorial dorsal, caracterizando dois setores renais separados por plano avascular. As artérias setoriais penetraram no hilo renal (100% dos casos). Estes vasos deram origem aos ramos segmentares responsáveis pela irrigação de territórios independentes em cada setor, os segmentos arteriais renais. No rim direito foram observados 3 (60%), 4 (35%) e 5 segmentos (5%) no setor arterial ventral e 3 (30%), 4 (45%), 5 (20%) e 6 (5%) segmentos no setor dorsal e, à esquerda, 2(10%), 3 (55%) e 4 (35%) segmentos no setor ventral e 3 (25%), 4 (50%) e 5 (25%) no dorsal. Com base na distribuição arterial nos rins de cutia, observaram-se setores e segmentos arteriais independentes, sendo possível, desta forma, a realização de setoriectomia e segmentectomia nesta espécie.

Diseño de un modelo para promover emprendimiento en estudiantes de secundaria en grados 10° y 11° de estratos 1,2 y 3 en Colombia

páginas: 150

A home-based treadmill training reduced epicardial and abdominal fat in postmenopausal women with metabolic syndrome

Introduction: The current study was designed to determine the effect of home-based treadmill training on epicardial and abdominal adipose tissue in postmenopausal women with metabolic syndrome (MS). A secondary objective was to identify significant correlations between imaging and conventional anthropometric parameters. Material and methods: Sixty postmenopausal women with MS volunteered for the current trial. Thirty were randomly assigned to perform a supervised home-based 16-week treadmill training program, 3 sessions/week, consisting of a warm-up, 30-40 min treadmill exercise (increasing 5-minutes each 4-weeks) at a work intensity of 60-75% of peak heart rate (increasing 5% each 4-weeks) and cooling-down. Epicardial fat thickness (EFT) was assessed by echocardiography. Abdominal fat mass in the lumbar regions L1-L4 and L4-L5 was determined by dual X-ray absorptiometry. Results: Epicardial fat thickness and abdominal fat percentages were significantly improved after the completion of the training program. Another striking feature of the current study was the moderate correlation that was found between EFT and waist circumference (WC). Conclusion: Home-based treadmill training reduced epicardial and abdominal fat in postmenopausal women with MS. A secondary finding was that a moderate correlation was found between EFT and WC. While current investigations are promising, future studies are still required to consolidate this approach in clinical application.

A polimedicação em pacientes geriátricos na consulta de medicina dentária da Clínica Universitária Egas Moniz

Dissertação para obtenção do grau de Mestre no Instituto Superior de Ciências da Saúde Egas Moniz