Endovascular aortic repair versus open surgical repair for descending thoracic aortic disease a systematic review and meta-analysis of comparative studies.

OBJECTIVES: The purpose of this study was to determine whether thoracic endovascular aortic repair (TEVAR) reduces death and morbidity compared with open surgical repair for descending thoracic aortic disease. BACKGROUND: The role of TEVAR versus open surgery remains unclear. Metaregression can be used to maximally inform adoption of new technologies by utilizing evidence from existing trials. METHODS: Data from comparative studies of TEVAR versus open repair of the descending aorta were combined through meta-analysis. Metaregression was performed to account for baseline risk factor imbalances, study design, and thoracic pathology. Due to significant heterogeneity, registry data were analyzed separately from comparative studies. RESULTS: Forty-two nonrandomized studies involving 5,888 patients were included (38 comparative studies, 4 registries). Patient characteristics were balanced except for age, as TEVAR patients were usually older than open surgery patients (p = 0.001). Registry data suggested overall perioperative complications were reduced. In comparative studies, all-cause mortality at 30 days (odds ratio [OR]: 0.44, 95% confidence interval [CI]: 0.33 to 0.59) and paraplegia (OR: 0.42, 95% CI: 0.28 to 0.63) were reduced for TEVAR versus open surgery. In addition, cardiac complications, transfusions, reoperation for bleeding, renal dysfunction, pneumonia, and length of stay were reduced. There was no significant difference in stroke, myocardial infarction, aortic reintervention, and mortality beyond 1 year. Metaregression to adjust for age imbalance, study design, and pathology did not materially change the results. CONCLUSIONS: Current data from nonrandomized studies suggest that TEVAR may reduce early death, paraplegia, renal insufficiency, transfusions, reoperation for bleeding, cardiac complications, pneumonia, and length of stay compared with open surgery. Sustained benefits on survival have not been proven.

"Just stories"

Lectio praecursoria at the public examination of his doctoral thesis Fictions to live in: narration as an argument for fiction in Salman Rushdies's novels, Department of English, University of Tampere, on October the ninth, 1998

Mineralização de nitrogênio em latossolos adubados com resíduos orgânicos

A taxa de mineralização do nitrogênio (N) varia de um resíduo orgânico para outro, evidenciando-se dependente da sua composição química e interação do material orgânico com o solo. Este estudo foi realizado com o objetivo de avaliar a dinâmica de mineralização de N de resíduos orgânicos incubados em Latossolos. O experimento foi conduzido no período de julho de 2007 a abril de 2008, sendo incubadas amostras de estercos, lodos, compostos, substrato e turfa em areia lavada, Latossolo Vermelho-Amarelo (LVA) e Latossolo Vermelho distroférrico (LVdf), com 240 e 670 g kg-1 de argila, respectivamente. O N mineralizado foi avaliado medindo-se os teores de N-NH4+ e N-NO3- em lixiviados coletados aos 15, 30, 45, 60, 75, 90, 120, 150, 180, 210, 240 e 270 dias de incubação. A mineralização de N ocorreu a maiores taxas nos períodos iniciais de incubação. O N mineralizado (33 a 199,2 mg kg-1) após 270 dias de incubação é regulado pelos teores de N total e de carbono solúvel em água dos resíduos orgânicos. Independentemente do meio utilizado para incubação, os estercos de galinha e de codorna propiciaram os maiores teores de N mineralizado nos Latossolos. À exceção dos estercos de galinha e codorna, há imobilização líquida de N no LVA; mineralização líquida de N é verificada no LVdf, para todos os resíduos orgânicos. Em relação às formas de N disponibilizadas pelos resíduos, predomina o N-nitrato, sendo a proporção N-nítrico/N-amoniacal dependente da mistura solo-resíduo estudada.

Animal manure phosphorus characterization by sequential chemical fractionation, release kinetics and 31P-NMR analysis

Phosphate release kinetics from manures are of global interest because sustainable plant nutrition with phosphate will be a major concern in the future. Although information on the bioavailability and chemical composition of P present in manure used as fertilizer are important to understand its dynamics in the soil, such studies are still scarce. Therefore, P extraction was evaluated in this study by sequential chemical fractionation, desorption with anion-cation exchange resin and 31P nuclear magnetic resonance (31P-NMR) spectroscopy to assess the P forms in three different dry manure types (i.e. poultry, cattle and swine manure). All three methods showed that the P forms in poultry, cattle and swine dry manures are mostly inorganic and highly bioavailable. The estimated P pools showed that organic and recalcitrant P forms were negligible and highly dependent on the Ca:P ratio in manures. The results obtained here showed that the extraction of P with these three different methods allows a better understanding and complete characterization of the P pools present in the manures.