Sudden death has been considered the main cause of death in patients with Chagas heart disease. Nevertheless, this information comes from a period before the introduction of drugs that changed the ...natural history of heart failure. We sought to study the mode of death of patients with heart failure caused by Chagas heart disease, comparing with non-Chagas cardiomyopathy.
We examined the REMADHE trial and grouped patients according to etiology (Chagas vs non-Chagas) and mode of death. The primary end-point was all-cause, heart failure and sudden death mortality; 342 patients were analyzed and 185 (54.1%) died. Death occurred in 56.4% Chagas patients and 53.7% non-Chagas patients. The cumulative incidence of all-cause mortality and heart failure mortality was significantly higher in Chagas patients compared to non-Chagas. There was no difference in the cumulative incidence of sudden death mortality between the two groups. In the Cox regression model, Chagas etiology (HR 2.76; CI 1.34-5.69; p = 0.006), LVEDD (left ventricular end diastolic diameter) (HR 1.07; CI 1.04-1.10; p<0.001), creatinine clearance (HR 0.98; CI 0.97-0.99; p = 0.006) and use of amiodarone (HR 3.05; CI 1.47-6.34; p = 0.003) were independently associated with heart failure mortality. LVEDD (HR 1.04; CI 1.01-1.07; p = 0.005) and use of beta-blocker (HR 0.52; CI 0.34-0.94; p = 0.014) were independently associated with sudden death mortality.
In severe Chagas heart disease, progressive heart failure is the most important mode of death. These data challenge the current understanding of Chagas heart disease and may have implications in the selection of treatment choices, considering the mode of death.
ClinicalTrials.gov NCT00505050 (REMADHE).
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Using the wave model SWAN (simulating waves nearshore), high waves on the southwestern Atlantic generated by extra-tropical cyclones are simulated from 2000 to 2010, and their impact on the Rio ...Grande do Sul (RS) coast is studied. The modeled waves are compared with buoy data and good agreement is found. The six extreme events in the period that presented significant wave heights above 5 m, on a particular point of interest, are investigated in detail. It is found that the cyclogenetic pattern between the latitudes 31.5 and 34° S is the most favorable for developing high waves. Hovmöller diagrams for deep water show that the region between the south of Rio Grande do Sul up to a latitude of 31.5° S is the most energetic during a cyclone's passage, although the event of May 2008 indicates that the location of this region can vary, depending on the cyclone's displacement. On the other hand, the Hovmöller diagrams for shallow water show that the different shoreface morphologies were responsible for focusing or dissipating the waves' energy; the regions found are in agreement with the observations of erosion and progradation regions. It can be concluded that some of the urban areas of the beaches of Hermenegildo, Cidreira, Pinhal, Tramandaí, Imbé and Torres have been more exposed during the extreme wave events on the Rio Grande do Sul coast, and are more vulnerable to this natural hazard.
Central blood pressure (BP) and BP variability are associated with cardiovascular disease risk. However, the influence of exercise on these hemodynamic parameters is unknown among patients with ...resistant hypertension. The EnRicH (The Exercise Training in the Treatment of Resistant Hypertension) was a prospective, single-blinded randomized clinical trial (NCT03090529). Sixty patients were randomized to a 12-week aerobic exercise program or usual care. The outcome measures include central BP, BP variability, heart rate variability, carotid-femoral pulse wave velocity, and circulating cardiovascular disease risk biomarkers including high-sensitivity C-reactive protein, angiotensin II, superoxide dismutase, interferon gamma, nitric oxide, and endothelial progenitor cells. Central systolic BP decreased by 12.22 mm Hg (95% CI, -1.88 to -22.57, P = 0.022) as did BP variability by 2.85 mm Hg (95% CI, -4.91 to -0.78, P = 0.008), in the exercise (n = 26) compared to the control group (n = 27). Interferon gamma -4.3 pg/mL (95%CI, -7.1 to -1.5, P = 0.003), angiotensin II -157.0 pg/mL (95%CI, -288.1 to -25.9, P = 0.020), and superoxide dismutase 0.4 pg/mL (95%CI, 0.1-0.6, P = 0.009) improved in the exercise compared to the control group. Carotid-femoral pulse wave velocity, heart rate variability, high-sensitivity C-reactive protein, nitric oxide, and endothelial progenitor cells were not different between groups (P > 0.05). In conclusion, a 12-week exercise training program improved central BP and BP variability, and cardiovascular disease risk biomarkers in patients with resistant hypertension. These markers are clinically relevant as they are associated with target organ damage and increased cardiovascular disease risk and mortality.
.
We have surveyed a series of elastic scattering measurements from the literature involving tightly bound (
9
Li,
10
Be,
12
C,
16
O,
19
F), weakly bound (
6
Li,
7
Li,
8
Li,
8
He,
9
Be,
17
F), and ...exotic (
6
He and
11
Li) nuclei on a
208
Pb target at energies close to the Coulomb barrier. The corresponding data were then converted and analyzed in terms of the interaction distance, where critical-interaction and strong-absorption distances were extracted. Larger values were obtained for the exotic
6
He and
11
Li nuclei, as compared with both weakly bound and tightly bound projectiles. The influence of long-range nuclear interactions and Coulomb dipole polarizability are discussed. A correlation between the critical interaction distance and binding energy for a given configuration is observed.
Reports suggest that the blood pressure (BP) response to an acute bout of exercise is associated with the BP response to aerobic training in participants with elevated BP. These associations have not ...been tested among patients with resistant hypertension. This study aimed to determine whether the BP response to acute exercise predicts the 24-h ambulatory BP response to a 12-week exercise training program in patients with resistant hypertension (n = 26, aged 59.3 ± 8.2 years, 24-h ambulatory BP 127.4 ± 12.2/75.6 ± 7.8 mm Hg) who completed the exercise arm of the EnRicH trial. Ambulatory BP measurements were obtained before and after the exercise program to assess the chronic BP response. To assess acute BP changes, resting BP was measured before and 10 min after three exercise sessions in the third week of training and averaged. The resting systolic (9.4 ± 6.7, p < 0.001) and diastolic BP (1.9 ± 3.2, p = 0.005) were reduced after acute exercise. The 24-h systolic (6.2 ± 12.2, p = 0.015) and diastolic BP (4.4 ± 6.1, p = 0.001) were decreased after exercise training. The reductions in systolic BP after acute exercise were associated with the reductions in 24-h systolic BP after exercise training (ß = 0.538, adjusted r
= 0.260, P = 0.005). The reductions in diastolic BP after acute exercise (ß = 0.453, adjusted r
= 0.187) and baseline 24-h diastolic BP (ß = -0.459, adjusted r
= 0. 199) accounted for 38.6% (p = 0.008) of the 24-h diastolic BP response to exercise training. In conclusion, the magnitude of the BP response to acute exercise appears to predict the ambulatory BP response to exercise training among patients with resistant hypertension.
Summary
Background
Around 300 million people world‐wide suffer from asthma, and the prevalence of allergic diseases has increased. Much effort has been used in the study of mechanisms involved in the ...immune response observed in asthma to intervene for the treatment of this condition. During inflammation in asthma, Th2 cytokines and eosinophils are essential components of the host immune system. Furthermore, for therapeutic interventions against this disease, IL‐10 is an important cytokine because it has a central role in the regulation of inflammatory cascades.
Objective
To evaluate the immunomodulatory effect of Lactococcus lactis strains expressing recombinant IL‐10 in a mouse model of ovalbumin (OVA)‐induced acute airway inflammation.
Methods
L. lactis expressing recombinant IL‐10 in a cytoplasmic (LL‐CYT) or secreted form (LL‐SEC) and wild‐type (LL‐WT) were used. IL‐10 production by the recombinant strains was evaluated by ELISA. After an intranasal administration of L. lactis producing recombinant IL‐10 and the induction of acute allergic airway inflammation in mice, blood samples were collected to detect IgE anti‐OVA, and bronchoalveolar lavage (BAL) was harvested for eosinophil count. Additionally, the lungs were collected for the detection of the eosinophil peroxidase (EPO) activity, measurement of cytokines and chemokines and evaluation of pathology.
Results
Mice that received LL‐CYT and LL‐SEC strains showed a significant decrease in eosinophils numbers, EPO activity, anti‐OVA IgE and IgG1 levels, IL‐4 and CCL3 production and pulmonary inflammation and mucus hypersecretion, compared with the asthmatic group. Only the LL‐CYT/OVA group showed reduced levels of IL‐5, CCL2, CCL5 and CCL11.
Conclusion
Treatment with L. lactis producing recombinant IL‐10 used in this study (LL‐CYT and LL‐SEC) modulated experimental airway inflammation in the mouse model independently of Treg cells. Additionally, the LL‐CYT strain was more efficient in the suppression of lung inflammation.
Cite this as: F. A. V. Marinho, L. G. G. Pacífico, A. Miyoshi, V. Azevedo, Y. Le Loir, V. D. Guimarães, P. Langella, G. D. Cassali, C. T. Fonseca and S. C. Oliveira, Clinical & Experimental Allergy, 2010 (40) 1541–1551.
Background
Ameloblastoma (unicystic, UA, or multicystic, MA) is a rare tumor associated with bone destruction and facial deformity. Its malignant counterpart is the ameloblastic carcinoma (AC). The ...BRAFV600E mutation is highly prevalent in all these tumors subtypes and cannot account for their different clinical behaviors.
Methods
We assessed copy number alterations (CNAs) and copy‐neutral loss of heterozygosity (cnLOH) in UA (n = 2), MA (n = 3), and AC (n = 1) using the CytoScan HD Array (Affymetrix) and the BRAFV600E status. RT‐qPCR was applied in four selected genes (B4GALT1, BAG1, PKD1L2, and PPP2R5A) covered by rare alterations, also including three MA and four normal oral tissues.
Results
Fifty‐seven CNAs and cnLOH were observed in the ameloblastomas and six CNAs in the AC. Seven of the CNAs were rare (six in UA and one in MA), four of them encompassing genes (gains of 7q11.21, 1q32.3, and 9p21.1 and loss of 16q23.2). We found positive correlation between rare CNA gene dosage and the expression of B4GALT1, BAG1, PKD1L2, and PPP2R5A. The AC and 1 UA were BRAF wild‐type; however, this UA showed rare genomic alterations encompassing genes associated with RAF/MAPK activation.
Conclusion
Ameloblastomas show rare CNAs and cnLOH, presenting a specific genomic profile with no overlapping of the rare alterations among UA, MA, and AC. These genomic changes might play a role in tumor evolution and in BRAFV600E‐negative tumors.
The hitherto unknown larva of Lopesia spinosa Maia (Diptera: Cecidomyiidae) is described and the geographical distribution of the species is extended in Brazil to Delfinópolis in Minas Gerais; ...Altinópolis and Jundiaí in São Paulo. Diagnostic characters of the species and illustration of the larva are presented.
Limited evidence suggests exercise reduces blood pressure (BP) in individuals with resistant hypertension, a clinical population with low responsiveness to drug therapy.
To determine whether an ...aerobic exercise training intervention reduces ambulatory BP among patients with resistant hypertension.
The Exercise Training in the Treatment of Resistant Hypertension (EnRicH) trial is a prospective, 2-center, single-blinded randomized clinical trial performed at 2 hospital centers in Portugal from March 2017 to December 2019. A total of 60 patients with a diagnosis of resistant hypertension aged 40 to 75 years were prospectively enrolled and observed at the hospitals' hypertension outpatient clinic.
Patients were randomly assigned in a 1:1 ratio to a 12-week moderate-intensity aerobic exercise training program (exercise group) or a usual care control group. The exercise group performed three 40-minute supervised sessions per week in addition to usual care.
The powered primary efficacy measure was 24-hour ambulatory systolic BP change from baseline. Secondary outcomes included daytime and nighttime ambulatory BP, office BP, and cardiorespiratory fitness.
A total of 53 patients completed the study, including 26 in the exercise group and 27 in the control group. Of these, 24 (45%) were women, and the mean (SD) age was 60.1 (8.7) years. Compared with the control group, among those in the exercise group, 24-hour ambulatory systolic BP was reduced by 7.1 mm Hg (95% CI, -12.8 to -1.4; P = .02). Additionally, 24-hour ambulatory diastolic BP (-5.1 mm Hg; 95% CI, -7.9 to -2.3; P = .001), daytime systolic BP (-8.4 mm Hg; 95% CI, -14.3 to -2.5; P = .006), and daytime diastolic BP (-5.7 mm Hg; 95% CI, -9.0 to -2.4; P = .001) were reduced in the exercise group compared with the control group. Office systolic BP (-10.0 mm Hg; 95% CI, -17.6 to -2.5; P = .01) and cardiorespiratory fitness (5.05 mL/kg per minute of oxygen consumption; 95% CI, 3.5 to 6.6; P < .001) also improved in the exercise group compared with the control group.
A 12-week aerobic exercise program reduced 24-hour and daytime ambulatory BP as well as office systolic BP in patients with resistant hypertension. These findings provide clinicians with evidence to embrace moderate-intensity aerobic exercise as a standard coadjutant therapy targeting this patient population.
ClinicalTrials.gov Identifier: NCT03090529.
Floods are fundamental components of Amazon nature and culture. The large flood of 2009, however, opened a new perspective on hazards and disasters in the Amazon basin. More than 238,000 residents ...from 38 municipalities were affected by floods along the Amazon River and lower reaches of its tributaries. Never before has a flood in the Amazon produced such a dramatic effect on the local population. The magnitude of the disaster suggested it was the largest recorded Amazon flood since the beginning of measurements in 1928 at Óbidos and that it could represent the largest recorded flood on Earth. A complex combination of atmospheric and hydrologic factors made the 2009 Amazon flood the most hazardous. It was the result of large scale and regional climatic events, non-typical mechanisms of flood transmission generating complex inter-relations in time and space between the main system and the tributaries, and recent urban growth of riverine cities without adequate planning. Our measurements at Óbidos, however, indicate that the 2009 flood was the highest recorded Amazon stage, but most likely not the largest water discharge. We propose as well that the magnitude of the Amazon floods at Óbidos has been overestimated for decades and that the available values of flood discharge have been a source of error for a multidisciplinary set of scientists developing climate and environmental modeling.
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