Implementation of a Brazilian Cardioprotective Nutritional (BALANCE) Program for improvement on quality of diet and secondary prevention of cardiovascular events: A randomized, multicenter trial

Background Complex percutaneous coronary intervention (PCI) is associated with higher ischemic risk, which can be mitigated by long-term dual antiplatelet therapy (DAPT). However, concomitant high bleeding risk (HBR) may be present, making it unclear whether short- or long-term DAPT should be prioritized. Objectives This study investigated the effects of ischemic (by PCI complexity) and bleeding (by PRECISE-DAPT [PRE dicting bleeding Complications in patients undergoing stent Implantation and Sub sequent Dual Anti Platelet Therapy] score) risks on clinical outcomes and on the impact of DAPT duration after coronary stenting. Methods Complex PCI was defined as ≥3 stents implanted and/or ≥3 lesions treated, bifurcation stenting and/or stent length >60 mm, and/or chronic total occlusion revascularization. Ischemic and bleeding outcomes in high (≥25) or non-high (<25) PRECISE-DAPT strata were evaluated based on randomly allocated duration of DAPT. Results Among 14,963 patients from 8 randomized trials, 3,118 underwent complex PCI and experienced a higher rate of ischemic, but not bleeding, events. Long-term DAPT in non-HBR patients reduced ischemic events in both complex (absolute risk difference: −3.86%; 95% confidence interval: −7.71 to +0.06) and noncomplex PCI strata (absolute risk difference: −1.14%; 95% confidence interval: −2.26 to −0.02), but not among HBR patients, regardless of complex PCI features. The bleeding risk according to the Thrombolysis In Myocardial Infarction scale was increased by long-term DAPT only in HBR patients, regardless of PCI complexity. Conclusions Patients who underwent complex PCI had a higher risk of ischemic events, but benefitted from long-term DAPT only if HBR features were not present. These data suggested that when concordant, bleeding, more than ischemic risk, should inform decision-making on the duration of DAPT. (AU)

Stress Distribution, Tooth Remaining Strain, and Fracture Resistance of Endodontically Treated Molars Restored Without or With One or Two Fiberglass Posts And Direct Composite Resin.

OBJECTIVES: To evaluate the effects of direct composite resin without a post or with one or two fiberglass posts on the restoration of severely compromised endodontically treated molars. METHODS AND MATERIALS: Forty-five molars with 2 mm of "remaining tooth structure" were divided into three groups: Wfgp, restored with Filtek Z350XT without a fiberglass post; 1fgp, restored with Z350XT with one fiberglass post in the distal root canal; and 2fgp, restored with Z350XT with two fiberglass posts, one in the distal root canal and the other in the mesial-buccal root canal. The teeth were load cycled. Tooth remaining strain was measured using strain gauges (n=10) at two moments: TrSt-100 N, during 100 N occlusal loading, and TrSt-Fr, at fracture load. Fracture resistance was calculated, and fracture mode was classified. The elastic modulus and Vickers hardness were calculated using dynamic indentation (n=5). Stress distribution was analyzed by three-dimensional finite element analysis. RESULTS: The use of two fiberglass posts resulted in lower fracture resistance than was noted in the groups with one fiberglass post and without fiberglass posts. The lingual surface of the remaining tooth had higher strain values than the buccal surface, regardless of the restorative technique and moment of evaluation. The absence of a fiberglass post resulted in significantly higher strain values and more irreparable fracture modes than were noted in the other groups. The use of one fiberglass post had a better strain/fracture resistance ratio. Stresses were concentrated in the occlusal portion of the post and in the furcation region. The presence of one fiberglass post resulted in better stress distribution in the entire distal root dentin, reducing stress on the critical areas. CONCLUSIONS: The use of one fiberglass post for restoring molars with direct composite resin resulted in higher fracture resistance than did the use of two fiberglass posts; it also resulted in better tooth remaining strain and stress distribution and more reparable fracture modes than were seen in the group without a fiberglass post.

Validity and reliability of the dietary sodium restriction questionnaire in patients with hypertension.

The study aimed to evaluate the reliability and the validity of the dietary sodium restriction questionnaire (DSRQ) in patients with hypertension receiving outpatient treatment at a tertiary care university hospital in Southern Brazil. This instrument is composed of three subscales: attitude, subjective norm and perceived behavioral control. A total of 104 patients were included. They were 63.3±8.9 years old and 75% were females. Cronbach's alpha coefficient for the subscales of attitude, subjective norm and perceived behavioral control were 0.75, 0.37 and 0.82, respectively. The PCA with the extraction of three factors explained a total of 53.5% of the variance. The data suggest that the 15-item DSRQ is reliable and has internal consistency of its construct to measure the barriers and the attitudes of hypertensive patients related to dietary sodium restriction and may be useful to improve blood pressure control.

Mechanical properties, shrinkage stress, cuspal strain and fracture resistance of molars restored with bulk-fill composites and incremental filling technique.

OBJECTIVES: To compare bulk-fill with incremental filling techniques for restoring large mesio-occlusal-distal (MOD) restorations. METHODS: Seventy-five molars with MOD preparations were divided into five groups: Z350XT, incrementally filled with Filtek Z350XT and four bulk-fills-FBF/Z350XT, Filtek Bulk Fill/Filtek Z350XT; VBF/CHA, Venus Bulk Fill/Charisma Diamond; SDR/EST-X, SDR/Esthet-X HD; TEC, TetricEvoCeram Bulk Fill. Cuspal strains were measured using strain-gauges (n=10): CSt-Re, during restorative procedure; CSt-100N, during 100N occlusal loading; CSt-Fr, at fracture load. Before fracture load, teeth were load-cycled. Fracture resistance, fracture mode, and enamel cracks were recorded. The other five teeth were used for Elastic modulus (E) and Vickers hardness (VH). Post-gel shrinkage (Shr), diametral tensile strength (DTS) and compressive strength (CS) were determined (n=10). Shrinkage stresses were analyzed using finite element analysis. RESULTS: SDR had similar CS values as TEC, lower than all other composites. CHA had similar DTS values as Z350XT, higher than all other composites. Z350XT had the highest mean Shr and SDR the lowest Shr. New enamel cracks and propagation was observed after the restoration, regardless of filling technique. Z350XT had lower fracture resistance than bulk-fill composite techniques. No significant differences in failure modes were found. E and VH were constant through the depth for all techniques. Bulk-filling techniques had lower stresses compared to Z350XT. CONCLUSIONS: Flowable bulk-fill composites had lower mechanical properties than paste bulk-fill and conventional composites. All bulk-fill composites had lower post-gel shrinkage than conventional composite. Bulk-fill filling techniques resulted in lower cusp strain, shrinkage stress and higher fracture resistance. CLINICAL SIGNIFICANCE: Using bulk-fill composites cause lower CSt wich indicates lower stress in restored tooth. Furthermore, bulk-fill composites have a higher fracture resistance. Therefore, clinicians may choose the bulk-fill composite to decrease undesirable effects of restoration while simplifying filling procedure.

Induction of resistance by silicon in wheat plants to alate and apterous morphs of Sitobion avenae (Hemiptera: Aphididae).

Despite the knowledge about the effects of silicon augmenting antibiosis and nonpreference of plants by apterous aphids, few studies exist on such effects with alate aphids. This study evaluated the effects of silicon fertilization on the biology of alate and apterous morphs of Sitobion avenae (F.) (Hemiptera: Aphididae), and the effect on nonpreference by S. avenae alates for wheat plants with or without silicon fertilization. A method for rearing aphids on detached leaves was evaluated comparing the biology of apterous aphids reared on wheat leaf sections and on whole plants with and without silicon fertilization. Because the use of detached leaves was a reliable method, the effect of silicon fertilization on the biology of apterous and alate S. avenae was assessed using wheat leaf sections. Biological data of aphids were used to calculate a fertility life table. Finally, the effect of silicon fertilization on the nonpreference of alate aphids was carried out for both vegetative and reproductive phases of wheat. Thirty alate aphids were released in the center of a cage, and the number of aphids per whole plant with or without silicon fertilization was observed. Silicon fertilization induced antibiosis resistance in wheat plants to apterous morphs as shown by reduced fecundity, reproductive period, longevity, intrinsic rate of increase, and net reproductive rate; however, alates were unaffected. Plants that received silicon fertilization had fewer alate aphids in both the vegetative and reproductive phases. Thus, silicon fertilization can reduce colonization by alates, enhancing nonpreference resistance, and population growth of apterous S. avenae in wheat plants.

First record of Trichodina heterodentata (Ciliophora: Trichodinidae) from channel catfish, Ictalurus punctatus cultivated in Brazil.

This study characterises morphologically Trichodina heterodentata Duncan, 1977 from channel catfish, Ictalurus punctatus (Rafinesque, 1818) in the State of Santa Catarina, Brazil. Body and gill smears were air-dried at room temperature, impregnated with silver nitrate and/or stained with Giemsa. Ten characteristics were selected to compare the present material with other morphological characterisations of T. heterodentata. Prevalence rate was 100%, mean intensity 89,333.70 (3,125 to 299,100 parasites per host). Trichodina heterodentata was considered medium-sized trichodinid with mean body diameter 59.4 +/- 8.5 microm, denticulate ring 38.5 +/- 4.5 microm, adhesive disc 60.2 +/- 6.7 microm diameter and 24.4 +/- 1.6 denticles. In relation to previous reports of T. heterodentata this material resembles in 90% of the analysed characters. This work confirms the biometrical variation that exists in the different populations of T. heterodentata. A list of hosts and comparative measurements of T. heterodentata are presented and the channel catfish is considered a new host.

First record of Trichodina heterodentata (Ciliophora: Trichodinidae) from channel catfish, Ictalurus punctatus cultivated in Brazil / Primeiro registro de Trichodina heterodentata (Ciliophora: Trichodinidae) em bagre-do-canal, Ictalurus punctatus cultivado no Brasil

This study characterises morphologically Trichodina heterodentata Duncan, 1977 from channel catfish, Ictalurus punctatus (Rafinesque, 1818) in the State of Santa Catarina, Brazil. Body and gill smears were air-dried at room temperature, impregnated with silver nitrate and/or stained with Giemsa. Ten characteristics were selected to compare the present material with other morphological characterisations of T. heterodentata. Prevalence rate was 100 percent, mean intensity 89,333.70 (3,125 to 299,100 parasites per host). Trichodina heterodentata was considered medium-sized trichodinid with mean body diameter 59.4 ± 8.5 μm, denticulate ring 38.5 ± 4.5 μm, adhesive disc 60.2 ± 6.7 μm diameter and 24.4 ± 1.6 denticles. In relation to previous reports of T. heterodentata this material resembles in 90 percent of the analysed characters. This work confirms the biometrical variation that exists in the different populations of T. heterodentata. A list of hosts and comparative measurements of T. heterodentata are presented and the channel catfish is considered a new host.

Este estudo caracteriza morfologicamente Trichodina heterodentata Duncan, 1977 em bagre-do-canal, Ictalurus punctatus (Rafinesque, 1818) no Estado de Santa Catarina, Brasil. Esfregaços do corpo e brânquias foram secados à temperatura ambiente, impregnados com nitrato de Prata e/ou corados com Giemsa. Dez características foram selecionadas para comparar o presente material com as diferentes caracterizações morfológicas de T. heterodentata. A taxa de prevalência foi de 100 por cento, a intensidade média foi de 89.333.75 (3.125 a 299.100 parasitos por hospedeiro). Trichodina heterodentata foi considerado um tricodinídeo de tamanho médio com a média do diâmetro do corpo de 59,4 ± 8.5 μm, anel denticulado 38,5 ± 4,5 μm, disco adesivo 60,2 ± 6,7 μm de diâmetro e 24,4 ± 1,6 dentículos. Em relação a registros prévios de T. heterodentata, 90 por cento das características foram semelhantes. Este trabalho confirma a variação biométrica que existe em diferentes populações de T. heterodentata. Uma lista de hospedeiros e medidas comparativas de T. heterodentata são apresentadas e o bagre-do-canal considerado um novo hospedeiro.

Craniofacial abnormalities, obesity, and hormonal alterations have similar effects in magnitude on the development of nocturnal hypoxemia in patients with acromegaly.

BACKGROUND: In patients with acromegaly, sleep apnea-related hypoxemia results in considerable morbidity and mortality. AIMS: To evaluate the relative weight of pathogenic factors in predicting such hypoxemia. METHODS: In this cross-sectional study, 34 acromegaly patients were submitted to clinical evaluation, nocturnal oximetry, and nasolaryngeal airway tomography. GH, IGF-I, and its upper limit normal value were measured. Nocturnal hypoxemia was defined as >5 episodes of desaturation/h of sleep. Craniofacial abnormalities were expressed using a linear parameter index (LPI). Nocturnal hypoxemia was predicted using logistic regression, including the variables markers of craniofacial abnormality, hormonal alteration, and obesity. Coefficients were standardized in order to determine their effect magnitudes relative to the outcome. The best model included the variables gender, age, LPI, body mass index (BMI), and IGFI upper limit normal value. MAIN RESULTS: In the absence of the age and gender variables, the odds ratio for the LPI (1.60) was slightly higher than those found for BMI (1.49) and upper limit normal value (1.40). When the data were adjusted for age, the hormone upper limit normal value presented little alteration (1.49), although the decrease in the LPI was considerable (1.21), as was the increase in the BMI (2.18). The relative weight of the LPI was age-dependent. The gender variable did not alter the relevance of the others. CONCLUSIONS: The effects that craniofacial aspect, obesity, and hormonal alterations have on nocturnal hypoxemia are of similar magnitude.

Genotoxic potentiality of aqueous extract prepared from Chrysobalanus icaco L. leaves.

Plants have been related to our lives, being used as medicine, regardless of scientific evidence of side effects. This work analyses the toxicological effects of Chrysobalanus icaco L. aqueous extract, used in different pathologies. It was studied through: (i) alteration of plasmid pUC 9.1 topology; (ii) survival of bacterial strains submitted, or not, to previous treatment with SnCl2; (iii) transformation efficiency of E. coli strain by the treatment with the plasmid pUC 9.1. In (i), the treatment of the plasmid resulted in DNA single-strand breaks (SSB). A decrease of the lethal effect induced by SnCl2 in presence of the extract was found, while no C. icaco bacterial survival reduction was observed. The transformation efficiency of the plasmid was also reduced. Results suggest that the extract could present a potential genotoxic effect, as demonstrated either by the induction of SSB in plasmid or in transformation efficiency experiments. Finally, it presents an antioxidant action.

Dna damage in peripheral blood nuclear cells assessed by comet assay from individuals submitted to scintigraphic examinations.

Stannous chloride (SnCl2) is employed as a reducing agent to obtain Technetium-99m-labelled radiophamaceuticals in nuclear medicine kits, being injected endovenously in humans. Toxic effects of these kits were not studied, thus making it important to evaluate their impact in humans. In this study, the toxic effects were evaluated from peripheral blood nuclear cells (PBNC) from patients who received radiopharmaceuticals obtained using such kits. The analyses included results performed by comet assay. DNA damage was visualized in PBNC samples collected within a time up to 2 hr, and 24 hr after radiopharmaceutical injection in the patients. Initially we observed an increase of comet signals, which subsequently were reduced to zero after 24 hr. The diminishing of comet amounts probably is associated with DNA repair of damaged cells or with the elimination by apoptosis of cells whose DNA are not repaired.

[Psychogenic dystonia: report of 2 cases]. / Distonia psicogênica: relato de dois casos.

Movement disorders have rarely been the result of psychiatric disturbances. Psychogenic dystonia is caracterized by inconsistent findings, a known precipitant factor, onset in legs, pain, multiple somatizations and incongruent association with other movement disorders. We report two patients with clinically established psychogenic dystonia. Patient 1: a female that presented sudden loss of strength in her four limbs; she developed feet dystonia, alternant laterocollis, generalized and irregular tremor, and limb hypertonia that disappeared with distraction; psychological examination showed severe depression, hypochondria and obsessive disorder. Patient 2: a female that presented with irregular limb tremors that disappeared with distraction and left foot dystonia nine years ago; she gradually lost her walk capacity; she complained pain in lumbar area and in her left limb, psychological examination showed infantile behaviour, low frustration tolerance, impulsivity and self-aggression. Their complementary exams showed no alterations and they had no response to specific pharmacological treatment. Dystonia is rarely psychogenic, but this etiology is suggested when clinical characteristics are inconsistent and incongrous with a classical disorder. It should be part of differential diagnosis when appears in association with other somatization or psychiatric disorders.

[Dementia caused by neurosyphilis: clinical and neuropsychological follow-up of a patient]. / Demência por neurossífilis: evolução clínica e neuropsicológica de um paciente.

Dementia is one of the manifestations of late syphilis and it is characterized by cognitive deterioration and behaviour disturbances. We report on a male patient with cognitive decline, behaviour disorder, hyperactivity, hallucinations, short-term memory and Argyll Robertson pupils due to neurosyphilis. Minimental state test (MST) was 16. Cerebrospinal fluid (CSF) protein concentration was 82 mg/dl, CSF-leucocyte count 128 cells/mm3 (98% mononuclear cells), CSF-VDRL 1:4, and CSF-T.pallidum haemaglutination assay 1:2560. MRI showed no cerebral alteration, but SPECT revealed left fronto-temporal hypocaptation. He received intravenous penicillin. MST done 3 months after the treatment scored 22. A new spinal tap showed normal CSF. Neurosyphilis should be part of the differential diagnosis of every patient showing cognitive deterioration and behaviour disturbances. During follow-up, MMS is an useful instrument to ++measure cognitive decline and response to treatment.

Alterations in the metabolism of fats and phosphatides in rat liver induced by halide ions.

The effects of halide ions on several pathways of lipid metabolism have been investigated in rat liver slices. Through the use of carboxyl-14-C-labeled acetate and palmitate and U-14-C-labeled glycine, striking differences were found when the effects of the four halide ions on the labeling of the lipids were compared. Both fluoride and iodide dpressed [14-C]acetate incorporation into phosphatide and triglyceride fractions. The effects of the halide ions on the labeling from the effects observed when [14-C]acetate was the precursor of the lipid molecule. In contrast with the phospholipid fractions, the level of radioactivity from [14-C]palmitate incorporated into the triglycerides was lower with fluoride than with chloride. The incorporation of [14-C]glycine into the phospholipids was also greatly depressed by fluoride. The effects of halide ions on acetoacetate formation, on 14-CO2 production and on the acetylcoenzyme A synthetase of rat liver were also investigated. Decreasing [I-14-C]-acetate conversion to acetoacetate iodide had an opposite effect on 14-CO2 production from the same labeled substrate. The effects of the four halide ions and the differences observed with the three labeled substrates on several pathways related to lipid metabolism are discussed.