Cardiac computed tomographic angiography after abnormal ischemia test as a gatekeeper to invasive coronary angiography.

This study aimed to determine the impact of systematic coronary computed tomographic angiography (CCTA) use following an abnormal non-invasive ischemia test (NIST) on patient selection strategy for invasive coronary angiography (ICA). In patients with suspected stable coronary artery disease (CAD), NIST use frequently results in sub-optimal diagnostic and revascularization yields of ICA. This randomized clinical trial, conducted at a single academic tertiary center, selected 220 symptomatic patients with mild-to-moderately abnormal NIST results who were referred for ICA. Patients received either the originally intended ICA (n = 105) or CCTA (n = 115). The primary endpoint was the diagnostic yield of ICA in each group. Revascularization yield and major adverse cardiovascular events at 12 months were also assessed. The patients were 69 ± 9 years old, 60% were men, and 31% had typical angina. Mean pre-test probability of obstructive CAD was 34%. Overall prevalence of obstructive CAD was 37.7% on the index angiographic procedure. In the CCTA group, ICA was cancelled by referring physicians in 83 patients (72.2%) after receiving CCTA results. For those undergoing ICA, diagnostic (84.4% vs. 41.7%, p<0.001) and revascularization (71.9% vs. 38.8%, p = 0.001) yields were significantly higher for CCTA-guided ICA than for standard NIST-guided ICA. Mean cumulative radiation exposure was significantly lower in the CCTA-guided ICA arm than in the NIST-guided ICA arm (12 ± 9 vs. 16 ± 10 mSv, respectively, p = 0.024). There were no significant differences in the primary safety endpoint rates between the strategies (p = 0.439). In patients with suspected CAD and mild-to-moderately abnormal ischemia tests, a diagnostic strategy including CCTA as a gatekeeper is safe and effective and significantly improves diagnostic and revascularization yields of ICA.

Narrow-Band Imaging for Detection of Neoplasia at Colonoscopy: A Meta-analysis of Data From Individual Patients in Randomized Controlled Trials.

BACKGROUND & AIMS: Adenoma detection rate (ADR) is an important quality assurance measure for colonoscopy. Some studies suggest that narrow-band imaging (NBI) may be more effective at detecting adenomas than white-light endoscopy (WLE) when bowel preparation is optimal. We conducted a meta-analysis of data from individual patients in randomized controlled trials that compared the efficacy of NBI to WLE in detection of adenomas. METHODS: We searched MEDLINE, EMBASE, and Cochrane Library databases through April 2017 for randomized controlled trials that assessed detection of colon polyps by high-definition WLE vs NBI and from which data on individual patients were available. The primary outcome measure was ADR adjusted for bowel preparation quality. Multilevel regression models were used with patients nested within trials, and trial included as a random effect. RESULTS: We collected data from 11 trials, comprising 4491 patients and 6636 polyps detected. Adenomas were detected in 952 of 2251 (42.3%) participants examined by WLE vs 1011 of 2239 (45.2%) participants examined by NBI (unadjusted odds ratio [OR] for detection of adenoma by WLE vs NBI, 1.14; 95% CI, 1.01-1.29; P = .04). NBI outperformed WLE only when bowel preparation was best: adequate preparation OR, 1.07 (95% CI, 0.92-1.24; P = .38) vs best preparation OR, 1.30 (95% CI, 1.04-1.62; P = .02). Second-generation bright NBI had a better ADR than WLE (second-generation NBI OR, 1.28; 95% CI, 1.05-1.56; P = .02), whereas first-generation NBI did not. NBI detected more non-adenomatous polyps than WLE (OR, 1.24; 95% CI, 1.06-1.44; P = .008) and flat polyps than WLE (OR, 1.24; 95% CI, 1.02-1.51; P = .03). CONCLUSIONS: In a meta-analysis of data from individual patients in randomized controlled trials, we found NBI to have a higher ADR than WLE, and that this effect is greater when bowel preparation is optimal.

Functionality of cow milk naturally enriched with polyunsaturated fatty acids and polyphenols in diets for diabetic rats.

The increasing incidence of diabetes mellitus is becoming a serious threat to human health in various parts of the world. Studies with dairy products have shown a potential beneficial effect against diabetes. This experiment evaluated the supplementation of milk naturally enriched with polyunsaturated fatty acids (PUFA) and polyphenols in rats with streptozotocin-induced diabetes. Forty male 28-day-old Wistar rats were distributed in four experimental treatments of diabetic animals (streptozotocin induction) and a normal group (non-induced). Experimental treatments were: control (water), whole common milk (COM-M), milk enriched with PUFA (PUFA-M), milk enriched with PUFA and polyphenols (PUFA/P-M) through a special diet offered to dairy cows. Milk supplementation at a dose 5 mL/kg body weight was performed for 77 days, 42 days before and 35 days after diabetes induction. The COM-M supplementation increased brown fat deposits, reduced post-induction glucose levels, reduced blood fructosamine levels, and improved glucose tolerance. Milk enriched with PUFA reduced final fasting glucose, LDL levels, and improved blood antioxidant capacity. Milk enriched with PUFA and polyphenols promoted an increase in gastrocnemius muscle mass, and a reduction in mesenteric fat and LDL levels. Milk intake, with an emphasis on milk enriched with PUFA and polyphenols, attenuated the metabolic disorders of streptozotocin-induced diabetes in rats.

Nitrogen metabolism, digestive parameters, and protein requirements for the maintenance of buffalo growth.

The objectives of this study were to evaluate the effect of crude protein (CP) levels in the diet of growing female buffaloes on nitrogen metabolism and estimate protein requirements for maintenance. Four female buffaloes were used, cannulated in the rumen, with an average initial body weight (BW) of 355 ± 3.5 kg, in a Latin square (4 × 4) with four animals and four levels of CP in the diet (70, 90, 110, and 130 g/kg dry matter (DM)) composed of corn silage and concentrate. The increase in protein intake with increasing levels of dietary CP resulted in a higher concentration of ammonia in the rumen and higher ruminal disappearance of PB. However, omasal flow of protein increased linearly as did the efficiency of microbial protein synthesis. The CP levels affected DM intake and other nutrients positively, but there was no effect on nutrient total digestibility. Nitrogen (N) balance, when expressed relative to N intake, had an average value of 48.5 % observed across. The protein requirement for the maintenance of growing female buffaloes was 4.6 g CP/kg BW(0.75).

Characterization of rumen bacterial strains isolated from enrichments of rumen content in the presence of propolis.

Propolis presents many biological properties, including antibacterial activities, and has been proposed as an additive in ruminant nutrition. Twenty bacterial strains, previously isolated from enrichments of Brazilian cow rumen contents in the presence of different propolis extracts (LLOS), were characterized using phenotyping and 16S rRNA identification. Seven strains were assigned to Streptococcus sp., most likely S. bovis, and were all degrading starch. One amylolytic lactate-utilizing strain of Selenomonas ruminantium was also found. Two strains of Clostridium bifermentans were identified and showed proteolytic activity. Two strains were assigned to Mitsuokella jalaludinii and were saccharolytic. One strain belonged to a Bacillus species and seven strains were affiliated with Escherichia coli. All of the 20 strains were able to use many sugars, but none of them were able to degrade the polysaccharides carboxymethylcellulose and xylans. The effect of three propolis extracts (LLOS B1, C1 and C3) was tested on the in vitro growth of four representative isolates of S. bovis, E. coli, M. jalaludinii and C. bifermentans. The growth of S. bovis, E. coli and M. jalaludinii was not affected by the three propolis extracts at 1 mg ml(-1). C. bifermentans growth was completely inhibited at this LLOS concentration, but this bacterium was partially resistant at lower concentrations. LLOS C3, with the lower concentration of phenolic compounds, was a little less inhibitory than B1 and C1 on this strain.

Antimicrobial activity of Brazilian propolis extracts against rumen bacteria in vitro.

The antimicrobial activity of three Brazilian propolis extracts was evaluated on bacterial strains representing major rumen functional groups. The extracts were prepared using different concentrations of propolis and alcohol, resulting in different phenolic compositions. The propolis extracts inhibited the growth of Fibrobacter succinogenes S85, Ruminococcus flavefaciens FD-1, Ruminococcus albus 7, Butyrivibrio fibrisolvens D1, Prevotella albensis M384, Peptostreptococcus sp. D1, Clostridium aminophilum F and Streptococcus bovis Pearl11, while R. albus 20, Prevotella bryantii B14 and Ruminobacter amylophilus H18 were resistant to all the extracts. The inhibited strains showed also different sensitivity to propolis; the hyper-ammonia-producing bacteria (C. aminophilum F and Peptostreptococcus sp. D1) being the most sensitive. Inhibition of hyper-ammonia-producing bacteria by propolis would be beneficial to the animal. The extract containing the lowest amount of phenolic compounds (LLOS C3) showed the lowest antimicrobial activity against all the bacteria. The major phenolic compounds identified in the propolis extracts (naringenin, chrysin, caffeic acid, p-coumaric acid and Artepillin C) were also evaluated on four sensitive strains. Only naringenin showed inhibitory effect against all strains, suggesting that naringenin is one of the components participating to the antibacterial activity of propolis.

Quantificação de ácido alfa-linolênico em caules e folhas de linho (Linum usitatissimum L.) colhidos em diferentes estágios de desenvolvimento / Quantification of alpha-linolenic acid in stems and leaves of flax (Linum usitatissimum L.) harvested in different stages of development

O objetivo deste estudo foi quantificar o ácido alfa-linolênico [LNA, 18:3 (n-3)], avaliar a composição centesimal das folhas e caules de linho (Linum usitatissimum L.) submetidos à secagem e colhidos em diferentes estágios de desenvolvimento (40, 80 e 120 dias), e determinar o potencial antioxidante das folhas colhidas aos 80 dias através do teste com o radical DPPH. As folhas obtiveram maiores teores de cinzas, proteína e lipídios totais em relação aos caules. Tanto as folhas quanto os caules apresentaram razões de AGPI/AGS e n-6/n-3 dentro dos valores considerados adequados para a alimentação. Os caules colhidos nos diferentes tempos não apresentaram diferenças significativas (P<0,05), quanto ao teor de LNA. As folhas colhidas aos 80 dias apresentaram a maior concentração de LNA, correspondendo a 1,262,36 mg/100g de folhas desidratadas. Os diferentes extratos (metanólico, butanólico, acetato e aquoso) foram eficientes na inibição do radical DPPH, com destaque para as frações butanólica e acetato, sendo os valores de IC50 de aproximadamente 42ppm para as duas frações. Tais resultados evidenciaram a atividade antioxidante e potencial nutritivo das folhas e caules de linho para futuro uso na alimentação animal e humana.

The objective of this study was to quantify the alpha-linolenic acid [LNA, 18:3 (n-3)] and to evaluate the proximate composition of leaves and stems of flax (Linum usitatissimum L.) dried and harvested at different stages of development (40, 80 and 120 days), and to determine the antioxidant potential of the leaf harvested at 80 days using the test of DPPH radical. The leaves had higher levels of ash, protein and total lipids when compared to the stems. Both the leaves as the stems had ratios of PUFA/SFA and n-6/n-3 within the values considered suitable for food. Stems in the different stages showed no significant difference (P<0.05) of LNA content. Leaves harvested at 80 days showed the highest concentration of LNA, corresponding to 1,262.36 mg/100g dried leaf. The different extracts (methanol, butanol, acetate and water) were efficient in the inhibition of DPPH radical, with emphasis on the butanolic and acetate fractions and the values of IC50 were approximately 42 ppm. These results highlight the nutritional potential and antioxidant activity of leaves and stems of flaxseed for future use in the animal and human feeding.

Variations in atherosclerosis and remodeling patterns in aorta and carotids.

BACKGROUND: Atherosclerosis is a progressive disease that causes vascular remodeling that can be positive or negative. The evolution of arterial wall thickening and changes in lumen size under current "standard of care" in different arterial beds is unclear. The purpose of this study was to examine arterial remodeling and progression/regression of atherosclerosis in aorta and carotid arteries of individuals at risk for atherosclerosis normalized over a 1-year period. METHODS: In this study, 28 patients underwent at least 2 black-blood in vivo cardiovascular magnetic resonance (CMR) scans of aorta and carotids over a one-year period (Mean 17.8 +/- 7.5 months). Clinical risk profiles for atherosclerosis and medications were documented and patients were followed by their referring physicians under current "standard of care" guidelines. Carotid and aortic wall lumen areas were matched across the time-points from cross-sectional images. RESULTS: The wall area increased by 8.67%, 10.64%, and 13.24% per year (carotid artery, thoracic aorta and abdominal aorta respectively, p < 0.001). The lumen area of the abdominal aorta increased by 4.97% per year (p = 0.002), but the carotid artery and thoracic aorta lumen areas did not change significantly. The use of statin therapy did not change the rate of increase of wall area of carotid artery, thoracic and abdominal aorta, but decreased the rate of change of lumen area of carotid artery (-3.08 +/- 11.34 vs. 0.19 +/- 12.91 p < 0.05). CONCLUSIONS: Results of this study of multiple vascular beds indicated that different vascular locations exhibited varying progression of atherosclerosis and remodeling as monitored by CMR.

Cardiovascular magnetic resonance parameters of atherosclerotic plaque burden improve discrimination of prior major adverse cardiovascular events.

AIMS: Patients with prior major cardiovascular or cerebrovascular events (MACE) are more likely to have future recurrent events independent of traditional cardiovascular disease risk factors. The purpose of this study was to determine if patients with traditional risk factors and prior MACE had increased cardiovascular magnetic resonance (CMR) plaque burden measures compared to patients with risk factors but no prior events. METHODS AND RESULTS: Black blood carotid and thoracic aorta images were obtained from 195 patients using a rapid extended coverage turbo spin echo sequence. CMR measures of plaque burden were obtained by tracing lumen and outer vessel wall contours. Patients with prior MACE had significantly higher MR plaque burden (wall thickness, wall area and normalized wall index) in carotids and thoracic aorta compared to those without prior MACE (Wall thickness carotids: 1.03 +/- 0.03 vs. 0.93+/- 0.03, p = 0.001; SD wall thickness carotids: 0.137 +/- 0.0008 vs. 0.102 +/- 0.0004, p < 0.001; wall thickness aorta: 1.63 +/- 0.10 vs. 1.50 +/- 0.04, p = 0.009; SD wall thickness aorta: 0.186 +/- 0.035 vs. 0.139 +/- 0.012, p = 0.009 respectively). Plaque burden (wall thickness) and plaque eccentricity (standard deviation of wall thickness) of carotid arteries were associated with prior MACE after adjustment for age, sex, and traditional risk factors. Area under ROC curve (AUC) for discriminating prior MACE improved by adding plaque eccentricity to models incorporating age, sex, and traditional CVD risk factors as model inputs (AUC = 0.79, p = 0.05). CONCLUSION: A greater plaque burden and plaque eccentricity is prevalent among patients with prior MACE.

Cross-sectional, prospective study of MRI reproducibility in the assessment of plaque burden of the carotid arteries and aorta.

BACKGROUND: The reliability of imaging techniques to assess early atherosclerosis remains unclear. We did a cross-sectional, prospective study to test reproducibility of MRI when imaging arteries, to assess risk of cardiovascular disease and correlations with age and sex. METHODS: Between January 2003 and December 2006 we performed black-blood MRI of both common carotid arteries and the thoracic descending aorta in patients with cardiovascular risk factors who were referred from clinics in New York, NY, USA. Mean wall area, wall thickness, lumen area, total vessel area, and ratio of the mean wall area to the mean total vessel area (WA/TVA) were manually measured. Reproducibility within and between readers was tested on subsets of images from randomly chosen patients. RESULTS: MRI was performed on 300 patients. Intrareader reproducibility, assessed in images from 20 patients, was high for all parameters (intraclass correlation coefficients >0.8), except WA/TVA ratio in the descending aorta. The inter-reader reproducibility, assessed in images from 187 patients, was acceptable (intraclass correlation coefficients >0.7) for the mean wall, lumen, and total vessel areas. Values for all MRI parameters in all vessels increased with increasing age for both sexes (all P <0.0005) but were always significantly higher in men than in women, except for aortic mean wall thickness and WA/TVA ratio in the carotid arteries. Mean wall area values correlated well between the carotid arteries and aorta, reflecting the systemic nature of atherosclerosis. CONCLUSIONS: Our findings support MRI as a reproducible measurement of plaque burden and demonstrate the systemic distribution of atherosclerosis.

Psicologia social e saúde coletiva: reconstruindo identidades / Social psychology and collective health: reconstruction of identities

O presente artigo consiste em uma revisão bibliográfica que apresenta um breve histórico da psicologia no campo da saúde, mais especificamente da psicologia na saúde pública. Problematiza as práticas da psicologia tradicional neste contexto e apresenta algumas alternativas e propostas de atuação da psicologia na saúde coletiva, centrada principalmente nas ações de políticas de saúde, prevenção de doenças e promoção de saúde, tendo como embasamento teórico principal a psicologia social. Conclui-se que a psicologia social não é uma teoria totalizadora das possibilidades de intervenção e entendimento do tema em questão, porém se apresenta como um campo coerente e importante para as ações em saúde coletiva.(AU)

The present paper consists of a bibliographic revision that presents a brief history of the health field of Psychology, more specifically public health. Questions the traditional practises of psychology in this context and presents alternative proposals of collective health psychological practises. Specially centred on public health policy, health problem prevention and health promotion, it is based on Social Psychology theoretical framework. It is concluded that Social Psychology does not summarise the total of all possibilities of intervention and understanding about the theme in question, but it presents itself as a coherent field and it is important for actions in collective heath.(AU)

Carotid black blood MRI burden of atherosclerotic disease assessment correlates with ultrasound intima-media thickness.

The aim of this study was to correlate carotid black blood MRI based measurements with those obtained by ultrasound intima-media thickness (IMT). Seventeen patients with intermediate to high Framingham cardiovascular risk score underwent both carotid ultrasound and rapid extended coverage double inversion recovery black blood carotid MRI. Overall, there was good correlation between wall area, wall thickness, and plaque index measured by MRI and the IMT measurements obtained from the ultrasound images (max r2 = 0.72, p < 0.05). Patients with mean IMT > or = 1.2 mm had significantly higher values of wall area, plaque index and wall thickness compared to patients with mean IMT < 1.2 mm. Vessel wall measurements assessed by black-blood MRI may be potentially used clinically to evaluate plaque progression and regression.

Comparison of gated and non-gated fast multislice black-blood carotid imaging using rapid extended coverage and inflow/outflow saturation techniques.

PURPOSE: To comparatively analyze two fast in vivo multislice black-blood carotid artery vessel wall imaging techniques with and without cardiac gating. MATERIALS AND METHODS: Eight subjects with carotid artery atherosclerosis, and four healthy subjects were studied using two black-blood multislice techniques: rapid extended coverage double inversion recovery (REX-DIR), and inflow/outflow saturation band (IOSB) rapid acquisition with relaxation enhancement (RARE) multislice acquisitions. Quantitative, qualitative, and morphometric analyses were performed on images. RESULTS: Gating produced significantly lower values for the REX-DIR sequence with respect to signal intensity in muscle and the carotid artery wall, whereas it had no effect on flow suppression compared to non-gated images. For the IOSB sequences, gating had no significant effect on signal intensity of muscle and the carotid artery wall, but worsened flow suppression. REX-DIR and IOSB sequences were statistically different with respect to signal intensity of muscle (with REX-DIR sequences having lower values), while no statistical significance was observed for flow suppression and wall delineation. A morphologic analysis of the vessel wall and lumen comparing REX-DIR gated, IOSB gated, REX-DIR non-gated, and IOSB non-gated sequences revealed no significant differences between the acquisition techniques tested. CONCLUSION: Non-gated sequences may be used instead of gated sequences in atherosclerotic vessel wall imaging without compromising image quality. This may shorten examination time and improve patient comfort.

Vascular MRI in the diagnosis and therapy of the high risk atherosclerotic plaque.

Disruption of a high risk plaque is known as the primary cause of cardiovascular events. Characterization of arterial wall components has become an essential adjunct in the identification of patients with plaques prone to rupture. Magnetic Resonance Imaging (MRI) has been revealed as one of the noninvasive tools possibly capable of identifying and characterizing high risk atherosclerotic plaque. MRI may facilitate diagnosis, and guide and serially monitor interventional and pharmacological treatment of atherosclerotic disease. In addition, it permits the simultaneous assessment of the anatomy, morphology, and hemodynamics for the study of flow-induced atherogenesis. It possibly will identify asymptomatic patients with subclinical atherosclerosis. This has potential significance for the improvement of strategies in primary and secondary prevention.

Retençäo de conhecimentos I: programas de dermatologia e de psiquiatria / Retention of knowledge I: dermatology and psychiatry programs

Os autores apresentam os resultados de uma investigacao educacional sobre retencao de conhecimentos. Foram estudados programas dos Departamentos de Dermatologia e de Psiquiatria que dispoem de uma disciplina no quarto ano e um estagio no internato de quinto ano. Foram comparadas as notas obtidas pelos alunos no quarto e no quinto ano, sendo a prova do quinto ano aplicada no primeiro dia do estagio, de mesmo conteudo da prova do quarto ano porem nao identica. Tais perdas nao foram influenciadas pelo tempo decorrido entre as duas provas, pelo sexo dos alunos, pela raca dos alunos (oriental e nao oriental) e pelo curriculo oculto pertinente aos programas estudados e eventualmente cumpridos pelos alunos

AçÅo lícita do soro para Pseudomonas aeruginosa mucóide e nåo mucóide de secreçöes respiratórias de pacientes com fibrose cística / Bactericidal activity of serum for mucoid and non-mucoid Pseudomonas aeruginosa isolated from cystic fibrosis patients

As infecçöes pulmonares por P. aeruginosa såo a causa de morte mais freqüente nos pacientes com fibrose cística, sobretudo as causadas pelas formas mucóides. Ao testarmos a sensibilidade à açåo bactericida do soro humano normal (SHN) e do soro autólogo (SA) de 44 amostras de P. aeruginosa, sendo 21 mucóides e 23 nåo mucóides, obtidas do trato respiratório de pacientes com Fibrose Cística, nåo encontramos diferença significativa no percentual de amostras soro-sensíveis entre as duas linhagens (SHN: 71,4 e 56,5; SA: 47,6 e 34,8, respectivamente para amostras mucóides e nåo mucóides; p>0,05). Sete amostras mostraram-se sensíveis ao SHNe resistentes ao SA, apesar da presença de anticorpos e de níveis normais ou aumentados de complemento, indicando a possível presença de fatores bloqueadores séricos. Nos pacientes que retornaram para estudo, verificamos que tanto com SHN como com SA, amostras de um mesmo morfotipo passaram de sensíveis a resistentes e vice-versa, evidenciando a necessidade de investigaçöes para melhor esclarecimento das interaçöes parasito-hospedeiro nestes pacientes