Effects of dual blockade in heart failure and renal dysfunction: Systematic review and meta-analysis

OBJECTIVE: The effect of dual renin-angiotensin system (RAS) inhibition in heart failure (HF) is still controversial. Systematic reviews have shown that dual RAS blockade may reduce mortality and hospitalizations, yet it has been associated with the increased risk of renal dysfunction (RD). Surprisingly, although RD in patients with HF is frequent, the effect of combining RAS inhibitors in HF patients with RD has never been studied in a meta-analysis. METHODS: A systematic review and meta-analysis of randomized clinical trials involving HF patients with RD who received dual blockade analyzing death, cardiovascular (CV) death or HF hospitalization, and adverse events. RESULTS: Out of 2258 screened articles, 12 studies were included (34,131 patients). Compared with monotherapy, dual RAS inhibition reduced hazard ratio of death to 0.94 (p=0.07) and significantly reduced CV death or HF hospitalization to 0.89 (p=0.0006) in all individuals, and to 0.86 (p=0.005) in patients with RD and to 0.91 (p=0.04) without RD. Nevertheless, dual RAS blockade significantly increased the risk of renal impairment (40%), hyperkalemia (44%), and hypotension (42%), although discontinuation of treatment occurs only in 3.68% versus 2.19% (p=0.00001). CONCLUSIONS: Dual RAS inhibition therapy reduces the risk of CV death or HF hospitalization. However, cautions monitoring for specific adverse events may be warranted

First report of anthracnose of Capsicum Chinense in Brazil caused by Colletotrichum brevisporum

Fruit of “yellow lantern” chili pepper (Capsicum chinense L.) with typical symptoms of anthracnose were observed in the city of Manaus in 2008 and Manacapuru in 2014, in Amazonas state, Brazil. The symptoms initially consisted of small dark-brown lesions, circular, depressed, with defined edges, progressing to the center and becoming gray to black, with concentric circles. Losses of up to 100% have occurred in some plantings. Isolation of the fungus was carried out from masses of spores present on the fruit lesions. Colonies were grown on potato dextrose agar (PDA) at 25°C and 12-h photoperiod. Monosporic cultures were obtained and the isolates were deposited in the Microorganisms Culture Collection of the National Institute of Amazonian Research, Manaus, Brazil (INPA 1858 and INPA 2800). After 7 days on PDA, single spore colonies had a cottony appearance and the color ranged from white to brownish, with orange-colored masses of conidia. Conidia were hyaline, aseptate, cylindrical with rounded ends, and measured 10.2 to 17.7 µm in length × 3.3 to 5.6 µm in width. Appressoria formed were dark-brown in color, irregularly shaped or lobate, and measured 5.9 to 12.0 µm in length and 5.5 to 8.9 µm in width. Partial sequences of actin (ACT) and glyceraldehyde-3-phosphate dehydrogenase (GAPDH) genes were amplified and comparted to GenBank accession nos. KU315567 and KX878886 for ACT and KU315572 and KX878887 for GAPDH. Bayesian inference analyses performed with concatenated gene sequences showed that the isolate INPA 1858 and INPA 2800 clustered with the ex-type specimen of Colletotrichum brevisporum (BCC 38876) in a clade with high support (posterior probability = 1). Pathogenicity tests with isolates INPA 1858 and INPA 2800 were conducted on healthy chili peppers using the wound inoculation method by droplet (106 conidia/ml) on the fruit surface (Lin et al. 2002). Pathogenicity tests were done with 10 fruit per isolate (INPA 1858 and INPA 2800) replicated three times. The controls were inoculated with sterile water. Typical symptoms of anthracnose were observed 7 days post inoculation, while the controls did not show any symptoms. The fungus C. brevisporum was recovered from the inoculated chili peppers, thereby confirming Koch’s postulates. C. brevisporum was described in Thailand causing symptoms in Neoregalia sp. and in Pandanus pygmaeus (Noireung et al. 2012), in Korea in Lycium chinense (Paul et al. 2014), and in Brazil in Carica papaya and Sechium edule (Bezerra et al. 2016; Vieira et al. 2013). To our knowledge, this is the first report of C. brevisporum on C. chinense fruits in Brazil. © 2017, American Phytopathological Society. All rights reserved

The Fluorescence Detector of the Pierre Auger Observatory

The Pierre Auger Observatory is a hybrid detector for ultra-high energy cosmic rays. It combines a surface array to measure secondary particles at ground level together with a fluorescence detector to measure the development of air showers in the atmosphere above the array. The fluorescence detector comprises 24 large telescopes specialized for measuring the nitrogen fluorescence caused by charged particles of cosmic ray air showers. In this paper we describe the components of the fluorescence detector including its optical system, the design of the camera, the electronics, and the systems for relative and absolute calibration. We also discuss the operation and the monitoring of the detector. Finally, we evaluate the detector performance and precision of shower reconstructions.Comment: 53 pages. Submitted to Nuclear Instruments and Methods in Physics Research Section

Evidence for a mixed mass composition at the `ankle' in the cosmic-ray spectrum

We report a first measurement for ultra-high energy cosmic rays of the correlation between the depth of shower maximum and the signal in the water Cherenkov stations of air-showers registered simultaneously by the fluorescence and the surface detectors of the Pierre Auger Observatory. Such a correlation measurement is a unique feature of a hybrid air-shower observatory with sensitivity to both the electromagnetic and muonic components. It allows an accurate determination of the spread of primary masses in the cosmic-ray flux. Up till now, constraints on the spread of primary masses have been dominated by systematic uncertainties. The present correlation measurement is not affected by systematics in the measurement of the depth of shower maximum or the signal in the water Cherenkov stations. The analysis relies on general characteristics of air showers and is thus robust also with respect to uncertainties in hadronic event generators. The observed correlation in the energy range around the `ankle' at $\lg(E/{\rm eV})=18.5-19.0$ differs significantly from expectations for pure primary cosmic-ray compositions. A light composition made up of proton and helium only is equally inconsistent with observations. The data are explained well by a mixed composition including nuclei with mass $A > 4$. Scenarios such as the proton dip model, with almost pure compositions, are thus disfavoured as the sole explanation of the ultrahigh-energy cosmic-ray flux at Earth.Comment: Published version. Added journal reference and DOI. Added Report Numbe

Atmospheric effects on extensive air showers observed with the Surface Detector of the Pierre Auger Observatory

Atmospheric parameters, such as pressure (P), temperature (T) and density, affect the development of extensive air showers initiated by energetic cosmic rays. We have studied the impact of atmospheric variations on extensive air showers by means of the surface detector of the Pierre Auger Observatory. The rate of events shows a ~10% seasonal modulation and ~2% diurnal one. We find that the observed behaviour is explained by a model including the effects associated with the variations of pressure and density. The former affects the longitudinal development of air showers while the latter influences the Moliere radius and hence the lateral distribution of the shower particles. The model is validated with full simulations of extensive air showers using atmospheric profiles measured at the site of the Pierre Auger Observatory.Comment: 24 pages, 9 figures, accepted for publication in Astroparticle Physic

The exposure of the hybrid detector of the Pierre Auger Observatory

The Pierre Auger Observatory is a detector for ultra-high energy cosmic rays. It consists of a surface array to measure secondary particles at ground level and a fluorescence detector to measure the development of air showers in the atmosphere above the array. The "hybrid" detection mode combines the information from the two subsystems. We describe the determination of the hybrid exposure for events observed by the fluorescence telescopes in coincidence with at least one water-Cherenkov detector of the surface array. A detailed knowledge of the time dependence of the detection operations is crucial for an accurate evaluation of the exposure. We discuss the relevance of monitoring data collected during operations, such as the status of the fluorescence detector, background light and atmospheric conditions, that are used in both simulation and reconstruction.Comment: Paper accepted by Astroparticle Physic