Mitral Regurgitation and Increased Risk of All-Cause and Cardiovascular Mortality in Patients with Type 2 Diabetes

Mitral regurgitation is the most common heart valve disease in the general population, but little is known about the prevalence and prognostic implications of mitral regurgitation in patients with type 2 diabetes

Clinical outcomes of transcatheter aortic valve implantation: from learning curve to proficiency

Objective: The use of transcatheter aortic valve implantation (TAVI) is growing rapidly in countries with a predominantly elderly population, posing a huge challenge to healthcare systems worldwide. The increment of human and economic resource consumption imposes a careful monitoring of clinical outcomes and cost-benefit balance, and this article is aimed at analysing clinical outcomes related to the TAVI learning curve.Methods: Outcomes of 177 consecutive transfemoral TAVI procedures performed in 5 years by a single team were analysed by the Cumulative Sum of failures method (CUSUM) according to the clinical events comprised in the Valve Academic Research Consortium (VARC-2) safety end point and the VARC-2 definition of device success. Margins for events acceptance were extrapolated from landmark trials that tested both balloon or self-expandable percutaneous valves.Results: 30-day and 1-year survival rates were 97.2% and 89.9%, respectively. Achievement of the primary end point (number of cases needed to provide the acceptable margin of the composite end point of any death, stroke, myocardial infarction, life-threatening bleeding, major vascular complications, stage 2-3 acute kidney injury and valve-related dysfunction requiring a repeat procedure) required the performance of 54 cases, while the learning curve to achieve 'device success' identified 32 cases to reach the expected proficiency. In this experience, the baseline clinical risk as assessed by the Society of Thoracic Surgeons (STS) score determined the long-term survival rather than the adverse events related to the learning curve.Conclusions: A relatively large number of cases are required to achieve clinical outcomes comparable to those reported in high-volume centres and controlled trials. According to our national workload standards, this represents more than 2 years of continuous activity

Ocupação KSA ROSA

A Associação KSA ROSA é um Centro de Educaçao Popular e Resistência Cultural que trabalha com catadores e moradores de rua nas proximidades do Centro de Porto Alegre. A coordenadora Maristoni Moura, juntamente com os demais integrantes, tem usado seu trabalho como fonte de reorganização social e produtiva do mundo da rua, articulando várias políticas públicas como por exemplo, de redução de danos. O objetivo desse trabalho pedagógico arquitetônico é colocar graduandos, extensionistas e pesquisadores em contato com realidades de extrema vulnerabilidade social e capacitá-los metodologicamente

The Jewish Ghetto of Rome. Tools and methods for knowledge the demolished urban fabrics.

In 1555 Pope Paul IV segregated the Jewish community of Rome, building a walled enclo-sure within the Sant'Angelo district, along the river Tiber. Despite rare exceptions, the situ-ation remained unchanged until 1848 when Pope Pius IX ordered the removal of the wall and isolation was temporarily abolished. Immediately after the Italian unification, when Rome was declared capital, the demolition of the Ghetto was decided: the dense building fabric - maybe unsanitary - was razed to the ground between 1885 and 1888 replaced with larger building blocks. The historical formative process that characterizes this piece of town differs from the urban history of the whole historic center of Rome. Forced to grow within the walls, the building fabric of the Ghetto developed atypically: it preserved archa-ic architectural and urban features and, due to the expansion limitation, it developed in an introverted multi-layered way. Because of these unique features, the urban fabric of the Rome Ghetto has been the object of many specific multidisciplinary research and studies. The research we present aims to contribute to the studies by providing additional tools for the knowledge of this lost portion of urban fabric using two specific sources. The first is the plan of Rome made by Leonardo Bufalini in 1551: redesigning this map on the 19th century cadastral base allows us to visualize the urban consistency just before the enclo-sure. The second source dates to the middle of the 19th century and consist of the built heritage survey drawn to make the commemorative model of the French siege of Rome in 1849. The analytical reading of these documents, together with their graphic reinterpreta-tion, helps us understand the urban structure of the Ghetto in two fundamental stages of the evolutionary process and to speculate about the related phenomena

High-resolution crystal structure of the recombinant diheme cytochrome c from Shewanella baltica (OS155)

Multiheme cytochromes c (cyts c) are c-type cyts characterized by non-standard structural and spectroscopic properties. The relative disposition of the heme cofactors in the core of these proteins is conserved and they can be classified from their geometry in two main groups. In one group the porphyrin planes are arranged in a perpendicular fashion, while in the other they are parallel. Orientation of the heme groups is a key factor that regulates the intramolecular electron transfer pathway. A 16.5 kDa diheme cyt c, isolated from the bacterium Shewanella baltica OS155 (Sb-DHC), was cloned and expressed in E. coli and its structure was investigated by X-ray crystallography. Using high-resolution data (1.14 \uc5) collected at ELETTRA (Trieste), the crystal structure, with an orthorhombic cell (a = 40.81, b = 42.97, c = 82.07 \uc5), was solved using the homologous diheme from Rhodobacter sphaeroides (Rs-DHC) as the initial model. The electron density map of the refined structure (Rfact of 13.8% and Rfree of 15.4%) shows a two domain structure connected by a central unstructured region (N72-G87). The Sb-DHC, like its homologue (Rs-DHC), folds into a new cyt c class: the N-terminal globular domain, with its three \u3b1-helices, belongs to class I of c-type cyts, while the C-terminal domain includes a rare \u3c0-helix. The metal centre of the c-type heme groups is axially coordinated by two His residues and it is covalently bound to the protein through two Cys bonds