Incidence, Predictors, and Significance of Abnormal Cardiac Enzyme Rise in Patients Treated With Bypass Surgery in the Arterial Revascularization Therapies Study (ARTS)

BACKGROUND: Although it has been suggested that elevation of CK-MB after percutaneous coronary intervention is associated with adverse clinical outcomes, limited data are available in the setting of coronary bypass grafting. The aim of the present study was to determine the incidence, predictors, and prognostic significance of CK-MB elevation following multivessel coronary bypass grafting (CABG). METHODS AND RESULTS: The population comprises 496 patients with multivessel coronary disease assigned to CABG in the Arterial Revascularization Therapies Study (ARTS). CK-MB was prospectively measured at 6, 12, and 18 hours after the procedure. Thirty-day and 1-year clinical follow-up were performed. Abnormal CK-MB elevation occurred in 61.9% of the patients. Patients with increased cardiac-enzyme levels after CABG were at increased risk of both death and repeat myocardial infarction within the first 30 days (P=0.001). CK-MB elevation was also independently related to late adverse outcome (P=0.009, OR=0.64). CONCLUSIONS: Increased concentrations of CK-MB, which are often dismissed as inconsequential in the setting of multivessel CABG, appear to occur very frequently and are associated with a significant increase in both repeat myocardial infarction and death beyond the immediate perioperative period

Hippocampal pyramidal cells: the reemergence of cortical lamination

The increasing resolution of tract-tracing studies has led to the definition of segments along the transverse axis of the hippocampal pyramidal cell layer, which may represent functionally defined elements. This review will summarize evidence for a morphological and functional differentiation of pyramidal cells along the radial (deep to superficial) axis of the cell layer. In many species, deep and superficial sublayers can be identified histologically throughout large parts of the septotemporal extent of the hippocampus. Neurons in these sublayers are generated during different periods of development. During development, deep and superficial cells express genes (Sox5, SatB2) that also specify the phenotypes of superficial and deep cells in the neocortex. Deep and superficial cells differ neurochemically (e.g. calbindin and zinc) and in their adult gene expression patterns. These markers also distinguish sublayers in the septal hippocampus, where they are not readily apparent histologically in rat or mouse. Deep and superficial pyramidal cells differ in septal, striatal, and neocortical efferent connections. Distributions of deep and superficial pyramidal cell dendrites and studies in reeler or sparsely GFP-expressing mice indicate that this also applies to afferent pathways. Histological, neurochemical, and connective differences between deep and superficial neurons may correlate with (patho-) physiological phenomena specific to pyramidal cells at different radial locations. We feel that an appreciation of radial subdivisions in the pyramidal cell layer reminiscent of lamination in other cortical areas may be critical in the interpretation of studies of hippocampal anatomy and function

Frequency of oral mucositis and microbiological analysis in children with acute lymphoblastic leukemia treated with 0.12% chlorhexidine gluconate

Tendo em vista o potencial de morbidade das complicações orais em pacientes com leucemia, este estudo avaliou as alterações clínicas e microbiológicas que ocorrem na mucosa bucal de crianças com leucemia linfoblástica aguda (LLA), submetidas à quimioterapia antineoplásica e administração profilática do gluconato de clorexidina 0,12%. A amostra foi constituída de 17 crianças de 2 a 12 anos, as quais foram submetidas a exame clínico da mucosa oral para a detecção de lesões bucais. Além disso, foi coletado material biológico das mucosas labial e jugal para análises microbiológicas. A mucosite oral foi observada em apenas 5 (29,4%) pacientes. A análise microbiológica revelou a presença de um número reduzido de microorganismos potencialmente patogênicos, como estafilococos coagulase-negativos (47%), Candida albicans (35,3%), Klebsiella pneumoniae (5,9%), Escherichia coli enteropatogênica (5,9%) e Stenotrophomonas maltophilia (5,9%). Pacientes com mucosite oral apresentaram uma maior freqüência de estafilococos coagulase-negativos (80%) quando comparados aos pacientes que exibiam mucosa oral normal (33,3%). Em conclusão, os resultados do presente estudo sugerem que o uso profilático do gluconato de clorexidina 0,12% reduz a freqüência de mucosite oral e de patógenos orais em crianças com LLA. Além disso, os presentes achados sugerem uma possível relação entre estafilococos coagulase-negativos e o desenvolvimento de mucosite oral. _________________________________________________________________________________________ ABSTRACT: In view of the morbidity potential of oral complications in patients with leukemia, this study evaluated the clinical and microbiological alterations that occur in the oral mucosa of children with acute lymphoblastic leukemia (ALL) undergoing antineoplastic chemotherapy and prophylactic administration of 0.12% chlorhexidine gluconate. The sample consisted of 17 children aged 2 to 12 years that underwent clinical examination of the oral mucosa for the detection of oral lesions. In addition, biological material was collected from labial and buccal mucosa for microbiological analysis. Oral mucositis was observed in only 5 (29.4%) patients. Microbiological analysis revealed a reduced number of potentially pathogenic microorganisms, such as coagulase-negative staphylococci (47%), Candida albicans (35.3%), Klebsiella pneumoniae (5.9%), enteropathogenic Escherichia coli (5.9%), and Stenotrophomonas maltophilia (5.9%). Patients with oral mucositis showed a higher frequency of coagulase-negative staphylococci (80%) when compared with patients with normal oral mucosa (33.3%). In conclusion, the results of the present study suggest that the prophylactic use of 0.12% chlorhexidine gluconate reduces the frequency of oral mucositis and oral pathogens in children with ALL. In addition, the present findings suggest a possible relationship between coagulase-negative staphylococci and the development of oral mucositis

Desempenho de Frangos de Corte Alimentados com Ovo em Pó Perfomance of Broiler Fed Dried Whole Eggs

Um experimento foi conduzido para estudar a adição do ovo em pó na dieta de frangos de corte no período de 1 a 28 dias, sendo dividido em duas fases (1 a 7 e 8 a 28 dias). No período de 1 a 7 dias, as aves receberam dietas contendo 0%, 5%, 10%, 15% e 20% de ovo em pó e de 8 a 28 dias de idade as aves foram distribuídas em um arranjo fatorial 2x5 (2 níveis de ovo em pó - 0% e 5% - e os 5 níveis da fase anterior). No período de 1 a 7 dias as aves do tratamento controle apresentaram melhor ganho de peso e as aves alimentadas com dietas contendo 20% de ovo em pó apresentaram menor ganho de peso e pior conversão alimentar. As aves deste mesmo tratamento apresentaram também menor peso e comprimento do intestino. Na segunda fase (8 a 28 dias) não houve interação entre os tratamentos estudados. O desempenho, peso e comprimento do intestino não foram afetados pelos tratamentos, ocorrendo apenas maior peso do coração em aves que receberam ovo em pó nesta fase. Os resultados obtidos demonstram ser economicamente inviável a utilização de ovo em pó na dietas de frangos de corte no período de 1 a 28 dias e pela falta de resposta que este ingrediente promove no desempenho da ave.<br>A experiment was conducted to study the addition of dried whole eggs (DWE) in broilers diets from 1 to 28 days of age in two phases (1to 7 and 8 to 28 days). From 1 to 7 days the birds received the diets with 0, 5, 10, 15 and 20% DWE and from 8 to 28 days of age the birds were assigned in a factorial arrangement 2x5 (2 levels of DWE - 0% and 5% - and the five previous levels). From 1 to 7 days of age birds fed control diet without DWE showed better weight gain and those fed the highest level of DWE showed the worst feed conversion. In the second phase (8 to 28 days) no interaction was found between treatments and also performance, gut weight and gut length were not affected by treatments. The results obtained suggest that the addition of DWE does not results in beneficial effects in broiler diets