Haemodialysis patients longitudinally assessed by highly sensitive cardiac troponin T and commercial cardiac troponin T and cardiac troponin I assays.

BACKGROUND: Elevated cardiac troponin (cTn) concentrations predict an increased mortality in patients suffering from end-stage renal disease (ESRD). This study compares the performance of a precommercial high-sensitive cTnT assay (hs-cTnT) with two contemporary cTn assays in detecting cTn elevations in ESRD patients during a six-month follow-up. METHODS: Thirty-two ESRD patients were followed for six months, during which cTn concentrations were assessed every two months. Baseline biomarker concentrations were compared with those in a simultaneously measured reference population of 501 healthy subjects. RESULTS: During follow-up 26 (81%), 32 (100%) and 9 (28%) of the patients showed elevated cTn concentrations according to the current cTnT, the hs-cTnT and the cTnI assays, respectively. The range of concentrations measured in each patient had a median (interquartile range) magnitude of 0.03 mug/L (0.02-0.06), 0.017 mug/L (0.011-0.029) and 0.011 mug/L (0-0.017) according to the aforementioned assays. CONCLUSION: According to the hs-cTnT assay, all of the ESRD patients had elevated cTnT concentrations at least once during the follow-up. As elevated cTn concentrations are highly prognostic of adverse events, the use of serial measurements has thus identified additional patients at risk for such events. The fact that we find cTn concentrations to be higher in patients with a history of cardiac disease is in line with this. Additional studies in ESRD patients are needed to investigate the added diagnostic and prognostic value of the very low cTnT concentrations and variations detected only by the hs-cTnT assay

Inflammation, overhydration and cardiac biomarkers in haemodialysis patients: a longitudinal study.

BACKGROUND: Inflammation, overhydration and elevated cardiac biomarkers are related to outcome in haemodialysis (HD) patients. Here, we explored the relationship between the body composition (BC), inflammation and cardiac biomarker concentrations in HD patients longitudinally. METHODS: A total of 44 HD patients were followed for 6 months. BC was assessed by multifrequency bioimpedance (BIA). Serum concentrations of cardiac troponin T (cTnT), high-sensitive C-reactive protein (hsCRP), brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) were assessed at 2 monthly intervals. The longitudinal data analysis was conducted with a marginal model. RESULTS: During the follow-up, the parameters describing the BC were highly predictive of both BNP and NT-proBNP and independent of gender, time, hsCRP and cTnT concentrations. The intracellular water (ICW)/body weight (BW) ratio (reflecting malnutrition) exerted a negative effect, whereas the extracellular water (ECW)/BW ratio (reflecting overhydration) had a positive effect on BNP and NT-proBNP concentrations. HsCRP and cTnT concentrations were significantly associated with each other. Furthermore, NT-proBNP concentrations were predictive of cTnT and hsCRP concentrations. CONCLUSIONS: In the present study, we find a significant relation between BIA-derived BC parameters and natriuretic peptide concentrations. This relationship was independent of the cardiac history of the patient and suggests that the natriuretic peptide levels are to some degree modifiable by changing a patient's fluid distribution. Moreover, cTnT, BNP, NT-proBNP and hsCRP were significantly related, showing a complex relation between overhydration, malnutrition, inflammation and cardiac biomarkers in dialysis patients

A Decision Support System for Efficient Crop Production Supply Chain Management

International audienceThis paper presents a decision support system for efficient and responsive crop production supply chain management, which captures harvesting, transportation and storage activities, through taking a holistic perspective as a whole. Crop production represents one of the most significant stage in agricultural sector for both agricultural cooperatives and individual farmers, due to its high cost and considerable impact on crop quality and yield. Whilst considering the dynamic behaviour and the intricacy of the studied agricultural system, combined discrete event simulation and optimization approaches, scenario analysis and performance measurement tools are implemented for supporting decision making for cooperatives and individual farmers, respectively. Likewise, it enables to examine and evaluate alternative system re-configurations and strategies for an eventual supply chain rethinking or redesign. The decision support system proves to be particularly responsive and effective when applied to a real life agricultural case study

Suplementação de vacas leiteiras com homeopatia: células somáticas do leite, cortisol e imunidade

Avaliou-se o efeito da suplementação de uma combinação homeopática sobre a contagem de células somáticas do leite (CCS), o teor sanguíneo de cortisol e a resposta de anticorpos neutralizantes antivírus da raiva de vacas leiteiras. Trinta e duas vacas Holandesas em lactação foram blocadas em pares e aleatoriamente alocadas a um de dois tratamentos por 63 dias, posterior a um período de padronização de 14 dias. A CCS mensurada no final da padronização ajustou os valores semanais de CCS no modelo de análise estatística. Os tratamentos foram: 150 gramas de uma combinação homeopática (Hypothalamus, 10-30; Colibacilinum, 10-30; Streptococus Beta Hemolyticum, 10-60; Streptococus Uberis, 10-60; Phytolacca, 10-60; Calcium Phosphoricum, 10-30; Natrum Muriaticum, 10-60; Urtica Urens, 10-30; Silicea Terra, 10-400) em veículo mineral, ou 150 gramas do mesmo veículo mineral (controle). A homeopatia tendeu a aumentar a CCS de 124 para 222 x1.000 células mL-1 (P=0,09) e a CCS linearizada (P=0,08). Não foram detectados efeitos de tratamento sobre a concentração sérica de cortisol após estresse induzido por aspiração percutânea do saco ventral do rúmen (P=0,59) ou sobre o título de anticorpos neutralizantes em resposta à vacinação antivírus da raiva (P=0,40). A suplementação com homeopatia tendeu a aumentar a CCS de vacas com baixa CCS