Nitroglycerin reverts clinical manifestations of poor peripheral perfusion in patients with circulatory shock

Introduction: Recent clinical studies have shown a relationship between abnormalities in peripheral perfusion and unfavorable outcome in patients with circulatory shock. Nitroglycerin is effective in restoring alterations in microcirculatory blood flow. The aim of this study was to investigate whether nitroglycerin could correct the parameters of abnormal peripheral circulation in resuscitated circulatory shock patients.Methods: This interventional study recruited patients who had circulatory shock and who persisted with abnormal peripheral perfusion despite normalization of global hemodynamic parameters. Nitroglycerin started at 2 mg/hour and doubled stepwise (4, 8, and 16 mg/hour) each 15 minutes until an improvement in peripheral perfusion was observed. Peripheral circulation parameters included capillary refill time (CRT), skin-temperature gradient (Tskin-diff), perfusion index (PI), and tissue oxygen saturation (StO2) during a reactive hyperemia test (RincStO2). Measurements were performed before, at the maximum dose, and after cessation of nitroglycerin infusion. Data were analyzed by using linear model for repeated measurements and are presented as mean (standard error).Results: Of the 15 patients included, four patients (27%) responded with an initial nitroglycerin dose of 2 mg/hour. In all patients, nitroglycerin infusion resulted in significant changes in CRT, Tskin-diff, and PI toward normal at the maximum dose of nitroglycerin: from 9.4 (0.6) seconds to 4.8 (0.3) seconds (P <0.05), from 3.3°C (0.7°C) to 0.7°C (0.6°C) (P <0.05), and from [log] -0.5% (0.2%) to 0.7% (0.1%) (P <0.05), respectively. Similar changes in StO2 and RincStO2 were observed: from 75% (3.4%) to 84% (2.7%) (P <0.05) and 1.9%/second (0.08%/second) to 2.8%/second (0.05%/second) (P <0.05), respectively. The magnitude of changes in StO2 was more prono

Clinical assessment of peripheral perfusion to predict postoperative complications after major abdominal surgery early: A prospective observational study in adults

Introduction: Altered peripheral perfusion is strongly associated with poor outcome in critically ill patients. We wanted to determine whether repeated assessments of peripheral perfusion during the days following surgery could help to early identify patients that are more likely to develop postoperative complications.Methods: Haemodynamic measurements and peripheral perfusion parameters were collected one day prior to surgery, directly after surgery (D0) and on the first (D1), second (D2) and third (D3) postoperative days. Peripheral perfusion assessment consisted of capillary refill time (CRT), peripheral perfusion index (PPI) and forearm-to-fingertip skin temperature gradient (Tskin-diff). Generalized linear mixed models were used to predict severe complications within ten days after surgery based on Clavien-Dindo classification.Results: We prospectively followed 137 consecutive patients, from among whom 111 were included in the analysis. Severe complications were observed in 19 patients (17.0%). Postoperatively, peripheral perfusion parameters were significantly altered in patients who subsequently developed severe complications compared to those who did not, and these parameters persisted over time. CRT was altered at D0, and PPI and Tskin-diff were altered on D1 and D2, respectively. Among the different peripheral perfusion parameters, the diagnostic accuracy in predicting severe postoperative complications was highest for CRT on D2 (area under the receiver operating characteristic curve = 0.91 (95% confidence interval (CI) = 0.83 to 0.92)) with a sensitivity of 0.79 (95% CI = 0.54 to 0.94) and a specificity of 0.93 (95% CI = 0.86 to 0.97). Generalized mixed-model analysis demonstrated that abnormal peripheral perfusion on D2 and D3 was an independent predictor of severe postoperative complications (D2 odds ratio (OR) = 8.4, 95% CI = 2.7 to 25.9; D2 OR = 6.4, 95% CI = 2.1 to 19.6).Conclusions: In a group of patients assessed following major abdominal surgery, peripheral perfusion alterations were associated with the development of severe complications independently of systemic haemodynamics. Further research is needed to confirm these findings and to explore in more detail the effects of peripheral perfusion-targeted resuscitation following major abdominal surgery

Biologia Reprodutiva De Artibeus Fimbriatus Gray 1838 (chiroptera) No Limite Sul De Sua Distribuição Geográfica

Bats of the Phyllostomidae family exhibit different reproductive patterns in Neotropical regions and the strategy adopted depends on the regional climate. Here we studied the reproductive biology of Artibeus fimbriatus at the southern limit of their distribution in Brazil. This region has no rainy season, and the climate is characterized by high temperatures and variable photoperiods. We examined 129 A. fimbriatus females over several months, and used histological procedures where necessary in order to determine whether bats were pregnant. Females exhibited a long reproductive period and were pregnant from June until February. The reproduction events were found to be dependent on the photoperiod, but independent of annual accumulated precipitation. Our results show that at the southern limit of their distribution, A. fimbriatus exhibit seasonal-dependent reproductive patterns, with parturition events occurring during spring and summer, in which the days are longer and temperature is warmer. © 2016, Universidade Estadual de Campinas UNICAMP. All rights reserved.1641

Acercamiento a la situacion socioeconomica de las comunidades campesinas del Departamento de Sucre desde la perspectiva del Programa Yuquero

An overview is given of the situation of farm communities in the dept. of Sucre, Colombia, where a cassava drying program operates. The lack of integration of the developmental activities carried out by different institutions is evident, indicating the need for greater participation in district planning. Since a trend to monocrop cassava was observed, more attention should be paid to agricultural diversification. An animal feed industry using dried cassava should be installed. Several technical aspects of agricultural production are also discussed such as mechanization, intercropping, plant density, improved technology, and income. Recommendations are also given regarding the current underutilization of the machinery of the existing agroindustries, the improvement of sanitary conditions in the plants, and the enforcement of basic industrial security measures. Product quality control should be conducted, especially regarding MC. Conditions favoring a greater participation of members in farmer organizations should be sought, in addition to enhanced institutional support in the search for a more integrated approach to regional development. (CIAT)Se presenta una percepcion global de la situacion de las comunidades campesinas del Depto. de Sucre, Colombia, donde se desarrolla un programa de secado de la yuca. Se destaca la falta de integracion de las actividades de desarrollo realizadas por diversas instituciones, lo cual indica la necesidad de una mayor participacion en la planificacion distrital. Puesto que se observo una tendencia al monocultivo de la yuca, se debe prestar mas atencion a la diversificacion agricola. Se sugiere instalar una planta para producir alimentos para animales que aproveche la yuca seca. Se discuten, ademas, varios aspectos tecnicos de la produccion agricola como mecanizacion, cultivos asociados, densidad de siembra, tecnologia mejorada e ingresos. Tambien se presentan recomendaciones sobre la actual subutilizacion de la maquinaria en las agroindustrias existentes, el mejoramiento de los servicios higienicos en las plantas y la implementacion de medidas basicas de seguridad industrial. Se debe efectuar un control de calidad del producto, especialmente en cuanto a CH. Se deben buscar las condiciones para fomentar mayor participacion de los socios en las organizaciones, ademas de incrementar el apoyo institucional en busca de un enfoque mas integrado de desarrollo a nivel regional. (CIAT

Continuity of the Maximum-Entropy Inference

We study the inverse problem of inferring the state of a finite-level quantum system from expected values of a fixed set of observables, by maximizing a continuous ranking function. We have proved earlier that the maximum-entropy inference can be a discontinuous map from the convex set of expected values to the convex set of states because the image contains states of reduced support, while this map restricts to a smooth parametrization of a Gibbsian family of fully supported states. Here we prove for arbitrary ranking functions that the inference is continuous up to boundary points. This follows from a continuity condition in terms of the openness of the restricted linear map from states to their expected values. The openness condition shows also that ranking functions with a discontinuous inference are typical. Moreover it shows that the inference is continuous in the restriction to any polytope which implies that a discontinuity belongs to the quantum domain of non-commutative observables and that a geodesic closure of a Gibbsian family equals the set of maximum-entropy states. We discuss eight descriptions of the set of maximum-entropy states with proofs of accuracy and an analysis of deviations.Comment: 34 pages, 1 figur

mu-Theraphotoxin-An1a: primary structure determination and assessment of the pharmacological activity of a promiscuous anti-insect toxin from the venom of the tarantula Acanthoscurria natalensis (Mygalomorphae, Theraphosidae)

Tarantulas are included in the mygalomorph spider family Theraphosidae. Although the pharmacological diversity of theraphosid toxins (theraphotoxins) is broad, studies dedicated to the characterization of biologically active molecules from the theraphosid genus Acanthoscurria have been restricted to the investigation of antimicrobial peptides and polyamines produced by the hemocytes of Acanthoscurria gomesiana. The present study reports the purification, primary structure determination and electrophysiological effects of an anti-insect toxin, named mu-theraphotoxin-An1a (mu-TRTX-An1a), from the venom of Acanthoscurria natalensis - a tarantula species occurring in the Brazilian biomes caatinga and cerrado. The analysis of the primary structure of mu-TRTX-An1a revealed the similarity of this toxin to theraphosid toxins bearing a huwentoxin-II-like fold. Electrophysiological experiments showed that mu-TRTX-An1a (100 nM) induces membrane depolarization, increases the spontaneous firing frequency and reduces spike amplitude of cockroach dorsal unpaired median (DUM) neurons. In addition, under voltage-clamp conditions, mu-TRTX-An1a (100 nM) only partially blocks voltage-dependent sodium current amplitudes in DUM neurons without any effect on their voltage dependence. This effect correlates well with the reduction of the spontaneous action potential amplitudes. Altogether, these last results suggest that mu-TRTX-An1a affects insect neuronal voltage-dependent sodium channels, which are among possible channels targeted by this promiscuous toxin

About Bianchi I with VSL

In this paper we study how to attack, through different techniques, a perfect fluid Bianchi I model with variable G,c and Lambda, but taking into account the effects of a $c$-variable into the curvature tensor. We study the model under the assumption,div(T)=0. These tactics are: Lie groups method (LM), imposing a particular symmetry, self-similarity (SS), matter collineations (MC) and kinematical self-similarity (KSS). We compare both tactics since they are quite similar (symmetry principles). We arrive to the conclusion that the LM is too restrictive and brings us to get only the flat FRW solution. The SS, MC and KSS approaches bring us to obtain all the quantities depending on \int c(t)dt. Therefore, in order to study their behavior we impose some physical restrictions like for example the condition q<0 (accelerating universe). In this way we find that $c$ is a growing time function and Lambda is a decreasing time function whose sing depends on the equation of state, w, while the exponents of the scale factor must satisfy the conditions $\sum_{i=1}^{3}\alpha_{i}=1$ and $\sum_{i=1}^{3}\alpha_{i}^{2}<1,$ $\forall\omega$, i.e. for all equation of state$,$ relaxing in this way the Kasner conditions. The behavior of $G$ depends on two parameters, the equation of state $\omega$ and $\epsilon,$ a parameter that controls the behavior of $c(t),$ therefore $G$ may be growing or decreasing.We also show that through the Lie method, there is no difference between to study the field equations under the assumption of a $c-$var affecting to the curvature tensor which the other one where it is not considered such effects.Nevertheless, it is essential to consider such effects in the cases studied under the SS, MC, and KSS hypotheses.Comment: 29 pages, Revtex4, Accepted for publication in Astrophysics & Space Scienc

The Harris-Luck criterion for random lattices

The Harris-Luck criterion judges the relevance of (potentially) spatially correlated, quenched disorder induced by, e.g., random bonds, randomly diluted sites or a quasi-periodicity of the lattice, for altering the critical behavior of a coupled matter system. We investigate the applicability of this type of criterion to the case of spin variables coupled to random lattices. Their aptitude to alter critical behavior depends on the degree of spatial correlations present, which is quantified by a wandering exponent. We consider the cases of Poissonian random graphs resulting from the Voronoi-Delaunay construction and of planar, ``fat'' $\phi^3$ Feynman diagrams and precisely determine their wandering exponents. The resulting predictions are compared to various exact and numerical results for the Potts model coupled to these quenched ensembles of random graphs.Comment: 13 pages, 9 figures, 2 tables, REVTeX 4. Version as published, one figure added for clarification, minor re-wordings and typo cleanu

On exact solutions for quintessential (inflationary) cosmological models with exponential potentials

We first study dark energy models with a minimally-coupled scalar field and exponential potentials, admitting exact solutions for the cosmological equations: actually, it turns out that for this class of potentials the Einstein field equations exhibit alternative Lagrangians, and are completely integrable and separable (i.e. it is possible to integrate the system analytically, at least by quadratures). We analyze such solutions, especially discussing when they are compatible with a late time quintessential expansion of the universe. As a further issue, we discuss how such quintessential scalar fields can be connected to the inflationary phase, building up, for this class of potentials, a quintessential inflationary scenario: actually, it turns out that the transition from inflation toward late-time exponential quintessential tail admits a kination period, which is an indispensable ingredient of this kind of theoretical models. All such considerations have also been done by including radiation into the model.Comment: Revtex4, 10 figure

Impact of a Tutored Theoretical-Practical Training to Develop Undergraduate Students’ Skills for the Detection of Caries Lesions: Study Protocol for a Multicenter Controlled Randomized Study

Background: Tutored laboratorial activities could be a manner of improving the competency development of students. However, its impact over conventional theoretical classes has not yet been tested. Additionally, different university contexts could influence this issue and should be explored. Objective: To assess the impact of a tutored theoretical-practical training for teaching undergraduate students to detect caries lesions as compared with theoretical teaching activities. The impact of these teaching/learning activities will be assessed in terms of efficacy, cost/benefit, retention of knowledge/acquired competences, and student acceptability. Methods: Sixteen centers (7 centers from Brazil and 9 centers from other countries throughout the world) are involved in the inclusion of subjects for this protocol. A randomized controlled study with parallel groups will be conducted. One group (control) will be exposed to a 60- to 90-minute conventional theoretical class and the other group (test) will be exposed to the same theoretical class and also a 90-minute laboratory class, including exercises and discussions based on the evaluation of a pool of images and extracted teeth. The mentioned outcomes will be evaluated immediately after the teaching activities and also in medium- and long-term analyses. To compare the long-term outcomes, students who enrolled in the university before the participating students will be interviewed for data collection and these data will be used as a control and compared with the trained group. This stage will be a nonrandomized phase of this study, nested in the main study. Appropriate statistical analysis will be performed according to the aims of this study. Variables related to the centers will also be analyzed and used to model adjustment as possible sources of variability among results. Results: This ongoing study is funded by a Brazilian national funding agency (CNPq- 400736/2014-4). We expect that the tutored theoretical-practical training will improve the undergraduate students’ performance in the detection of caries lesions and subsequent treatment decisions, mainly in terms of long-term retention of knowledge. Our hypothesis is that tutored theoretical-practical training is a more cost-effective option for teaching undergraduate students to detect caries lesions. Conclusions: If our hypothesis is confirmed, the use of laboratory training in conjunction with theoretical classes could be used as an educational strategy in Cariology to improve the development of undergraduate students’ skills in the detection of caries lesions and clinical decision-making