An Adult with Episodic Abnormal Limb Posturing

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BP Reduction, Kidney Function Decline, and Cardiovascular Events in Patients without CKD.

BACKGROUND AND OBJECTIVES: In the Systolic Blood Pressure Intervention Trial (SPRINT), intensive systolic BP treatment (target <120 mm Hg) was associated with fewer cardiovascular events and higher incidence of kidney function decline compared with standard treatment (target <140 mm Hg). We evaluated the association between mean arterial pressure reduction, kidney function decline, and cardiovascular events in patients without CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We categorized patients in the intensive treatment group of the SPRINT according to mean arterial pressure reduction throughout follow-up: <20, 20 to <40, and ≥40 mm Hg. We defined the primary outcome as kidney function decline (≥30% reduction in eGFR to <60 ml/min per 1.73 m2 on two consecutive determinations at 3-month intervals), and we defined the secondary outcome as cardiovascular events. In a propensity score analysis, patients in each mean arterial pressure reduction category from the intensive treatment group were matched with patients from the standard treatment group to calculate the number needed to treat regarding cardiovascular events and the number needed to harm regarding kidney function decline. RESULTS: In the intensive treatment group, 1138 (34%) patients attained mean arterial pressure reduction <20 mm Hg, 1857 (56%) attained 20 to <40 mm Hg, and 309 (9%) attained ≥40 mm Hg. Adjusted hazard ratios for kidney function decline were 2.10 (95% confidence interval, 1.22 to 3.59) for mean arterial pressure reduction between 20 and 40 mm Hg and 6.22 (95% confidence interval, 2.75 to 14.08) for mean arterial pressure reduction ≥40 mm Hg. In propensity score analysis, mean arterial pressure reduction <20 mm Hg presented a number needed to treat of 44 and a number needed to harm of 65, reduction between 20 and <40 mm Hg presented a number needed to treat of 42 and a number needed to harm of 35, and reduction ≥40 mm Hg presented a number needed to treat of 95 and a number needed to harm of 16. CONCLUSIONS: In the intensive treatment group of SPRINT, larger declines in mean arterial pressure were associated with higher incidence of kidney function decline. Intensive treatment seemed to be less favorable when a larger reduction in mean arterial pressure was needed to attain the BP target.info:eu-repo/semantics/publishedVersio

Comment on Bress et al. Effect of Intensive Versus Standard Blood Pressure Treatment According to Baseline Prediabetes Status: A Post Hoc Analysis of a Randomized Trial. Diabetes Care 2017;40:1401-1408.

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Towards self-organized service-oriented multi-agent systems

The demand for large-scale systems running in complex and even chaotic environments requires the consideration of new paradigms and technologies that provide flexibility, robustness, agility and responsiveness. Multiagents systems is pointed out as a suitable approach to address this challenge by offering an alternative way to design control systems, based on the decentralization of control functions over distributed autonomous and cooperative entities. However, in spite of their enormous potential, they usually lack some aspects related to interoperability, optimization in decentralized structures and truly self-adaptation. This paper discusses a new perspective to engineer adaptive complex systems considering a 3-layer framework integrating several complementary paradigms and technologies. In a first step, it suggests the integration of multi-agent systems with service-oriented architectures to overcome the limitations of interoperability and smooth migration, followed by the use of technology enablers, such as cloud computing and wireless sensor networks, to provide a ubiquitous and reconfigurable environment. Finally, the resulted service-oriented multi-agent system should be enhanced with biologically inspired techniques, namely self-organization, to reach a truly robust, agile and adaptive system

Mesofauna do solo em floresta secundária e em cultivos do cupuaçuzeiro e do guaranazeiro no município de Belém-Pará.

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Macrofauna do solo em capoeiras natural e enriquecidas com leguminosas arbóreas.

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