Coronary angiography and angioplasty in diabetic patients

Screening, diagnosis and revascularization of coronary artery disease (CAD) in type 2 diabetes mellitus are major challenges for current clinical practice. Diagnostic (angiography) and therapeutic (angioplasty) cardiac catheterization are important resources for the clinical assessment and management of coronary atherosclerosis. Anatomic peculiarities of CAD in diabetics can be well characterized by angiography, associated or not by intravascular ultrasound. The worse outcome following coronary revascularization procedures, either angioplasty or surgery, in diabetic is one of the main fields of clinical research. In spite of controversies, about one quarter of angioplasty and one third of surgical revascularization procedures are performed in diabetics. Two ongoing, large, randomized, multicentric trials are investigating the best management of CAD in diabetics. The BARI 2D trial is randomizing asymptomatic or mildly symptomatic patients with CAD for either medical therapy or revascularization (angioplasty or surgery, according to the best clinical judgment). The FREEDOM trial is randomizing stable patients with multivessel CAD for either angioplasty with drug eluting stents or surgery, with or without extracorporeal circulation. While the evidences are not available, in order to decide on the best revascularization procedure for individual patients, medical practice has been balanced according to a number of variables. Conditions that favor angioplasty: short lesions, lesions in large vessels, absence of left anterior descending artery disease, previous coronary bypass surgery and high surgical risk due to co-morbidities. Conditions that favor surgery: long lesions, lesions in small vessels, presence of left anterior descending artery disease and need for associated valve surgery.O rastreamento, o diagnóstico e a revascularização da doença arterial coronária (DAC) no diabetes tipo 2 representam enormes desafios para a prática médica. Neste contexto, o cateterismo cardíaco diagnóstico (angiografia) e terapêutico (angioplastia) são recursos fundamentais na avaliação clínica e manejo da aterosclerose coronária. Avaliações das particularidades anatômicas da DAC no diabetes são detalhadamente caracterizadas pela angiografia coronária, associada ou não ao ultra-som intracoronário. Por outro lado, a resposta pior aos procedimentos de revascularização (angioplastia e cirurgia) da DAC nos diabéticos representa umas das áreas de maior investigação clínica contemporânea. A despeito das controvérsias, cerca de um quarto dos pacientes submetidos a angioplastia e um terço dos pacientes submetidos a cirurgia são diabéticos. Dois grandes estudos multicêntricos randomizados, em andamento, investigam o melhor manejo da DAC nos diabéticos. O BARI 2D está randomizando pacientes com DAC assintomáticos ou com sintomas leves para tratamento clínico ou revascularização (angioplastia ou cirurgia, conforme melhor julgamento clínico). O FREEDOM está randomizando pacientes diabéticos estáveis com DAC multiarterial, para angioplastia com stent farmacológico ou cirurgia, com ou sem uso de circulação extra-corpórea. Enquanto as evidências não estão disponíveis, a prática médica atual é balanceada por um conjunto de variáveis na decisão sobre a melhor alternativa de revascularização. Condições que favorecem a angioplastia: estenoses curtas, vasos grandes, ausência de estenose na artéria descendente anterior (ADA), cirurgia de revascularização prévia e risco cirúrgico elevado. Condições que favorecem a indicação de cirurgia: estenoses longas, vasos pequenos, presença de estenose da ADA e cirurgia valvar associada.UNIFESP-EPMSPDM Hospital São Paulo Serviço de Hemodinâmica e Cardiologia IntervencionistaFOR Hospital do Rim e HipertensãoUNIFESP, EPMSPDM Hospital São Paulo Serviço de Hemodinâmica e Cardiologia IntervencionistaSciEL

Sentimientos de adolescentes con Diabetes Mellitus delante del proceso de vivir con la enfermedad

Qualitative research conducted in a diabetes service in the countryside of the state of Ceará, Brazil, with 11 teenagers with diabetes mellitus. The study aimed to understand the experience of adolescents facing the process of living with diabetes. Data were collected in 2007 May and June, through semi-structured interviews. It was observed that the teenager faces difficulties since the moment of diagnosis, especially because their food habits and lifestyles need to change, triggering feelings like fear, insecurity and anger. Over time, they incorporate the necessary changes to treatment and care, and begin to see the disease as normal. One concludes that it is necessary to understand teenagers, their behaviors, fears and desires and support them in the different areas of this experience.Investigación cualitativa, llevada a cabo en un servicio de diabetes del interior del estado de Ceará, Brasil, con 11 adolescentes con diabetes mellitus. El objetivo fue comprender la experiencia del adolescente delante del proceso de vivir con diabetes. Los datos fueron recolectados entre mayo y junio de 2007 a través de entrevistas semi estructuradas. Se observó que el adolescente enfrenta dificultades desde el momento del diagnóstico, sobre todo en el plan alimentar y cambios en el estilo de vida, desencadenando sentimientos como miedo, inseguridad e ira. Con el tiempo, incorporan los cambios necesarios al tratamiento y atención, y llegan a ver la enfermedad como algo normal. En conclusión, que es necesario entender los adolescentes, sus comportamientos, miedos y deseos, y apoyarlos en las diferentes áreas de esta experiencia.Pesquisa de natureza qualitativa, realizada em um serviço de diabetes do interior do Ceará com 11 adolescentes portadores de diabetes mellitus. O estudo objetivou compreender a experiência do adolescente frente ao processo de viver com o diabetes. Os dados foram coletados nos meses de maio e junho de 2007 por meio de entrevista semiestruturada. Constatou-se que o adolescente enfrenta dificuldades desde o momento do diagnóstico, principalmente no plano alimentar e nas mudanças no estilo de vida, desencadeando sentimentos como medo, insegurança e revolta. Com o passar do tempo, incorporam as mudanças necessárias ao tratamento e cuidados; e passam a ver a doença de forma normal. Conclui-se que é necessário compreender os adolescentes, seus comportamentos, medos e anseios e apoiá-los nos diversos âmbitos dessa experiência.Secretaria Municipal de Saúde de Pio IX-PI Programa de Saúde da FamíliaUniversidade Federal do Ceará Faculdade de Farmácia Odontologia e Enfermagem Departamento de EnfermagemUniversidade Federal de São Paulo (UNIFESP) Programa de Pós-Graduação em Saúde ColetivaUNIFESP, Programa de Pós-Graduação em Saúde ColetivaSciEL

Mach's Principle and the Origin of Inertia

The current status of Mach's principle is discussed within the context of general relativity. The inertial properties of a particle are determined by its mass and spin, since these characterize the irreducible unitary representations of the inhomogeneous Lorentz group. The origin of the inertia of mass and intrinsic spin are discussed and the inertia of intrinsic spin is studied via the coupling of intrinsic spin with rotation. The implications of spin-rotation coupling and the possibility of history dependence and nonlocality in relativistic physics are briefly mentioned.Comment: 14 pages. Dedicated to Carl Brans in honor of his 80th birthday. To appear in the Brans Festschrift; v2: typo corrected, published in: At the Frontier of Spacetime, edited by T. Asselmeyer-Maluga (Springer, 2016), Chapter 10, pp. 177-18

Conservation of geosites as a tool to protect geoheritage: the inventory of Ceará Central Domain, Borborema Province - NE/Brazil

The Ceará Central Domain, in the northern Borborema Province/NE Brazil, encompasses important geological records (geosites) which allow understanding a relevant period of the Earth’s evolution, mainly associated to Neoproterozoic Brazilian/Pan-African Cycle and West Gondwana amalgamation, besides Neoarchean to Ordovician records. The presented geoheritage inventory aims to characterise the geosites with scienti c relevance of Ceará Central Domain. By applying a method for large areas, the nal selection resulted in eight geological frameworks represented by 52 geosites documented in a single database. This is the rst step for a geoconservation strategy based on systematic inventories, statutory protection, geoethical behaviour and awareness about scienti c, educational and/or cultural relevance of geosites.We specially thank all experts that helped us with this inventory: Afonso Almeida, Carlos E.G. de Araújo, César Veríssimo, Christiano Magini, Clóvis Vaz Parente, Felipe G. Costa, Irani C. Mattos, Neivaldo de Castro, Otaciel de Melo, Sebástian G. Chiozza, Ticiano Santos and Stefano Zincone. We are also thankful to Kátia Mansur, Ricardo Fraga Pereira and anonymous reviewers for their valuable contributions. PM is grateful to Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) for PhD mobility scholarship PDSE Program/Process n 88881.132168/2016-01info:eu-repo/semantics/publishedVersio

Proinflammatory genotype is associated with the frailty phenotype in the English Longitudinal Study of Ageing

Background: Frailty is a state of increased vulnerability to poor resolution of homeostasis after a stressor event, which increases the risk of adverse outcomes including falls, disability and death. The underlying pathophysiological pathways of frailty are not known but the hypothalamic–pituitary–adrenal axis and heightened chronic systemic inflammation appear to be major contributors. Methods: We used the English Longitudinal Study of Ageing dataset of 3160 individuals over the age of 50 and assessed their frailty status according to the Fried-criteria. We selected single nucleotide polymorphisms in genes involved in the steroid hormone or inflammatory pathways and performed linear association analysis using age and sex as covariates. To support the biological plausibility of any genetic associations, we selected biomarker levels for further analyses to act as potential endophenotypes of our chosen genetic loci. Results: The strongest association with frailty was observed in the Tumor Necrosis Factor (TNF) (rs1800629, P = 0.001198, β = 0.0894) and the Protein Tyrosine Phosphatase, Receptor type, J (PTPRJ) (rs1566729, P = 0.001372, β = 0.09397) genes. Rs1800629 was significantly associated with decreased levels of high-density lipoprotein (HDL) (P = 0.00949) and cholesterol levels (P = 0.00315), whereas rs1566729 was associated with increased levels of HDL (P = 0.01943). After correcting for multiple testing none of the associations remained significant. Conclusions: We provide potential evidence for the involvement of a multifunctional proinflammatory cytokine gene (TNF) in the frailty phenotype. The implication of this gene is further supported by association with the endophenotype biomarker results

A review of elliptical and disc galaxy structure, and modern scaling laws

A century ago, in 1911 and 1913, Plummer and then Reynolds introduced their models to describe the radial distribution of stars in `nebulae'. This article reviews the progress since then, providing both an historical perspective and a contemporary review of the stellar structure of bulges, discs and elliptical galaxies. The quantification of galaxy nuclei, such as central mass deficits and excess nuclear light, plus the structure of dark matter halos and cD galaxy envelopes, are discussed. Issues pertaining to spiral galaxies including dust, bulge-to-disc ratios, bulgeless galaxies, bars and the identification of pseudobulges are also reviewed. An array of modern scaling relations involving sizes, luminosities, surface brightnesses and stellar concentrations are presented, many of which are shown to be curved. These 'redshift zero' relations not only quantify the behavior and nature of galaxies in the Universe today, but are the modern benchmark for evolutionary studies of galaxies, whether based on observations, N-body-simulations or semi-analytical modelling. For example, it is shown that some of the recently discovered compact elliptical galaxies at 1.5 < z < 2.5 may be the bulges of modern disc galaxies.Comment: Condensed version (due to Contract) of an invited review article to appear in "Planets, Stars and Stellar Systems"(www.springer.com/astronomy/book/978-90-481-8818-5). 500+ references incl. many somewhat forgotten, pioneer papers. Original submission to Springer: 07-June-201

Cytokine preconditioning of engineered cartilage provides protection against interleukin-1 insult

Research reported in this publication was supported in part by the National Institute of Arthritis and Musculoskeletal and Skin Diseases and National Institute of Biomedical Imaging and Bioengineering of the National Institutes of Health under Award Number R01AR60361, R01AR061988, P41EB002520). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. ART was supported by a National Science Foundation Graduate Fellowship

Targeted metatranscriptomics of compost derived consortia reveals a GH11 exerting an unusual exo-1,4-β-xylanase activity

Background: Using globally abundant crop residues as a carbon source for energy generation and renewable chemicals production stands out as a promising solution to reduce current dependency on fossil fuels. In nature, such as in compost habitats, microbial communities efficiently degrade the available plant biomass using a diverse set of synergistic enzymes. However, deconstruction of lignocellulose remains a challenge for industry due to recalcitrant nature of the substrate and the inefficiency of the enzyme systems available, making the economic production of lignocellulosic biofuels difficult. Metatranscriptomic studies of microbial communities can unveil the metabolic functions employed by lignocellulolytic consortia and identify new biocatalysts that could improve industrial lignocellulose conversion. Results: In this study, a microbial community from compost was grown in minimal medium with sugarcane bagasse sugarcane bagasse as the sole carbon source. Solid-state nuclear magnetic resonance was used to monitor lignocellulose degradation; analysis of metatranscriptomic data led to the selection and functional characterization of several target genes, revealing the first glycoside hydrolase from Carbohydrate Active Enzyme family 11 with exo-1,4-β-xylanase activity. The xylanase crystal structure was resolved at 1.76 Å revealing the structural basis of exo-xylanase activity. Supplementation of a commercial cellulolytic enzyme cocktail with the xylanase showed improvement in Avicel hydrolysis in the presence of inhibitory xylooligomers. Conclusions: This study demonstrated that composting microbiomes continue to be an excellent source of biotechnologically important enzymes by unveiling the diversity of enzymes involved in in situ lignocellulose degradation

Antigen-specific B-cell receptor sensitizes B cells to infection by influenza virus

Influenza A virus-specific B lymphocytes and the antibodies they produce protect against infection. However, the outcome of interactions between an influenza haemagglutinin-specific B cell via its receptor (BCR) and virus is unclear. Through somatic cell nuclear transfer we generated mice that harbour B cells with a BCR specific for the haemagglutinin of influenza A/WSN/33 virus (FluBI mice). Their B cells secrete an immunoglobulin gamma 2b that neutralizes infectious virus. Whereas B cells from FluBI and control mice bind equivalent amounts of virus through interaction of haemagglutinin with surface-disposed sialic acids, the A/WSN/33 virus infects only the haemagglutinin-specific B cells. Mere binding of virus is not sufficient for infection of B cells: this requires interactions of the BCR with haemagglutinin, causing both disruption of antibody secretion and FluBI B-cell death within 18 h. In mice infected with A/WSN/33, lung-resident FluBI B cells are infected by the virus, thus delaying the onset of protective antibody release into the lungs, whereas FluBI cells in the draining lymph node are not infected and proliferate. We propose that influenza targets and kills influenza-specific B cells in the lung, thus allowing the virus to gain purchase before the initiation of an effective adaptive response.National Institutes of Health (U.S.

Animal models for clinical and gestational diabetes: maternal and fetal outcomes

<p>Abstract</p> <p>Background</p> <p>Diabetes in pregnant women is associated with an increased risk of maternal and neonatal morbidity and remains a significant medical challenge. Diabetes during pregnancy may be divided into clinical diabetes and gestational diabetes. Experimental models are developed with the purpose of enhancing understanding of the pathophysiological mechanisms of diseases that affect humans. With regard to diabetes in pregnancy, experimental findings from models will lead to the development of treatment strategies to maintain a normal metabolic intrauterine milieu, improving perinatal development by preventing fetal growth restriction or macrosomia. Based on animal models of diabetes during pregnancy previously reported in the medical literature, the present study aimed to compare the impact of streptozotocin-induced severe (glycemia >300 mg/dl) and mild diabetes (glycemia between 120 and 300 mg/dl) on glycemia and maternal reproductive and fetal outcomes of <it>Wistar </it>rats to evaluate whether the animal model reproduces the maternal and perinatal results of clinical and gestational diabetes in humans.</p> <p>Methods</p> <p>On day 5 of life, 96 female <it>Wistar </it>rats were assigned to three experimental groups: control (n = 16), severe (n = 50) and mild diabetes (n = 30). At day 90 of life, rats were mated. On day 21 of pregnancy, rats were killed and their uterine horns were exposed to count implantation and fetus numbers to determine pre- and post-implantation loss rates. The fetuses were classified according to their birth weight.</p> <p>Results</p> <p>Severe and mild diabetic dams showed different glycemic responses during pregnancy, impairing fetal glycemia and weight, confirming that maternal glycemia is directly associated with fetal development. Newborns from severe diabetic mothers presented growth restriction, but mild diabetic mothers were not associated with an increased rate of macrosomic fetuses.</p> <p>Conclusion</p> <p>Experimental models of severe diabetes during pregnancy reproduced maternal and fetal outcomes of pregnant women presenting uncontrolled clinical diabetes. On the other hand, the mild diabetes model caused mild hyperglycemia during pregnancy, although it was not enough to reproduce the increased rate of macrosomic fetuses seen in women with gestational diabetes.</p