Rotator cuff calcific tendinopathy : from diagnosis to treatment

Rotator cuff calcific tendinopathy (RCCT) is a very common condition caused by the presence of calcific deposits in the rotator cuff (RC) or in the subacromial-subdeltoid (SASD) bursa when calcification spreads around the tendons. The pathogenetic mechanism of RCCT is still unclear. It seems to be related to cell-mediated disease in which metaplastic transformation of tenocytes into chondrocytes induces calcification inside the tendon of the RC. RCCT is a frequent finding in the RC that may cause significant shoulder pain and disability. It can be easily diagnosed with imaging studies as conventional radiography (CR) or ultrasound (US). Conservative management of RCCT usually involves rest, physical therapy, and oral NSAIDs administration. Imaging-guided treatments are currently considered minimally-invasive, yet effective methods to treat RCCT with about 80% success rate. Surgery remains the most invasive treatment option in chronic cases that fail to improve with other less invasive approaches

Human health and ocean pollution

Background: Pollution – unwanted waste released to air, water, and land by human activity – is the largest environmental cause of disease in the world today. It is responsible for an estimated nine million premature deaths per year, enormous economic losses, erosion of human capital, and degradation of ecosystems. Ocean pollution is an important, but insufficiently recognized and inadequately controlled component of global pollution. It poses serious threats to human health and well-being. The nature and magnitude of these impacts are only beginning to be understood. Goals: (1) Broadly examine the known and potential impacts of ocean pollution on human health. (2) Inform policy makers, government leaders, international organizations, civil society, and the global public of these threats. (3) Propose priorities for interventions to control and prevent pollution of the seas and safeguard human health. Methods: Topic-focused reviews that examine the effects of ocean pollution on human health, identify gaps in knowledge, project future trends, and offer evidence-based guidance for effective intervention. Environmental Findings: Pollution of the oceans is widespread, worsening, and in most countries poorly controlled. It is a complex mixture of toxic metals, plastics, manufactured chemicals, petroleum, urban and industrial wastes, pesticides, fertilizers, pharmaceutical chemicals, agricultural runoff, and sewage. More than 80% arises from land-based sources. It reaches the oceans through rivers, runoff, atmospheric deposition and direct discharges. It is often heaviest near the coasts and most highly concentrated along the coasts of low- and middle-income countries. Plastic is a rapidly increasing and highly visible component of ocean pollution, and an estimated 10 million metric tons of plastic waste enter the seas each year. Mercury is the metal pollutant of greatest concern in the oceans; it is released from two main sources – coal combustion and small-scale gold mining. Global spread of industrialized agriculture with increasing use of chemical fertilizer leads to extension of Harmful Algal Blooms (HABs) to previously unaffected regions. Chemical pollutants are ubiquitous and contaminate seas and marine organisms from the high Arctic to the abyssal depths. Ecosystem Findings: Ocean pollution has multiple negative impacts on marine ecosystems, and these impacts are exacerbated by global climate change. Petroleum-based pollutants reduce photosynthesis in marine microorganisms that generate oxygen. Increasing absorption of carbon dioxide into the seas causes ocean acidification, which destroys coral reefs, impairs shellfish development, dissolves calcium-containing microorganisms at the base of the marine food web, and increases the toxicity of some pollutants. Plastic pollution threatens marine mammals, fish, and seabirds and accumulates in large mid-ocean gyres. It breaks down into microplastic and nanoplastic particles containing multiple manufactured chemicals that can enter the tissues of marine organisms, including species consumed by humans. Industrial releases, runoff, and sewage increase frequency and severity of HABs, bacterial pollution, and anti-microbial resistance. Pollution and sea surface warming are triggering poleward migration of dangerous pathogens such as the Vibrio species. Industrial discharges, pharmaceutical wastes, pesticides, and sewage contribute to global declines in fish stocks. Human Health Findings: Methylmercury and PCBs are the ocean pollutants whose human health effects are best understood. Exposures of infants in utero to these pollutants through maternal consumption of contaminated seafood can damage developing brains, reduce IQ and increase children’s risks for autism, ADHD and learning disorders. Adult exposures to methylmercury increase risks for cardiovascular disease and dementia. Manufactured chemicals – phthalates, bisphenol A, flame retardants, and perfluorinated chemicals, many of them released into the seas from plastic waste – can disrupt endocrine signaling, reduce male fertility, damage the nervous system, and increase risk of cancer. HABs produce potent toxins that accumulate in fish and shellfish. When ingested, these toxins can cause severe neurological impairment and rapid death. HAB toxins can also become airborne and cause respiratory disease. Pathogenic marine bacteria cause gastrointestinal diseases and deep wound infections. With climate change and increasing pollution, risk is high that Vibrio infections, including cholera, will increase in frequency and extend to new areas. All of the health impacts of ocean pollution fall disproportionately on vulnerable populations in the Global South – environmental injustice on a planetary scale. Conclusions: Ocean pollution is a global problem. It arises from multiple sources and crosses national boundaries. It is the consequence of reckless, shortsighted, and unsustainable exploitation of the earth’s resources. It endangers marine ecosystems. It impedes the production of atmospheric oxygen. Its threats to human health are great and growing, but still incompletely understood. Its economic costs are only beginning to be counted. Ocean pollution can be prevented. Like all forms of pollution, ocean pollution can be controlled by deploying data-driven strategies based on law, policy, technology, and enforcement that target priority pollution sources. Many countries have used these tools to control air and water pollution and are now applying them to ocean pollution. Successes achieved to date demonstrate that broader control is feasible. Heavily polluted harbors have been cleaned, estuaries rejuvenated, and coral reefs restored. Prevention of ocean pollution creates many benefits. It boosts economies, increases tourism, helps restore fisheries, and improves human health and well-being. It advances the Sustainable Development Goals (SDG). These benefits will last for centuries. Recommendations: World leaders who recognize the gravity of ocean pollution, acknowledge its growing dangers, engage civil society and the global public, and take bold, evidence-based action to stop pollution at source will be critical to preventing ocean pollution and safeguarding human health. Prevention of pollution from land-based sources is key. Eliminating coal combustion and banning all uses of mercury will reduce mercury pollution. Bans on single-use plastic and better management of plastic waste reduce plastic pollution. Bans on persistent organic pollutants (POPs) have reduced pollution by PCBs and DDT. Control of industrial discharges, treatment of sewage, and reduced applications of fertilizers have mitigated coastal pollution and are reducing frequency of HABs. National, regional and international marine pollution control programs that are adequately funded and backed by strong enforcement have been shown to be effective. Robust monitoring is essential to track progress. Further interventions that hold great promise include wide-scale transition to renewable fuels; transition to a circular economy that creates little waste and focuses on equity rather than on endless growth; embracing the principles of green chemistry; and building scientific capacity in all countries. Designation of Marine Protected Areas (MPAs) will safeguard critical ecosystems, protect vulnerable fish stocks, and enhance human health and well-being. Creation of MPAs is an important manifestation of national and international commitment to protecting the health of the seas

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Melhoramento do cafeeiro: XXIII - Novos dados sôbre a variabilidade em linhas isogênicas de café Coffee breeding: XXIII variability in isogenic lines of cofeea arabica

Os resultados apresentados e discutidos neste trabalho referem-se a informações adicionais sôbre a variabilidade no vigor vegetativo e na produção de plantas de um ensaio de progênies de cafeeiros da Seção de Genética. Várias características foram estudadas, porém, neste trabalho, consideraram-se apenas os dados de produção e a altura dos cafeeiros. A análise dos dados no período 1953-1958 revelou que as progênies J 24 ('Bourbon Amarelo') e C 959 (variação do 'Bourbon Vermelho'), foram as mais produtivas e alcançaram as maiores alturas médias em 1958. Três linhas isogênicas de café 'Bourbon Vermelho' incluídas neste ensaio, duas linhas puras e o híbrido entre elas, foram estudadas com mais detalhes a fim de verificar se a capacidade homeostática estaria associada à heterozigosidade neste cultivar de Coffea arabica. No que concerne à altura das plantas nas linhas isogênicas, o híbrido revelou-se estatisticamente semelhante aos pais, mostrando que não existe manifestação heterótica para essa característica. Quanto à produção total, o híbrido F1 se mostrou pouco mais produtivo do que os pais. O coeficiente de variação e os valores das variâncias do híbrido revelaram-se mais próximos ao pai, com menor variabilidade, no que se refere à altura das plantas e à produção. A análise da variação da produtividade, para cada um dos seis anos separadamente, mostrou que em apenas um ano a variância do híbrido se apresentou maior que a de um dos pais. Nos demais, revelou-se menor ou intermediária, porém as diferenças não foram estatisticamente significativas.<br>Sixteen strains of different cultivars of Coffea arabica were evaluated for yielding capacity, vigor and plant height. The data collected after six cumulative harvests have indicated that the high yielding progenies (J 24ex 'Bourbon Amarelo' and C 959 'Bourbon Vermelho') had also better vigor and were taller than the other progenies. Attention was turned to yield and plant height variability since among the progenies there were two isogenic lines obtained by doubling the chromosomes of two haploid coffee trees and the hybrid between them. Concerning plant height the variability of the hybrid was similar to that of both isogenic parents indicating no relation between heterozygosis for factors controlling plant height and the uniformity of the progenies. The yield variation of the hybrid was found to be higher,intermediate or lower than the parents depending on the year considered, but the differences between the variances were not statistically significant. The information so far gathered about genetic variability and homeostasis in coffee indicate that heterozygosity seems not to improve the plasticity of the individuals. Natural selection seems to have maintained in the original population genic combinations which would result in better homeostatic strength. It is also possible that the lines studied are genetically not so distinct and only a few loci would be in heterozygous condition. Additional data are required before deciding about the relation between homeostasis and heterozygosis in Coffea arabica

Qualidade da bebida em espécies e populações derivadas de híbridos interespecíficos de Coffea Cupping quality of coffee species and interspecific hybrids

Avaliou-se, em dois experimentos, a qualidade da bebida das espécies Coffea canephora e C. congensis e derivados de híbridações interespecíficas [C. canephora duplicado (dp) x C. arabica, C. canephora x C. eugenioides, C. arabica x C. dewevrei dp e C. racemosa x C. arabica]. Por tratar-se de análise de bebida de cafés pouco conhecidos, avaliou-se a eficiência de uma escala de 1 a 10 pontos em comparação à escala de 0 a 5 pontos utilizada para C. arabica. Foram, também, acrescentadas pelos provadores indicações relacionadas ao gosto da bebida. A escala de 6 pontos mostrou-se pouco eficaz na discriminação dos tratamentos e a de 10 pontos, utilizada alternativamente, revelou-se mais eficiente nos dois experimentos. No primeiro, verificou-se, quanto à qualidade, uma superioridade dos grupos C arabica x C. dewevrei dp e C. canephora dp x C. arabica pelas duas escalas. No segundo experimento, o grupo C. racemosa x C. arabica apresentou a maior média, apesar de não diferir, pela escala 1, dos demais grupos. Pela escala 2, superou, no entanto, os grupos C. canephora e C. congensis. Gostos incomuns foram observados nas amostras com relação à bebida. Atribuem-se à grande diversidade do material analisado e a falta de familiarização dos provadores com espécies bem diferentes de C. arabica, certas discrepâncias com relação à determinação desses defeitos nas amostras analisadas.<br>Investigations on coffee cupping quality of the species C. canephora, C. congensis and several populations derived from interespecific crosses (C. canephora dp x C. arabica, C. canephora x C. eugenioides, C. arabica x C. dewevrei dp and C. racemosa x C. arabica) were undertaken in two trials, in order to guide breeding programs using this germoplasm. Two grading systems were used for classification of the cupping quality, the normal six points scale used for C. arabica samples and a new one with 10 points, 1 for the lowest and 10 for the highest quality. Coffee liquorer experts graded the overall cupping quality and added remarks to any unpleasant taste noticed in the samples. The analysis of the data pointed out that both scales were not adequate for a complete characterization and discrimination of the individual samples. When coffee samples ware grouped according to the species involved in the crosses, the results indicated the superiority of the C. arabica x C, dewevrei dp and C. canephora dp x C. arabica groups in the first trial. In the second trial the C. racemosa x C. arabica group revealed the best average cupping quality, statistically superior to C. canephora and C. congensis. Most of the non-commercial coffees displayed unique tastes and were characterized in 13 unpleasant types. Due to the inherent diversity of the analysed material the liquorer experts had difficulty in classifying the several abnormal tastes influencing the classification of the mild standard sample. The results indicated the necessity of more accurate studies of the beverage produced by these species mainly when they participate in the breeding of Arabica coffee

Image-guided thermal ablation of benign thyroid nodules

Benign thyroid nodules are a common disease in the general population. Most often, they are completely asymptomatic and discovered occasionally during routine ultrasound examinations, and do not require any treatment. When thyroid nodules become symptomatic, surgical excision is still considered standard treatment. In the last few years, several experiences in the treatment of benign thyroid nodules through image-guided percutaneous thermal ablation have been reported with encouraging results, so that currently, these treatments are often proposed as first-choice options for patients with symptomatic benign thyroid nodules. In this paper, we discuss the present literature on the topic, focusing on different techniques available for image-guided percutaneous ablation, particularly radiofrequency (RFA), laser (LA), microwave (MWA), and high-intensity-focus ultrasound (HIFU). Little evidence about the efficacy of MWA and HIFU is now available. According to the literature, good results have been obtained with RFA and LA. Regarding RFA, volume reduction after ablative treatment has been found to range from 47 to 84\ua0% at 3\u20136\ua0months, and from 62 to 93\ua0% at 1\ua0year; LA also seems to be effective in achieving shrinkage of thyroid nodules, with volume reduction from 37 to 81\ua0% at 3\u20136\ua0months, and from 13 to 82\ua0% at 1-year follow-up. Moreover, applications of advanced image-guidance modality, such as contrast-enhanced ultrasound and virtual navigation with fusion imaging, are discussed