Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.

A reorientação do ensino e da prática em enfermagem: implantação do Pró-Saúde em Mossoró, Brasil La reorientación de la enseñanza y práctica de la enfermería: implantación del Pró-Saúde en Mossoró, Brasil Teaching and nursing practices reorientation: Pro-Health implantation in Mossoró Brasil

A Faculdade de Enfermagem da Universidade do Estado do Rio Grande do Norte, através do Programa Nacional de Reorientação da Formação Profissional em Saúde (Pró-Saúde) visa articular ensino/serviço contribuindo na reflexão da formação em enfermagem em Mossoró, Rio Grande do Norte. Esta pesquisa objetivou conhecer a implantação e inserção do Pró-Saúde nas Unidades Básicas de Saúde do município de Mossoró, para entender como os enfermeiros se posicionam diante da articulação ensino/serviço. Foram realizadas entrevistas com seis profissionais que atuam nas Unidades de Saúde parceiras neste projeto. Os resultados demonstraram que estes trabalhadores detinham poucos conhecimentos acerca do Pró-Saúde. Essa falta de conhecimento, associada às dificuldades na integração ensino/serviço, não contribuía para a reflexão e reorientação das práticas de enfermagem. Portanto, é necessário repensar saberes e práticas, pactuando mudanças que contribuam com uma formação em saúde que estabeleça um cuidado de qualidade, baseado nos princípios estabelecidos pelo Sistema Único de Saúde.<br>La Facultad de Enfermería de la Universidad del Estado del Rio Grande do Norte, a través del Programa Nacional de Reorientación de la Formación Profesional en Salud (Pró-Saúde) articula enseñanza/servicio contribuyendo en la reflexión de la formación en enfermería en Mossoró, Rio Grande do Norte, Brasil. Esta pesquisa buscó conocer la implantación e inserción del Pró-Saúde en las Unidades Básicas de Salud del municipio de Mossoró, para entender el posicionamiento de los enfermeros en la articulación enseñanza/servicio. Fueron realizadas entrevistas con seis profesionales que actúan en las Unidades de Salud colaboradoras en este proyecto. Los resultados demuestran que estos trabajadores poco conocían el Pró-Saúde. Este factor, asociado a dificultades en la integración enseñanza/servicio, dificuldaba la reflexión y reorientación de las prácticas de enfermería. Así, hay que repensar conocimientos y prácticas, pactando cambios que contribuyan con una formación en salud que establezca un cuidado de calidad, basado en los principios del Sistema Único de Salud.<br>The Nursing School of Universidade do Estado do Rio Grande do Norte through the Programa Nacional de Reorientação da Formação Profissional em Saúde (Pro-Health) seeks to articulate the teaching / service, contributing to develop the concept of nursing education in Mossoró, Rio Grande do Norte, Brazil. This research aimed to investigate the implementation of Pro Health in the Basic Units of Health in Mossoró understanding the position of nursing workers in the teach/service link. Thus, interviews were conducted with six nurses who work in health clinics partners of this project. The results demonstrated that these workers had a lack of knowledge about the Pro-Health. Therefore, this lack of knowledge associated with difficulties in integrating teaching and service did not contribute to the nursing practice reflection and reorientation. Thus it is necessary to rethink the knowledge and nursing practices for a gradual change, contributing to improve the health care quality, based on the norms established by the Unified Health System in Brazil

Cytotaxonomy of some species and of interspecific hybrids of Pennisetum (Poaceae, Poales)

Cytotaxonomic studies were carried out on 26 accessions of Pennisetum spp. originating from the Active Germplasm Bank of Embrapa Gado de Leite-Juiz de Fora, Minas Gerais, Brazil.This study presents cytogenetics and reproductive morphological data for each one of these accessions, which allowed groupings and suggest botanical identifications to be established. The metaphases of the accessions characterized as P. purpureum confirmed the presence of 2n = 28 chromosomes that have already been described for this species. For the hybrids between P. purpureum and P. glaucum and for the hexaploids, resulting from the chromosome duplication of these hybrids, 2n = 21 and 2n = 42 chromosomes were confirmed, respectively. The wild accession identified as P. setosum showed metaphases with 2n = 54 chromosomes, while those characterized as P. nervosum had cells with 2n = 36 chromosomes. The wild accession 15 was different from the others for the morphological characters, with 2n = 36 chromosomes, and was classified as P. orientale. Two statistical procedures were used (canonical variables and cluster analysis on the basis of the Mahalanobis distance), and the results confirmed the conclusions obtained from the cytogenetic and morphologic analysis

Punção aspirativa por agulha fina guiada por ultra-sonografia de nódulos tireoidianos: estudo de 63 casos Ultrasound-guided fine needle aspiration biopsy of thyroid nodules: study of 63 cases

Neste trabalho foi revisada a técnica empregada na execução da punção aspirativa por agulha fina guiada por ultra-sonografia, e são descritos os seus benefícios no diagnóstico de nódulos tireoidianos. Foram realizadas punções aspirativas por agulha fina em 63 pacientes do Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro, encaminhados ao Serviço de Radiodiagnóstico, no período de agosto de 2001 a junho de 2002. Dos 63 pacientes estudados, 58 (92%) eram do sexo feminino e cinco (8%) eram do sexo masculino, com uma relação mulher/homem de cerca de 11:1. Trinta e um pacientes (49%) se situaram na quinta e sexta décadas de vida. Oitenta e nove por cento dos pacientes apresentaram-se com nódulos múltiplos ao exame ecográfico; apenas 11% dos pacientes tinham nódulo único. Em relação aos laudos citológicos dos nódulos puncionados, 47% foram benignos, 31%, suspeitos, 17%, inadequados e apenas 5%, malignos. Todos os nódulos malignos (três pacientes) tiveram o diagnóstico citológico de carcinoma papilífero. Dos nódulos benignos, 93% foram diagnosticados como hiperplasia nodular e apenas 7% tiveram diagnóstico de tireoidite. Dos laudos considerados inadequados, 70% foram considerados hemorrágicos, sendo 30% considerados hipocelulares. Os dados encontrados no nosso trabalho estiveram de acordo com os encontrados na literatura médica.<br>In this study we reviewed the technique for ultrasound-guided fine needle aspiration biopsy and its benefits in the diagnosis of thyroid nodules. Ultrasound-guided fine needle aspiration was performed in 63 patients referred to the Department of Radiology of "Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro", Rio de Janeiro, Brazil, between August 2001 and June 2002. Fifty-eight (92%) of the patients were female and five patients (8%) were male; 11:1 female/male ratio. Thirty-one patients (49%) had 50-60 years of age and 89% of the patients showed multiple nodules on ultrasound; only 11% of the patients had single nodules. The cytological reports of the aspirated nodules showed that 47% of the nodules were benign, 31% suspected, 17% inadequate material and only 5% malignant. The cytological diagnosis of all malignant nodules (three patients) was papillary carcinoma. Among the benign nodules, 93% were diagnosed as nodular hyperplasia and only 7% had were diagnosed as thyroiditis. Among the patients with inadequate material, 70% were hemorrhagic, and 30% were hypocellular. The findings observed in this study are concordant with the results in the medical literature

Oregano production under various water depths estimated by means of the class A pan evaporation Produção de orégano com diferentes lâminas de irrigação estimadas a partir da evaporação do tanque classe A

The purpose of this experiment was to analyze the effect of five irrigation water depths on oregano production. Oregano is a plant rich in essential oil, commonly used as seasoning in food preparation. The water depths were estimated based on the class A pan evaporation (CPE): 0 CPE (without water replacement); 25 CPE, 50 CPE, 75 CPE, and 100% CPE. The analyzed variables were fresh and dry weight of leaves and roots, yield, net return, and water use efficiency. The experiment was carried out in Presidente Prudente, São Paulo State, Brazil, from February to May 2006. The best results for all the studied variables were found when 100% CPE was used. A linear positive relation was observed between water increments and fresh and dry weight of both the aboveground part and roots. The use of a water depth corresponding to 100% CPE resulted in the maximum productivity (8,089.7 kg ha-1), and in the highest net annual return (R$57,637.87 ha-1).<br>Foi analisado o efeito de cinco lâminas de irrigação na produção do orégano, planta rica em óleo essencial, muito usada como tempero na preparação de alimentos. As lâminas de água foram baseadas na evaporação do tanque classe A (ECA) sendo: 0 ECA (sem reposição de água); 25 ECA; 50 ECA; 75 ECA e 100$ 57.637,87 ha-1)