OS FUNDAMENTOS DO ESTADO DESENVOLVIMENTISTA BRASILEIRO: A EXPERIÊNCIA DO PARTIDO REPUBLICANO RIOGRANDENSE (PRR) DURANTE A PRIMEIRA REPÚBLICA

Along the Brazilian transition to capitalism (1888-1930) the "gaúcho" state and society created the bourgeois state and therefore were able to develop the foundations of the "Brazilian developmental state". These phenomena were never recognized because the history of the meridional society was always viewed as peripheral. Thus the most important and central fact in the history of the Brazilian social formation - the bourgeois revolution during the transition to capitalism - could not be ascribed to the region. The creation of the bourgeois state which toppled the framework of the oligarchic and patrimonial state required the accomplishment of three fundamental tasks: the creation of an autonomous state facing the region's ruling class; the separation between the public and the private spheres; a reform to abandon the fiscal structure of the oligarchic, patrimonalist, mono-agricultural exporter state. These tasks were accomplished between 1892 and 1913 by the government of the positivist republicains who were in office between 1892 and 1930.

Systemic and intraperitoneal interleukin‐6 system during the first year of peritoneal dialysis

Perit Dial Int. 2006 Jan-Feb;26(1):53-63. Systemic and intraperitoneal interleukin-6 system during the first year of peritoneal dialysis. Pecoits-Filho R, Carvalho MJ, Stenvinkel P, Lindholm B, Heimbürger O. Division of Renal Medicine and Baxter Novum, Karolinska Institutet, K-56, Huddinge University Hospital, 141 86 Stockholm, Sweden. [email protected] Comment in: Perit Dial Int. 2006 Jan-Feb;26(1):35-7. Abstract OBJECTIVE: To investigate if intraperitoneal and systemic interleukin-6 (IL-6) and soluble IL-6 receptor (sIL-6R) are related to each other and to peritoneal solute transport rate (PSTR). DESIGN: Longitudinal study in retrospectively selected patients. SETTING: Peritoneal dialysis (PD) unit of a university-based hospital. PATIENTS AND METHODS: 31 PD patients on treatment with conventional glucose-based solutions participated in a longitudinal study. IL-6 and sIL-6R were measured in plasma and overnight effluent, both at baseline and after 12 +/- 2 months on PD. C-reactive protein (CRP) and serum albumin were used as surrogate markers of inflammation. PSTR of small solutes was evaluated using the dialysate-to-plasma ratio (D/P) of creatinine after a 4-hour dwell; PSTR of large solutes was evaluated using the 24-hour D/P ratio of albumin. RESULTS: D/P creat increased over time (0.67 +/- 0.15 vs 0.80 +/- 0.11, p or = median had higher (p or = median [24.7 (16.5 - 38.5) pg/mL] compared to patients with IL-6 < median [14.1 (10 - 25.7) pg/mL]. Neither CRP nor albumin changed over time on PD, although they were closely linked to plasma IL-6 levels. A strong positive correlation was found between D/P creat and dialysate IL-6 (rho = 0.77, p < 0.0001) at baseline, but not at 1 year. In contrast, there was a significant correlation between D/P creat and dialysate sIL-6R (rho = 0.39, p < 0.05) at 1 year, but not at baseline. At 1 year, 17 patients with increasing PSTR had higher increases in dialysate IL-6 (28 +/- 26 vs -21 +/- 78 pg/mL, p < 0.05) and levels of dialysate sIL-6R (693 +/- 392 vs 394 +/- 274 pg/mL, p = 0.05) compared to patients with stable PSTR (n = 11). Patients who had peritonitis presented higher baseline serum IL-6 concentration (6.8 +/- 1.0 pg/mL) compared with patients without peritonitis (4.0 +/- 0.6 pg/mL, p < 0.05). Finally, both at baseline and after 1 year, there were significant correlations between plasma and dialysate IL-6 (rho = 0.46, p < 0.05, and rho = 0.40, p < 0.05) respectively. CONCLUSIONS: These findings indicate that, (1) intraperitoneal and systemic inflammation increase in PD patients during the first year of therapy; (2) intraperitoneal and systemic inflammation may be interrelated and the IL-6 system may be the link; (3) the IL-6 system (both intraperitoneal and systemic) is associated with PSTR, particularly in the early phase of PD treatment, in which small and large solute transport are linked. Signs of a transition between acute and chronic inflammation were observed in the follow-up evaluation. Inflammation may, at least in part, be responsible for the development of a high PSTR, and this could be one reason for the high mortality in patients with high PSTR. PMID: 16538876 [PubMed - indexed for MEDLIN

Assessment of dipyridamole stress echocardiography for risk stratification of diabetic patients

BACKGROUND: Despite advances in medical therapy, cardiovascular disease, mainly coronary artery disease (CAD), remains the leading cause of mortality among patients with diabetes mellitus (DM). The objective of the present study was to assess the effectiveness of dipyridamole stress echocardiography in identify diabetic patients at high risk for cardiovascular events. METHODS: Dipyridamole stress echocardiography was administered to 483 diabetic patients (294 women; mean age 63.41 ± 11.28 years) between July 2006 and December 2012. RESULTS: Follow-up data were available for 264 patients (163 women; mean age 64.3 ± 10.5 years): 250 with a negative stress echocardiography and 14 with a positive stress echo. During a mean follow-up time of 18 ± 14 months, a cardiovascular event occurred in 18 (6.8 %) patients, 12 (4.8 %) in patients with a negative stress echo (n = 250) during a mean follow-up period of 20 ± 16 months and 6 (42 %) in patients with positive stress echo (n = 14) during a mean follow-up of 13 ± 13 months. The positive and negative predictive values of stress echocardiography were 42 % and 96 % respectively. The accuracy value was 92 %. A Cox regression model showed that CAD (hazard ratio [HR] 5.4, 95 % confidence interval [CI] 1.9-15.4; p = 0.002) and positive stress echocardiography (HR 7.1, 95 % CI 2.5-20.5; p < 0.001) were significant predictors of cardiovascular events. CONCLUSIONS: For patients with diabetes, a negative dipyridamole stress echocardiogram predicts favorable outcome during the first year of follow-up. A new stress imaging test should be done after 12 months in diabetic patients

Textural and geochemical features of freshwater microbialites from Laguna Bacalar, Quintana Roo, Mexico

Microbialites provide some of the oldest direct evidence of life on Earth. They reached their peak during the Proterozoic and declined afterward. Their decline has been attributed to grazing and/or burrowing by metazoans, to changes in ocean chemistry, or to competition with other calcifying organisms. The freshwater microbialites at Laguna Bacalar (Mexico) provide an opportunity to better understand microbialite growth in terms of interaction between grazing organisms versus calcium carbonate precipitation. The Laguna Bacalar microbialites are described in terms of their distinct mesostructures. Stromatolites display internal lamination, attributed to the precipitation of calcite and the upward migration of cyanobacteria during periods of low sedimentation. Thrombolitic stromatolites show internal lamination in addition to internal clotting. The clotting is seen as a result of binding and/or trapping of micritic peloids by cyanobacteria and attributed to periods of high sedimentation. The carbonates in both microbialites had similar C- and O-stable–isotopic signatures, both enriched in ^(13)C relative to bivalves, suggesting photosynthetic CO_2 uptake was the trigger for carbonate precipitation. This implies that the rate of microbialite growth is largely a function of ambient carbonate saturation state, while the texture is especially dependent on accretion rates and sediment deposition on their surface. Importantly, the coexistence with grazing animals suggests no significant inhibition on microbialite growth, thereby calling into question the decline of microbialite as a result of metazoan evolution. Varying sedimentation rates are likely important in controlling the distribution of thrombolite–stromatolite packages in the geological record, given the importance of this factor at Bacalar

Authigenic iron oxide proxies for marine zinc over geological time and implications for eukaryotic metallome evolution

Author Posting. © The Author(s), 2012. This is the author's version of the work. It is posted here by permission of John Wiley & Sons for personal use, not for redistribution. The definitive version was published in Geobiology 11 (2013): 295-306, doi:10.1111/gbi.12036.Here we explore enrichments in paleomarine Zn as recorded by authigenic iron oxides including Precambrian iron formations, ironstones and Phanerozoic hydrothermal exhalites. This compilation of new and literature-based iron formation analyses track dissolved Zn abundances and constrain the magnitude of the marine reservoir over geological time. Overall, the iron formation record is characterized by a fairly static range in Zn/Fe ratios throughout the Precambrian, consistent with the shale record (Scott et al., 2013, Nature Geoscience, 6, 125-128). When hypothetical partitioning scenarios are applied to this record, paleomarine Zn concentrations within about an order of magnitude of modern are indicated. We couple this examination with new chemical speciation models used to interpret the iron formation record. We present two scenarios: first, under all but the most sulfidic conditions and with Zn binding organic ligand concentrations similar to modern oceans, the amount of bioavailable Zn remained relatively unchanged through time. Late proliferation of Zn in eukaryotic metallomes has previously been linked to marine Zn biolimitation, but under this scenario, the expansion in eukaryotic Zn metallomes may be better linked to biologically intrinsic evolutionary factors. In this case zinc’s geochemical and biological evolution may be decoupled, and viewed as a function of increasing need for genome regulation and diversification of Zn-binding transcription factors. In the second scenario, we consider Archean organic ligand complexation in such excess that it may render Zn bioavailability low. However, this is dependent on Zn organic ligand complexes not being bioavailable, which remains unclear. In this case, although bioavailability may be low, sphalerite precipitation is prevented, thereby maintaining a constant Zn inventory throughout both ferruginous and euxinic conditions. These results provide new perspectives and constraints 50 on potential couplings between the trajectory of biological and marine geochemical coevolution.This work was supported by a NSERC Discovery Grant to KOK, a NSERC PDF to SVL, a NSERC CGSM to LJR, and an NSF-EAR-PDF to NJP. MAS acknowledges support from the Gordon and Betty Moore Foundation Grant #2724. This work was also supported by grants from the Deutsche Forschungsgemeinschaft (DFG) to A.K. (KA 1736/4-1 and 12-1)

Left ventricular hypertrophy in patients with chronic kidney disease under conservative treatment

Cardiovascular disease (CVD) remains the major cause of death in patients with chronic kidney disease (CKD). Left ventricular hypertrophy (LVH) is present in 75% of patients starting dialysis, suggesting that LVH might be present from an early stage of CKD. Few studies have addressed the predialysis prevalence of LVH. This study evaluated 309 clinically stable patients under treatment for at least three months at five Brazilian centers. Biochemical profile and inflammatory markers were assessed. Data were shown as mean ± SD. Left ventricular hypertrophy was present in 53% of the patients, whose mean age was 60 ± 13years. The mean age of those without LVH was 55 ± 14 years. Diabetes mellitus was the underlying disease in 35% of the patients in both groups. Estimated glomerular filtration rate was 30 ± 11 and 32 ± 12 mL/min for patients with and without LVH, respectively (p = 0.19). The distribution of patients showed that 60% of those with LVH were in stage 4. Multivariate logistic regression analysis indicated the following independent determinants for LVH: age (p < 0.001); calcium (p < 0.001); hemoglobin (p < 0.048); and diastolic blood pressure (p < 0.001). Systolic blood pressure, lipids, and inflammatory markers showed no correlation with LVH. In conclusion, the incidence of LVH was high even among patients under conservative treatment, and, except for age, LVH correlated with reversible factors. The need for strictly diagnosing CKD and preventing LVH in the predialysis phase is emphasized to decrease mortality due to CVD in that population.A doença cardiovascular (DCV) permanece sendo uma das maiores causas de morte em pacientes com doença renal crônica (DRC). A hipertrofia ventricular esquerda (HVE) está presente em 75% dos pacientes ao iniciarem diálise, sugerindo que esta deve estar presente precocemente no curso da DRC. Poucos estudos avaliaram a prevalência de HVE na pré-diálise. Foram avaliados 309 pacientes clinicamente estáveis em acompanhamento por pelo menos três meses em cinco Centros no Brasil. Perfil bioquímico e marcadores inflamatórios foram avaliados. Dados são apresentados como media ± DP. Observamos que a HVE esteve presente em 53% dos pacientes, idade = 60 ± 13 anos, e 55 ± 14 anos para aqueles sem HVE. Diabetes mellitus como doença de base esteve presente em 35% dos pacientes em ambos os grupos. Filtração glomerular estimada foi 30 ± 11 e 32 ± 12 mL/min para pacientes com HVE e sem, respectivamente (p = 0,19). A distribuição de pacientes mostrou que 60% com HVE se encontravam no estágio 4. Análise logística multivariada mostrou que eram determinantes independentes para HVE: idade (p < 0,001), cálcio (p < 0,001), hemoglobina (p < 0,048) e pressão arterial diastólica (p < 0,001). Pressão arterial sistólica, lipídeos e marcadores inflamatórios não se correlacionaram com a HVE. Em conclusão, a incidência de HVE foi alta mesmo entre pacientes sob tratamento especializado e com exceção da idade, a HVE se correlacionou com fatores reversíveis. Alertamos para a necessidade do diagnóstico da DRC e prevenção da HVE na pré-diálise de forma rigorosa para diminuir a mortalidade decorrente de DCV nesta população.Universidade do Estado do Rio de JaneiroPontifícia Universidade Católica do Paraná Centro de Ciências Biológicas e da SaúdeUniversidade de São Paulo Facildade de Medicina Hospital das ClínicasUniversidade Federal de São Paulo (UNIFESP)Universidade Federal de Juiz de ForaUNIFESP, EPM, São PauloSciEL

Identifying critically important vascular access outcomes for trials in haemodialysis : an international survey with patients, caregivers and health professionals

BACKGROUND: Vascular access outcomes reported across haemodialysis (HD) trials are numerous, heterogeneous and not always relevant to patients and clinicians. This study aimed to identify critically important vascular access outcomes. METHOD: Outcomes derived from a systematic review, multi-disciplinary expert panel and patient input were included in a multilanguage online survey. Participants rated the absolute importance of outcomes using a 9-point Likert scale (7-9 being critically important). The relative importance was determined by a best-worst scale using multinomial logistic regression. Open text responses were analysed thematically. RESULTS: The survey was completed by 873 participants [224 (26%) patients/caregivers and 649 (74%) health professionals] from 58 countries. Vascular access function was considered the most important outcome (mean score 7.8 for patients and caregivers/8.5 for health professionals, with 85%/95% rating it critically important, and top ranked on best-worst scale), followed by infection (mean 7.4/8.2, 79%/92% rating it critically important, second rank on best-worst scale). Health professionals rated all outcomes of equal or higher importance than patients/caregivers, except for aneurysms. We identified six themes: necessity for HD, applicability across vascular access types, frequency and severity of debilitation, minimizing the risk of hospitalization and death, optimizing technical competence and adherence to best practice and direct impact on appearance and lifestyle. CONCLUSIONS: Vascular access function was the most critically important outcome among patients/caregivers and health professionals. Consistent reporting of this outcome across trials in HD will strengthen their value in supporting vascular access practice and shared decision making in patients requiring HD

Establishing a core outcome set for peritoneal dialysis : report of the SONG-PD (standardized outcomes in nephrology-peritoneal dialysis) consensus workshop

Outcomes reported in randomized controlled trials in peritoneal dialysis (PD) are diverse, are measured inconsistently, and may not be important to patients, families, and clinicians. The Standardized Outcomes in Nephrology-Peritoneal Dialysis (SONG-PD) initiative aims to establish a core outcome set for trials in PD based on the shared priorities of all stakeholders. We convened an international SONG-PD stakeholder consensus workshop in May 2018 in Vancouver, Canada. Nineteen patients/caregivers and 51 health professionals attended. Participants discussed core outcome domains and implementation in trials in PD. Four themes relating to the formation of core outcome domains were identified: life participation as a main goal of PD, impact of fatigue, empowerment for preparation and planning, and separation of contributing factors from core factors. Considerations for implementation were identified: standardizing patient-reported outcomes, requiring a validated and feasible measure, simplicity of binary outcomes, responsiveness to interventions, and using positive terminology. All stakeholders supported inclusion of PD-related infection, cardiovascular disease, mortality, technique survival, and life participation as the core outcome domains for PD

Avaliação da aterosclerose subclínica e de níveis plasmáticos de LDL minimamente modificada em pacientes com espondilite anquilosante e sua correlação com a atividade da doença

AbstractIntroductionAccelerated atherosclerosis has been shown in some autoimmune diseases, mainly in Systemic Lupus Erythematosus and Rheumatoid Arthritis. Although high preva- lence of corticosteroids use may be a confounding factor due to their detrimental effects on several risk factors, systemic inflammation per se is supposed to play an important role in atherogenesis in these patients.MethodsWe have evaluated sub-clinical atherosclerosis and plasma levels of circulating electronegative LDL, which represents the fraction of LDL that is minimally modified, in patients with ankylosing spondylitis (AS). Fourteen patients who fulfilled the modified New York criteria for AS were compared with 13 paired controls. Carotid intimal-media thick- ness (IMT) was assessed by ultrasonography bilaterally in common carotid artery, internal carotid artery and in the bifurcation. Groups were homogeneous regarding cardiovascular risk factors. Only a single patient in AS group was in use of corticosteroid.ResultsThe presence of active inflammation was demonstrated by elevated BASDAI and higher CRP levels and in patients versus controls (12.36 vs. 3.45mg/dl, P = 0.002). No dif- ference was found in carotid IMT between both groups, in any site of artery. Averaged IMT (6 measurements, at 3 pre-specified sites bilaterally) was 0.72 ± 0.28 in AS group and 0.70 ± 0.45mm in controls (P = 0.91). Minimally modified LDL did not differ significantly either between patients and controls (14.03 ± 17.40 vs. 13.21 ± 10.21; P = 0.88).ConclusionsPatients with AS did not show increased carotid IMT in comparison to con- trols. In the same way, circulating plasma levels of LDL (-), did not differ significantly in both groups

Vascular Damage in Kidney Disease: Beyond Hypertension

Chronic kidney disease (CKD) is highly prevalent and a multiplier of cardiovascular disease (CVD) and cannot be completely explained by traditional Framinghan risk factors. Consequently, greater emphasis has been placed in nontraditional risk factors, such as inflammation, endothelial dysfunction, sympathetic overactivation, protein-energy wasting oxidative stress, vascular calcification, and volume overload. The accumulation of uremic toxins (and the involvement of genetic factors) is responsible for many of the clinical consequences of a condition known as uremia. In this brief paper, we discuss mechanisms involved in the vascular damage of CKD patients, aiming to point out that important factors beyond hypertension are largely responsible for endothelial activation and increased CVD risk, with potential impact on risk stratification and development of novel therapeutic options