Type 2 myocardial infarction: a diagnostic and therapeutic challenge in contemporary cardiology

In the expanding world of cardiovascular diseases, rapidly reaching pandemic proportions, the main focus is still on coronary atherosclerosis and its clinical consequences. However, at least in the Western world, middle-aged male patients with acute myocardial infarction are no more the rule. Due to a higher life expectancy and major medical advances, physicians are to treat older and frailer individuals, usually with multiple comorbidities. In this context, myocardial ischaemia and infarction frequently result from an imbalance between myocardial oxygen supply and demand\u2014i.e., type 2 myocardial infarction (T2MI), according to the current universal definition\u2014rather than coronary atherothrombosis. Moreover, the increasing use of high-sensitivity cardiac troponin assays has led to a heightened detection of T2MI\u2014often causing relatively little myocardial injury\u2014, which seems to have doubled its numbers in recent years. Nevertheless, owing to its multifaceted pathophysiology and clinical presentation, T2MI is still underdiagnosed. Perhaps more importantly, T2MI is also victim of undertreatment, as drugs that constitute the cornerstone of therapy in most cardiovascular diseases are much more unlikely to be prescribed in T2MI than in coronary atherothrombosis. In this paper, we review the recent literature on the classification, pathophysiology, epidemiology, and management of T2MI, trying to summarise the state-of-the-art knowledge about this increasingly important pathologic condition. Finally, based on the current scientific evidence, we also propose an algorithm that may be easily utilised in clinical practice, in order to improve T2MI diagnosis and risk stratification

Avaliacao de plantas matrizes de umbuzeiro em condicoes irrigadas para fornecimento de propagulos vegetativos.

Com o objetivo de avaliar o desenvolvimento de plantas matrizes de umbuzeiro, para o fornecimento de propagulos vegetativos, foi conduzido um experimento em condicoes irrigadas, no Campo Experimental de Bebedouro pertencente a Embrapa Semi-Arido em Petrolina-PE. O experimento foi instalado no mes de fevereiro de 1999. O delineamento utilizado foi em blocos ao acaso com quatro tratamentos, em dois metodos de enxertia por garfagem (fenda cheia e a inglesa simples): um de borbulhia ("T" invertido) e outro de mudas propagadas por estaquia. Os garfos e as estacas usadas no experimento foram provenientes de plantas que corresponde a um clone de umbu gigante, selecionado para maior tamanho de fruto. As variaveis observadas foram altura de plantas, diametro e comprimento dos ramos. A formacao do matrizeiro pode ser feito atraves dos tres processos de enxertia empregado, pois os mesmos nao apresentaram diferencas significativas entre si, para as variaveis estudadas. A estaquia pode ser realizada, na ausencia de disponibilidade de mudas propagadas por enxertia, levando-se em consideracao a variabilidade genetica das plantas e a disponibilidade de estacas com espessura impropria para a realizacao de enxertia. Devido ao bom desenvolvimento e o vigor das plantas matrizes aos 18 meses, ja foi possivel a realizacao da retirada de garfos

The Use of Both Therapeutic and Prophylactic Vaccines in the Therapy of Papillomavirus Disease

Human papillomavirus (HPV) is the most common sexually transmitted virus. The high-risk HPV types (i.e., HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59) are considered to be the main etiological agents of genital tract cancers, such as cervical, vulvar, vaginal, penile, and anal cancers, and of a subset of head and neck cancers. Three prophylactic HPV vaccines are available that are bivalent (vs. HPV16, 18), tetravalent (vs. HPV6, 11, 16, 18), and non-avalent (vs. HPV6, 11, 16, 18, 31, 33,45, 52, 58). All of these vaccines are based on recombinant DNA technology, and they are prepared from the purified L1 protein that self-assembles to form the HPV type-specific empty shells (i.e., virus-like particles). These vaccines are highly immunogenic and induce specific antibodies. Therapeutic vaccines differ from prophylactic vaccines, as they are designed to generate cell-mediated immunity against transformed cells, rather than neutralizing antibodies. Among the HPV proteins, the E6 and E7 oncoproteins are considered almost ideal as targets for immunotherapy of cervical cancer, as they are essential for the onset and evolution of malignancy and are constitutively expressed in both premalignant and invasive lesions. Several strategies have been investigated for HPV therapeutic vaccines designed to enhance CD4+ and CD8+ T-cell responses, including genetic vaccines (i.e., DNA/ RNA/virus/ bacterial), and protein-based, peptide-based or dendritic-cell-based vaccines. However, no vaccine has yet been licensed for therapeutic use. Several studies have suggested that administration of prophylactic vaccines immediately after surgical treatment of CIN2 cervical lesions can be considered as an adjuvant to prevent reactivation or reinfection, and other studies have described the relevance of prophylactic vaccines in the management of genital warts. This review summarizes the leading features of therapeutic vaccines, which mainly target the early oncoproteins E6 and E7, and prophylactic vaccines, which are based on the L1 capsid protein. Through an analysis of the specific immunogenic properties of these two types of vaccines, we discuss why and how prophylactic vaccines can be effective in the treatment of HPV-related lesions and relapse

Adaptabilidade e estabilidade como critérios para seleção de genótipos de girassol.

O objetivo deste trabalho foi comparar critérios para seleção de genótipos de girassol com base na média geral obtida em vários locais e sua decomposição em ambientes favoráveis e desfavoráveis e por meio de outros métodos de análise de adaptabilidade e estabilidade, como os de Eberhart & Russell, Lin & Binns, Carneiro e Carvalho et al. Foram analisados dados obtidos entre os anos de 1999 e 2004 na Rede Nacional de Ensaios de Girassol, coordenada pela Embrapa Soja e que conta com a participação de empresas públicas e privadas. Os caracteres avaliados foram rendimento de grãos e de óleo (kg ha-1). A análise da decomposição da média geral em médias de ambientes favoráveis e desfavoráveis (método da indicação com base na decomposição da média geral - IDMG) foi o critério mais adequado para a indicação de genótipos. A análise de regressão contribuiu com informações adicionais, indicando a responsividade e previsibilidade dos genótipos diante das mudanças ambientais

Gastroduodenal tolerability of nimesulide and diclofenac in patients with osteoarthritis

This 1-month, randomized, double-masked, parallel-group study was conducted to compare nimesulide (100 mg twice daily) with diclofenac (50 mg three times daily) with respect to gastroduodenal tolerability and efficacy in patients with osteoarthritis. Results of gastroduodenal endoscopy in 83 patients (42 receiving nimesulide, 41 receiving diclofenac) revealed that, after 30 days, 4 patients (1 nimesulide, 3 diclofenac) had developed ulcers and 6 patients (4 nimesulide, 2 diclofenac) had developed erosions; however, differences between the treatment groups were not statistically significant. Both study drugs were well tolerated. Ten patients (5 in each group) withdrew from the study prematurely because of adverse events. Efficacy was assessed by measuring pain on visual analogue scales, using the functional index of Lequesne, and by scoring spontaneous pain, pain on passive movement, and functional impairment. Nocturnal pain was also checked. All efficacy variables showed a significant improvement during the study, and no statistically significant differences were observed between the treatment group

Desempenho e variabilidade genética de linhagens de tilápia cultivada em água salobra.

O objetivo foi avaliar o desempenho das linhagens cultivadas em água salobra e realizar análise da variabilidade genética das mesmas

Enriquecimento da Caatinga com clones de umbuzeiro (Spondias tuberosa Arr.) selecionados para maior tamanho de fruto.

A cobertura vegetal da regiao semi-arida, e caracterizada pelas formacoes naturais do tipo caatinga, que ocupa a maior parte da zona seca do Nordeste. O umbuzeiro, que e endemico deste tipo de vegetacao, e uma frutifera da familia Anacardiaceae com potencial socio-economico para a agricultura de sequeiro. Em seu ambiente natural, o numero de plantas e bastante reduzido, sendo observado cada vez mais sua diminuicao. Este trabalho teve como objetivo promover o enriquecimento da caatinga em estado natural, com plantas de umbuzeiro clonadas de caracteristicas superiores para maior tamanho de fruto. O trabalho foi implantado em uma area de ocorrencia natural de um hecatre no Campo Experimental da Caatinga pertencente a Embrapa Semi-Arido, situada a 45 km de Petrolina-PE. Foi realizada a abertura de trilhas e feito o coroamento nos locais das covas, retirando-se o estrato herbaceo, para a implantacao das mudas. O plantio foi realizado no inicio das chuvas, sobre condicoes de sequeiro absoluto. A avaliacao da sobrevivencia das plantas realizadas aos 18 meses do plantio foi de 97%. O desenvolvimento e vigor das plantas na epoca da avaliacao, quando comparados com o cultivo em areas desmatadas são bastante satisfatorios

Human Papillomavirus infections in cervical samples from HIV-positive women: evaluation of the presence of the nonavalent HPV genotypes and genetic diversity

Non-nonavalent vaccine (9v) Human papillomavirus (HPV) types have been shown to have high prevalence among HIV-positive women. Here, 1444 cervical samples were tested for HPV DNA positivity. Co-infections of the 9v HPV types with other HPV types were evaluated. The HPV81 L1 and L2 genes were used to investigate the genetic variability of antigenic epitopes. HPV-positive samples were genotyped using the HPVCLART2 assay. The L1 and L2 protein sequences were analyzed using a self-optimized prediction method to predict their secondary structure. Co-occurrence probabilities of the 9v HPV types were calculated. Non9v types represented 49% of the HPV infections; 31.2% of the non9v HPV types were among the low-grade squamous intraepithelial lesion samples, and 27.3% among the high-grade squamous intraepithelial lesion samples, and several genotypes were low risk. The co-occurrence of 9v HPV types with the other genotypes was not correlated with the filogenetic distance. HPV81 showed an amino-acid substitution within the BC loop (N75Q) and the FGb loop (T315N). In the L2 protein, all of the mutations were located outside antigenic sites. The weak cross-protection of the 9v types suggests the relevance of a sustainable and effective screening program, which should be implemented by HPV DNA testing that does not include only high-risk types