Left Atrial Volume: an Old Echocardiographic Measure with Renewed Prognostic Significance: a Study in Patients with Dilated Cardiomyopathy

Recentemente, surgiram alguns trabalhos que ressaltaram a importância do cálculo do volume da aurícula esquerda (VAE) como um marcador de eventos cardíacos adversos. Foi objectivo deste estudo avaliar a importância prognóstica deste parâmetro em doentes (dts) com deficiente função ventricular esquerda e correlacioná-lo com outros parâmetros clássicos de prognóstico – consumo de O2 (VO2 max) e pro-BNP (pBNP). Métodos: Analisou-se o volume da aurícula esquerda (VAE) por método de Simpson, numa população de 35 dts com cardiopatia dilatada (idiopática e isquémica) com fracção de ejecção (FE) 31±9,6% doentes (dts) eram de sexo masculino e a média de idades foi de 50,5±10,5 anos. Toda a população efectuou estudos de ecocardiografia convencional (incluindo avaliação por M-mode, bidimensional e Doppler), prova cardiorespiratória (VO2max) e doseamento de pro-BNP. O tempo médio de seguimento foi de 24 ± 4 meses, tendo-se considerado como eventos cardíacos (EC): internamento por insuficiência cardíaca, transplante e morte. Resultados: Dos parâmetros da ecocardiografia - o diâmetro da AE foi de 46,6±5,7mm, as dimensões do VE em diástole – 73,5±10mm e em sístole -58,9±11mm, a média da fracção de ejecção foi de 31±9,6%, o VAE foi de 78,6±33 ml, os volumes do VE foram de 214±82ml em diástole e de 153±75ml em sístole, 15 dts tinham padrão restritivo de enchimento ventricular (E/A>2), a média da área (Doppler cor) da insuficiência mitral foi de 4±3,3cm2, 14 dts tinham E/E’>15. O VO2 max médio foi de 20±5,8ml/kg/min e o pro-BNP de 3146±4629pg/mL. Para além da correlação de outros parâmetros clássicos ecocardiográficos com o prognóstico (volumes VE, FE e E/E’), o VAE e o volume indexado da AE (VAE/SC) mostraram uma correlação com o prognóstico (EC) com r=0,4 (p=0,02) que não se verificou para o diâmetro da AE (p=ns). Em relação à tolerância ao esforço, houve uma correlação inversa entre o diâmetro, o volume e o volume indexado da AE e o VO2max, com maior significado estatístico para o VAE e VAE/SC com r=-0,48, p=0,008. Quanto ao pro-BNP, quer o diâmetro, quer o VAE (ou volume indexado) tiverem o mesmo nível de significado estatístico (r=0,43; p=0,02). O valor predictivo de eventos (curvas ROC) para o VAE foi de 70ml e de 37ml/m2 para o VAE/m2. Conclusão: O volume da aurícula esquerda/volume indexado é um parâmetro ecocardiográfico com significado prognóstico em dts com deficiente função ventricular esquerda, correlacionando-se com a tolerância ao esforço e pro-BNP

Barriers to innovation and sustainability at universities around the world

This paper explores the link between innovation and sustainability in the context of higher education, with the purpose of investigating the fundamental barriers for innovation and sustainable development in universities around the world. The method used involves both a quantitative and a qualitative approach, gathering the views of 301 experts from 172 universities across all continents. The results show that there are similar barriers across different geographical regions that require greater support from university administrations and management. In particular, the willingness of leaders, policy makers and decision-makers to envisage a sustainable future inside universities is often missing. Yet, without the support of senior management within a university, bottom-up sustainable initiatives seem destined to fail in the longer term due to a lack of investment and administrative support. This study also identifies that in order to yield the anticipated benefits, barriers need to be tackled in an integrated way, and that closer cooperation between sustainability researchers, university administrations and students is needed

Prognostic Implications of Tissue Doppler in Patients with Dilated Cardiomyopathy

Previous studies have shown that a ratio of early transmitral flow velocity to early diastolic velocity of the mitral annulus (E/E') of > 15, obtained by tissue Doppler imaging (TDI), correlates with left ventricular filling pressure. OBJECTIVE: The aim of our study was to assess whether E/E' provides prognostic information in patients with dilated cardiomyopathy. METHODS: We studied 33 patients with dilated cardiomyopathy and mean ejection fraction of 31%. All the patients underwent routine two-dimensional and Doppler echocardiographic examination and TDI to determine early peak velocity of the mitral annulus. Pro-B-type natriuretic peptide (pro-BNP) and peak oxygen consumption (VO2max) were also measured. Patients were divided into two groups according to the value of E/E': Group I (n = 15 patients) with E/E' > or = 15 and Group II (n = 18 patients) with E/E' < 15. Patients were followed for 12+/-4 months; new hospital admission due to heart failure, heart transplantation and death were considered as cardiac events. RESULTS: There were significant differences between the two groups in conventional two-dimensional echocardiographic measurements (dimensions and ejection fraction) and Doppler parameters (mitral inflow). With regard to mitral annular velocities obtained by TDI at two different points (septum and lateral wall), the E', A' and S' velocities differed significantly between the two groups, with lower velocities in Group I. Systolic velocity measured in the lateral portion of the mitral annulus showed the most significant difference: Group I - 4.46 cm/sec versus Group II - 7.19 cm/sec, p < 0.00001. Pro-BNP was 5622 pg/ml in Group I, and 1254 pg/ml in Group II, p = 0.004. VO2 max was significantly different between the two groups: Group I - 17.6 ml/kg/min versus Group II - 22.8 ml/kg/min, p = 0.004. During follow-up, events were more common in Group I, with 9 patients (60%) having events, while in Group II, the event rate was 11.1% (2 patients), p = 0.004. CONCLUSION: The ratio of early transmitral flow velocity to early diastolic velocity of the mitral annulus is a powerful predictor of clinical outcome. Lower velocities of mitral annulus on TDI are expected in patients with E/E' > or = 15. Systolic velocities of under 5 cm/sec measured in the lateral portion of the mitral annulus appeared to be strongly related to prognosis

Molecular Characterization of Growth Hormone-producing Tumors in the GC Rat Model of Acromegaly

D.A.C. was supported by the Nicolás Monardes program of the Andalusian Ministry of Health (C-0015-2014) and by a grant from the Andalusian Ministry of Science and Innovation (CTS-7478). A.S-M and A.L.C were supported by grants from the ISCIII-Subdirección General de Evaluación y Fomento de la Investigación co-funded with Fondos FEDER (PI12/0143 and PI13/02043, respectively) and the Andalusian Regional Government (CTS-444) and a grant from Pfizer Spain. R.L.C. was supported by a grant from Andalusian Ministry of Health (PI0302-2012). R.M.L. was supported by grants from Proyecto de Investigación en Salud (FIS) PI13- 00651 (funded by Instituto de Salud Carlos III), CTS-1406, PI-0639-2012, BIO-0139 (funded by Junta de Andalucía) and by Ayuda Merck Serono 2013. J. P. C. was funded by a grant (BFU2013-43282-R) from Ministerio de Economía y Competitividad. CIBER is an initiative of Instituto de Salud Carlos III, Ministerio de Sanidad, Servicios Sociales e Igualdad, Spain. J.F.M.R. is supported by the “Sara Borrell” program from the Instituto de Salud Carlos III. R.M. Luque and J.P. Castaño have received grants and lecture fees from Ipsen and Novartis. E. Venegas-Moreno and A. Soto-Moreno received grants and lecture fees from Ipsen, Novartis and Pfizer. A. Leal-Cerro received grants from Novartis and Pfizer. David Cano received a grant from Novartis

Odorant Receptor from the Southern House Mosquito Narrowly Tuned to the Oviposition Attractant Skatole

Oviposition attractants are environmental cues that allow Culex gravid female mosquitoes to locate suitable sites for egg-laying and, therefore, may be exploited for environmentally friendly strategies for controlling mosquito populations. Naturally occurring skatole has been identified as an oviposition attractant for the Southern House mosquito, Culex quinquefasciatus. Previously, we identified in Cx. quinquefasciatus female antennae an olfactory receptor neuron (ORN) highly sensitive to skatole and an odorant-binding protein involved in the detection of this semiochemical. Here, we describe the characterization of an odorant receptor (OR), CquiOR10, which is narrowly tuned to skatole when expressed in the Xenopus oocyte system. Odorant-induced response profiles generated by heterologously expressed CquiOR10 suggest that this OR is expressed in the mosquito ORN sensitive to skatole. However, geranylacetone, which stimulates the antennal ORN, was not detected by CquiOR10-expressing oocytes, thus raising interesting questions about reception of oviposition attractants in mosquitoes

Prognostic Value of Left Atrial Volume in Patients with Dilated Cardiomyopathy

Introdução: O aumento da aurícula esquerda (AE) é um marcador de mortalidade na população geral. Os doentes com miocardiopatia dilatada (MCD) têm um amplo espetro de tamanhos deAE, mas a importância clínica desta observação tem sido pouco estudada. Objectivo: Avaliar a importância prognóstica a longo prazo do volume da AE (VAE) em doentes com MCD. Métodos: Estudo prospetivo de doentes admitidos durante o ano de 2004 com o diagnóstico deMCD, em ritmo sinusal. Foi realizado estudo ecocardiográfico completo em repouso e após stress farmacológico. O endpoint composto considerou a assistência ventricular mecânica (AVM), a transplantação cardíaca ou a morte. Resultados: Foram incluídos 35 doentes (68,6% sexo masculino, idade média 52,0), 82,9% etiologia não isquémica. Fração ejeção em repouso 31,1 ± 9,4%.Durante o seguimento, oito doentes morreram, um foi colocado em AVM e um foi transplantado. A análise de Cox univariável revelou potenciais marcadores ecocardiográficos de prognóstico na amostra tais como a dimensão da AE em modo M (HR-1,12; IC: 0,99-1,26;p = 0,067); VAE (HR-1,02; IC: 1,00-1,04; p = 0,046); VAE ajustado à superfície corporal (HR-1,03;IC: 1,00-1,07; p = 0,049); E/A (HR-0,99; IC: 0,99-1,81; p = 0,060); E/A > 2 (HR-7,00; IC:1,48-32,43; p = 0,014) e E/E’ mitral (HR-1,04; IC: 1,00-1,09; p = 0,074). Na análise multivariável a única variável que permaneceu no modelo foi o VAE com o ponto de corte de 63 ml (HR-7,7, IC:0,97-60,61, p = 0,05).Conclusão: Nesta amostra, o VAE foi o único parâmetro ecocardiográfico determinante de AVM,transplantação cardíaca ou morte. Os parâmetros ecocardiográficos habitualmente utilizadospara estratificação de risco, tais como a fração ejeção do ventrículo esquerdo, a dimensão do ventrículo esquerdo e a reserva contrátil não tiveram valor prognóstico na nossa amostra

An analysis of the applications of Analytic Hierarchy Process (AHP) for selection of energy efficiency practices in public lighting in a sample of Brazilian cities

© 2019 Elsevier Ltd In Brazil, the public lighting sector is a responsibility of the municipal government and typically represents around 4% of the electricity consumed by cities. Considering the significant importance and functions of this service, sustainable management is necessary. The aim of this paper is to investigate the main practices used worldwide in terms of energy efficiency of public lighting and propose the use of the multi-criteria method called Analytic Hierarchy Process to choose the best options for a group of Brazilian cities, namely Passo Fundo, Santa Maria and Porto Alegre. The methodology of this paper consists of searching for best practices in public lighting, which worked as alternatives for applying the Analytic Hierarchy Process. The final step consisted of presenting the impacts of a potential implementation, through analysis of energy and financial savings. The results suggest the preferred practices to each municipality (Audit and Guide Elaboration, Retrofit, Alternative Energy and Management) and their potential implementation can promote energy and financial savings up to 6 GWh/year and 600,000.00 US$/year. The main implications of this paper are related to proposing the use of a multi-criteria method to the public lighting sector and providing useful insights for local governments and especially for developing countries