Oral aspirin for treating venous leg ulcers

Background Venous leg ulcers (VLUs) or varicose ulcers are the final stage of chronic venous insufficiency (CVI), and are the most common type of leg ulcer. The development of VLUs on ankles and lower legs can occur spontaneously or after minor trauma. The ulcers are often painful and exudative, healing is often protracted and recurrence is common. This cycle of healing and recurrence has a considerable impact on the health and quality of life of individuals, and healthcare and socioeconomic costs. VLUs are a common and costly problem worldwideprevalence is estimated to be between 1.65% to 1.74% in the western world and is more common in adults aged 65 years and older. The main treatment for a VLU is a firm compression bandage. Compression assists by reducing venous hypertension, enhancing venous return and reducing peripheral oedema. However, studies show that it only has moderate effects on healing, with up to 50% of VLUs unhealed after two years of compression. Non-adherence may be the principal cause of these poor results, but presence of inflammation in people with CVI may be another factor, so a treatment that suppresses inflammation (healing ulcers more quickly) and reduces the frequency of ulcer recurrence (thereby prolonging time between recurrent episodes) would be an invaluable intervention to complement compression treatments. Oral aspirin may have a significant impact on VLU clinical practice worldwide. Evidence for the effectiveness of aspirin on ulcer healing and recurrence in high quality RCTs is currently lacking. Objectives To assess the benefits and harms of oral aspirin on the healing and recurrence of venous leg ulcers. Search methods In May 2015 we searched: The Cochrane Wounds Specialised RegisterThe Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library)Ovid MEDLINEOvid MEDLINE (In-Process & Other Non-Indexed Citations)Ovid EMBASE and EBSCO CINAHL. Additional searches were made in trial registers and reference lists of relevant publications for published or ongoing trials. There were no language or publication date restrictions. Selection criteria We included randomised controlled trials (RCTs) that compared oral aspirin with placebo or no drug intervention (in the presence or absence of compression therapy) for treating people with venous leg ulcers. Our main outcomes were time to complete ulcer healing, rate of change in the area of the ulcer, proportion of ulcers healed in the trial period, major bleeding, pain, mortality, adverse events and ulcer recurrence (time for recurrence and proportion of recurrence). Data collection and analysis Two review authors independently selected studies for inclusion, extracted data, assessed the risk of bias of each included trial and assessed overall quality of evidence for the main outcomes in the 'Summary of findings' table. Main results The electronic search located 62 studies. We included two RCTs of oral aspirin (300 mg/daily) given in addition to compression compared with compression and placebo, or compression alone. To date, the impact of aspirin on VLUs has been examined by only two randomised clinical trials, both with a small number of participants. The first RCT was conducted in the United Kingdom (n=20) and reported that daily administration of aspirin (300mg) in addition to compression bandages increased both the rate of healing, and the number of participants healed when compared to placebo in addition to compression bandaging over a four month period. Thirty-eight per cent of the participants given aspirin reported complete healing compared with 0% in the placebo group. Improvement (assessed by reduction in wound size) occurred in 52% of the participants taking aspirin compared with 26% in those taking placebo). The study identified potential benefits of taking aspirin as an adjunct to compression but the sample size was small, and neither the mechanism by which aspirin improved healing nor its effects on recurrence were investigated. In 2012 an RCT in Spain (n=51) compared daily administration of aspirin (300mg) in addition to compression bandages with compression alone over a five month period. There was little difference in complete healing rates between groups (21/28 aspirin and 17/23 compression bandages alone) but the average time to healing was shorter (12 weeks in the treated group vs 22 weeks in the compression only group) and the average time for recurrence was longer in the aspirin group (39 days: [SD 6.0] compared with 16.3 days [SD 7.5] in the compression only group). Although this trial provides some limited data about the potential use of aspirin therapy, the sample size (only 20 patients) was too small for us to draw meaningful conclusions. In addition, patients were only followed up for 4 months and no information on placebo was reported. Authors' conclusions Low quality evidence from two trials indicate that there is currently insufficient evidence for us to draw definitive conclusions about the benefits and harms of oral aspirin on the healing and recurrence of venous leg ulcers. We downgraded the evidence to low quality due to potential selection bias and imprecision due to the small sample size. The small number of participants may have a hidden real benefit, or an increase in harm. Due to the lack of reliable evidence, we are unable to draw conclusions about the benefits and harms of oral daily aspirin as an adjunct to compression in VLU healing or recurrence. Further high quality studies are needed in this area.Evidence Based Actions Department From Marilia Medical School - FAMEMA, BrazilFAPESP-Fundacao de Amparo a Pesquisa do Estado de Sao Paulo, BrazilNational Institute for Health ResearchEvidence Based Health Actions Department and Thoracic Surgery Department, Marilia Medical School, Marilia, BrazilDepartment of Medicine, Federal University of São Paulo, São Paulo, BrazilDepartment of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, AustraliaDepartment of Medicine, Federal University of São Paulo, São Paulo, BrazilWeb of Scienc

ToffA-DSPL: an approach of trade-off analysis for designing dynamic software product lines

Software engineers have adopted the Dynamic Software Product Lines (DSPL) engineering practices to develop Dynamically Adaptable Software (DAS). DAS is seen as a DSPL application and must cope with a large number of configurations of features, Non-functional Requirements (NFRs), and contexts. However, the accurate representation of the impact of features over NFRs and contexts for the identification of optimal configurations is not a trivial task. Software engineers need to have domain knowledge and design DAS before deploying to satisfy those requirements. Aiming to handle them, we proposed an approach of Trade-off Analysis for DSPL at design-time, named ToffA-DSPL. It deals with the configuration selection process considering interactions between NFRs and contexts. We performed an exploratory study based on simulations to identify the usefulness of the ToffA-DSPL approach. In general, the configurations suggested by ToffA-DSPL provide high satisfaction levels of NFRs. Based on simulations, we evidenced that our approach aims to explore reuse and is useful for generating valid and optimal configurations. In addition, ToffA-DSPL enables software engineers to conduct trade-off analysis, evaluate changes in the context feature, and define an adaptation model from optimal configurations found in the analysis.https://d197for5662m48.cloudfront.net/documents/publicationstatus/156667/preprint_pdf/230f9301f4e7f05519c53c203b8c615f.pdfFirst author draf

Utilização da hipodermóclise em pessoas idosas no ambiente domiciliar: protocolo de revisão de escopo

The aim is to map and summarize scientific productions on the use of hypodermoclysis in elderly people in the home environment. The scoping review will be conducted under recommendations from the JBI Institute and Prisma-Scr. This scoping review will search for sources of evidence in full texts of primary studies and gray literature theses and dissertations, available in the main databases: PubMed, CINAHL, SCOPUS, Web of Science, Science Direct, and SciELO. As an exclusion criterion, review studies (secondary) or those that do not meet the PCC mnemonic combination will not be included: P Population – Health Caregivers; C Concept – Hypodermoclysis; C Context – Domiciled elderly person. In this review there will be no language restrictions, however, a time frame was established starting in 2009. The selection of studies will be made by two independent reviewers using the Endnote and Rayyan software, while a third will resolve differences between them. For extraction, analysis of evidence, and synthesis of knowledge, a structured data extraction tool developed by the JBI Institute and adapted by reviewers will be used to meet the objective and main question of the research. In the final scoping review, there will be a description of the research results and the process of including articles in the study.Objetiva-se mapear e sumarizar as produções científicas sobre o uso da hipodermóclise em pessoas idosas no ambiente domiciliar. A revisão de escopo será conduzida de acordo recomendações do Instituto JBI e Prisma-Scr. Esta revisão de escopo buscará fontes de evidência em textos completos de estudos primários e na literatura cinzenta teses e dissertações, disponíveis nas principais bases de dados: PubMed, CINAHL, SCOPUS, Web of Science, Science Direct e SciELO. Como critério de exclusão, não serão incluídos os estudos de revisão (secundários) ou que não atendam a combinação mnemônica PCC: P Population – Cuidadores de Saúde; C Concept – Hipodermóclise; C Context – Pessoa idosa domiciliada. Nessa revisão não haverá restrição de idioma, entretanto estabeleceu-se um recorte temporal a partir do ano de 2009. A seleção dos estudos será feita por dois revisores independentes utilizando os softwares Endnote e Rayyan, enquanto um terceiro resolverá divergências entre esses. Para extração, análise das evidências e síntese do conhecimento será utilizado uma ferramenta de extração de dados estruturada desenvolvido pelo Instituto JBI e adaptado pelos revisores para atender ao objetivo e questão principal da pesquisa. Na revisão de escopo final haverá descrição dos resultados da pesquisa e do processo de inclusão dos artigos no estudo

Estrutura genética de populações de azevém anual (Lolium multiflorum) estimada por RAPD

Annual ryegrass is a temperate climate annual foraging grass, grown mostly in the South of Brazil, especially in the state of Rio Grande do Sul. Despite its importance, little is known about its genetic diversity, both within and among the populations cultivated. This knowledge is of fundamental importance for developing breeding and conservation strategies. The aim of this study was to characterize the genetic diversity and structure of four populations of annual ryegrass. Three of the populations were located in Rio Grande do Sul and the fourth in Uruguay. RAPD markers were used to study the genetic diversity and structure of these populations. Analysis of 375 individuals sampled from the populations, using six RAPD primers, generated a total of 82 amplified bands. They included 73 polymorphic bands (89,02%). The value of the total genetic diversity index obtained, ;(0,71) was high, indicating the presence of wide genetic diversity in the four populations. Genetic structure analysis revealed that 98% of total diversity is intrapopulational, whereas interpopulational genetic diversity was only 2%. These results suggest that before these populations separated, they had gone through a period of gene exchange and, even after the separation event, gene frequency stayed at levels similar to the original levels, with no differential selection for these genes in the different cultivation areas.O azevém anual é a gramínea anual forrageira de clima temperado de maior utilização no sul do Brasil, particularmente no Estado do Rio Grande do Sul. Apesar de toda a importância que a espécie apresenta, pouco se conhece a respeito da diversidade genética presente entre e dentro das populações cultivadas. Este conhecimento é de fundamental importância para o estabelecimento das estratégias de melhoramento genético e de conservação destes materiais. O objetivo deste estudo foi caracterizar a diversidade genética e a estrutura genética de quatro populações de azevém anual, sendo três populações do Estado do Rio Grande do Sul e uma do Uruguai. O nível de diversidade e a estrutura genética destas populações foram estudados com marcadores RAPD. A análise de 375 indivíduos amostrados nas populações, com seis iniciadores, gerou um total de 82 bandas que foram utilizados nas análises, dentre as quais 73 (89,02%) foram polimórficas. O valor do índice de diversidade genética total obtido, ;(0,71) foi elevado evidenciando a presença de uma grande diversidade genética nas quatro populações. A análise da estrutura genética revelou que 98% da diversidade total esta contida dentro das populações, enquanto que a diversidade genética entre as populações representou somente 2%. Sugere-se que antes da separação destas populações, as mesmas tenham passado por um período de troca de genes e que mesmo após o evento de separação elas mantiveram a freqüência destes em níveis semelhantes aos originais, não tendo ocorrido uma seleção diferencial destes genes nos locais de cultivo

Sudden Deafness as a Presenting Symptom of Acoustic Neuroma: Case Report

SummaryVestibular schwannoma, also known as acoustic neurinoma, is the most frequent tumor of the cerebellopontine angle, and represents 9% of all intracranial tumors. Case Report: The authors report a case of sudden deafness with unilateral tinnitus. The patients responded to therapy with Prednisone and Pentoxifylline after the diagnosis of acoustic neurinoma by imaging exams. Discussion: Sudden deafness can be described as an intense and abrupt sensorineural loss. Usually it is higher than 30 dB at three or more frequencies and develops in less than three days. Conclusion: Investigation of the etiology of sudden deafness is extremely important to establish the adequate strategy for the case

Anatomy of the abdominal aorta in the hoary fox (Lycalopex vetulus, Lund, 1842)

The hoary fox (Lycalopex vetulus, Lund, 1842) is the smallest Brazilian canid, whose weight varies between 2 and 4 kg, has a slender body, a small head, and a short and blackened snout. Despite being considered an endemic species, little is known about the hoary fox as it is one of the seven less studied canids in the world. Thus, this study aimed to describe the anatomy of the abdominal aorta artery of the hoary fox and to compare it with the pre-established literature data in domestic canids. For this purpose, we used two adult hoary foxes without definite age. We collected the corpses of these animals along roadsides of Catalão-GO, being later fixed and conserved in a 10% formalin solution. The results showed that the abdominal aorta in hoary fox is at the ventral face of the lumbar region vertebral bodies, being slightly displaced to the left of the median plane. The first branch is visceral, named celiac artery, followed by a paired parietal branch: the phrenic abdominal arteries. The third and fourth branches are the cranial mesenteric arteries and the rightand left are the renal arteries, respectively. The posterior branches of the renal arteries are equally visceral, paired, being called testicular arteries. Distal to the latter, both the caudal mesenteric artery and deep circumflex iliac arteries originate. Finally, two large external iliac arteries and its terminal branches composed of internal iliac arteries and the median sacral artery originate. In addition, five pairs of lumbar arteries originate alongside the abdominal segment of the aorta. Considering these findings, it is possible to conclude that despite the hoary fox being a wild animal, the anatomy of its abdominal aorta is very similar to that of domestic canids.A raposa-do-campo (Lycalopex vetulus) é o menor canídeo brasileiro, cujo peso varia entre 2 e 4 quilos, possui corpo esguio, a cabeça é pequena, focinho curto e enegrecido. Considerada uma espécie endêmica, pouco se sabe a seu respeito, e é um dos sete canídeos menos estudados no mundo. Assim, o presente estudo teve o objetivo de descrever a anatomia da parte abdominal da artéria aorta em raposa-do-campo e comparar com dados literários pré-estabelecidos de canídeos domésticos. Para a realização deste estudo foram utilizados dois exemplares de raposa-do-campo, adultos, sem idade definida. Os cadáveres dos animais foram recolhidos às margens de rodovias no entorno da Catalão-Goiás, fixados em solução aquosa de formol a 10% e conservados na mesma solução. Os resultados mostraram que a aorta abdominal da raposa-do-campo está localizada sobre a face ventral dos corpos vertebrais da região lombar, levemente deslocada para a esquerda do plano mediano. O primeiro ramo é visceral, denominado artéria celíaca, seguido por um ramoparietal, pareado, as artérias frênico-abdominais. O terceiro e quarto ramos são a artéria mesentérica caudal e as artérias renais direita e esquerda, respectivamente. Os ramos posteriores das artérias renais são igualmente viscerais, pareados, denominados artérias testiculares. Distal à essas últimas, originam-se a artéria mesentérica caudal e as artérias circunflexas ilíacas profundas. Finalmente surgem duas grandes artérias ilíacas externas e os ramos terminais compostos pelas artérias ilíacas internas e artéria sacral mediana. Ao longo do trajeto da aorta abdominal, cinco pares de artérias lombares se originam da face dorsal. Considerando esses achados, pode ser concluído que a anatomia da aorta abdominal da raposa-do-campo é muito similar àquela de canídeos domésticos, embora ela seja um animal silvestre

Amelioration of Cardiac Function and Activation of Anti-Inflammatory Vasoactive Peptides Expression in the Rat Myocardium by Low Level Laser Therapy

Low-level laser therapy (LLLT) has been used as an anti-inflammatory treatment in several disease conditions, even when inflammation is a secondary consequence, such as in myocardial infarction (MI). However, the mechanism by which LLLT is able to protect the remaining myocardium remains unclear. the present study tested the hypothesis that LLLT reduces inflammation after acute MI in female rats and ameliorates cardiac function. the potential participation of the Renin-Angiotensin System (RAS) and Kallikrein-Kinin System (KKS) vasoactive peptides was also evaluated. LLLT treatment effectively reduced MI size, attenuated the systolic dysfunction after MI, and decreased the myocardial mRNA expression of interleukin-1 beta and interleukin-6 in comparison to the non-irradiated rat tissue. in addition, LLLT treatment increased protein and mRNA levels of the Mas receptor, the mRNA expression of kinin B2 receptors and the circulating levels of plasma kallikrein compared to non-treated post-MI rats. On the other hand, the kinin B1 receptor mRNA expression decreased after LLLT. No significant changes were found in the expression of vascular endothelial growth factor (VEGF) in the myocardial remote area between laser-irradiated and non-irradiated post-MI rats. Capillaries density also remained similar between these two experimental groups. the mRNA expression of the inducible nitric oxide synthase (iNOS) was increased three days after MI, however, this effect was blunted by LLLT. Moreover, endothelial NOS mRNA content increased after LLLT. Plasma nitric oxide metabolites (NOx) concentration was increased three days after MI in non-treated rats and increased even further by LLLT treatment. Our data suggest that LLLT diminishes the acute inflammation in the myocardium, reduces infarct size and attenuates left ventricle dysfunction post-MI and increases vasoactive peptides expression and nitric oxide (NO) generation.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Univ Nove Julho, UNINOVE, São Paulo, BrazilUniversidade Federal de São Paulo, UNIFESP, São Paulo, BrazilUniv São Paulo, Heart Inst InCor, São Paulo, BrazilUniversidade Federal de São Paulo, UNIFESP, São Paulo, BrazilCNPq: 477458/2009-2CNPq: 309715/2011-3CNPq: 479395/2012-8: 2009/54225-8Web of Scienc

Foliar water uptake in Amazonian trees: evidence and consequences

This is the author accepted manuscript. The final version is available from Wiley via the DOI in this recordThe absorption of atmospheric water directly into leaves enables plants to alleviate the water stress caused by low soil moisture, hydraulic resistance in the xylem and the effect of gravity on the water column, while enabling plants to scavenge small inputs of water from leaf-wetting events. By increasing the availability of water, and supplying it from the top of the canopy (in a direction facilitated by gravity), foliar uptake (FU) may be a significant process in determining how forests interact with climate, and could alter our interpretation of current metrics for hydraulic stress and sensitivity. FU has not been reported for lowland tropical rainforests; we test whether FU occurs in six common Amazonian tree genera in lowland Amazônia, and make a first estimation of its contribution to canopy–atmosphere water exchange. We demonstrate that FU occurs in all six genera and that dew-derived water may therefore be used to “pay” for some morning transpiration in the dry season. Using meteorological and canopy wetness data, coupled with empirically derived estimates of leaf conductance to FU (kfu), we estimate that the contribution by FU to annual transpiration at this site has a median value of 8.2% (103 mm/year) and an interquartile range of 3.4%–15.3%, with the biggest sources of uncertainty being kfu and the proportion of time the canopy is wet. Our results indicate that FU is likely to be a common strategy and may have significant implications for the Amazon carbon budget. The process of foliar water uptake may also have a profound impact on the drought tolerance of individual Amazonian trees and tree species, and on the cycling of water and carbon, regionally and globally.Natural Environment Research Council (NERC)Australian Research Council (ARC)CNPQEuropean Union FP7Royal SocietyCoordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brasil (CAPES