Risco Cardiovascular Associadoà Interrupção dos Antiagregantes Plaquetares e Anticoagulantes Orais

Diversas situações clínicas estão associadas a risco aterotrombótico (por exemplo endopróteses coronárias) ou tromboembólico (por exemplo próteses valvulares mecânicas). Inúmeros doentes fazem terapêutica regular com antiagregantes ou anticoagulantes, cujo risco hemorrágico associado coloca problemas delicados quando o doente tem que ser submetido a um procedimento cirúrgico. Por outro lado, a suspensão da medicação antitrombótica repõe o risco da situação de base e vulnerabiliza o doente. Os autores reveêm a literatura recente sobre este tema e propõem esquemas práticos de actuação em diversas situações

The use of histological analysis for the detection of somatic embryos in sugarcane

The aim of this study was to establish an in vitro system for the induction, maturation and regeneration of somatic embryo in sugarcane from buds of cultivar RB 867515. Embryogenic calluses were obtained on semi-solid MS medium supplemented with 4.42 mg L-1 2,4-D. After four weeks of culture of explants on the callus induction medium, globular structures were obtained. At the end of 20 days in maturation medium, somatic embryos were observed. Histological analysis showed somatic embryos with caulinarand root apex, protodermal tissue, and the vascular system, which  apparently has no connection with the vascular tissue explant that gave rise to it confirming the presence of the somatic embryo. The embryos were transferred to regeneration medium containing 1 mg L-1 GA3 and BAP, and after 1 to 2 weeks of culture, green points were observed, indicating the beginning of the formation of shoots. Key words: Saccharum spp, bud culture, 2.4-D, morphogenetic pathway, embryogenesis, plant regeneration

Downscaling the Gap: Protected Areas, Scientific Knowledge and the Conservation of Amphibian Species in Minas Gerais, Southeastern Brazil

Protected areas (PAs) cover a small proportion of the Earth's surface and most species are not covered by the current network. Amphibians are the least represented group in PAs around the world and expanding the network is still the major recommendation for species conservation. We evaluated the effectiveness of PAs in safeguarding endemic amphibians in the Cerrado biome of Minas Gerais state, southeastern Brazil. We conducted a gap analysis to highlight site-based conservation actions for target species within study site. We extracted occurrence points from the national database and calculated the intersection between the minimum convex polygon and natural vegetation remnants for each species. For each target species, we calculated the percentage of the range covered by PAs and assessed the scientific knowledge based on academic publications between 1950–2015. We recorded 206 amphibians in Minas Gerais, of which 127 occur in the Cerrado. We identified 24 target species and concluded that 80% are insufficiently protected by the current PA network. A quarter of the species have zero coverage and most species have < 30% of their range legally protected. In southwestern Minas Gerais, we recommend habitat restoration and connectivity to provide additional habitat to target species. In western Minas Gerais, the creation of PA seems to be the best solution. The distribution of target species is concentrated in the Espinhaço Mountain Range, where we recommend the establishment of biodiversity corridors. We examined 246 publications, most of which focus on taxonomy. Few species have sufficient information to have their conservation status re-assessed, with only 26.8% of publications containing specific information on conservation. Scientific knowledge must be improved for all research areas, especially species distributions and ecology, to support evidence-based conservation and management actions

Prediction of sarcomere mutations in subclinical hypertrophic cardiomyopathy.

BACKGROUND: Sarcomere protein mutations in hypertrophic cardiomyopathy induce subtle cardiac structural changes before the development of left ventricular hypertrophy (LVH). We have proposed that myocardial crypts are part of this phenotype and independently associated with the presence of sarcomere gene mutations. We tested this hypothesis in genetic hypertrophic cardiomyopathy pre-LVH (genotype positive, LVH negative [G+LVH-]). METHODS AND RESULTS: A multicenter case-control study investigated crypts and 22 other cardiovascular magnetic resonance parameters in subclinical hypertrophic cardiomyopathy to determine their strength of association with sarcomere gene mutation carriage. The G+LVH- sample (n=73) was 29 ± 13 years old and 51% were men. Crypts were related to the presence of sarcomere mutations (for ≥1 crypt, β=2.5; 95% confidence interval [CI], 0.5-4.4; P=0.014 and for ≥2 crypts, β=3.0; 95% CI, 0.8-7.9; P=0.004). In combination with 3 other parameters: anterior mitral valve leaflet elongation (β=2.1; 95% CI, 1.7-3.1; P<0.001), abnormal LV apical trabeculae (β=1.6; 95% CI, 0.8-2.5; P<0.001), and smaller LV end-systolic volumes (β=1.4; 95% CI, 0.5-2.3; P=0.001), multiple crypts indicated the presence of sarcomere gene mutations with 80% accuracy and an area under the curve of 0.85 (95% CI, 0.8-0.9). In this G+LVH- population, cardiac myosin-binding protein C mutation carriers had twice the prevalence of crypts when compared with the other combined mutations (47 versus 23%; odds ratio, 2.9; 95% CI, 1.1-7.9; P=0.045). CONCLUSIONS: The subclinical hypertrophic cardiomyopathy phenotype measured by cardiovascular magnetic resonance in a multicenter environment and consisting of crypts (particularly multiple), anterior mitral valve leaflet elongation, abnormal trabeculae, and smaller LV systolic cavity is indicative of the presence of sarcomere gene mutations and highlights the need for further study

Um insucesso de desfibrilhação por CDI resolvido de uma forma pouco habitual

Um Cardioversor Desfibrilhador Implantável (CDI) destina-se a detectar arritmias ventriculares potencialmente fatais e a terminá-las, quer por estimulação ventricular rápida quer através de uma descarga eléctrica. Actualmente, é uma terapia aceite na prevenção primária e secundária da morte súbita cardíaca. A configuração típica de um CDI é de um eléctrodo de sensing e de desfibrilhação no ventrículo direito (VD) com dois coils (um distal, no ventrículo e outro próximal, na junção da veia cava superior (VCS) com a aurícula direita) que juntamente com o gerador, forma a designada “tríade ventricular”. Esta configuração embora seja eficaz na maior parte dos doentes, não é a mais racional do ponto de vista eléctrico pois o vector de choque encontra-se deslocado anteriormente em relação à maior parte do ventrículo esquerdo (VE). Descreve-se um caso de incapacidade de desfibrilhação pelo CDI resolvido com a implantação de um eléctrodo adicional numa veia tributária do seio coronário

Síndrome coronária aguda de origem paradoxal

We describe a rare case of acute myocardial infarction secondary to paradoxical embolism complicating acute pulmonary embolism. A 44-year-old woman presented to the emergency department with chest pain. The physical examination was unremarkable except for oxygen saturation of 75%, and the electrocardiogram showed ST-segment elevation in the inferior leads. Urgent coronary angiography showed a distal occlusion of the right coronary artery and multiple thrombi were aspirated. Despite relief of chest pain and electrocardiogram normalization, her oxygen saturation remained low (90%) with high-flow oxygen by mask. The transthoracic echocardiogram showed a mass in the left atrium and dilatation of the right chambers, while the transesophageal echocardiogram showed a thrombus attached to the interatrial septum in the region of the foramen ovale. Color flow imaging was consistent with a patent foramen ovale. Thoracic computed tomography angiography documented thrombi in both branches of the pulmonary trunk. After five days on anticoagulation, the patient underwent surgical foramen ovale closure

LHC diphoton Higgs signal and top quark forward-backward asymmetry in quasi-inert Higgs doublet model

In the quasi-inert Higgs doublet model, we study the LHC diphoton rate for a standard model-like Higgs boson and the top quark forward-backward asymmetry at Tevatron. Taking into account the constraints from the vacuum stability, unitarity, electroweak precision tests, flavor physics and the related experimental data of top quark, we find that compared with the standard model prediction, the diphoton rate of Higgs boson at LHC can be enhanced due to the light charged Higgs contributions, while the measurement of the top quark forward-backward asymmetry at Tevatron can be explained to within $1\sigma$ due to the non-standard model neutral Higgs bosons contributions. Finally, the correlations between the two observables are discussed.Comment: 14 pages, 5 figues. Version to appear in JHEP, some references adde

Evaluation of polymer choice on immunogenicity of chitosan coated PLGA NPs with surface-adsorbed pneumococcal protein antigen PspA4Pro

Polymeric nanoparticles (NPs) are recognized as potential delivery vehicles for vaccines. PLGA is a biocompatible polymer synonymous with polymeric NPs, which can be coated with other polymers such as chitosan that has intrinsic adjuvant properties as well as mucoadhesive properties. Numerous modifications and variations exist for PLGA and chitosan, which can influence the NP characteristics and the resulting immunogenicity. The current study investigated variations for making chitosan coated PLGA NPs incorporating recombinant pneumococcal surface protein A from family 2, clade 4 (PspA4Pro) antigen as a vaccine targeting the vast majority of pneumococcal strains and determine the effect of the polymers on particle size, surface charge, and surface marker upregulation on a dendritic cell (DC) line in vitro. PLGA variations tested with the ester-terminal group had the greatest detriment for prospective vaccine use, due to the lowest PspA4Pro adsorption and induction of CD40 and CD86 cell surface markers on DCs. The negatively charged chitosans exhibited the lowest surface marker expressions, similar to the uncoated NP, supporting the commonly accepted notion that positive surface charge augments immunogenic effects of the NPs. However, the study indicated that NPs made from PLGA with an acid terminated group, and chitosan HCl salt, exhibit particle characteristics, antigen adsorption efficiency and immunogenicity, which could be most suitable as a vaccine formulation