Aspartic protease supplementation enhancing the performance, carcass characteristics, nutrient digestibility and economic viability, without changing blood parameters and salivary cortisol of pigs.

Aiming to study the performance, carcass characteristics, nutrient digestibility, blood parameters, salivary cortisol levels, and economic viability of pigs administered aspartic protease, a total of 135 pigs were housed in pens in a randomized block design, divided into five treatments with nine replications. The experimental diets were positive control (PC), basic diet with a 5.0% reduction in protein and amino acid requirements; negative control (NC) with a 7.5% reduction in protein and amino acid requirements; NC + 100 g/mT of aspartic protease (NC100); NC + 150 g/mT of aspartic protease (NC150); and NC + 200 g/mT of neutral serine protease (NC200). The inclusion of protease, independently of the source and amount, increased the average daily weight gain (P < 0.05) of animals compared with the control treatments (PC and NC), improved feed conversion (P < 0.05) in early stages, and improved diet digestibility (P < 0.05) compared with the PC. Treatment with NC150 and NC200 resulted in greater carcass weights (P < 0.05) than treatment with the PC. NC100 led to a greater carcass yield than PC (P < 0.05), and NC150 resulted in a greater loin eye area than PC (P < 0.05). No differences (P > 0.05) in the blood parameters or salivary cortisol levels were found. Regarding economic viability, proteases increased the profitability, with NC150 leading to the best results. Thus, the use of aspartic proteases is recommended to improve performance and further facilitate pork production.

Evaluation of a Phytogenic Compound with Minerals as a Possible Alternative to Ractopamine for Finishing Pigs.

The objective of this work was to evaluate the effect of a phytogenic compound for pigs in the growing and finishing phases as a possible substitute for ractopamine. A total of 140 pigs with an average initial weight of 48.8 kg ± 5.9 kg were used, distributed in a randomized block design, in a 3 × 2 factorial scheme (control diet (CONT), diet with inclusion of 2.5 kg per ton of a phytogenic compound (PC), and diet with 10 ppm of ractopamine (RAC), and two sexes: gilts and barrows), distributed in eight pens per treatment. The performance parameters were measured, and, at the end of the experimental period, the animals were slaughtered for carcass characteristics and pork quality analysis. The animals consuming RAC showed a better feed conversion, 4% improvement in relation to the group with the PC (p < 0.05). For daily weight gain, the animals supplemented with the PC showed 4.46% lower gain compared to RAC, and 3% greater gain compared to the CONT (p < 0.05). The animals that consumed the PC showed 5.6% lower shear force of the pork (p < 0.05) in relation to the CONT group and 29% lower in relation to the RAC group. The TBARS value presented a significant difference (p < 0.05), the CONTT group was 29% higher than the RAC, and the PC was 15.5% higher than the RAC. For chroma, the pork of the RAC group was 14% lower than the CONTT group and 10.3% less than the PC. There was no significant difference for the carcass parameters. It was concluded that the pigs in the ractopamine group presented the best performance; however, the phytogenic compound can be used against ractopamine's restriction because it improves daily weight gain and promotes a softer and less pale meat when compared with ractopamine.

Y-shaped Bifurcated Graft to Pulmonary Arteries After Arterial Switch Operation.

Pulmonary artery stenosis is a frequent complication after arterial switch operation. This case study presented a complex pulmonary artery stenosis initially treated with bilateral pulmonary artery stenting. The patient was found to have aortic valve endocarditis and recurrent pulmonary artery stenosis. The aortic valve was replaced and the pulmonary valve was repaired, followed by interposition of a Y-shaped graft from the sinotubular junction to both pulmonary arteries. The patient had an uneventful recovery and was discharged home asymptomatic after endocarditis antibacterial treatment.

Multi-Locus Models to Address Hb F Variability in Portuguese ß-Thalassemia Carriers.

Hb F production is under the influence of major quantitative trait loci (QTL). The present study aims: i) to replicate the association with Hb F for representative genetic variants in the three major Hb F QTLs in a Portuguese sample of ß-thalassemia (ß-thal) carriers; and ii) to test different genetic multi-locus models to account for the genetic component of Hb F variation. A population sample of 79 Portuguese ß-thal carriers (39 males, 40 females), aged between 2 to 70 years old, were genotyped for polymorphisms in the locus control region (LCR)-5' hypersensitive site 4 (5'HS4) rs16912979, XmnI-HBG2 rs7482144, BCL11A rs1427407 and HMIP rs66650371, using standard biomolecular procedures. Univariate linear regression models were used to test for genetic associations with Hb F. The minor alleles of the individual variants BCL11A rs1427407 (T) (0.165), HMIP rs66650371 (3 bp del) (0.247) and XmnI-HBG2 rs7482144 (T) (0.196), were found to be significantly associated with increased levels of Hb F (p = 0.029, p = 0.002 and p = 0.0004, respectively), explaining about 6.0, 12.0 and 15.0% of Hb F variation, respectively. In a multiple linear regression approach, the three loci accounted for about 30.0% of Hb F variance. Two genetic risk scores (GRS), rationalizing the number of minor alleles into a single genetic variable, explained about 30.0 and 32.0% of the Hb F variation. In conclusion, we replicated in ß-thal carriers previously reported associations with Hb F. Multi-locus models combining three representative variants of Hb F influencing QTLs can explain a larger amount of Hb F variability.

Relationship between Obesity and Coronary Artery Disease Defined by Coronary Computed Tomography Angiography

Abstract Background: Although associated with traditional cardiovascular risk factors, it is unclear whether obesity alone is associated with coronary artery disease (CAD). Objective: To investigate the role of obesity as a risk factor for CAD, defined by coronary computed tomography angiography (CCTA). Methods: This study retrospectively included 1,814 patients referred for CCTA in a hospital in São Paulo, from August 2010 to July 2012. CAD was identified by coronary calcium score and presence of coronary stenosis > 50%. Images were analyzed by two specialists, and the coronary findings were compared between obese and non-obese groups. A multivariate analysis model was used to assess obesity as an independent variable for the occurrence of obstructive CAD. Results: Among the study population, mean age was 58.5 +/- 11.5 years, 22.8% were obese (BMI = 30 kg/m2) and 66.3% were male. The prevalence of obstructive CAD was 18.4% in both groups. Obese patients had higher median calcium score compared to non-obese subjects (14.7 vs. 1.4, respectively, p = 0.019). In the multivariate analysis, obesity was not an independent factor for obstructive CAD (coefficient = -0.035, p = 0.102). Conclusion: Although no differences were observed in the prevalence of obstructive CAD between obese and non-obese individuals, coronary calcium scores were significantly in lower the latter group.

Interleukin 1α and 1ß gene variations are associated with tuberculosis in silica exposed subjects.

INTRODUCTION: Silicosis is a fibrotic lung disease resulting from the inhalation of crystalline silica and can be classified as simple or complicated according to the International Labour Organization criteria. Furthermore, individuals exposed to crystalline silica also have a higher risk for the development of tuberculosis (Tb). The contribution of inflammatory cytokines to the risk of silicosis and Tb in different populations has previously been reported. Since genetic background might be related to susceptibility to silicosis and Tb, the study of polymorphisms within IL-1α, IL-1ß, and tumor necrosis factor protein-coding genes may contribute to elucidating the genetic basis of these diseases. METHODS: Single nucleotide polymorphisms (SNPs) were genotyped by polymerase chain reaction using restriction fragment length polymorphism or by Taqman methodology, in a sample of 102 silica-exposed patients from Brazil. RESULTS: No significant associations were observed between the SNPs studied and the severity of silicosis. However, significant associations were found between Tb and the C allele (odds ratio [OR] = 1.93, 95% confidence interval [CI], 1.01-3.73) and the CC genotype (OR = 2.34, 95% CI, 1.04-5.31) of IL1A -899C>T. The IL1B +3954C>T polymorphism also showed an association with Tb (T allele dominant model OR = 2.38, 95% CI, 1.04-5.41). CONCLUSION: These preliminary results demonstrate that the IL1A and IL1B gene variations may contribute to some extent to susceptibility to Tb, but not silicosis. However, additional studies are still needed to confirm these results.

Desempenho diagnóstico da reserva de fluxo fracionado por tomografia na detecção de estenoses coronárias hemodinamicamente significativas / Fractional flow reserve by tomography diagnostic performance in the detection of coronary stenoses hemodynamically significant

BACKGROUND: Coronary computed tomography angiography is a noninvasive anatomic test for the diagnosis of coronary artery disease. The coronary fractional flow reserve is the gold standard method to determine if coronary stenosis is hemodynamically significant but requires an invasive procedure. Fractional flow reserve measurement by tomography is a new method to determine the hemodynamic significance of coronary luminal reduction. OBJECTIVE: To compare the accuracy of the invasive fractional flow reserve with the fractional flow reserve measurement by tomography. METHOD: Patients submitted to invasive coronary computed tomography angiography and fractional flow reserve were included in the study. Flow-restricted stenosis was defined by fractional flow reserve measurement by tomography and fractional flow reserve ≤ 0.8, and anatomically significant coronary artery disease was defined as stenosis ≥ 50%. Diagnostic performance of fractional flow reserve measurement by tomography and stenosis by coronary computed tomography angiography was accessed with invasive fractional flow reserve as the gold standard. RESULTS: Among the patients, 33% had fractional flow reserve ≤0.8. There was no significant difference between the fractional flow reserve measurement by tomography and fractional flow reserve averages (0.87 versus 0.84; p = 0.4). The correlation between the values of the methods was r = 0.77, and concordance was moderate (k = 0.54). When fractional flow reserve ≤ 0.75 was analyzed, the concordance between the methods was absolute. The sensitivity, specificity, positive predictive value and negative predictive value of fractional flow reserve measurement by tomography were, respectively, 50%, 100%, 100% and 75%, for the threshold of 0.8. The mean difference between fractional flow reserve and fractional flow reserve measurement by tomography was -0.033 (95%CI -0.072-0.007), with concordance limits between -0.176 and -0.1111. CONCLUSION: Fractional flow reserve measurement by tomography is a new method with high diagnostic performance in the detection of hemodynamically significant coronary stenoses and significantly elevates the specificity of the isolated coronary computed tomography angiography.

FUNDAMENTO: A angiotomografia de coronárias é um teste anatômico não invasivo para diagnóstico de doença arterial coronariana. A reserva de fluxo fracionado coronariano é o método padrão-ouro para determinar se a estenose coronariana é hemodinamicamente significativa e requer procedimento invasivo. A mensuração da reserva de fluxo fracionado por tomografia é um novo método para determinar a significância hemodinâmica da redução luminal coronária. OBJETIVO: Comparar a acurácia da reserva de fluxo fracionado invasiva com a reserva de fluxo fracionado por tomografia. MÉTODO: Pacientes submetidos à angiotomografia de coronárias e à reserva de fluxo fracionado invasiva foram incluídos neste estudo. Estenose com limitação de fluxo foi definida por reserva de fluxo fracionado por tomografia e reserva de fluxo fracionado ≤ 0,8. Doença arterial coronariana anatomicamente significativa foi definida por estenose ≥ 50%. O desempenho da reserva de fluxo fracionado por tomografia e da estenose pela angiotomografia de coronárias foi acessado com a reserva de fluxo fracionado invasiva como padrão-ouro. RESULTADOS: Dentre os pacientes, 33% tinham reserva de fluxo fracionado ≤ 0,8. Não houve diferença significativa entre as médias de reserva de fluxo fracionado por tomografia e reserva de fluxo fracionado (0,87 versus 0,84; p=0,4). A correlação entre os valores dos métodos foi r = 0,77, com concordância moderada (k=0,54). Quando analisada a reserva de fluxo fracionado ≤ 0,75, a concordância entre os métodos foi absoluta. Sensibilidade, especificidade, valor preditivo positivo e negativo da reserva de fluxo fracionado por tomografia foram, respectivamente, 50%, 100%, 100% e 75%, para o limiar de 0,8. A média da diferença entre reserva de fluxo fracionado e reserva de fluxo fracionado por tomografia foi de -0,033 (IC95% -0,072-0,007), com limites de concordância entre -0,176 e -0,111. CONCLUSÃO: A reserva de fluxo fracionado por tomografia é um novo método, com alto desempenho diagnóstico na detecção de estenoses coronárias hemodinamicamente significativas, e eleva significativamente a especificidade da angiotomografia de coronárias isolada.

Scimitar sign in the absence of anomalous pulmonary venous drainage: a case report.

BACKGROUND: Scimitar syndrome consists of anomalous pulmonary vein drainage to the inferior vena cava. Its name derives from the image this anomalous pulmonary vein creates on a chest radiograph. We describe a case of normal venous pulmonary vein drainage that also presented the scimitar sign due to an aorto-collateral vessel. CASE SUMMARY: A 15-month-old girl presented with mild dyspnoea and fever. Control chest X-ray showed an image of cardiac dextroposition, hypoplastic right lung, and the 'scimitar sign'. Although the transthoracic echocardiogram confirmed the initial suspicion of anomalous pulmonary venous drainage, the computed tomography (CT) scan showed normal right pulmonary veins connected to the left atrium and revealed that an aorto-collateral vessel caused the scimitar sign. DISCUSSION: Although the patient had several typical alterations of the scimitar syndrome, the pulmonary venous connection was normal, and the scimitar sign was due to an aorto-collateral vessel. It might be difficult to describe venous pulmonary connections on the basis of echocardiography, so an angio CT scan proved to be a valuable tool in this scenario.

Image Quality and Radiation Exposure Comparison of a Double High-Pitch Acquisition for Coronary Computed Tomography Angiography Versus Standard Retrospective Spiral Acquisition in Patients With Atrial Fibrillation.

OBJECTIVE: The aim of this study was to compare image quality and radiation dose of coronary computed tomography (CT) angiography performed with dual-source CT scanner using 2 different protocols in patients with atrial fibrillation. METHODS: Forty-seven patients with AF underwent 2 different acquisition protocols: double high-pitch (DHP) spiral acquisition and retrospective spiral acquisition. The image quality was ranked according to a qualitative score by 2 experts: 1, no evident motion; 2, minimal motion not influencing coronary artery luminal evaluation; and 3, motion with impaired luminal evaluation. A third expert solved any disagreement. RESULTS: A total of 732 segments were evaluated. The DHP group (24 patients, 374 segments) showed more segments classified as score 1 than the retrospective spiral acquisition group (71.3% vs 37.4%). Image quality evaluation agreement was high between observers (κ = 0.8). There was significantly lower radiation exposure for the DHP group (3.65 [1.29] vs 23.57 [10.32] mSv). CONCLUSIONS: In this original direct comparison, a DHP spiral protocol for coronary CT angiography acquisition in patients with atrial fibrillation resulted in lower radiation exposure and superior image quality compared with conventional spiral retrospective acquisition.

The shift from high to low turnover bone disease after parathyroidectomy is associated with the progression of vascular calcification in hemodialysis patients: A 12-month follow-up study.

Parathyroidectomy (PTX) may cause low levels of PTH, leading to an excessive reduction of bone turnover, which is associated with poor outcomes in dialysis patients, including vascular calcification (VC). We aimed to prospectively investigate the impact of PTX on bone remodeling and its potential consequence on the progression of VC in hemodialysis patients. In this prospective study, 19 hemodialysis patients with severe secondary hyperparathyroidism (sHPT) were evaluated. All patients underwent laboratorial tests and coronary tomography at baseline and, 6 and 12 months after PTX; bone biopsy was performed at baseline and 12-month. At baseline, all patients had increased PTH levels up to 2500 pg/mL and high turnover bone disease in their bone biopsies. Fourteen (74%) patients had VC. During the follow-up, there was a significant decrease of PTH at 6 and 12-month. At 12-month, 90% of the patients evolved to low turnover bone disease. During the period of the hungry bone syndrome (first 6 months), no change of coronary calcium score was observed. However, calcium score increased significantly thereafter (12th month). There was an association between VC progression and the severity of low turnover bone disease. In conclusion, the shift from high to low turnover bone disease after PTX occurs in parallel to VC progression, contributing to the understanding of the complex pathophysiology involving mineral metabolism and cardiovascular disease in hemodialysis patients.

Fenómeno del niño historia y perspectivas / The "el niño" phenomenon history and perspectives

Ecuador se ubica en zona de riesgo para la llegada del Fenómeno del Niño, por lo que es necesario estar informados sobre este tema y diferenciar que es la Corriente del Niño (corriente cálida del Pacífico Sudamericano) y el Niño-Oscilación del Sur (patrón climático en el que se producen oscilaciones de la temperatura en dos fases: el Fenómeno del Niño y La Niña). En los años 1997-1998 este fenómeno afectó el 60% del total de la población, con un impacto muy alto en la salud de la ciudadanía, así como en la propiedad pública privada y en diversos ecosistemas. Ante la amena-za en el periodo 2015-2016, la Secretaría de Gestión de Riesgos (SGR) planificó tres etapas de acción: Preparación, Respuesta y Re-habilitación. Luego de la revisión los autores recomiendan entre otras cosas: brindar información oportuna sobre los cambios meteorológicos, informar sobre los planes de contingencia, garantizar la seguridad alimentaria y el acceso al agua; y fortalecer la atención integral que proveen los Servicios de Salud.

Ecuador is located in the a danger zone for the arrival of "El Niño" phenomenon, so it is really necessary to be informed about this issue and notice the difference between "El Niño" (South American Pacific warm current) and "El Niño" Southern Oscillation (ENSO) ( weather pattern in which temperature fluc-tuations occur in two phases: "El Niño" and "La Niña"). In 1997-1998 this phenomenon affected the 60% of the total population, with a very high impact on the public health as well as private and public property in different ecosystems. Faced to a possible threat in the period 2015-2016, the Risk Management Secretary (RMS) planned three action stages: Preparation, Response and Rehabilitation. After reviewing the authors recommend: provide timely infor-mation about weather changes, report on contingency plans, confirm food security and water access, and strengthen the compre-hensive care that provides the Health Servi-ces.

Estudo comparativo entre o uso do antiagregante plaquetário e do anticoagulante oral na profilaxia de trombose em pacientes submetidos à operação cavopulmonar total com tubo extracardíaco: análise ecocardiográfica, angiotomográfica, cintilográfica, laboratorial e clínica / Comparative trial of the use of antiplatelet and oral anticoagulant in thrombosis prophylaxis in patients undergoing total cavopulmonary operation with extracardiac conduit: echocardiographic, tomographic, scintigraphic, clinical and laboratory analysis

Objetivo: Comparar a eficácia do AAS e da Varfarina na profilaxia da trombose em pacientes submetidos a operação cavopulmonar total. Avaliar se fatores de coagulação (VII, VIII e Proteína C), dados clínicos, fenestração ou fatores hemodinâmicos, interferem na trombose no pós-operatório. Métodos: Estudo prospectivo e randomizado de 30 pacientes, randomizados em Grupo I (Varfarina) e Grupo II (AAS), submetidos à derivação cavopulmonar total com tubo extracardíaco, entre 2008 e 2011, com seguimento de dois anos. Foram realizadas consultas clínicas que avaliavam efeitos colaterais e aderência. Realizado ecocardiograma transesofágico no pós-operatório imediato, 3, 6,12 e 24 meses; angiotomografia aos 6, 12 e 24 meses de pós-operatório para avaliação de alterações na parede interna do tubo ou trombos e cintilografia pulmonar, para avaliar possível TEP. Resultados: Dois óbitos no grupo I; 33,3% dos pacientes apresentaram trombo (46,7% no Grupo II). A ocorrência prévia de trombo e baixos níveis de proteína C da coagulação foram os únicos fatores que influenciaram no tempo livre de trombo (P=0,035 e 0,047). Avaliação angiotomográfica: 35,7% dos pacientes do grupo II tinham atapeteamento maior que 2 mm (P=0,082). Cintilografia: dois pacientes apresentaram TEP no grupo II. Cinco pacientes tiveram dificuldade de aderência, 4 no grupo I com INR variando de 1 a 6,4. Conclusão: A ocorrência prévia de trombo é um fator de risco para trombose no pós-operatório. Pacientes em uso de AAS tendem a depósito de material na parede do tubo. O número reduzido da amostra não permitiu concluir qual a droga mais eficaz na prevenção da trombose na população estudada. .

Objective: To compare the efficacy of aspirin and warfarin for prophylaxis of thrombosis in patients undergoing total cavopulmonary anastomosis. Evaluate whether coagulation factors (VII, VIII and protein C), clinical data, fenestration or hemodynamic factors, interfere with postoperative thrombosis. Methods: A prospective, randomized study of 30 patients, randomized into Group I (Warfarin) and Group II (AAS), underwent total cavopulmonary shunt with extracardiac conduit, between 2008 and 2011, with follow-up by clinical visits to evaluate side effects and adhesion. Performed transesophageal echocardiography in post operatory time, 3, 6,12 and 24 months; angiotomography at 6, 12 and 24 months to evaluate changes in the internal tube wall or thrombi and pulmonary scintigraphy to evaluate possible PTE. Results: Two deaths in group I; 33.3% of patients had thrombus (46.7% in Group II). The previous occurrence of thrombus and low levels of coagulation protein C were the only factors that influenced the time free of thrombus (P=0.035 and 0.047). Angiotomographic evaluation: 35.7% in group II presented material accumulation greater than 2 mm (P=0.082). Scintigraphy: two patients had PTE in group II. Five patients had difficulty to comply with the treatment, 4 in group I with INR ranging from 1 to 6.4. Conclusion: The previous occurrence of thrombus is a risk factor for thrombosis in the postoperative period. Patients using AAS tend to deposit material in the tube wall. The small sample size did not allow to conclude which is the most effective drug in the prevention of thrombosis in this population. .