Hemoglobin in large vessel occlusion: Look further than collaterals.

BACKGROUND: Abnormal hemoglobin (Hb) levels lead to poorer outcomes in ischemic stroke, though the mechanisms remain elusive. We aimed to study the role of Hb on imaging and clinical outcomes, namely on collaterals as it is a known mediator of infarct growth. METHODS: Retrospective cohort study of patients with large vessel occlusion ischemic stroke admitted to our center. Demographics, clinical and imaging variables were collected, particularly baseline hemoglobin, presence of anemia and collateral score. Collaterals were scored from 0 to 3 and defined as poor if 0-1. Multivariable analyses were performed for collateral score and clinical outcomes (3-month mortality and good prognosis). RESULTS: We included 811 patients, 215 (26.5 %) with anemia. Patients with anemia were older, had more comorbidities and more severe strokes. Hemoglobin levels and anemia were not associated with collateral score (OR 0.97, 95 % CI 0.89-1.05, p = 0.414 and OR 0.89, 95 % CI 0.64-1.24, p = 0.487, respectively) nor with poor collaterals (OR 0.96, 95 % CI 0.88-1.05, p = 0.398 and OR 0.86, 95 % CI 0.60-1.23, p = 0.406, respectively). Hb levels were associated with 3-month mortality (OR 0.85, 95 % CI 0.76-0.96, p = 0.008). CONCLUSION: Hemoglobin or anemia were not found to be associated with collateral status. Our results raise further questions regarding the pathophysiology of anemia and outcomes in ischemic stroke, highlighting the need for future research.

Autonomic dysfunction is common in liver cirrhosis and is associated with cardiac dysfunction and mortality: prospective observational study.

BACKGROUND: Although autonomic dysfunction has been shown to be associated with liver cirrhosis, the prevalence and prognostic implications are unclear. Abnormal heart rate variability (HRV), a measure of autonomic function, has not been well investigated in cirrhosis. OBJECTIVE: To evaluate the prevalence of high-risk HRV parameters in a cohort of cirrhotic patients and their association with cardiac dysfunction and mortality. DESIGN AND SETTING: Prospective observational study conducted in the Federal University of São Paulo. METHOD: A cohort of 120 patients, comprising 17 healthy controls and 103 cirrhotic outpatients, was evaluated and followed for 10 months. HRV analysis was based on 24-hour Holter monitoring and defined using time-domain and frequency-domain parameters. RESULTS: The HRV parameters were statistically lower in cirrhotic patients than in healthy subjects. High-risk HRV parameters were prevalent, such that 64% had at least one high-risk parameter. Time-domain parameters correlated with Child scores (P < 0.0001). In regression models, HRV parameters were independent predictors of diastolic dysfunction and mortality. During 10 months of follow-up, there were 11 deaths, all of patients with at least one high-risk HRV parameter. Kaplan-Meier analysis estimated low survival rates among patients with standard deviation of normal-to-normal RR intervals (SDNN) < 100. CONCLUSION: Reduced HRV is prevalent in liver cirrhosis and is related to cardiac dysfunction, severity of liver disease and mortality. Abnormal high-risk HRV parameters are prevalent among cirrhotic patients and are also predictors of mortality. Our findings highlight the need for a more careful cardiac evaluation of cirrhotic patients.

Nationwide Access to Endovascular Treatment for Acute Ischemic Stroke in Portugal.

INTRODUCTION: Since the publication of endovascular treatment trials and European Stroke Guidelines, Portugal has re-organized stroke healthcare. The nine centers performing endovascular treatment are not equally distributed within the country, which may lead to differential access to endovascular treatment. Our main aim was to perform a descriptive analysis of the main treatment metrics regarding endovascular treatment in mainland Portugal and its administrative districts. MATERIAL AND METHODS: A retrospective national multicentric cohort study was conducted, including all ischemic stroke patients treated with endovascular treatment in mainland Portugal over two years (July 2015 to June 2017). All endovascular treatment centers contributed to an anonymized database. Demographic, stroke-related and procedure-related variables were collected. Crude endovascular treatment rates were calculated per 100 000 inhabitants for mainland Portugal, and each district and endovascular treatment standardized ratios (indirect age-sex standardization) were also calculated. Patient time metrics were computed as the median time between stroke onset, first-door, and puncture. RESULTS: A total of 1625 endovascular treatment procedures were registered. The endovascular treatment rate was 8.27/100 000 inhabitants/year. We found regional heterogeneity in endovascular treatment rates (1.58 to 16.53/100 000/year), with higher rates in districts closer to endovascular treatment centers. When analyzed by district, the median time from stroke onset to puncture ranged from 212 to 432 minutes, reflecting regional heterogeneity. DISCUSSION: Overall endovascular treatment rates and procedural times in Portugal are comparable to other international registries. We found geographic heterogeneity, with lower endovascular treatment rates and longer onset-to-puncture time in southern and inner regions. CONCLUSION: The overall national rate of EVT in the first two years after the organization of EVT-capable centers is one of the highest among European countries, however, significant regional disparities were documented. Moreover, stroke-onset-to-first-door times and in-hospital procedural times in the EVT centers were comparable to those reported in the randomized controlled trials performed in high-volume tertiary hospitals.

Introdução: A aprovação do tratamento endovascular para o acidente vascular cerebral isquémico obrigou à reorganização dos cuidados de saúde em Portugal. Os nove centros que realizam tratamento endovascular não estão distribuídos equitativamente pelo território, o que poderá causar acesso diferencial a tratamento. O principal objetivo deste estudo é realizar uma análise descritiva da frequência e métricas temporais do tratamento endovascular em Portugal continental e seus distritos. Material e Métodos: Estudo de coorte nacional multicêntrico, incluindo todos os doentes com acidente vascular cerebral isquémico submetidos a tratamento endovascular em Portugal continental durante um período de dois anos (julho 2015 a junho 2017). Foram colhidos dados demográficos, relacionados com o acidente vascular cerebral e variáveis do procedimento. Taxas de tratamento endovascular brutas e ajustadas (ajuste indireto a idade e sexo) foram calculadas por 100 000 habitantes/ano para Portugal continental e cada distrito. Métricas de procedimento como tempo entre instalação, primeira porta e punção foram também analisadas. Resultados: Foram registados 1625 tratamentos endovasculares, indicando uma taxa bruta nacional de tratamento endovascular de 8,27/100 000 habitantes/ano. As taxas de tratamento endovascular entre distritos variaram entre 1,58 e 16,53/100 000/ano, com taxas mais elevadas nos distritos próximos a hospitais com tratamento endovascular. O tempo entre sintomas e punção femural entre distritos variou entre 212 e 432 minutos. Discussão: A análise nacional a taxas de tratamento endovascular e tempos de atuação é comparável a outros registos internacionais. Verificaram-se heterogeneidades geográficas, com taxas de tratamento endovascular menores e maior tempo para tratamento nos distritos do sul e interior. Conclusão: Portugal continental apresenta uma taxa nacional de tratamento endovascular elevada, apresentando, contudo, assimetrias regionais no acesso. As métricas temporais foram comparáveis com as observadas nos ensaios clínicos piloto.

Characterization of Brazilian lager and brown ale beers based on color, phenolic compounds, and antioxidant activity using chemometrics.

BACKGROUND: Epidemiological studies have shown that beer has positive effects on inhibiting atherosclerosis, decreasing the content of serum low-density lipoprotein cholesterol and triglycerides, by acting as in vivo free radical scavenger. In this research, the antioxidant activity of commercial Brazilian beers (n = 29) was determined by the oxygen radical absorbance capacity (ORAC) and 1,1-diphenyl-2-picrylhydrazyl (DPPH(·) ) assays and results were analyzed by chemometrics. RESULTS: The brown ale samples (n = 11) presented higher (P < 0.05) flavonoids (124.01 mg L(-1) ), total phenolics (362.22 mg L(-1) ), non-flavonoid phenolics (238.21 mg L(-1) ), lightness (69.48), redness (35.75), yellowness (55.71), color intensity (66.86), hue angle (59.14), color saturation (0.9620), DPPH(·) values (30.96% inhibition), and ORAC values (3, 659.36 µmol Trolox equivalents L(-1) ), compared to lager samples (n = 18). Brown ale beers presented higher antioxidant properties (P < 0.05) measured by ORAC (1.93 times higher) and DPPH (1.65 times higher) compared to lager beer. ORAC values correlated well with the content of flavonoids (r = 0.47; P = 0.01), total phenolic compounds (r = 0.44; P < 0.01) and DPPH (r = 0.67; P < 0.01). DPPH values also correlated well to the content of flavonoids (r = 0.69; P < 0.01), total phenolic compounds (r = 0.60; P < 0.01), and non-flavonoid compounds (r = 0.46; P = 0.01). CONCLUSION: The results suggest that brown ale beers, and less significantly lager beers, could be sources of bioactive compounds with suitable free radical scavenging properties.

Functional Foods and Nondairy Probiotic Food Development: Trends, Concepts, and Products.

Recently, the focus of scientific investigations has moved from the primary role of food as the source of energy and body-forming substances to the more subtle action of biologically active food components on human health. There has been an explosion of consumer interest in the active role of food in the well-being and life prolongation, as well as in the prevention of initiation, promotion, and development of nontransmissible chronic diseases. As a result, a new term-functional food-was proposed. Among these foods, probiotics may exert positive effects on the composition of gut microbiota and overall health, and the market is increasing annually. An increased demand for nondairy probiotic products comes from vegetarianism, milk cholesterol content, and lactose intolerance. Therefore, the development of these products is a key research priority for food design and a challenge for both industry and science sectors. This article presents an overview of functional food development, emphasizing nondairy foods that contain probiotic bacteria strains.

Probiotic Dairy Products as Functional Foods.

Foods that affect specific functions or systems in the human body, providing health benefits beyond energy and nutrients-functional foods-have experienced rapid market growth in recent years. This growth is fueled by technological innovations, development of new products, and the increasing number of health-conscious consumers interested in products that improve life quality. Since the global market of functional foods is increasing annually, food product development is a key research priority and a challenge for both the industry and science sectors. Probiotics show considerable promise for the expansion of the dairy industry, especially in such specific sectors as yogurts, cheeses, beverages, ice creams, and other desserts. This article presents an overview of functional foods and strategies for their development, with particular attention to probiotic dairy products. Moreover, special attention is paid to the sensory properties of such products to provide important information about their most desirable attributes.

Autonomic dysfunction is common in liver cirrhosis and is associated with cardiac dysfunction and mortality: prospective observational study

ABSTRACT BACKGROUND: Although autonomic dysfunction has been shown to be associated with liver cirrhosis, the prevalence and prognostic implications are unclear. Abnormal heart rate variability (HRV), a measure of autonomic function, has not been well investigated in cirrhosis. OBJECTIVE: To evaluate the prevalence of high-risk HRV parameters in a cohort of cirrhotic patients and their association with cardiac dysfunction and mortality. DESIGN AND SETTING: Prospective observational study conducted in the Federal University of São Paulo. METHOD: A cohort of 120 patients, comprising 17 healthy controls and 103 cirrhotic outpatients, was evaluated and followed for 10 months. HRV analysis was based on 24-hour Holter monitoring and defined using time-domain and frequency-domain parameters. RESULTS: The HRV parameters were statistically lower in cirrhotic patients than in healthy subjects. High-risk HRV parameters were prevalent, such that 64% had at least one high-risk parameter. Time-domain parameters correlated with Child scores (P < 0.0001). In regression models, HRV parameters were independent predictors of diastolic dysfunction and mortality. During 10 months of follow-up, there were 11 deaths, all of patients with at least one high-risk HRV parameter. Kaplan-Meier analysis estimated low survival rates among patients with standard deviation of normal-to-normal RR intervals (SDNN) < 100. CONCLUSION: Reduced HRV is prevalent in liver cirrhosis and is related to cardiac dysfunction, severity of liver disease and mortality. Abnormal high-risk HRV parameters are prevalent among cirrhotic patients and are also predictors of mortality. Our findings highlight the need for a more careful cardiac evaluation of cirrhotic patients.

Reversed ocular ischaemic syndrome secondary to carotid cavernous sinus embolisation.

Ocular ischaemic syndrome is a progressive and serious vision-threatening condition that is usually associated with carotid artery disease, and poor effective therapeutic options are available. In the present case, a 65-year-old woman was submitted to embolisation of spontaneous carotid-cavernous fistula with complete resolution of initial ophthalmoplaegia and ocular hypertension. Later, ocular ischaemia was detected. Cerebral angiography showed delayed choroidal flush and the patient was admitted for hypervolaemic hypertension therapy and medicated with nimodipine. The ischaemia was reversed and visual function improved.

Effect of the simultaneous interaction among ascorbic acid, iron and pH on the oxidative stability of oil-in-water emulsions.

The objective of this study was to demonstrate how different factors can simultaneously influence the oxidative stability of an oil-in-water emulsion, and how these factors can be used to enlarge the variation range of oxidation markers, expressed as peroxide value (PV) and TBARS. Initially, a Plackett-Burman design was used to screen seven factors (temperature, pH, and iron, copper, ascorbyl palmitate, ascorbic acid, and sodium chloride concentrations). A temperature elevation of 30 to 60 °C reduced PV and TBARS, a pH change from 3.0 to 7.0 increased PV and reduced TBARS, and the presence of ascorbic acid (1 mmol/L) had no significant effect on PV but increased TBARS (p < 0.05). Thus, the temperature was fixed at 30 °C, and an emulsion was formulated with different combinations of ascorbic acid, iron, and pH according to a central composite rotatable design. Regression models were fitted to PV and TBARs responses and optimized to get the higher values of both markers of oxidation. The optimized emulsion contained 1.70 mmol/L AH (ascorbic acid) and 0.885 mmol/L FeSO(4) · 7H(2)O (1.0 mmol/L Fe(2+)) at pH 5.51 and 30 °C. The range of variation observed for oxidation markers in the optimized emulsion model (PV, 0-4.27 mequiv/L; TBARS, 0-13.55 mmol/L) was larger than the variation observed in the nonoptimized model (PV, 0-1.05 mequiv/L; TBARS, 0-1.00 mmol/L). The antioxidant activity of six compounds (Trolox, α-tocopherol, caffeic acid, gallic acid, catechin, and TBHQ) was evaluated using the optimized emulsion conditions. After application of the Tukey HSD post hoc statistical test, the samples that were not different (p < 0.05) in the nonoptimized emulsions showed a significant difference in the optimized emulsions. Considering the importance of the interactions on oxidation studies, our model represents a significant improvement in a direct methodology that can be applied to evaluate natural compounds under different combination of factors.

Reprodutibilidade da manometria anal em mulheres sem distúrbios evacuatórios / Reproducibility of manometry anal in women without evacuating disturbances

O estudo visa verificar a reprodutibilidade da manometria anal, em pacientes do sexo feminino, sem distúrbios evacuatórios, internadas no Serviço de Clínica Cirúrgica do Hospital Universitário de Taubaté, no período de 12 de maio a 16 de agosto de 2003. Pacientes e Métodos: Estudo prospectivo em 11 pacientes voluntárias internadas para tratamento de doença não orifícial ou pélvica, selecionadas de acordo com os seguintes critérios de inclusão: ausência de constipação intestinal e ausência de incontinência fecal. O exame foi realizado sem preparo intestinal prévio com as pacientes em decúbito lateral esquerdo. O balão do manômetro era introduzido no orifício anal até cinco centímetros do rebordo anal. Realizaram-se medidas em intervalo de um em um centímetro no sentido crânio-caudal, em cada ponto medindo: pressão máxima de repouso, pressão máxima de contração, pressão mínima de evacuação. Com a análise dessas variáveis obtivemos mais duas: ponto de maior pressão e comprimento do canal anal. Após 12 horas o exame foi repetido. Para a análise estatística foi utilizado o teste não paramétrico de Wilcoxon. Resultados: O resultado obtido nos dois exames para as mesmas variáveis não apresentou diferença significativa, com exceção da pressão de evacuação a cinco centímetros cujo p foi menor que 0,050.Conclusão:Concluímos com os valores das variáveis pressão máxima de repouso, pressão máxima de contração, pressão minima de evacuação, ponto de maior pressão e comprimento do canal anal foram reprodutíveis após 12 horas, exceto a pressão de evacuação a cinco centímetros do rebordo anal.

Pesquisa de combustíveis com metanol; relatório final / Research into fuels with methanol; final report

O relatório aborda algumas possibilidades de combustíveis alternativos, passíveis de serem usados de forma a suprir a falta de etanol combustível anidro e hidratado, em 1990, sem penalizar significantemente o meio ambiente e o funcionamento e durabilidade dos veículos em uso. É premissa do trabalho que a nova especificaçäo de um combustível näo obrigue a adoçäo de adaptaçäo ou regulagens especiais dos veículos já em circulaçäo, o que comprometeria qualquer possibilidade de controle dessa estratégia e, portanto, da poluiçäo do ar.Este relatório dá resposta a algumas questöes que estavam ainda pendentes, como a emissäo de formaldeido e acetaldeido, o efeito residual do AEHC no abastecimento com a mistura ternária e vice-versa e a influência dessa mistura na regulagem do veículo.Com os resultados obtidos, fica demonstrada a viabilidade técnica para o abastecimento dos veículos a alcool atuais com uma mistura ternária de combustíveis e que assegura a continuidade do controle da qualidade do ar e da proteçäo a saúde pública, sem prejuíjo do transporte por automóveis, para tranquilidade daqueles que se posicionaram contra o uso do metanol em razäo da sua toxicidade. Foram incluídas, também, a análise dos efeitos do metanol na emissäo evaporativa e uma comparaçäo da estratégia emergencial do uso da mistura ternária aqui proposta, com a adiçäo pura e simples de gasolina ao etanol hidratado.