Purification of pineapple bromelain by IMAC chromatography using chlorophyll-activated macroporous matrices.

This study investigated the purification of bromelain obtained from pineapple fruit using a new adsorbent for immobilized metal ion affinity chromatography (IMAC), with chlorophyll obtained from plant leaves as a chelating agent. The purification of bromelain was evaluated in batches from the crude extract of pineapple pulp (EXT), and the extract precipitated with 50 % ammonium sulfate (EXT.PR), the imidazole buffer (200 mM, pH 7.2) being analyzed and sodium acetate buffer, pH 5.0 + 1.0 NaCl as elution solutions. All methods tested could separate forms of bromelain with molecular weights between ±21 to 25 kDa. Although the technique using EXT.PR stood out in terms of purity, presenting a purification factor of around 3.09 ± 0.31 for elution with imidazole and 4.23 ± 0.12 for acetate buffer solution. In contrast, the EXT methods obtained values between 2.44 ± 0.23 and 3.21 ± 0.74 for elution with imidazole and acetate buffer, respectively, for purification from EXT.PR has lower yield values (around 5 %) than EXT (around 15 %). The number of steps tends to reduce yield and increase process costs, so the purification process in a monolithic bed coupled to the chromatographic system using the crude extract was evaluated. The final product obtained had a purification factor of 6, with a specific enzymatic activity of 59.61 ± 0.00 U·mg-1 and a yield of around 39 %, with only one band observed in the SDS-PAGE electrophoresis analysis, indicating that the matrix produced can separate specific proteins from the total fraction in the raw material. The IMAC matrix immobilized with chlorophyll proved promising and viable for application in protease purification processes.

conTemporary reflectiOns regarding heart failure manaGEmenT - How to ovERcome the PorTuguese barriers (TOGETHER-PT).

INTRODUCTION AND OBJECTIVES: Heart failure (HF) is a complex clinical syndrome that is a significant burden in hospitalisations, morbidity, and mortality. Although a significant effort has been made to better understand its consequences and current barriers in its management, there are still several gaps to address. The present work aimed to identify the views of a multidisciplinary group of health care professionals on HF awareness and literacy, diagnosis, treatment and organization of care, identifying current challenges and providing insights into the future. METHODS: A steering committee was established, including members of the Heart Failure Study Group of the Portuguese Society of Cardiology (GEIC-SPC), the Heart Failure Study Group of the Portuguese Society of Internal Medicine (NEIC-SPMI) and the Cardiovascular Study Group (GEsDCard) of the Portuguese Association of General and Family Medicine (APMGF). This steering committee produced a 16-statement questionnaire regarding different HF domains that was answered to by a diversified group of 152 cardiologists, internists, general practitioners, and nurses with an interest or dedicated to HF using a five-level Likert scale. Full agreement was defined as ≥80% of level 5 (fully agree) responses. RESULTS: Globally, consensus was achieved in all but one of the 16 statements. Full agreement was registered in seven statements, namely 3 of 4 statements for patient education and HF awareness and 2 in 4 statements of both HF diagnosis and healthcare organization, with proportions of fully agree responses ranging from 82.9% to 96.7%. None of the HF treatment statements registered full agreement but 3 of 4 achieved ≥80% of level 4 (agree) responses. CONCLUSION: This document aims to be a call-to-action to improve HF patients' quality of life and prognosis, by promoting a change in HF care in Portugal.

Endoplasmic reticulum stress controls PIN-LIKES abundance and thereby growth adaptation.

Extreme environmental conditions eventually limit plant growth [J. R. Dinneny, Annu. Rev. Cell Dev. Biol. 35, 1-19 (2019), N. Gigli-Bisceglia, C. Testerink, Curr. Opin. Plant Biol. 64, 102120 (2021)]. Here, we reveal a mechanism that enables multiple external cues to get integrated into auxin-dependent growth programs in Arabidopsis thaliana. Our forward genetics approach on dark-grown hypocotyls uncovered that an imbalance in membrane lipids enhances the protein abundance of PIN-LIKES (PILS) [E. Barbez et al., Nature 485, 119 (2012)] auxin transport facilitators at the endoplasmic reticulum (ER), which thereby limits nuclear auxin signaling and growth rates. We show that this subcellular response relates to ER stress signaling, which directly impacts PILS protein turnover in a tissue-dependent manner. This mechanism allows PILS proteins to integrate environmental input with phytohormone auxin signaling, contributing to stress-induced growth adaptation in plants.

PILS proteins provide a homeostatic feedback on auxin signaling output.

Multiple internal and external signals modulate the metabolism, intercellular transport and signaling of the phytohormone auxin. Considering this complexity, it remains largely unknown how plant cells monitor and ensure the homeostasis of auxin responses. PIN-LIKES (PILS) intracellular auxin transport facilitators at the endoplasmic reticulum are suitable candidates to buffer cellular auxin responses because they limit nuclear abundance and signaling of auxin. We used forward genetics to identify gloomy and shiny pils (gasp) mutants that define the PILS6 protein abundance in a post-translational manner. Here, we show that GASP1 encodes an uncharacterized RING/U-box superfamily protein that impacts on auxin signaling output. The low auxin signaling in gasp1 mutants correlates with reduced abundance of PILS5 and PILS6 proteins. Mechanistically, we show that high and low auxin conditions increase and reduce PILS6 protein levels, respectively. Accordingly, non-optimum auxin concentrations are buffered by alterations in PILS6 abundance, consequently leading to homeostatic auxin output regulation. We envision that this feedback mechanism provides robustness to auxin-dependent plant development.

Medical Device-Related Pressure Injury in an Intensive Care Unit: A Cross-Sectional Study.

BACKGROUND: Medical devices can cause pressure injuries. PURPOSE: This study was conducted to determine the prevalence of and factors associated with medical device-related pressure injury (MDRPI) in an intensive care unit (ICU). METHODS: A cross-sectional study was performed among adult patients (at least 18 years of age) admitted to an ICU in a referral hospital in Brazil between December 2019 and February 2020. The skin of patients who consented to participate was assessed for the presence of an MDRPI, and the use of all medical devices was noted. Other independent variables (sociodemographic variables, medical history, pressure injury risk factors, medications, and length of hospitalization) were abstracted from the medical records. Bivariate data analysis included Pearson's chi-square test or Fisher's exact test; odds ratio and a confidence interval of 95% also were established. Correlation among independent variables and MDRPI was determined using the ρ Spearman correlation test, and a hierarchical binary logistic regression analysis was performed using statistically significant variables from the bivariate analysis. P < .05 was considered statistically significant. RESULTS: The 125 study participants ranged in age from 15 to 97 years (mean, 63.02 ± 19.2), 76 (60.8%) were men, and 76 (60.8%) were White. Of the 125 participants, 43 (34%) experienced MDRPI; the total number of MDRPIs was 58 (3 patients had 3 injuries, and 7 patients had 2 injuries). Of those 58 MDRPIs, 46 were stage 1, and 12 were stage 2. Polypharmacy (> 4 medications) was a significant risk factor for MDRPI. Use of a nasal catheter, cord for orotracheal tube fixation, oximeter, intra-abdominal pressure equipment, and indwelling urinary catheter was significantly associated with the presence of MDRPI. Renal and respiratory diseases and the presence of infection were positively related to the presence of MDRPI. CONCLUSION: Medical device-related pressure injury was prevalent in this patient population. Most of these injuries were stage 1, which suggests that frequent monitoring and device repositioning (when possible) may help prevent more serious injuries. Additional research involving other hospitals in Brazil is needed to increase the understanding of the prevalence and risk factors of MDRPIs in patients in the ICU.

Análise de correspondência aplicada para a identificação de plantas benéficas da região de Salinas-MG / Correspondence analysis applied for the identification of beneficial plants of the Salinas-MG region

Plantas nativas são utilizadas na alimentação humana e na cura de enfermidades. No que diz respeito às plantas medicinais, o emprego das substâncias nelas contidas, advém do conhecimento empírico. Já as PANC’s são conhecidas pela infinidade de benefícios à saúde, no entanto, há uma variedade de compostos desconhecidos por parte da comunidade científica. Diante do mencionado, objetivou-se coletar informações acerca das plantas com propriedades benéficas e, posteriormente dissipar este conhecimento. Foram feitas visitas in loco para obtenção de dados, e estes tratados pela técnica estatística de análise de correspondência. Foi feito, ainda, uma pesquisa na literatura para a comprovação dos dados encontrados na análise, e, por fim foram criadas cartilhas contendo as informações em relação a utilização das plantas endêmicas da região.

A Novel Predictive Model to Estimate the Number of Mature Oocytes Required for Obtaining at Least One Euploid Blastocyst for Transfer in Couples Undergoing in vitro Fertilization/Intracytoplasmic Sperm Injection: The ART Calculator.

The POSEIDON group (Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number) has introduced "the ability to retrieve the number of oocytes needed to achieve at least one euploid embryo for transfer" as an intermediate marker of successful outcome in IVF/ICSI cycles. This study aimed to develop a novel calculator to predict the POSEIDON marker. We analyzed clinical and embryonic data of infertile couples who underwent IVF/ICSI with the intention to have trophectoderm biopsy for preimplantation genetic testing for aneuploidy. We used the negative binomial distribution to model the number of euploid blastocysts and the adaptive LASSO (Least Absolute Shrinkage and Selection Operator) method for variable selection. The fitted model selected female age, sperm source used for ICSI, and the number of mature (metaphase II) oocytes as predictors (p < 0.0001). Female age was the most important factor for predicting the probability of a blastocyst being euploid given each mature oocyte (loglikelihood of age [adjusted for sperm source]: 30.9; df = 2; p < 0.0001). The final predictive model was developed using logistic regression analysis, and internally validated by the holdout method. The predictive ability of the model was assessed by the ROC curve, which resulted in an area under the curve of 0.716. Using the final model and mathematical equations, we calculated the individualized probability of blastocyst euploidy per mature retrieved oocyte and the minimum number of mature oocytes required to obtain ≥1 euploid blastocyst-with their 95% confidence interval [CI]-for different probabilities of success. The estimated predicted probabilities of a mature oocyte turn into a euploid blastocyst decreased progressively with female age and was negatively modulated overall by use of testicular sperm across age (p < 0.001). A calculator was developed to make two types of predictions automatically, one using pretreatment information to estimate the minimum number of mature oocytes to achieve ≥1 euploid blastocyst, and another based on the actual number of mature oocytes collected/accumulated to estimate the chances of having a euploid blastocyst using that oocyte cohort for IVF/ICSI. The new ART calculator may assist in clinical counseling and individualized treatment planning regarding the number of oocytes required for at least one euploid blastocyst in IVF/ICSI procedures.

Moving the needle towards the democratization of echocardiography: a case report.

BACKGROUND: Echocardiography has been traditionally performed in echo labs and the potential benefits of its use by primary care physicians (PCPs) are still unexplored. We present a case where POCUS (point-of-care ultrasound) was used as a complement of physical examination by a family doctor, allowing a prompt clinical decision in a heart failure (HF) patient. CASE SUMMARY: An 85-year-old woman, living independently, asks her family doctor for a home consultation due to increasing dyspnoea. On examination, severe dyspnoea and bilateral ankle oedema was noted and a point-of-care echocardiogram was performed by the primary care physician, who observed: severely compromised left ventricular systolic function, moderate mitral and tricuspid regurgitation, and severe dilation of the inferior vena cava. As a result, the diagnosis of HF with decreased ejection fraction was formed supporting the therapeutic decision. DISCUSSION: This case represents an elderly patient with dyspnoea, without previous HF diagnosis. The primary care physician, used portable ultrasound as a complement of physical examination, which confirmed a HF diagnosis, allowing a prompt decision-making on therapy. POCUS, can be a powerful tool to expedite treatment in different settings, including the home consultations by PCPs.

CT perfusion imaging of lung cancer: benefit of motion correction for blood flow estimates.

PURPOSE: CT perfusion (CTP) imaging assessment of treatment response in advanced lung cancer can be compromised by respiratory motion. Our purpose was to determine whether an original motion correction method could improve the reproducibility of such measurements. MATERIALS AND METHODS: The institutional review board approved this prospective study. Twenty-one adult patients with non-resectable non-small-cell lung cancer provided written informed consent to undergo CTP imaging. A motion correction method that consisted of manually outlining the tumor margins and then applying a rigid manual landmark registration algorithm followed by the non-rigid diffeomorphic demons algorithm was applied. The non-motion-corrected and motion-corrected images were analyzed with dual blood supply perfusion analysis software. Two observers performed the analysis twice, and the intra- and inter-observer variability of each method was assessed with Bland-Altman statistics. RESULTS: The 95% limits of agreement of intra-observer reproducibility for observer 1 improved from -84.4%, 65.3% before motion correction to -33.8%, 30.3% after motion correction (r = 0.86 and 0.97, before and after motion correction, p < 0.0001 for both) and for observer 2 from -151%, 96% to -49 %, 36 % (r = 0.87 and 0.95, p < 0.0001 for both). The 95% limits of agreement of inter-observer reproducibility improved from -168%, 154% to -17%, 25%. CONCLUSION: The use of a motion correction method significantly improves the reproducibility of CTP estimates of tumor blood flow in lung cancer. KEY POINTS: • Tumor blood flow estimates in advanced lung cancer show significant variability. • Motion correction improves the reproducibility of CT blood flow estimates in advanced lung cancer. • Reproducibility of blood flow measurements is critical to characterize lung tumor biology and the success of treatment in lung cancer.

Trimethylation of histone 3 at lysine 4 in cryopreserved bovine embryos produced in vivo with sexed semen.

The production rates of viable embryos using sexed semen through the conventional methodologies of multiple ovulation and embryo transfer are generally not satisfactory. However, the cryopreservation of these embryos is considered efficient. Knowledge of epigenetics can provide new tools or allow for adapting new protocols that could enhance the efficiency of reproductive biotechnologies. The aim of this study was to characterize the pattern of trimethylation of histone 3 at lysine 4 (H3K4me3) in bovine embryos produced in vivo with sexed semen that were submitted to cryopreservation. Bos taurus × Bos indicus cows (n = 5) were superovulated and inseminated with sexed (two sessions) or conventional (two sessions) semen. A portion of the embryos collected on Day 7 was immediately stored in paraformaldehyde (3%) and another portion was stored in paraformaldehyde after cryopreservation/thawing. All embryos from the four groups (fresh, conventional semen; fresh, sexed semen; cryopreserved, conventional semen; and cryopreserved, sexed semen; 15 embryos per group) were evaluated by immunofluorescence under confocal microscopy to identify and quantify the H3K4me3 status. In total, 190 embryos were recovered, 100 of which were produced with conventional semen and 90 with sexed semen. The use of conventional semen after superovulation yielded 72% (72 of 100) viable embryos, which were mostly (81%; 59 of 72) in advanced stages of development (blastocysts and expanded blastocysts). Embryos produced with sexed semen had a lower viability rate (36.7%; 33 of 90), and most of them were collected at earlier stages of development (morulae and early blastocysts; P < 0.05). The H3K4me3 signal was similar among groups; however, there was a difference between morulae and blastocysts. A high intensity of H3K4me3 was observed in bovine embryos produced in vivo, and this pattern did not vary using sexed semen and the slow cryopreservation process. The lower viability of bovine embryos produced with sexed semen could be not explained by differences in H3K4me. Cryopreservation did not alter the pattern of H3K4me3; in this sense, we suggest that it is a process that exerts minimal damage to the embryos.

Neem oil increases the efficiency of the entomopathogenic fungus Metarhizium anisopliae for the control of Aedes aegypti (Diptera: Culicidae) larvae.

BACKGROUND: Entomopathogenic fungi are potential candidates for use in integrated vector management and many isolates are compatible with synthetic and natural insecticides. Neem oil was tested separately and in combination with the entomopathogenic fungus Metarhizium anisopliae against larvae of the dengue vector Aedes aegypti. Our aim was to increase the effectiveness of the fungus for the control of larval mosquito populations. METHODS: Commercially available neem oil was used at concentrations ranging from 0.0001 to 1%. Larval survival rates were monitored over a 7 day period following exposure to neem. The virulence of the fungus M. anisopliae was confirmed using five conidial concentrations (1 × 10(5) to 1 × 10(9) conidia mL(-1)) and survival monitored over 7 days. Two concentrations of fungal conidia were then tested together with neem (0.001%). Survival curve comparisons were carried out using the Log-rank test and end-point survival rates were compared using one-way ANOVA. RESULTS: 1% neem was toxic to A. aegypti larvae reducing survival to 18% with S50 of 2 days. Neem had no effect on conidial germination or fungal vegetative growth in vitro. Larval survival rates were reduced to 24% (S50 = 3 days) when using 1 × 10(9) conidia mL(-1). Using 1 × 10(8) conidia mL(-1), 30% survival (S50 = 3 days) was observed. We tested a "sub-lethal" neem concentration (0.001%) together with these concentrations of conidia. For combinations of neem + fungus, the survival rates were significantly lower than the survival rates seen for fungus alone or for neem alone. Using a combination of 1 × 10(7) conidia mL(-1) + neem (0.001%), the survival rates were 36%, whereas exposure to the fungus alone resulted in 74% survival and exposure to neem alone resulted in 78% survival. When using 1 × 10(8) conidia mL(-1), the survival curves were modified, with a combination of the fungus + neem resulting in 12% survival, whilst the fungus alone at this concentration also significantly reduced survival rates (28%). CONCLUSIONS: The use of adjuvants is an important strategy for maintaining/increasing fungal virulence and/or shelf-life. The addition of neem to conidial suspensions improved virulence, significantly reducing larval survival times and percentages.

Proyecciones del Grupo de Investigación en Muerte Súbita 20 añosdespués de su creación / Projections of the Research Group on Sudden Death 20 years after its foundation

Ante el desafío que impone la muerte súbita cardiovascular para los sistemas sanitarios a nivel mundial resulta de gran importancia su enfoque multi e interdisciplinario, donde se integren todos los factores médicos y no médicos involucrados en su atención. A partir de los resultados de las investigaciones epidemiológicas realizadas en Cuba en un período de 20 años por el Grupo de Investigación en Muerte Súbita, que ponen de manifiesto la importancia de esta problemática de salud en atención a su elevada incidencia y su impacto económico, familiar y social; se definen las proyecciones de trabajo futuras de este colectivo de investigadores en el abordaje de esta enfermedad. El propósito de este artículo ha sido describir dichas proyecciones para lograr una mejor atención a estos pacientes, por lo que se incluyen: una mejor competencia y desempeño en su conocimiento y accionar, y el logro de un consenso que permita contar con una definición universal para su estudio, diagnóstico y registro estadístico de los datos. El intercambio científico entre las diversas especialidades y grupos de trabajo que participan en su atención resulta esencial para encarar su elevada inci-dencia y trazar estrategias conjuntas que permitan disminuir su impacto(AU)

Tratamento endodôntico, em sessão única, de seis dentes envolvidos em grande lesão periapical / Single-session endodontic treatment of six teeth involved in a wide periapical lesion

O presente trabalho tem como objetivo relatar o tratamento endodôntico de uma lesão periapical em sessão única, ressaltando a eficácia e segurança da técnica. O paciente apresentou-se, sem sintomatologia dolorosa, para exame da bateria anterossuperior, em decorrência de trauma sofrido dois anos antes. Ao exame radiográfico, notou-se uma lesão no periodonto apical, estendendo-se da região do dente 13 ao dente 23. Os dentes foram isolados e procedeu-se à cirurgia de acesso em todas as coroas. Realizou-se limpeza e modelagem (NaOCl 6%) com brocas Gattes-Glidden, com recuo progressivo do número 2 ao número 4. Em seguida, cateterismo com limas manuais #25 até o comprimento de trabalho (NaOCl 6%), confirmado com o localizador foraminal, e limpeza e modelagem de todos os canais, utilizando-se os instrumentos ProTapers F4 e F5 (Dentsply/Maillefer) (NaOCl 6%). Irrigação passiva ultrassônica por 3 minutos, em cada dente, com irrigação contínua de EDTA a 17% e inserto ultrassônico Irrisonic (Helse). Irrigação final com NaOCl 6% e secagem com cones de papel. Colocação de azul de metileno a 0,05% por 5 minutos em cada dente, seguida de uma descarga de laser (terapia fotodinâmica) por 80 segundos, em cada dente. Nova irrigação com NaOCl a 6%, para remoção do restante de azul de metileno. Nova secagem com cones de papel e obturação com cones de guta-percha ProTapers F5, termoplastificados com condensador de guta-percha # 60 e pasta AHPlus. Acompanhamento realizado após dois anos constatou a integridade do procedimento realizado, confirmando o sucesso do tratamento endodôntico, em sessão única, de canais radiculares infectados.

Resultados del Grupo de Investigación en Muerte Súbita, 20 años después de su creación / The Research Group on Sudden Death and its results after 20 years

Introducción: la muerte súbita representa en la actualidad uno de los principales desafíos para los sistemas sanitarios a nivel mundial dada su elevada incidencia, dramatismo en su presentación y años de vida que se pierden prematuramente como consecuencia de esta entidad.Objetivo: describir los antecedentes de la creación hace 20 años del Grupo de Investigación en Muerte Súbita en Cuba y mostrar sus resultados más significativos. Método: se realizó una revisión documental de los primeros 20 años de trabajo de investigación científica del Grupo de Investigación en Muerte Súbita en Cuba (1995-2014).Resultados: se estudiaron 24 758 muertes naturales a las cuales se les aplicó un algoritmo diagnóstico para documentar 1 953 eventos de muerte súbita cardiovascular, que representaron el 7,8 por ciento de la mortalidad global registrada. El 98,1 por ciento de la casuística investigada correspondió a 14 municipios de la provincia La Habana. El 2 por ciento restante incluyó 26 municipios de 11 provincias del país. Los estudios han demostrado un incremento en la probabilidad para este evento en pacientes con hipertensión arterial, obesidad, diabetes mellitus, cardiopatía isquémica, necrosis miocárdica previa, tabaquismo, engrosamiento ventricular izquierdo y alteración del perfil lipídico.Conclusiones: la creación del Grupo de Investigación en Muerte Súbita ha permitido, en los últimos 20 años, el diseño y ejecución de investigaciones científicas encaminadas a la caracterización epidemiológica de este problema de salud en Cuba, elementos útiles para trazar estrategias de intervención que permitan lograr una disminución sensible en la incidencia e impacto económico, familiar y social de esta entidad(AU)

Introduction: sudden death presently represents one of the main challenges for the health care systems worldwide due to high incidence, dramatic presentation and life years prematurely lost as a result of this event.Objective: to describe the background of the creation of the research group on sudden death in Cuba twenty years ago, and to show its most significant results.Methods: a documentary review of the first 20 years of scientific research work performed by the Research Group on Sudden Death in Cuba (1995-2014).Results: twenty four thousand eight hundred and seventy six deaths of natural causes were studied and applied a diagnostic algorithm to document 1 953 events of sudden cardiovascular death accounting for 7.8 percent of recorded global mortality. In the studied casuistry, 98.1 percent went to 14 municipalities from 11 provinces. The studies showed increased probabilities for this event in patients suffering blood hypertension, obesity, diabetes mellitus, ischemia, previous myocardial necrosis, smoking, left ventricle thickening, and lipid profile impairment.Conclusions: the creation of the Research Group on Sudden Death allowed in the last twenty years designing and performing scientific research studies aimed at the epidemiological characterization of this health problem in Cuba and those are useful elements to draw up intervention strategies to significantly reduce the incidence and the economic, family and social impact of this event(AU)

Resultados del Grupo de Investigación en Muerte Súbita, 20 años después de su creación / The Research Group on Sudden Death and its results after 20 years

La muerte súbita representa en la actualidad uno de los principales desafíos para los sistemas sanitarios a nivel mundial dada su elevada incidencia, dramatismo en su presentación y años de vida que se pierden prematuramente como consecuencia de esta entidad. OBJETIVO: describir los antecedentes de la creación hace 20 años del Grupo de Investigación en Muerte Súbita en Cuba y mostrar sus resultados más significativos. MÉTODO: se realizó una revisión documental de los primeros 20 años de trabajo de investigación científica del Grupo de Investigación en Muerte Súbita en Cuba (1995-2014). RESULTADOS: se estudiaron 24 758 muertes naturales a las cuales se les aplicó un algoritmo diagnóstico para documentar 1 953 eventos de muerte súbita cardiovascular, que representaron el 7,8 por ciento de la mortalidad global registrada. El 98,1 por ciento de la casuística investigada correspondió a 14 municipios de la provincia La Habana. El 2 por ciento restante incluyó 26 municipios de 11 provincias del país. Los estudios han demostrado un incremento en la probabilidad para este evento en pacientes con hipertensión arterial, obesidad, diabetes mellitus, cardiopatía isquémica, necrosis miocárdica previa, tabaquismo, engrosamiento ventricular izquierdo y alteración del perfil lipídico. CONCLUSIONES: la creación del Grupo de Investigación en Muerte Súbita ha permitido, en los últimos 20 años, el diseño y ejecución de investigaciones científicas encaminadas a la caracterización epidemiológica de este problema de salud en Cuba, elementos útiles para trazar estrategias de intervención que permitan lograr una disminución sensible en la incidencia e impacto económico, familiar y social de esta entidad(AU)

Sudden death presently represents one of the main challenges for the health care systems worldwide due to high incidence, dramatic presentation and life years prematurely lost as a result of this event. OBJECTIVE: to describe the background of the creation of the research group on sudden death in Cuba twenty years ago, and to show its most significant results. METHODs: a documentary review of the first 20 years of scientific research work performed by the Research Group on Sudden Death in Cuba (1995-2014). RESULTS: twenty four thousand eight hundred and seventy six deaths of natural causes were studied and applied a diagnostic algorithm to document 1 953 events of sudden cardiovascular death accounting for 7.8 percent of recorded global mortality. In the studied casuistry, 98.1 percent went to 14 municipalities from 11 provinces. The studies showed increased probabilities for this event in patients suffering blood hypertension, obesity, diabetes mellitus, ischemia, previous myocardial necrosis, smoking, left ventricle thickening, and lipid profile impairment. CONCLUSIONS: the creation of the Research Group on Sudden Death allowed in the last twenty years designing and performing scientific research studies aimed at the epidemiological characterization of this health problem in Cuba and those are useful elements to draw up intervention strategies to significantly reduce the incidence and the economic, family and social impact of this event(AU)

Non-rigid registration of serial dedicated breast CT, longitudinal dedicated breast CT and PET/CT images using the diffeomorphic demons method.

RATIONALE AND OBJECTIVES: Dedicated breast CT and PET/CT scanners provide detailed 3D anatomical and functional imaging data sets and are currently being investigated for applications in breast cancer management such as diagnosis, monitoring response to therapy and radiation therapy planning. Our objective was to evaluate the performance of the diffeomorphic demons (DD) non-rigid image registration method to spatially align 3D serial (pre- and post-contrast) dedicated breast computed tomography (CT), and longitudinally-acquired dedicated 3D breast CT and positron emission tomography (PET)/CT images. METHODS: The algorithmic parameters of the DD method were optimized for the alignment of dedicated breast CT images using training data and fixed. The performance of the method for image alignment was quantitatively evaluated using three separate data sets; (1) serial breast CT pre- and post-contrast images of 20 women, (2) breast CT images of 20 women acquired before and after repositioning the subject on the scanner, and (3) dedicated breast PET/CT images of 7 women undergoing neo-adjuvant chemotherapy acquired pre-treatment and after 1 cycle of therapy. RESULTS: The DD registration method outperformed no registration (p < 0.001) and conventional affine registration (p ≤ 0.002) for serial and longitudinal breast CT and PET/CT image alignment. In spite of the large size of the imaging data, the computational cost of the DD method was found to be reasonable (3-5 min). CONCLUSIONS: Co-registration of dedicated breast CT and PET/CT images can be performed rapidly and reliably using the DD method. This is the first study evaluating the DD registration method for the alignment of dedicated breast CT and PET/CT images.

Expresión clínica del síndrome de muerte súbita cardíaca / Clinical expression of cardiac sudden death syndrome

Objetivo: Describir la expresión clínica del síndrome de muerte súbita cardíaca en poblaciones de Ciudad de La Habana, Cuba, durante el período 2000-2004. Diseño: Observacional, descriptivo, prospectivo, transversal. Métodos: Se estudiaron las muertes naturales atribuibles a causas cardíacas, durante 5 años, y se determinaron cuáles de estas fueron súbitas. El estudio SUCADES I (SUdden CArdiac DEath Study I) fue realizado en la municipalidad de Arroyo Naranjo con una población de 210 000 hab, incluyó 5 098 decesos por muerte natural, de los cuales, 474 fueron por muerte súbita. Se documentó la expresión clínica del síndrome a partir del tiempo de aparición, tiempo de inicio de los síntomas y síntomas premonitorios en los sucesos instantáneos y los no instantáneos. El lugar de presentación incluyó el medio extrahospitalario y el intrahospitalario. Resultados: El 45,4 por ciento de las muertes súbitas fueron instantáneas, el 38,2 por ciento ocurrió en la primera hora del inicio de los síntomas, en el horario de 06:00-11:59 a.m. (30,0 por ciento). La pérdida de la conciencia (72,4 por ciento) y la disnea (36,9 por ciento) fueron los síntomas premonitorios de muerte instantánea y no instantánea más frecuentes, respectivamente. El 66,2 por ciento de las paradas cardíacas se iniciaron en el ámbito extrahospitalario, predominó el domicilio de las víctimas (35,0 por ciento). Conclusiones: Clínicamente la muerte súbita se manifestó por pérdida de la conciencia (instantánea), durante la primera hora del inicio de los síntomas, en el domicilio de las víctimas, en el período de 06:00-11:59 a.m

Objective: To describe the clinical expression of cardiac sudden death syndrome in populations from Ciudad de La Habana over 2000-2004. Design: Observational, descriptive, prospective and cross-sectional. Methods: The natural deaths attributable to cardiac causes over 5 years determining which of them were sudden. The SUCADES I study (Sudden Cardiac Death Syndrome) was conducted in the Arroyo Naranjo municipality with a population of 210 000 inhabitants and included 5 098 deceases from natural death, from which 474 were sudden deaths. The clinical expression of the syndrome was documented from the time of appearance, time of onset of the premonitory symptoms and warning symptoms in instantaneous and non-instantaneous events. The place of presentation included the outside hospital environment. Results: The 45,4 percent of sudden events were instantaneous, the 38,2 percent occurred during the first hour of the onset of symptoms at 06.00-11.59 hours (30 percent). The consciousness loss (72,4 percent) and dyspnea (36,9 percent) were the more frequent premonitory symptoms of instantaneous ad non-instantaneous death, respectively. The 66,2 percent of cardiac arrest occurred outside the hospital mainly at home of victims (35,0 percent). Conclusions: Clinically, the sudden death is characterized by the consciousness loss (instantaneous) during the first hour of symptoms onset, at home and at 06.00-11.59 hours

Expresión clínica del síndrome de muerte súbita cardíaca / Clinical expression of cardiac sudden death syndrome

Objetivo: Describir la expresión clínica del síndrome de muerte súbita cardíaca en poblaciones de Ciudad de La Habana, Cuba, durante el período 2000-2004. Diseño: Observacional, descriptivo, prospectivo, transversal. Métodos: Se estudiaron las muertes naturales atribuibles a causas cardíacas, durante 5 años, y se determinaron cuáles de estas fueron súbitas. El estudio SUCADES I (SUdden CArdiac DEath Study I) fue realizado en la municipalidad de Arroyo Naranjo con una población de 210 000 hab, incluyó 5 098 decesos por muerte natural, de los cuales, 474 fueron por muerte súbita. Se documentó la expresión clínica del síndrome a partir del tiempo de aparición, tiempo de inicio de los síntomas y síntomas premonitorios en los sucesos instantáneos y los no instantáneos. El lugar de presentación incluyó el medio extrahospitalario y el intrahospitalario. Resultados: El 45,4 por ciento de las muertes súbitas fueron instantáneas, el 38,2 por ciento ocurrió en la primera hora del inicio de los síntomas, en el horario de 06:00-11:59 a.m. (30,0 por ciento). La pérdida de la conciencia (72,4 por ciento) y la disnea (36,9 por ciento) fueron los síntomas premonitorios de muerte instantánea y no instantánea más frecuentes, respectivamente. El 66,2 por ciento de las paradas cardíacas se iniciaron en el ámbito extrahospitalario, predominó el domicilio de las víctimas (35,0 por ciento). Conclusiones: Clínicamente la muerte súbita se manifestó por pérdida de la conciencia (instantánea), durante la primera hora del inicio de los síntomas, en el domicilio de las víctimas, en el período de 06:00-11:59 a.m(AU)

Objective: To describe the clinical expression of cardiac sudden death syndrome in populations from Ciudad de La Habana over 2000-2004. Design: Observational, descriptive, prospective and cross-sectional. Methods: The natural deaths attributable to cardiac causes over 5 years determining which of them were sudden. The SUCADES I study (Sudden Cardiac Death Syndrome) was conducted in the Arroyo Naranjo municipality with a population of 210 000 inhabitants and included 5 098 deceases from natural death, from which 474 were sudden deaths. The clinical expression of the syndrome was documented from the time of appearance, time of onset of the premonitory symptoms and warning symptoms in instantaneous and non-instantaneous events. The place of presentation included the outside hospital environment. Results: The 45,4 percent of sudden events were instantaneous, the 38,2 percent occurred during the first hour of the onset of symptoms at 06.00-11.59 hours (30 percent). The consciousness loss (72,4 percent) and dyspnea (36,9 percent) were the more frequent premonitory symptoms of instantaneous ad non-instantaneous death, respectively. The 66,2 percent of cardiac arrest occurred outside the hospital mainly at home of victims (35,0 percent). Conclusions: Clinically, the sudden death is characterized by the consciousness loss (instantaneous) during the first hour of symptoms onset, at home and at 06.00-11.59 hours(AU)

THE DEVELOPMENT AND FEASIBILITY OF A BRIEF RISK REDUCTION INTERVENTION FOR NEWLY HIV-DIAGNOSED MEN WHO HAVE SEX WITH MEN.

Men who have sex with men (MSM) represent more than half of all new HIV infections in the United States. Utilizing a collaborative, community based approach, a brief risk reduction intervention was developed and pilot tested among newly HIV-diagnosed MSM receiving HIV care in a primary care setting. Sixty-five men, within 3 months of diagnosis, were randomly assigned to the experimental condition or control condition and assessed at baseline, 3-month, and 6-month follow-up. Effect sizes were calculated to explore differences between conditions and over time. Results demonstrated the potential effectiveness of the intervention in reducing risk behavior, improving mental health, and increasing use of ancillary services. Process evaluation data demonstrated the acceptability of the intervention to patients, clinic staff, and administration. The results provide evidence that a brief intervention can be successfully integrated into HIV care services for newly diagnosed MSM and should be evaluated for efficacy.