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There is a need of simple, inexpensive, and reliable noninvasive testing to predict coronary artery disease (CAD) in patients with chronic kidney disease (CKD), where the prevalence of cardiovascular (CV) events and death is elevated. We analyzed the association between peripheral artery disease (PAD) and CAD in 201 patients with stage 5 CKD on dialysis using a prospective observational cohort. Diagnosis of PAD by both palpation and USD were significantly correlated. In patients with PAD diagnosed by palpation, CAD was observed in 80%, while in those diagnosed by USD, CAD was present in 79.1%. The absence of a pulse by palpation predicted CAD with a sensitivity of 55% and a specificity of 76%; USD showed a sensitivity of 62% and specificity of 60% to predict CAD. The risk of combined serious CV events and death was significantly higher in subjects with PAD diagnosed by palpation, but not by USD. PAD assessed by palpation also correlated with the occurrence of multivessel CAD and with the probability of coronary intervention. Both methods are moderately useful for predicting CAD, but PAD diagnosis by palpation was a better predictor of combined CV events and death and was also associated with CAD severity and likelihood of intervention.
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INTRODUCTION: Normal (120-140 mm Hg) systolic peridialysis blood pressure (BP) is associated with higher mortality in hemodialysis (HD) patients. AIM: We explored the relationship between hypertension and BP on outcomes using data collected at the interdialytic period. METHODS: This was a single-center observational cohort study with 2672 HD patients. BP was determined at inception, in mid-week, between 2 consecutive dialysis sessions. Hypertension was defined as systolic BP ≥ 140 mm Hg and/or diastolic BP ≥ 90 mm Hg. Endpoints were major CV events and all-cause mortality. RESULTS: During a median follow-up of 31 months, 761 patients (28%) experienced CV events and 1181 (44%) died. Hypertensive patients had lower survival free of CV than normotensive patients (P = 0.031). No difference occurred in the incidence of death between groups. Compared with the reference category of SBP ≥ 171 mmHg, the incidence of cardiovascular events was reduced in patients with SBP 101-110 (HR 0.647, 95% CI 0.455 to 0.920), 111-120 (HR 0.663, 95%CI 0.492 to 0.894), 121-130 (HR 0.747, 95%CI 0.569 to 0.981), and 131-140 (HR 0.757, 95%CI 0.596 to 0.962). On multivariate analysis, systolic and diastolic BP were not independent predictors of CV events or death. Normal interdialytic BP was not associated with mortality or CV events, and hypertension predicted an increased probability of CV complications. CONCLUSIONS: Interdialytic BP may be preferred to guide treatment decisions, and HD patients should be treated according to guidelines for the general population until specific BP targets for this population are identified.
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Hipertensão , Humanos , Pressão Sanguínea/fisiologia , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/complicações , Diálise Renal/efeitos adversosRESUMO
AIMS: Emerging evidence suggests the existence of a crosstalk between dipeptidyl peptidase 4 (DPP4) and the renin-angiotensin system (RAS). Therefore, combined inhibition of DPP4 and RAS may produce similar pharmacological effects rather than being additive. This study tested the hypothesis that combining an inhibitor of DPP4 with an angiotensin II (Ang II) receptor blocker does not provide additional cardioprotection compared to monotherapy in heart failure (HF) rats. MAIN METHODS: Male Wistar rats were subjected to left ventricle (LV) radiofrequency ablation or sham operation. Six weeks after surgery, radiofrequency-ablated rats who developed HF were assigned into four groups and received vehicle (water), vildagliptin, valsartan, or both drugs, for four weeks by oral gavage. KEY FINDINGS: Vildagliptin and valsartan in monotherapy reduced LV hypertrophy, alleviated cardiac interstitial fibrosis, and improved systolic and diastolic function in HF rats, with no additional effect of combination treatment. HF rats displayed higher cardiac and serum DPP4 activity and abundance than sham. Surprisingly, not only vildagliptin but also valsartan in monotherapy downregulated the catalytic function and expression levels of systemic and cardiac DPP4. Moreover, vildagliptin and valsartan alone or in combination comparably upregulate the components of the cardiac ACE2/Ang-(1-7)/MasR while downregulating the ACE/Ang II/AT1R axis. SIGNIFICANCE: Vildagliptin or valsartan alone is as effective as combined to treat cardiac dysfunction and remodeling in experimental HF. DPP4 inhibition downregulates classic RAS components, and pharmacological RAS blockade downregulates DPP4 in the heart and serum of HF rats. This interplay between DPP4 and RAS may affect HF progression and pharmacotherapy.
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Dipeptidil Peptidase 4 , Insuficiência Cardíaca , Animais , Dipeptidil Peptidase 4/metabolismo , Insuficiência Cardíaca/tratamento farmacológico , Masculino , Ratos , Ratos Wistar , Sistema Renina-Angiotensina , Valsartana/farmacologia , Valsartana/uso terapêutico , Vildagliptina/farmacologia , Vildagliptina/uso terapêuticoRESUMO
BACKGROUND: The incidence of myocardial infarction (MI) is elevated in patients receiving renal replacement therapy (RRT). We hypothesized that an invasive strategy of assessment of coronary artery disease (CAD) will identify patients more prone to developing MI. METHODS: This was a single-center observational cohort study that included 1678 patients receiving RRT (hemodialysis and renal transplantation) assessed for CAD prospectively and analyzed retrospectively. Endpoints were the incidence of MI and death. RESULTS: The median follow-up was 43 months, and 180 patients experienced an MI with a mortality rate of 74%. Multivariate analysis showed that diabetes (HR 1.633; 95% CI 1.165-2.289), prior MI (HR 1.724; 95% CI 1.153-2.579), and CAD (HR 2.073; 95% CI 1.400-3.071) were predictors of MI. Altered myocardial scan did not correlate with MI. At the discretion of the attending physicians, 20/180 patients (11%) underwent coronary intervention that was associated with a higher cumulative survival (Log-rank 0.007). CONCLUSION: Patients with CAD suffered an MI more frequently, independently of symptoms and risk factors for MI, including noninvasive testing. Because of the elevated rate of the lethality of MI, invasive coronary studies may be indicated in select patients on RRT. Once an MI occurs, our data suggest that an invasive therapeutic approach is warranted.
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Doença da Artéria Coronariana , Infarto do Miocárdio , Angiografia Coronária , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/epidemiologia , Humanos , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/etiologia , Terapia de Substituição Renal , Estudos Retrospectivos , Fatores de RiscoRESUMO
Angina is a significant contributor to disability and impairment in quality of life in patients with chronic coronary syndromes (CCS). An elevated heart rate (HR) may trigger myocardial ischemia by increasing oxygen consumption and decreasing the diastolic time, compromising the coronary flow. HR-lowering strategies offer symptom control and prevent cardiovascular events in subgroups of patients with CCS. However, the best therapeutic approach to achieve the desired HR in patients with CCS can be challenging based on efficacy and tolerability. Guidelines usually propose ß-blockers and/or non-dihydropyridine calcium channel blockers (CCB) for angina patients with elevated HR. Nonetheless, there is no clear evidence of greater antianginal efficacy of this strategy versus an alternative HR-lowering agent. Ivabradine reduces the HR by blocking the If current in the sinoatrial node without affecting myocardial contractility or vascular tone. The magnitude of the HR reduction by ivabradine is proportional to the initial HR, which decreases the risk of significant bradycardia. Ivabradine increases the diastolic time and the coronary flow reserve to a greater extent than ß-blockers and favors collateralization, improving the regional blood flow. We present two clinical cases of patients with symptomatic CCS in whom HR control with ivabradine was fundamental for symptom control and improvement in left ventricular (LV) function. An earlier combination of ivabradine plus ß-blockers would have provided more rapid symptom control and improved LV function in the first case. In the second case, the primary mechanism responsible for angina was most likely a coronary vasomotor abnormality, in which the use of ß-blockers aggravated the discomfort. The combination of a dihydropyridine CCB plus ivabradine was highly influential in symptom control. Due to its effects beyond HR reduction and good tolerability, ivabradine should be considered an essential ally in managing patients with angina and high HR with or without LV dysfunction.
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AIMS: Left ventricular diastolic dysfunction (LVDD) and LV systolic dysfunction (LVSD) are prevalent in CKD, but their prognostic relevance is debatable. We intent to verify whether LVDD and LVSD are independently predictive of all-cause mortality and if they have comparable or different effects on outcomes. METHODS: A retrospective analysis was conducted of the echocardiographic data of 1285 haemodialysis patients followed up until death or transplantation. LVDD was classified into 4 grades of severity. Endpoint was all-cause mortality. RESULTS: During a follow-up of 30 months, 419/1285 (33%) patients died, 224 (53%) due to CV events. LVDD occurred in 75% of patients, grade 1 DD was the prevalent diastolic abnormality, and pseudonormal pattern was the predominant form of moderate-severe DD. Moderate-severe LVDD (HR 1.379, CI% 1.074-1.770) and LVSD (HR 1.814, CI% 1.265-2.576) independently predicted death; a graded, progressive association was found between LVDD categories and the risk of death; and the impact of isolated severe-moderate LVDD on the risk of death was comparable to that exercised by isolated compromised LV systolic function. CONCLUSION: Moderate-severe LVDD and LVSD were independently associated with a higher probability of death and had a similar impact on survival. A progressive association was observed between LVDD grades and mortality.
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Insuficiência Cardíaca Diastólica , Insuficiência Cardíaca Sistólica , Diálise Renal , Insuficiência Renal Crônica , Disfunção Ventricular Esquerda , Idoso , Brasil/epidemiologia , Ecocardiografia Doppler/métodos , Feminino , Insuficiência Cardíaca Diastólica/diagnóstico , Insuficiência Cardíaca Diastólica/epidemiologia , Insuficiência Cardíaca Diastólica/fisiopatologia , Insuficiência Cardíaca Sistólica/diagnóstico , Insuficiência Cardíaca Sistólica/epidemiologia , Insuficiência Cardíaca Sistólica/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Diálise Renal/métodos , Diálise Renal/estatística & dados numéricos , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/terapia , Estudos Retrospectivos , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Índice de Gravidade de Doença , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/mortalidade , Disfunção Ventricular Esquerda/fisiopatologiaRESUMO
Aerogels are 3-D nanostructures of non-fluid colloidal interconnected porous networks consisting of loosely packed bonded particles that are expanded throughout their volume by gas and exhibit ultra-low density and high specific surface area. Cellulose-based aerogels can be obtained from hydrogels through a drying process, replacing the solvent (water) with air and keeping the pristine three-dimensional arrangement. In this work, hybrid cellulose-based aerogels were produced and their potential for use as dressings was assessed. Nanofibrilated cellulose (NFC) hydrogels were produced by a co-grinding process in a stone micronizer using a kraft cellulosic pulp and a phenolic extract from Maclura tinctoria (Tajuva) heartwood. NFC-based aerogels were produced by freeze followed by lyophilization, in a way that the Tajuva extract acted as a functionalizing agent. The obtained aerogels showed high porosity (ranging from 97% to 99%) and low density (ranging from 0.025 to 0.040 g·cm-3), as well a typical network and sheet-like structure with 100 to 300 µm pores, which yielded compressive strengths ranging from 60 to 340 kPa. The reached antibacterial and antioxidant activities, percentage of inhibitions and water uptakes suggest that the aerogels can be used as fluid absorbers. Additionally, the immobilization of the Tajuva extract indicates the potential for dentistry applications.
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INTRODUCTION: It is unclear whether the increased risk associated with diabetes in patients on dialysis is due to diabetes or a consequence of associated cardiovascular disease (CVD). AIM: The purpose of this work was to answer the question: do diabetes and CVD have a similar impact on the incidence of cardiovascular events in patients undergoing maintenance hemodialysis? METHODS: A prespecified protocol was used to prospectively evaluate and follow up 310 diabetic patients on hemodialysis without clinical evidence of CVD and 395 nondiabetic patients with CVD. Endpoint was the incidence of composite CV events and coronary events. RESULTS: The incidence of composite CV events (log-rank = 0.540) and coronary events (log-rank = 0.400) did not differ between groups. Because of the potential influence of occult CVD in patients with diabetes, we repeated the analysis excluding subjects with altered ejection fraction, a myocardial perfusion scan defect, and coronary artery disease in the group of patients with diabetes. Again we found no difference between groups (log-rank = 0.657). CONCLUSION: In patients on hemodialysis, diabetes and CVD carry similar risks for CV events. These results are congruent with the diabetes mellitus-CVD equivalence risk concept reported in the general population.
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Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus/epidemiologia , Diálise Renal , Insuficiência Renal Crônica/terapia , Idoso , Doenças Cardiovasculares/diagnóstico , Diabetes Mellitus/diagnóstico , Feminino , Fatores de Risco de Doenças Cardíacas , Humanos , Incidência , Itália , Masculino , Pessoa de Meia-Idade , Prognóstico , Diálise Renal/efeitos adversos , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Estudos Retrospectivos , Medição de RiscoRESUMO
BACKGROUND: The purpose of this study was to verify the risk factors present in patients on the kidney transplant waiting list that may interfere with the incidence of cardiovascular (CV) events and death during the first 12 months after transplantation. METHODS: Based on the data collected prospectively during pretransplant workups, a retrospective study was conducted including 665 patients followed up until death or completing 12 months posttransplantation. Endpoints were the composite incidence of CV events and death. RESULTS: The prevalence of diabetes, LV hypertrophy, and CV disease at baseline was high; 14% of patients had angina, 26% an abnormal myocardial scan, and 47% coronary artery disease. CV events occurred in 53 patients (8.4%) and in 29 (55%) caused death. The independent predictors of events were age ≥ 50 years (HR 2.292; CI% 1.093-4.806), angina (HR 1.969; CI% 1.039-3.732), and altered myocardial scan (HR 1.905, CI% 1.059-3.428). Altered myocardial scan (HR 2.822, 95% CI 1.095-6.660) was also one of the independent predictor of CV death. CONCLUSION: The incidence of CV events and death were predicted by variables associated with myocardial ischemia, a potentially modifiable risk factor. Patients with pretransplantation myocardial ischemia should be considered at a higher risk of developing early CV complications and managed accordingly before, during, and after kidney transplantation.
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Doenças Cardiovasculares/epidemiologia , Transplante de Rim , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/cirurgia , Adulto , Fatores Etários , Angina Pectoris/epidemiologia , Doenças Cardiovasculares/mortalidade , Comorbidade , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Diabetes Mellitus/epidemiologia , Feminino , Seguimentos , Humanos , Hipertrofia Ventricular Esquerda/epidemiologia , Incidência , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/epidemiologia , Período Pré-Operatório , Prevalência , Estudos Retrospectivos , Fatores de RiscoRESUMO
BACKGROUND: In patients eligible for coronary artery bypass grafting, no data assess the importance of the Heart Team in programming the best surgical strategy for patients with diffuse coronary artery disease (CAD). This study aims to determine the contribution of the Heart Team in predicting the feasibility of coronary artery bypass graft and angiographic surgical success in these patients based on visual angiographic analysis. METHODS: Patients with diffuse and severe CAD undergoing incomplete coronary artery bypass graft surgery were prospectively included. One-year postoperative coronary angiograms were obtained to evaluate graft occlusion. Two clinical cardiologists, two cardiovascular surgeons, and one interventional cardiologist retrospectively analyzed preoperative angiograms. A subjective scale was applied at a single moment to quantify the chance of successful coronary artery bypass grafting for each coronary territory with anatomical indication for revascularization. Based on individual scores, the Heart Team's and the specialists' scores were calculated and compared. RESULTS: The examiners evaluated 154 coronary territories, of which 85 (55.2%) were protected. The Heart Team's accuracy for predicting the angiographic success of the surgery was 74.9%, almost equal to that of the surgeons alone (73.2%). Only the interventional cardiologist predicted left anterior descending territory grafting success. The Heart Team had good specificity and reasonable sensitivity, and the surgeons had high sensitivity and low specificity in predicting angiographic success. CONCLUSION: The multispecialty Heart Team achieved good accuracy in predicting the angiographic coronary artery bypass graft success in patients with diffuse CAD, with a high specificity and reasonable sensitivity.
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Doença da Artéria Coronariana , Angiografia Coronária , Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Humanos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
During deceased donor procurement, the heart procurement team may cut the supra-hepatic inferior vena cava (IVC) too close to the liver surface, depriving the liver allograft from having enough supra-hepatic IVC to perform the anastomosis with the recipient's IVC or hepatic veins. In such instances, liver grafts usually are deemed as non-appropriate for transplantation, being discarded. Here we report a technique for reconstruction of damaged supra-hepatic IVCs through the use of a segment of the infra-hepatic IVC of the liver graft.
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Transplante de Fígado , Aloenxertos , Anastomose Cirúrgica , Veias Hepáticas/cirurgia , Humanos , Fígado/cirurgia , Doadores Vivos , Veia Cava Inferior/cirurgiaRESUMO
The relationship between disturbances in glucose homeostasis and heart failure (HF) progression is bidirectional. However, the mechanisms by which HF intrinsically impairs glucose homeostasis remain unknown. The present study tested the hypothesis that the bioavailability of intact glucagon-like peptide-1 (GLP-1) is affected in HF, possibly contributing to disturbed glucose homeostasis. Serum concentrations of total and intact GLP-1 and insulin were measured after an overnight fast and 15 min after the ingestion of a mixed breakfast meal in 49 non-diabetic patients with severe HF and 40 healthy control subjects. Similarly, fasting and postprandial serum concentrations of these hormones were determined in sham-operated rats, and rats with HF treated with an inhibitor of the GLP-1-degrading enzyme dipeptidyl peptidase-4 (DPP4), vildagliptin, or vehicle for 4 weeks. We found that HF patients displayed a much lower increase in postprandial intact and total GLP-1 levels than controls. The increase in postprandial intact GLP-1 in HF patients correlated negatively with serum brain natriuretic peptide levels and DPP4 activity and positively with the glomerular filtration rate. Likewise, the postprandial increases in both intact and total GLP-1 were blunted in HF rats and were restored by DPP4 inhibition. Additionally, vehicle-treated HF rats displayed glucose intolerance and hyperinsulinemia, whereas normal glucose homeostasis was observed in vildagliptin-treated HF rats. We conclude that the postprandial increase in GLP-1 is blunted in non-diabetic HF. Impaired GLP-1 bioavailability after meal intake correlates with poor prognostic factors and may contribute to the establishment of a vicious cycle between glucose disturbance and HF development and progression.
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Glicemia/metabolismo , Peptídeo 1 Semelhante ao Glucagon/metabolismo , Insuficiência Cardíaca/etiologia , Período Pós-Prandial/fisiologia , Idoso , Animais , Peptídeo C/sangue , Feminino , Intolerância à Glucose/fisiopatologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Insulina/sangue , Masculino , Pessoa de Meia-Idade , Obesidade/metabolismo , Obesidade/fisiopatologia , Fragmentos de Peptídeos/sangue , Ratos WistarRESUMO
BACKGROUND: Cardiovascular mortality is increased in chronic kidney disease, a condition with a high prevalence of periodontal disease. Whether periodontitis treatment improves prognosis is unknown. METHODS: The effect of periodontal treatment on the incidence of cardiovascular events and death in 206 waitlist hemodialysis subjects was compared with that in 203 historical controls who did not undergo treatment. Patients were followed up for 24 months or until death or transplantation. RESULTS: The prevalence of moderate/severe periodontitis was 74%. Coronary artery disease correlated with the severity of periodontal disease (P = .02). Survival free of cardiovascular events (94% vs 83%, log-rank 0.009), coronary events (97% vs 89%, log-rank = 0.009), and cardiovascular death (96% vs 87%, log-rank = 0.037) was higher in the evaluated group. Death by any cause did not differ between groups. Multivariate analysis showed that treatment was associated with reduction in cardiovascular events (HR 0.43; 95% CI 0.22-0.87), coronary events (HR 0.31; 95% CI 0.12-0.83), and cardiovascular deaths (HR 0.43; 95% CI 0.19-0.98). CONCLUSION: Periodontal treatment reduced the 24-month incidence of cardiovascular events and cardiovascular death, suggesting that periodontal treatment may improve cardiovascular outcomes. We suggest that periodontal screening and eventual treatment may be considered in patients with advanced renal disease.
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Doenças Cardiovasculares/prevenção & controle , Assistência Odontológica/estatística & dados numéricos , Falência Renal Crônica/fisiopatologia , Transplante de Rim/mortalidade , Doenças Periodontais/terapia , Listas de Espera/mortalidade , Brasil/epidemiologia , Doenças Cardiovasculares/epidemiologia , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Doenças Periodontais/complicações , Prognóstico , Estudos Retrospectivos , Fatores de RiscoRESUMO
An experiment was conducted to compare different oilseeds in replacement of ground corn in diets of fattening lambs, evaluating performance, apparent diet digestibility, ingestive behavior, and carcass traits. Twenty-four crossbred lambs, three months old and with initial body weight 25.97 ± 0.75 kg, were kept in individual pens. The animals received one of the following diets: control (no oilseeds, 3.11% Ether Extract - EE), cottonseed (6.14% EE), sunflower (6.33% EE), and soybean (6.30% EE). All diets contained 23.63% of coast cross hay and 76.37% of concentrate. After 84 days in feedlot, the animals were slaughtered and the carcasses were evaluated. The dry matter intake (DMI) and daily weight gain (DWG) of animals fed with the control diet was higher than sunflower (P≤0.05). Final body weight and carcass weight were higher (P≤0.05) in the control (42.42 kg and 19.27 kg, respectively) than for sunflower diet (34.85 kg and 16.05 kg, respectively). Neutral detergent fiber (NDF) digestibility was reduced (P≤0.05) when the animals received cottonseed diet (50.34%) in comparison to soybean (71.07%), sunflower (67.07%) and control (66.50%). NDF digestibility for soybean, sunflower and control diets did not differ from each other. Lower (P≤0.05) EE digestibility was observed for the control diet (73.67%). There were no differences (P≥0.05) in the ingestive behavior, however, the addition of cottonseed or sunflower negatively affected (P≤0.05) rumination efficiency of NDF. Sunflower should not be included in high concentrate diets for fattening lambs.(AU)
Um experimento foi conduzido para comparar diferentes oleaginosas em substituição ao milho moído na dieta de cordeiros em engorda, avaliando o desempenho, a digestibilidade aparente da dieta, o comportamento ingestivo e as características de carcaça. Vinte e quatro cordeiros cruzados, com 3 meses de idade e peso corporal inicial de 25,97 ± 0,75 kg, foram mantidos em baias individuais. Eles receberam uma das seguintes dietas ou tratamentos: controle (sem grãos de oleaginosas, 3,11% de Extrato Etéreo - EE), caroço de algodão (6,14% EE), girassol (6,33% EE) e soja (6,30% EE). Todas as dietas continham 23,63% de feno de coast cross e 76,37% de concentrado. Após 84 dias de confinamento, os animais foram abatidos e as carcaças avaliadas. O consumo de matéria seca e ganho de peso diário dos animais alimentados com a dieta controle foi maior daqueles alimentados com girassol (P≤0,05). O peso corporal final e o peso da carcaça foram maiores (P≤0,05) para aqueles alimentados com a dieta controle (42,42 kg e 19,27 kg, respectivamente) que aqueles da dieta com girassol (34,85 kg e 16,05 kg, respectivamente). A digestibilidade da Fibra em Detergente Neutro (FDN) foi reduzida (P≤0,05) quando os animais receberam caroço de algodão (50,34%) comparado à soja (71,07%); para as dietas com girassol (67,07%) e controle (66,50%) não houve diferenças das demais. Menor (P≤0,05) digestibilidade do extrato etéreo foi observada para a dieta controle (73,67%). Não houve diferenças (P≥0,05) no comportamento ingestivo, no entanto, a inclusão de caroço de algodão ou girassol afetou negativamente (P≤0,05) a eficiência de ruminação da FDN. Grãos de girassol não devem ser incluídos em dietas de alto concentrado para cordeiros em engorda.(AU)
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Animais , Recém-Nascido , Grão Comestível/efeitos adversos , Gossypium , Helianthus , Glycine max , Ovinos/crescimento & desenvolvimento , Ração Animal , Sementes/efeitos adversosRESUMO
An experiment was conducted to compare different oilseeds in replacement of ground corn in diets of fattening lambs, evaluating performance, apparent diet digestibility, ingestive behavior, and carcass traits. Twenty-four crossbred lambs, three months old and with initial body weight 25.97 ± 0.75 kg, were kept in individual pens. The animals received one of the following diets: control (no oilseeds, 3.11% Ether Extract - EE), cottonseed (6.14% EE), sunflower (6.33% EE), and soybean (6.30% EE). All diets contained 23.63% of coast cross hay and 76.37% of concentrate. After 84 days in feedlot, the animals were slaughtered and the carcasses were evaluated. The dry matter intake (DMI) and daily weight gain (DWG) of animals fed with the control diet was higher than sunflower (P≤0.05). Final body weight and carcass weight were higher (P≤0.05) in the control (42.42 kg and 19.27 kg, respectively) than for sunflower diet (34.85 kg and 16.05 kg, respectively). Neutral detergent fiber (NDF) digestibility was reduced (P≤0.05) when the animals received cottonseed diet (50.34%) in comparison to soybean (71.07%), sunflower (67.07%) and control (66.50%). NDF digestibility for soybean, sunflower and control diets did not differ from each other. Lower (P≤0.05) EE digestibility was observed for the control diet (73.67%). There were no differences (P≥0.05) in the ingestive behavior, however, the addition of cottonseed or sunflower negatively affected (P≤0.05) rumination efficiency of NDF. Sunflower should not be included in high concentrate diets for fattening lambs.
Um experimento foi conduzido para comparar diferentes oleaginosas em substituição ao milho moído na dieta de cordeiros em engorda, avaliando o desempenho, a digestibilidade aparente da dieta, o comportamento ingestivo e as características de carcaça. Vinte e quatro cordeiros cruzados, com 3 meses de idade e peso corporal inicial de 25,97 ± 0,75 kg, foram mantidos em baias individuais. Eles receberam uma das seguintes dietas ou tratamentos: controle (sem grãos de oleaginosas, 3,11% de Extrato Etéreo - EE), caroço de algodão (6,14% EE), girassol (6,33% EE) e soja (6,30% EE). Todas as dietas continham 23,63% de feno de coast cross e 76,37% de concentrado. Após 84 dias de confinamento, os animais foram abatidos e as carcaças avaliadas. O consumo de matéria seca e ganho de peso diário dos animais alimentados com a dieta controle foi maior daqueles alimentados com girassol (P≤0,05). O peso corporal final e o peso da carcaça foram maiores (P≤0,05) para aqueles alimentados com a dieta controle (42,42 kg e 19,27 kg, respectivamente) que aqueles da dieta com girassol (34,85 kg e 16,05 kg, respectivamente). A digestibilidade da Fibra em Detergente Neutro (FDN) foi reduzida (P≤0,05) quando os animais receberam caroço de algodão (50,34%) comparado à soja (71,07%); para as dietas com girassol (67,07%) e controle (66,50%) não houve diferenças das demais. Menor (P≤0,05) digestibilidade do extrato etéreo foi observada para a dieta controle (73,67%). Não houve diferenças (P≥0,05) no comportamento ingestivo, no entanto, a inclusão de caroço de algodão ou girassol afetou negativamente (P≤0,05) a eficiência de ruminação da FDN. Grãos de girassol não devem ser incluídos em dietas de alto concentrado para cordeiros em engorda.
Assuntos
Animais , Recém-Nascido , Gossypium , Grão Comestível/efeitos adversos , Helianthus , Ovinos/crescimento & desenvolvimento , Glycine max , Ração Animal , Sementes/efeitos adversosRESUMO
Objetivou-se avaliar desempenho, digestibilidade aparente, características da carcaça e da carne de cordeiros alimentados com dietas de alta proporção de concentrado (92,65%) contendo grãos de diferentes cereais (grão moído de milho; grão inteiro de milho; grão inteiro de sorgo; ou substituição de 40% do grão inteiro do milho por grão inteiro de milheto). Foram utilizados vinte e quatro machos inteiros, sem raça definida, com peso corporal de 22,35 ± 3,71 kg, confinados em baias individuais por 56 dias, alocados em delineamento inteiramente casualizado. O consumo de matéria seca em porcentagem do peso corporal foi maior (P=0,0046) para as dietas com sorgo e grão moído de milho, 3,73% e 3,39%, que para milheto e grão inteiro de milho, 3,23% e 3,13%. A eficiência alimentar foi maior (P=0,0140) para grão inteiro de milho e milheto, 0,293 e 0,269, e menor para grão moído de milho e sorgo, 0,247 e 0,226. A digestibilidade aparente da matéria orgânica, matéria seca e proteína bruta foram menores (P=0,0003) para a dieta com sorgo. As características de carcaça e dos cortes cárneos não foram influenciadas pelas dietas fornecidas aos animais, bem como a maciez objetiva do músculo Longissimus. Os parâmetros de cor e luminosidade da carne foram melhores (P<0,0001; P=0,0063) com a inclusão dos grãos inteiros. Recomenda-se a utilização de grãos inteiros de milho e de milheto na alimentação de cordeiros em confinamento, considerando os benefícios nutricionais, eficiência alimentar e a melhoria nas características da carcaça e atributos de qualidade da carne...
The objective of this study was to evaluate the performance, apparent digestibility, and carcass and meat traits of lambs fed high-concentrate diets (92.65%) containing different cereal grains (ground corn, whole grain corn, whole grain sorghum, or replacement of 40% whole grain corn with whole grain millet). Twenty-four feedlot intact lambs of undefined breed, with a body weight of 22.35 ± 3,.71 kg, kept in individual pens for 56 days were allocated in a completely randomized design. Dry matter intake expressed as a percentage of body weight was higher (P=0.0046) for the diets containing sorghum and ground corn (3.73% and 3.39%, respectively) compared to the diets containing millet and whole grain corn (3.23% and 3.13%, respectively). Feed efficiency was higher (P=0.014) for whole grain corn and millet (0.293 and 0.269, respectively) and lower for ground corn and sorghum (0.247 and 0.226, respectively). The apparent digestibility of organic matter, dry matter and crude protein was lower for the sorghum diet (P=0.0003). The carcass traits, meat cuts traits or objective longissimus muscle tenderness were not influenced by the diets offered to the animals. Meat color (P<0.0001) and luminosity (P=0.0063) were improved with inclusion of whole grains. The use of whole corn and millet grains is recommended for the feeding of feedlot lambs considering their nutritional benefits, feed efficiency, and improved carcass traits and meat quality attributes...
Assuntos
Animais , Carne , Digestão , Milhetes , Ração Animal , Zea mays , OvinosRESUMO
Objetivou-se avaliar desempenho, digestibilidade aparente, características da carcaça e da carne de cordeiros alimentados com dietas de alta proporção de concentrado (92,65%) contendo grãos de diferentes cereais (grão moído de milho; grão inteiro de milho; grão inteiro de sorgo; ou substituição de 40% do grão inteiro do milho por grão inteiro de milheto). Foram utilizados vinte e quatro machos inteiros, sem raça definida, com peso corporal de 22,35 ± 3,71 kg, confinados em baias individuais por 56 dias, alocados em delineamento inteiramente casualizado. O consumo de matéria seca em porcentagem do peso corporal foi maior (P=0,0046) para as dietas com sorgo e grão moído de milho, 3,73% e 3,39%, que para milheto e grão inteiro de milho, 3,23% e 3,13%. A eficiência alimentar foi maior (P=0,0140) para grão inteiro de milho e milheto, 0,293 e 0,269, e menor para grão moído de milho e sorgo, 0,247 e 0,226. A digestibilidade aparente da matéria orgânica, matéria seca e proteína bruta foram menores (P=0,0003) para a dieta com sorgo. As características de carcaça e dos cortes cárneos não foram influenciadas pelas dietas fornecidas aos animais, bem como a maciez objetiva do músculo Longissimus. Os parâmetros de cor e luminosidade da carne foram melhores (P<0,0001; P=0,0063) com a inclusão dos grãos inteiros. Recomenda-se a utilização de grãos inteiros de milho e de milheto na alimentação de cordeiros em confinamento, considerando os benefícios nutricionais, eficiência alimentar e a melhoria nas características da carcaça e atributos de qualidade da carne...(AU)
The objective of this study was to evaluate the performance, apparent digestibility, and carcass and meat traits of lambs fed high-concentrate diets (92.65%) containing different cereal grains (ground corn, whole grain corn, whole grain sorghum, or replacement of 40% whole grain corn with whole grain millet). Twenty-four feedlot intact lambs of undefined breed, with a body weight of 22.35 ± 3,.71 kg, kept in individual pens for 56 days were allocated in a completely randomized design. Dry matter intake expressed as a percentage of body weight was higher (P=0.0046) for the diets containing sorghum and ground corn (3.73% and 3.39%, respectively) compared to the diets containing millet and whole grain corn (3.23% and 3.13%, respectively). Feed efficiency was higher (P=0.014) for whole grain corn and millet (0.293 and 0.269, respectively) and lower for ground corn and sorghum (0.247 and 0.226, respectively). The apparent digestibility of organic matter, dry matter and crude protein was lower for the sorghum diet (P=0.0003). The carcass traits, meat cuts traits or objective longissimus muscle tenderness were not influenced by the diets offered to the animals. Meat color (P<0.0001) and luminosity (P=0.0063) were improved with inclusion of whole grains. The use of whole corn and millet grains is recommended for the feeding of feedlot lambs considering their nutritional benefits, feed efficiency, and improved carcass traits and meat quality attributes...(AU)
Assuntos
Animais , Ração Animal , Zea mays , Milhetes , Digestão , Carne , OvinosRESUMO
We examined the impact of obesity (BMI ≥30 kg/m(2) , n = 357) on prognosis in 1696 hemodialysis (HD) patients before and after renal transplantation (TX). End-points were coronary events, composite cardiovascular (CV) events, and death. Obese HD patients were older (55.9 ± 9.2 vs. 54.2 ± 11), had more diabetes (54% vs. 40%), dyslipidemia (49% vs. 30%), altered myocardial scan (38% vs. 31%), myocardial infarction (MI) (16% vs. 10%), coronary intervention (11% vs. 7%), higher total cholesterol (186 ± 52 vs. 169 ± 47), and triglycerides (219 ± 167 vs. 144 ± 91). Obese undergoing TX had more dyslipidemia (46% vs. 31%), angina (23% vs. 14%), MI (18% vs. 5%), increased total cholesterol (185 ± 56 vs. 172 ± 48), and triglycerides (237 ± 190 vs. 149 ± 100). Obesity was independently associated with coronary events (log-rank = 0.008, HR 2.55% CI 1.27-5.11) and death (log-rank 0.046, HR 1.52, % CI 1.007-2.30) in TX but not in HD. Obese HD patients had more risk factors and ischemic heart disease, but these characteristics did not interfere with prognosis. In TX patients, obesity predicts coronary events and death.
Assuntos
Doença da Artéria Coronariana/etiologia , Falência Renal Crônica/cirurgia , Transplante de Rim/efeitos adversos , Obesidade/complicações , Complicações Pós-Operatórias , Diálise Renal/efeitos adversos , Feminino , Seguimentos , Taxa de Filtração Glomerular , Humanos , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de RiscoRESUMO
It is unknown whether mild chronic kidney disease (CKD) is associated with adverse cardiovascular (CV) prognosis after accounting for coronary artery disease (CAD). Here we evaluated the interplay between CKD and CAD in predicting CV death or myocardial infarction (MI) and all-cause death. We included 1541 consecutive patients in the Partners registry (mean age 55 years, 43% female) over 18 years old with no known prior CAD who underwent coronary computed tomography angiography (CCTA). The results of CCTA were categorized as normal, nonobstructive (under half), or obstructive (half and over). Overall, 653 of the patients had no CAD, 583 had nonobstructive CAD, and 305 had obstructive CAD, while 1299 had eGFR over 60 ml/min per 1.73 m(2) and 242 had an eGFR under this value. The presence and severity of CAD was significantly associated with an increased rate of CV death or MI and all-cause death, even after adjustment for age, gender, symptoms, and risk factors. Similarly, reduced eGFR was significantly associated with CV death or MI and all-cause death after similar adjustment. The addition of reduced GFR to a model which included both clinical variables and CCTA findings resulted in significant improvement in the prediction of CV death or MI and all-cause death. Thus, among individuals referred for CCTA to evaluate CAD, renal dysfunction is associated with an increased rate of CV events, mainly driven by an increase in the rate of noncoronary CV events. In this group of patients, both eGFR and the presence and severity of CAD together improve the prediction of future CV events and death.
Assuntos
Doença das Coronárias/diagnóstico por imagem , Infarto do Miocárdio/epidemiologia , Insuficiência Renal Crônica/fisiopatologia , Adulto , Idoso , Doenças Cardiovasculares/mortalidade , Causas de Morte , Angiografia Coronária , Doença das Coronárias/complicações , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Insuficiência Renal Crônica/complicações , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios XRESUMO
Chorea may be secondary to hyperosmolar nonketotic hyperglycemia, but such situation has rarely been described in adolescents, particularly as the initial and single manifestation of type 1 diabetes. We describe a case of a previously healthy 14-year-old girl with sudden onset of choreic movements on her left upper and lower limbs. Brain computed tomography (CT) and magnetic resonance imaging (MRI) revealed an area of hyperdensity/hyperintensity affecting the right striatum. Blood glucose was 349 mg/dL. Despite adequate glucose control, the involuntary movements persisted and haloperidol, later substituted with valproate, was prescribed, with satisfactory but not complete resolution of the chorea. In 2 other occasions, when the patient had an infection and subsequent hyperglycemia, the chorea relapsed. Although not common, hyperglycemia must be considered in the differential diagnosis of acute hemichorea-hemiballismus in children and adolescents, particularly because it is a potentially reversible cause.