BR (Brazil) Hair Transplant

Owing to Brazil’s continental dimensions, varied geography, history and people, the country’s culture is rich and diverse. It has several regional variations, and in spite of being mostly unified by a single language, some regions are so different from each other that they could have become different countries altogether.

Music plays an important part in Brazilian identity. Styles like choro, samba and bossa nova are considered genuinely Brazilian. Caipira music is also in the roots of sertanejo (the national equivalent to country music). MPB stands for Brazilian Popular Music, which mixes several national styles under a single concept. Forr?, a north-eastern happy dancing music style, has also become common nationwide. New urban styles include funk - name given to a dance music genre from Rio's favelas that mixes heavy electronic beats and often raunchy rapping - and techno-brega, a crowd-pleaser in northern states, that fuses romantic pop, dance music and caribbean rhythms.

A mixture of martial arts, dance, music and game, capoeira was brought to Brazil by African slaves. Distinguished by vivacious complicated movements and accompanying music, it can be seen and practiced in many Brazilian cities.

Context  Abciximab infusion and uncoated-stent implantation is a complementary treatment strategy to reduce major adverse cardiac events in patients undergoing angioplasty for ST-segment elevation myocardial infarction (STEMI). It is uncertain whether there may be similar benefits in replacing abciximab with high-dose bolus tirofiban. Similarly, the use of drug-eluting stents in this patient population is currently discouraged because of conflicting results on efficacy reported in randomized trials and safety concerns reported by registries.

Objective  To evaluate the effect of high-dose bolus tirofiban and of sirolimus-eluting stents as compared with abciximab infusion and uncoated-stent implantation in patients with STEMI undergoing percutaneous coronary intervention.

Design, Setting, and Patients  An open-label, 2 x 2 factorial trial of 745 patients presenting with STEMI or new left bundle-branch block at 16 referral centers in Italy, Spain, and Argentina between October 2004 and April 2007.

Interventions  High-dose bolus tirofiban vs abciximab infusion and sirolimus-eluting stent vs uncoated stent implantation.

Main Outcome Measures  For drug comparison, at least 50% ST-segment elevation resolution at 90 minutes postintervention with a prespecified noninferiority margin of 9% difference (relative risk, 0.89); for stent comparison, the rate of major adverse cardiac events, defined as the composite of death from any cause, reinfarction, and clinically driven target-vessel revascularization within 8 months.

Results  ST-segment resolution occurred in 302 of 361 patients (83.6%) who had received abciximab infusion and 308 of 361 (85.3%) who had received tirofiban infusion (relative risk, 1.020; 97.5% confidence interval, 0.958-1.086; P < .001 for noninferiority). Ischemic and hemorrhagic outcomes were similar in the tirofiban and abciximab groups. At 8 months, major adverse cardiac events occurred in 54 patients (14.5%) with uncoated stents and 29 (7.8%) with sirolimus stents (P = .004), predominantly reflecting a reduction of revascularization rates (10.2% vs 3.2%). The incidence of stent thrombosis was similar in the 2 stent groups.

Conclusions  In patients with STEMI undergoing percutaneous coronary intervention, compared with abciximab, tirofiban therapy was associated with noninferior resolution of ST-segment elevation at 90 minutes following coronary intervention, whereas sirolimus-eluting stent implantation was associated with a significantly lower risk of major adverse cardiac events than uncoated stents within 8 months after intervention.

Trial Registration  clinicaltrials.gov Identifier: NCT00229515

Published online March 30, 2008 (doi:10.1001/jama.299.15.joc80026).