BACKGROUNDVolatile (inhaled) anesthetic agents have cardioprotective effects, which might improve clinical outcomes in patients undergoing coronary-artery bypass grafting (CABG). METHODSWe conducted a pragmatic, multicenter, single-blind, controlled trial at 36 centers in 13 countries. Patients scheduled to undergo elective CABG were randomly assigned to an intraoperative anesthetic regimen that included a volatile anesthetic (desflurane, isoflurane, or sevoflurane) or to total intravenous anesthesia. The primary outcome was death from any cause at 1 year. RESULTSA total of 5400 patients were randomly assigned: 2709 to the volatile anesthetics group and 2691 to the total intravenous anesthesia group. On-pump CABG was performed in 64% of patients, with a mean duration of cardiopulmonary bypass of 79 minutes. The two groups were similar with respect to demographic and clinical characteristics at baseline, the duration of cardiopulmonary bypass, and the number of grafts. At the time of the second interim analysis, the data and safety monitoring board advised that the trial should be stopped for futility. No significant difference between the groups with respect to deaths from any cause was seen at 1 year (2.8% in the volatile anesthetics group and 3.0% in the total intravenous anesthesia group; relative risk, 0.94; 95% confidence interval [CI], 0.69 to 1.29; P = 0.71), with data available for 5353 patients (99.1%), or at 30 days (1.4% and 1.3%, respectively; relative risk, 1.11; 95% CI, 0.70 to 1.76), with data available for 5398 patients (99.9%). There were no significant differences between the groups in any of the secondary outcomes or in the incidence of prespecified adverse events, including myocardial infarction. CONCLUSIONSAmong patients undergoing elective CABG, anesthesia with a volatile agent did not result in significantly fewer deaths at 1 year than total intravenous anesthesia.

The trial will determine whether the simple intervention of adding a volatile anesthetic, an intervention that can be implemented by all anesthesiologists, can improve one-year survival in patients undergoing coronary artery bypass graft surgery.

The molluscan fauna of southwestern Brazilian Amazonia is poorly known due to the lack of focused collection areas in the region since the early 20th century. The present study provides an inventory of the terrestrial gastropods from a forest fragment in the eastern Acre state, Brazil: the Humaitá Forest Reserve (“Reserva Florestal Humaitá”). Live specimens and empty shells were collected between August 2018 and January 2019. A total of 20 species were identified, distributed in 11 families. Most (13) of these species were recorded in Acre for the first time. Furthermore, we confirm the occurrence of Systrophia helicycloides (d’Orbigny, 1835) in Brazil, reiterate the synonymy of Plekocheilus pentadinus (d’Orbigny, 1835) with P. floccosus (Spix in Wagner, 1827), and synonymize Solaropsis peruviana Haas, 1951 with S. juruana Ihering, 1905.

The terrestrial and freshwater malacofauna of southern Bahia is little known, especially in comparison to the well-studied eastern portion of the state covered by remnants of Atlantic Forest. We present here a synopsis of all gastropod species known from the central southern region of Bahia state, known as ‘Centro-Sul Baiano’, focusing on four municipalities: Condeúba, Cordeiros, Mortugaba, and Piripá. The list herein contains data from the literature, historical material deposited in museum collections, and two recent expeditions undertaken in the region. The survey resulted in 21 species of gastropods, with nearly 700 voucher specimens (mostly freshwater) deposited in the collection of the Museu de Zoologia da Universidade de São Paulo (São Paulo, Brazil). Circa 30% of the species are non-indigenous; previously, the only known exotic in the region was Melanoides tuberculata (Müller, 1774). The family Achatinidae was the most diverse group in number of native species, while the typically diverse superfamily Orthalicoidea was represented by only two species.

Idiopyrgus is a relict genus of freshwater snails from Brazil traditionally classified in the family Pomatiopsidae. Herein, we use molecular data from newly acquired specimens to test that classification through Bayesian inference phylogenetic analysis. We conclude that Idiopyrgus belongs in the Gondwanan family Tomichiidae, together with the African genus Tomichia and the Australian genus Coxiella. Furthermore, we reassess currently synonymized genus- and species-level names in Idiopyrgus. The genera Hydracme and Aquidauania are considered synonymous with Idiopyrgus. The species I. brasiliensis and I. pilsbryi are restored as accepted species; I. walkeri is considered a taxon inquirendum. Two new species from caves in Bahia state are described herein: Idiopyrgus adamanteussp. nov. and Idiopyrgus minorsp. nov.

New records for Helicina schereri Baker, 1913, are reported. It was a species previously restricted to the states of Ceará, Rio Grande do Norte, Paraíba, Alagoas and Tocantins in Northeastern Brazil, and State of Santa Catarina, much further south. The new occurrences reported herein fill distribution gaps and also significantly expand the range of the species ca. 970 km westwards. The new records are from the following locations: Bahia State (Ituaçu and Itaquara municipalities) in Northeast Brazil; Mato Grosso do Sul State (Bonito Municipality) in the Midwest; and Minas Gerais (Lagoa Santa municipality) in the Southeast.

The malacological collection of the Universidade Federal de Santa Maria, curated by Dr. Carla B. Kotzian, has been recently donated to the Museu de Zoologia da Universidade de São Paulo (MZSP, Brazil). The collection is rich in well preserved specimens of terrestrial gastropods from central Rio Grande do Sul state, in southernmost Brazil. That region, centered in the municipality of Santa Maria, represents a transitional area between the Atlantic Rainforest and Pampas biomes and has been scarcely reported in the literature. Therefore, we present a taxonomical study of these specimens, complemented by historical material of the MZSP collection. Overall, we report 20 species, mostly belonging to the Stylommatophora, from which four represent new records for Rio Grande do Sul: Adelopoma brasiliense, Happia vitrina, Macrodontes gargantua, and Cyclodontina corderoi. The present report of C. corderoi is also the first from Brazil. Two introduced species were found in the studied material: Bradybaena similaris and Zonitoides sp.

Samples of terrestrial gastropods were collected year-round in seven caves in Presidente Olegário municipality, Minas Gerais state, southeastern Brazil, during several expeditions from 2012 to 2014. Twenty-four taxa (plus a single freshwater species), mainly stylommatophorans, were found in the material. The following species are reported for the first time for Minas Gerais state: Alcadia iheringi Wagner, 1910 and Helicina sordida King, 1831 (Helicinidae); Cecilioides consobrina (d’Orbigny, 1841) (Ferussaciidae); Entodina gionensis Morretes, 1940 and Scolodonta interrupta (Suter, 1900) (Scolodontidae); Megalobulimus sanctipauli (Ihering & Pilsbry, 1900) (Strophocheilidae); Drymaeus coarctatus (Pfeiffer, 1845) (Bulimulidae); Habroconus semenlini (Moricand, 1846) (Euconulidae); and Solaropsis aff. rosaria (Pfeiffer, 1849) (Solaropsidae). Furthermore, the species Drymaeus iracema (Simone, 2015) and Drymaeus terreus (Simone, 2015) are synonymized with Drymaeus coarctatus (L. Pfeiffer, 1845).