P4459The influence of the polymorphism BUD13-ZNF259 rs964184 on coronary disease according to age

Objective

Investigate the association of BUD13-ZNF259 rs964184 with dyslipidemia and its impact on CAD risk. Evaluate its impact in different age groups of our population.

Methods

A case-control study was performed with 3050 subjects (1619 coronary patients with 53.3±8 years; 78.9% male and 1431 controls with 52.8±8 years; 76.6% male) from the GENEMACOR study population. Traditional risk factors (smoking, dyslipidemia, diabetes, family history, hypertension, body mass index, alcohol consumption, physical inactivity) and others considered new, such as creatinine clearance, pulse wave velocity, homocysteine, fibrinogen, lipoprotein (a), APOB and PCR (hs) were investigated. BUD13-ZNF259 variant was genotyped and analyzed using the dominant model (CG + GG vs. CC). Bivariate and multivariate analyzes (logistic regression) were used to estimate the ORs and 95% CI, after adjusting for potential confounding factors, in 3 different age groups (<45; 45–55; >55).

Results

BUD13-ZNF259 polymorphism presented an independent and significant risk of CAD (OR=1.58; 95% CI: 1.07–2.32; p=0.019) only in the group of young coronary patients <45 years (n=482 patients), as well as dyslipidemia (OR=2.04; 95% CI: 1.26–3.31; p=0.003). After binary logistic regression entering with the interaction between dyslipidemia and the dominant model ZNF259 (CG + GG vs. CC), we verified an association with CAD risk (OR= 1.78; 95% CI: 1.08–2.95; p=0.025).

Conclusion

BUD13-ZNF259 rs964184 variant showed a significant risk for the onset of CAD in the young population (<45 years). The impact of the interaction of ZPR1 protein with tyrosine kinase (Syk) at the cellular level seems to be more relevant in young patients. This aspect may represent a possible prophylactic and therapeutic target, especially in coronary disease in young people.

The ESC ACCA EAPCI EORP acute coronary syndrome ST-elevation myocardial infarction registry

Aims 

The Acute Cardiac Care Association (ACCA)–European Association of Percutaneous Coronary Intervention (EAPCI) Registry on ST-elevation myocardial infarction (STEMI) of the EurObservational programme (EORP) of the European Society of Cardiology (ESC) registry aimed to determine the current state of the use of reperfusion therapy in ESC member and ESC affiliated countries and the adherence to ESC STEMI guidelines in patients with STEMI.

Methods and results 

Between 1 January 2015 and 31 March 2018, a total of 11 462 patients admitted with an initial diagnosis of STEMI according to the 2012 ESC STEMI guidelines were enrolled. Individual patient data were collected across 196 centres and 29 countries. Among the centres, there were 136 percutaneous coronary intervention centres and 91 with cardiac surgery on-site. The majority of centres (129/196) were part of a STEMI network. The main objective of this study was to describe the demographic, clinical, and angiographic characteristics of patients with STEMI. Other objectives include to assess management patterns and in particular the current use of reperfusion therapies and to evaluate how recommendations of most recent STEMI European guidelines regarding reperfusion therapies and adjunctive pharmacological and non-pharmacological treatments are adopted in clinical practice and how their application can impact on patients’ outcomes. Patients will be followed for 1 year after admission.

Conclusion 

The ESC ACCA-EAPCI EORP ACS STEMI registry is an international registry of care and outcomes of patients hospitalized with STEMI. It will provide insights into the contemporary patient profile, management patterns, and 1-year outcome of patients with STEMI.

Discovery and Further Studies on Giant Viruses at the IHU Mediterranee Infection That Modified the Perception of the Virosphere

The history of giant viruses began in 2003 with the identification of Acanthamoeba polyphaga mimivirus. Since then, giant viruses of amoeba enlightened an unknown part of the viral world, and every discovery and characterization of a new giant virus modifies our perception of the virosphere. This notably includes their exceptional virion sizes from 200 nm to 2 µm and their genomic complexity with length, number of genes, and functions such as translational components never seen before. Even more surprising, Mimivirus possesses a unique mobilome composed of virophages, transpovirons, and a defense system against virophages named Mimivirus virophage resistance element (MIMIVIRE). From the discovery and isolation of new giant viruses to their possible roles in humans, this review shows the active contribution of the University Hospital Institute (IHU) Mediterranee Infection to the growing knowledge of the giant viruses' field.

Can the Combination of Acute Alcohol Intake and One Night of Sleep Deprivation Affect Neuromuscular Performance in Healthy Male Adults? A Cross-over Randomized Controlled Trial

Rodrigues, R, Franke, RA, Teixeira, BC, Macedo, RCO, Diefenthaeler, F, Baroni, BM, and Vaz, MA. Can the combination of acute alcohol intake and one night of sleep deprivation affect neuromuscular performance in healthy male adults? A cross-over randomized controlled trial. J Strength Cond Res 33(5): 1244-1251, 2019-The aim of this work was to perform a cross-over study to compare isolated and combined effects of alcohol intake and sleep deprivation on neuromuscular responses. Ten young and physically active male subjects were allocated to 4 conditions: (a) placebo intake + normal sleep (PLA + SLE); (b) alcohol intake + normal sleep (ALC + SLE); (c) placebo intake + sleep deprivation (PLA + SDP); and (d) alcohol intake + sleep deprivation (ALC + SDP). In each condition, volunteers ingested 1 g of alcohol per kg of body mass of alcoholic beer or nonalcoholic beer (placebo), followed by one night of normal sleep or sleep deprivation. In the next morning, neuromuscular performance (knee extensor isometric and concentric peak torque and time to task failure during the endurance test) and muscle activation were assessed. No differences were observed in the neuromuscular performance. We observed a significant reduction in quadriceps activation during the knee extensor isometric test in ALC + SDP compared with PLA + SLE (-20.8%; p = 0.02; d = 0.56). Our results demonstrated that acute alcohol intake and one night of sleep deprivation reduced quadriceps muscle activation without impact on neuromuscular performance.

Accuracy of quick sequential organ failure assessment score to predict mortality in hospitalized patients with suspected infection in an HIV/AIDS reference centre in Rio de Janeiro, Brazil

OBJECTIVES

To compare the discriminatory capacity of the quick sequential organ failure assessment (qSOFA) vs. the systemic inflammatory response syndrome (SIRS) score for predicting 30-day mortality and intensive care unit (ICU) admission in patients with suspicion of infection at an HIV reference centre.

METHODS

We performed a prospective cohort study including consecutive adult patients who had suspected infection and who were subsequently admitted to the medical ward. Variables related to qSOFA and SIRS were measured at admission. The performance (area under the receiver operating curve, AUROC) of qSOFA (score ≥2) and SIRS (≥2 criteria) as a predictor of 30-day mortality and ICU admission was evaluated.

RESULTS

One hundred seventy-three patients (mean ± standard deviation age, 42.6 ± 12.4 years) were included in the analysis; 107 (61.8%) were male, and 111 (64.2%) were HIV positive. Respiratory and gastrointestinal infections occurred in 49 (28.3%) and 23 (13.3%), respectively. The 30-day mortality rate was 9 (5.2%) of 173. The prognostic performance of qSOFA was similar compared to SIRS, with an AUROC of 0.68 (95% confidence interval, 0.55-0.81) and 0.69 (95% confidence interval, 0.53-0.86) (p 0.96). Twenty patients (11%) were admitted to the ICU; qSOFA and SIRS had a similar discriminatory capacity for ICU admission (AUROC 0.63 (95% confidence interval, 0.51-0.75) and 0.63 (95% confidence interval, 0.50-0.76)), respectively).

CONCLUSIONS

We found a poor prognostic accuracy of the qSOFA to predict 30-day mortality in hospitalized patients suspected of infection in a setting with a high burden of HIV infection.

Immunoprofile of α-Gal- and B-antigen-specific responses differentiates red meat-allergic patients from healthy individuals

BACKGROUND

The galactose-α-1,3-galactose (α-Gal) epitope is involved in red meat allergy. As α-Gal is structurally similar to the blood group B-antigen, we explored the relationship between the immune responses to α-Gal- and the B-antigen in red meat-allergic patients compared to healthy A/O or B blood donors.

METHODS

Sera from 51 red meat-allergic patients IgE-positive to α-Gal and 102 healthy blood donors (51 blood group A/O; 51 blood group B) were included. α-Gal- and B-antigen-specific IgE (ImmunoCAP) and IgG/IgG_1-4 (ELISA) responses were determined. Basophil activation tests were performed.

RESULTS

Fifteen healthy donors were IgE positive to α-Gal, of which 3 had blood group B. The allergic patients had significantly higher α-Gal IgE levels compared to the healthy donors. The majority of the allergic patients, but none of the healthy donors, had IgE against the B-antigen. Inhibition studies revealed cross-reactivity between α-Gal and the B-antigen. The biological activity of the B-antigen was confirmed by basophil activation tests. Anti-α-Gal IgG₁ and IgG₄ levels were significantly higher in the patients compared to the healthy donors. Moreover, the IgG response to the B-antigen was comparable between the allergic patients and healthy A/O donors.

CONCLUSION

Red meat-allergic patients showed significantly higher α-Gal IgE, IgG₁ , and IgG₄ levels, reflecting a Th2 response, compared to healthy blood donors. Blood group B donors had significantly reduced antibody responses to α-Gal, due to similarities with the B-antigen, resulting in a lower risk of sensitization to α-Gal and development of red meat allergy.

Tailed giant Tupanvirus possesses the most complete translational apparatus of the known virosphere

Here we report the discovery of two Tupanvirus strains, the longest tailed Mimiviridae members isolated in amoebae. Their genomes are 1.44–1.51 Mb linear double-strand DNA coding for 1276–1425 predicted proteins. Tupanviruses share the same ancestors with mimivirus lineages and these giant viruses present the largest translational apparatus within the known virosphere, with up to 70 tRNA, 20 aaRS, 11 factors for all translation steps, and factors related to tRNA/mRNA maturation and ribosome protein modification. Moreover, two sequences with significant similarity to intronic regions of 18 S rRNA genes are encoded by the tupanviruses and highly expressed. In this translation-associated gene set, only the ribosome is lacking. At high multiplicity of infections, tupanvirus is also cytotoxic and causes a severe shutdown of ribosomal RNA and a progressive degradation of the nucleus in host and non-host cells. The analysis of tupanviruses constitutes a new step toward understanding the evolution of giant viruses.

Giant viruses are the largest viruses of the known virosphere and their genetic analysis can provide insights into virus evolution. Here, the authors discover Tupanvirus, a unique giant virus that has an unusually long tail and contains the largest translational apparatus of the known virosphere.

Aorto-left ventricular tunnel: a rare cause of heart failure in the newborn

Aorto-left ventricular tunnel is a rare congenital cardiac anomaly, consisting of a short abnormal pathway, usually from a sinus of Valsalva into the left ventricular cavity. It is usually diagnosed with echocardiography. We report a case of a newborn presenting with heart murmur and rapid progression to heart failure and left ventricular enlargement due to an aorto-left ventricular tunnel. Despite successful closure of the tunnel, the patient required a Ross procedure due to progressive aortic disease.

Combined and Isolated Effects of Alcohol Intake and One Night of Sleep Deprivation on Mood States, Hormonal and Inflammatory Responses in Healthy Male Adults: a Crossover Randomized Controlled Trial

Alcohol (ALC) intake and sleep deprivation (SDP) are conditions that cause changes in the physiological status. However, the relationship between biological markers and mood states is not entirely clear yet. The purpose of the study was to compare isolated and combined effects of ALC intake and SDP on hormonal and inflammatory responses and in changes in the state of mood. Also, we intended to explain possible changes in mood states through biochemical variations using multiple stepwise regression analysis. Ten healthy male were randomized in four situations: (1) placebo intake + normal sleep (PLA + SLE); (2) ALC intake + SLE; (3) PLA intake + SDP; (4) ALC intake + SDP. While subjects ingested ALC (1 g/kg of beer), PLA intake was a non-alcoholic beer. The subjects had one night of SLE or were subjected to SDP in the lab for 8 h. After each experimental condition, morning blood samples were taken for assessments of serum levels of glucose, cortisol, testosterone, epinephrine, interleukin-6 (IL-6), interleukin-10 (IL-10) and C-reactive protein (CRP). The subjects were also asked to fill in a Profile of Mood State questionnaire. The results showed that the glucose level was significant lower in ALC + SDP compared to the PLA + SLE condition. Total Mood Disturbance was lower in ALC + SDP and PLA + SDP compared to the PLA + SLE condition. Fatigue was higher under SDP conditions compared to PLA + SLE. Vigor was lower under the ALC + SDP condition compared to the PLA + SLE condition. Regression analysis showed that Total Mood Disturbance and fatigue under ALC + SDP were associated with changes in the cortisol levels. Our results showed that combined and isolated ALC intake and one night of SDP did not change the hormonal and inflammatory responses tested, and the combined effects caused a reduction in the glucose levels. Vigor, fatigue and Total Mood Disturbance were affected by each condition. Furthermore, Total Mood Disturbance and fatigue were possibly explained by changes in the cortisol levels in the combined condition.

Multiple genetic resistances in Capsicum spp

This study aimed to identify Capsicum genotypes with resistance to bacterial spot (BS), anthracnose and Pepper yellow mosaic virus (PepYMV). Fifty-four genotypes of Capsicum spp were evaluated. Resistance reaction against BS was evaluated using three replicates, testing hypersensitivity and quantitative resistance in leaves. After evaluation, inoculated leaves were detached from the plants, being then cultivated until reproductive stage for evaluations anthracnose resistance in immature and mature fruit, totalizing 18 fruits per genotype. For PepYMV resistance was performed with five replications. Each genotype reaction was evaluated by a scoring scale, using the area under the disease progress curve for each pathosystem, and incubation period for the three systems. The latent period was evaluated only for the pathosystem Capsicum-Colletotrichum gloeosporioides. Means were grouped by the Scott-Knott test. Measures of dissimilarity matrix among the genotypes were obtained by Gower's algorithm and the grouping was obtained by the UPGMA clustering method. The accessions belonging to the Capsicum frutescens were the most susceptible to the three diseases. At least one genotype of Capsicum baccatum var. pendulum, Capsicum annuum, and Capsicum chinense showed resistance potential to BS and PepYMV, for use in breeding programs. The accession UENF 1381 (C. annuum) was resistant to the three pathogens.

Methionine and/or Methionine Sulfoxide Alter Ectoenzymes Activities in Lymphocytes and Inflammatory Parameters in Serum from Young Rats: Acute and Chronic Effects

In this study we investigated the effect of acute and chronic treatment with Met and/or methionine sulfoxide (MetO) on ectonucleotidases and cholinesterases activities from lymphocytes and purine derivatives compounds, C-protein reactive, interleukin-10, interleukin-6, and tumor necrosis factor-α levels in serum of young rats. Adenosine triphosphate hydrolysis was decreased in lymphocytes 1 h after treatment by MetO and Met + MetO. However, adenosine triphosphate and adenosine diphosphate hydrolysis in lymphocytes was increased in the groups MetO and Met + MetO and adenosine deaminase activity was increased in MetO 3 h after the treatment. Acetylcholinesterase activity was increased in lymphocytes after 3 h and 21 days of treatment by MetO and Met + MetO, while serum butyrycholinesterase activity was decreased after 1 h and 21 days of treatment in the same groups. In chronic treatment, interleukin-6 and tumor necrosis factor-α level were increased, while that interleukin-10 level was decreased by Met, MetO, and Met + MetO when compared to control group. C-protein reactive level was increased by MetO and Met + MetO. Adenosine triphosphate and adenosine monophosphate levels were reduced in all amino acids treated groups, while adenosine diphosphate and hypoxanthine were enhanced by MetO and Met + MetO. Adenosine and xanthine were reduced in the MetO group, whereas inosine levels were decreased in the MetO and Met + MetO groups. These findings help to understand the inflammatory alterations observed in hypermethioninemia.

Inheritance of bacterial spot resistance in Capsicum annuum var. annuum

Since 2008, Brazil is the largest consumer of agrochemicals, which increases production costs and risks of agricultural products, environment, and farmers' contamination. Sweet pepper, which is one of the main consumed vegetables in the country, is on top of the list of the most sprayed crops. The bacterial spot, caused by Xanthomonas spp, is one of the most damaging diseases of pepper crops. Genetic resistant consists of a suitable way of disease control, but development of durable resistant cultivars as well as understanding of plant-bacterium interaction is being a challenge for plant breeders and pathologists worldwide. Inheritance of disease resistance is often variable, depending on genetic background of the parents. The knowledge of the genetic base controlling such resistance is the first step in a breeding program aiming to develop new genotypes, bringing together resistance and other superior agronomic traits. This study reports the genetic basis of bacterial spot resistance in Capsicum annuum var. annuum using mean generation analysis from crosses between accessions UENF 2285 (susceptible) and UENF 1381 (resistant). The plants of each generation were grown in a greenhouse and leaflets were inoculated with bacterial strain ENA 4135 at 10⁵ CFU/mL in 1.0 cm² of the mesophyll. Evaluations were performed using a scoring scale whose grades ranged from 1.0 (resistant) to 5.0 (susceptible), depending on symptom manifestation. Genetic control of bacterial spot has a quantitative aspect, with higher additive effect. The quantitative analysis showed that five genes were the minimum number controlling bacterial spot resistance. Additive effect was higher (6.06) than dominant (3.31) and explained 86.36% of total variation.

Genotype x environment interaction on experimental hybrids of chili pepper

In Brazil, cultivation of hybrid plants comprise near 40% of the area grown with vegetables. For Capsicum, hybrids of bell and chili peppers have already exceeded 50% and over 25% of all are commercialized seeds. This study aimed to evaluate new pepper hybrids in two environments, Cáceres, MT, and Campos dos Goytacazes, RJ, Brazil. Nine experimental hybrids of C. baccatum var. pendulum were tested and trials were performed in a randomized block design, with three replications and eight plants per plot. In each environment, plants were assessed for canopy diameter, plant height, number of fruit per plant, mean fruit mass per plant, fruit length and diameter, pulp thickness, and content of soluble solids. Seven of the eight traits have differed significantly due to environment variation. Furthermore, genotype and environment interaction was highly significant for number of fruit per plant, mean fruit mass per plant, fruit length, and fruit diameter. Choosing a hybrid to be grown in one of the studied locations must be in accordance with the sought characteristics since there is a complex interaction for some studied traits.

Psychogenic nonepileptic seizures

Introduction

Psychogenic nonepileptic seizures (PNES) are defined as a somatoform conversion disorder manifesting as paroxysmal events not associated with electroencephalographic (EEG) epileptiform correlates. This entity is poorly understood and often misdiagnosed as epilepsy. It is important to recognize that misdiagnosis leads to inappropriate use of antiepileptic drugs, which may worsen the course of the disease.

Recent studies have suggested that the frequency of psychogenic nonepileptic seizures ranges from 10 to 23% of referrals to a pediatric epilepsy center, as well as 60% of children with PNES achieve symptom improvement and event freedom of symptoms following appropriate treatment.

Objectives

The aim of this study is to conduct a literature review of studies which the purpose was better understand the etiologies, features, and care outcomes of psychogenic nonepileptic seizures (PNESs) in a pediatric setting.

Conclusion

A early identification of the risk factors for comorbid psychopathology, diagnosis and appropriate care for PNESs reduces inappropriate medical investigation and therapy, expedites rates of remission, and decreases health-care utilization in a pediatric setting.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Synthetic 2-aryl-3-((piperidin-1-yl)ethyl)thiazolidin-4-ones exhibit selective in vitro antitumoral activity and inhibit cancer cell growth in a preclinical model of glioblastoma multiforme

Glioblastoma multiforme (GBM) is the worst form of primary brain tumor, which has a high rate of infiltration and resistance to radiation and chemotherapy, resulting in poor prognosis for patients. Recent studies show that thiazolidinones have a wide range of pharmacological properties including antimicrobial, anti-inflammatory, anti-oxidant and anti-tumor. Here, we investigate the effect antiglioma in vitro of a panel of sixteen synthetic 2-aryl-3-((piperidin-1-yl)ethyl)thiazolidin-4-ones where 13 of these decreased the viability of glioma cells 30-65% (100 μM) compared with controls. The most promising compounds such as 4d, 4l, 4m and 4p promoted glioma reduction of viability greater than 50%, were further tested at lower concentrations (12.5, 25, 50 and 100 μM). Also, the data showed that the compounds 4d, 4l, 4m and 4p induced cell death primarily through necrosis and late apoptosis mechanisms. Interestingly, none of these 2-aryl-3-((piperidin-1-yl)ethyl)thiazolidin-4-ones were cytotoxic for primary astrocytes, which were used as a non-transformed cell model, indicating selectivity. Our results also show that the treatment with sub-therapeutic doses of 2-aryl-3-((piperidin-1-yl)ethyl)thiazolidin-4-ones (4d, 4l and 4p) reduced in vivo glioma growth as well as malignant characteristics of implanted tumors such as intratumoral hemorrhage and peripheral pseudopalisading. Importantly, 2-aryl-3-((piperidin-1-yl)ethyl)thiazolidin-4-ones treatment did not induce mortality or peripheral damage to animals. Finally, 2-aryl-3-((piperidin-1-yl)ethyl)thiazolidin-4-ones also changed the nitric oxide metabolism which may be associated with reduced growth and malignity characteristics of gliomas. These data indicates for the first time the therapeutic potential of synthetic 2-aryl-3-((piperidin-1-yl)ethyl)thiazolidin-4-ones to GBM treatment.

Transition metal-catalyzed iodine(iii)-mediated nitrene transfer reactions: efficient tools for challenging syntheses

The main synthetic applications of catalytic C(sp³)–H amination and alkene aziridination reactions are discussed in the context of natural product synthesis. The examples highlight that these synthetic methods now firmly belong in the organic chemist's toolbox.

Association of ADAMTS7 gene polymorphism with cardiovascular survival in coronary artery disease

Recent genetic studies have revealed an association between polymorphisms at the ADAMTS7 gene locus and coronary artery disease (CAD) risk. Functional studies have shown that a CAD-associated polymorphism (rs3825807) affects ADAMTS7 maturation and vascular smooth muscular cell (VSMC) migration. Here, we tested whether ADAMTS7 (A/G) SNP is associated with cardiovascular (CV) survival in patients with established CAD. A cohort of 1,128 patients with angiographic proven CAD, who were followed up prospectively for a mean follow-up period of 63 (range 6–182) mo, were genotyped for rs3825807 A/G. Survival statistics (Cox regression) compared heterozygous (AG) and wild-type (AA) with the reference homozygous GG. Kaplan-Meier (K-M) survival curves were performed according to ADAMTS7 genotypes for CV mortality. Results showed that 47.3% of patients were heterozygous (AG), 36.5% were homozygous for the wild-type allele (AA) and only 16.2% were homozygous for the GG genotype. During the follow-up period, 109 (9.7%) patients died, 77 (6.8%) of CV causes. Survival analysis showed that AA genotype was an independent risk factor for CV mortality compared with reference genotype GG (HR = 2.7, P = 0.025). At the end of follow-up, the estimated survival probability (K-M) was 89.8% for GG genotype, 82.2% for AG and 72.3% for AA genotype ( P = 0.039). Carriage of the mutant G allele of the ADAMTS7 gene was associated with improved CV survival in patients with documented CAD. The native overfunctional ADAMTS7 allele (A) may accelerate VSMC migration and lead to neointimal thickening, atherosclerosis progression and acute plaque events. ADAMTS7 gene should be further explored in CAD for risk prediction, mechanistic and therapeutic goals.

Are the Responses to Resistance Training Different Between the Preferred and Nonpreferred Limbs?

Humans preferentially recruit limbs to functionally perform a range of daily tasks, which may lead to performance asymmetries. Because initial training status plays an important role in the rate of progression during resistance training, could asymmetries between the preferred and nonpreferred limbs lead to different magnitudes of strengthening during a resistance training program? This issue motivated this study, in which 12 healthy and physically active men completed a 4-week control period followed by a 12-week isokinetic resistance training program, performed twice a week, including 3-5 sets of 10 maximal eccentric contractions for each limb. Every 4 weeks, knee extensor peak torques at concentric, isometric, and eccentric tests were measured using an isokinetic dynamometer and the sum of quadriceps muscle thickness was determined by ultrasound images. Before training, concentric peak torque was similar between limbs but isometric and eccentric peak torques were significantly smaller in the nonpreferred compared with the preferred limb (4.9 and 5.8%, respectively). Bilateral strength symmetry remained constant throughout the training period for concentric tests. For eccentric and isometric tests, symmetry was reached at the fourth and eighth training weeks, respectively. After 12 weeks, between-limb percent nonsignificant differences were -0.62% for isometric and -1.93% for eccentric tests. The sum of knee extensor muscle thickness had similar values before training and presented similar changes throughout the study for both the preferred and the nonpreferred limbs. In conclusion, the nonpreferred limb presents higher strength gain than the preferred limb at the initial phase of an isokinetic resistance training program, and this increased strength gain is not associated with muscle hypertrophy.

Molecular and agronomic analysis of intraspecific variability in Capsicum baccatum var. pendulum accessions

Capsicum baccatum is one of the most important chili peppers in South America, since this region is considered to be the center of origin and diversity of this species. In Brazil, C. baccatum has been widely explored by family farmers and there are different local names for each fruit phenotype, such as cambuci and dedo-de-moça (lady's finger). Although very popular among farmers and consumers, C. baccatum has been less extensively studied than other Capsicum species. This study describes the phenotypic and genotypic variability in C. baccatum var. pendulum accessions. Twenty-nine accessions from the Universidade Estadual do Norte Fluminense Darcy Ribeiro gene bank, and one commercial genotype ('BRS-Mari') were evaluated for 53 morphoagronomic descriptors (31 qualitative and 22 quantitative traits). In addition, accessions were genotyped using 30 microsatellite primers. Three accessions from the C. annuum complex were included in the molecular characterization. Nine of 31 qualitative descriptors were monomorphic, while all quantitative descriptors were highly significant different between accessions (P < 0.01). Using the unweighted pair group method using arithmetic averages, four groups were obtained based on multicategoric variables and five groups were obtained based on quantitative variables. In the genotyping analysis, 12 polymorphic simple sequence repeat primers amplified in C. baccatum with dissimilarity between accessions ranging from 0.13 to 0.91, permitting the formation of two distinct groups for Bayesian analysis. These results indicate wide variability among the accessions comparing phenotypic and genotypic data and revealed distinct patterns of dissimilarity between matrices, indicating that both steps are valuable for the characterization of C. baccatum var. pendulum accessions.

PROPOSAL OF A CLINICAL CARE PATHWAY FOR THE MANAGEMENT OF ACUTE UPPER GASTROINTESTINAL BLEEDING

BACKGROUND

Upper gastrointestinal bleeding implies significant clinical and economic repercussions. The correct establishment of the latest therapies for the upper gastrointestinal bleeding is associated with reduced in-hospital mortality. The use of clinical pathways for the upper gastrointestinal bleeding is associated with shorter hospital stay and lower hospital costs.

OBJECTIVE

The primary objective is the development of a clinical care pathway for the management of patients with upper gastrointestinal bleeding, to be used in tertiary hospital.

METHODS

It was conducted an extensive literature review on the management of upper gastrointestinal bleeding, contained in the primary and secondary information sources.

RESULTS

The result is a clinical care pathway for the upper gastrointestinal bleeding in patients with evidence of recent bleeding, diagnosed by melena or hematemesis in the last 12 hours, who are admitted in the emergency rooms and intensive care units of tertiary hospitals. In this compact and understandable pathway, it is well demonstrated the management since the admission, with definition of the inclusion and exclusion criteria, passing through the initial clinical treatment, posterior guidance for endoscopic therapy, and referral to rescue therapies in cases of persistent or rebleeding. It was also included the care that must be taken before hospital discharge for all patients who recover from an episode of bleeding.

CONCLUSION

The introduction of a clinical care pathway for patients with upper gastrointestinal bleeding may contribute to standardization of medical practices, decrease in waiting time for medications and services, length of hospital stay and costs.

Morphoagronomic and molecular profiling of Capsicum spp from southwest Mato Grosso, Brazil

The genus Capsicum ranks as the second most exported vegetable in Brazil, which is also considered to be a center of diversity for this genus. The aim of this study was to rescue genetic variability in the genus Capsicum in the southwest region of Mato Grosso, and to characterize and estimate the genetic diversity of accessions based on morphoagronomic descriptors and inter-simple sequence repeat molecular markers. Data were obtained following the criteria of the International Plant Genetic Resources Institute, renamed Bioversity International for Capsicum. Data were analyzed using different multivariate statistical techniques. An array of binary data was used to analyze molecular data, and the arithmetic complement of the Jaccard index was used to estimate the genetic dissimilarity among accessions. Six well-defined groups were formed based on the morphological characterization. The most divergent accessions were 142 and 126, with 125 and 126 being the most similar. The groups formed following agronomic characterization differed from those formed by morphological characterization, and there was a need to subdivide the groups for better distinction of accessions. Based on molecular analysis, accessions were divided into two groups, and there was also a need to subdivide the groups. Based on joint analysis (morphological + agronomic + molecular), six groups were formed with no duplicates. For all groups, the cophenetic correlation coefficient was higher than 0.8. These results provide useful information for the better management of the work collection. All correlations between the combined distance matrix were significant by the Mantel test.

Adjuvant use of antibiotics with corticosteroids in inflammatory bowel disease exacerbations requiring hospitalisation: a retrospective cohort study and meta-analysis

BACKGROUND

Patients hospitalised with an exacerbation of inflammatory bowel disease (IBD) often receive antibiotics in addition to intravenous steroids. However, their efficacy in this setting is unclear.

AIM

To ascertain if the addition of antibiotics to intravenous steroids modifies short and long-term clinical outcomes.

METHODS

Our study included IBD patients hospitalised between 2009 and 2014 who received intravenous (IV) steroids with or without adjuvant antibiotics. Outcomes of interest included length of stay (LOS), need for medical and surgical rescue therapy during the hospitalisation, and at 90 and 365 days. A meta-analysis of previously published randomised trials was additionally performed.

RESULTS

A total of 354 patients were included [145 ulcerative colitis (UC); 209 Crohn's disease (CD)]. In CD, combination of IV steroids and antibiotics did not change need for in-hospital medical rescue therapy, surgery or hospitalisations at 1 year but was associated with greater LOS (6.1 vs. 4.6 days, P = 0.02). In UC, patients receiving antibiotics were less likely to require in-hospital medical rescue therapy [odds ratio (OR): 0.42, 95% confidence interval (CI): 0.19-0.93] but experienced no statistically significant differences in LOS, in-hospital surgery, re-hospitalisations or surgery by 1 year. A meta-analysis of three relevant randomised trials demonstrated no difference in clinical improvement with antibiotics over placebo (OR: 1.08, 95% CI: 0.50-2.32).

CONCLUSIONS

The addition of antibiotics to intravenous steroids for treatment of IBD exacerbations was associated with a reduced need for in-hospital medical rescue therapy in ulcerative colitis without significant long-term benefit, and did not affect short- or long-term outcomes in Crohn's disease.