Do microplastics affect the zoanthid Zoanthus sociatus?

Microplastics (1 μm-5 mm), a ubiquitous and persistent marine pollutant, pose a severe threat to coral reefs when recently associated with physiological distress and increased diseases on corals. Studies conducted so far have only reported effects on scleractinian species. Knowledge about its effects on other corals (e.g. Order Zoantharia) remains uncovered, and responses at biochemical levels remain poorly documented. This study aimed to assess the potential effects induced by the presence of microplastics (1 and 10 mg L^-1 low-density polyethylene, LDPE MP, or polyvinyl chloride, PVC MP) in the tropical and subtropical cosmopolitan species Zoanthus sociatus (order Zoantharia. Anthozoa: Hexacorallia), at organism level (survival and behaviour), endosymbionts (photosynthetic efficiency) and the cellular level (oxidative stress, detoxification capacity and energy metabolism). In a short-term exposure (96 h), this species was more sensitive to PVC MP. The presence of this polymer at a concentration of 10 mg L^-1 caused a ten-fold higher adhesion to the coral epidermis, increased photosynthetic efficiency, lipid peroxidation, and antioxidant defences; without, however, inducing energetic costs. Although the observed physiological and biochemical effects did not compromise Z. sociatus survival in the short term, it does not rule out potential long-term (cumulative) effects that could endanger this and other physiologically similar species that underlie coral reefs.

Effects of gold nanoparticles in gilthead seabream-A proteomic approach

Despite the widespread use of nanoparticles (NPs), there are still major gaps of knowledge regarding the impact of nanomaterials in the environment and aquatic animals. The present work aimed to study the effects of 7 and 40 nm gold nanoparticles (AuNPs) - citrate and polyvinylpyrrolidone (PVP) coated - on the liver proteome of the estuarine/marine fish gilthead seabream (Sparus aurata). After 96 h, exposure to AuNP elicited alterations on the abundance of 26 proteins, when compared to the control group. AuNPs differentially affected several metabolic pathways in S. aurata liver cells. Among the affected proteins were those related to cytoskeleton and cell structure, gluconeogenesis, amino acids metabolism and several processes related to protein activity (protein synthesis, catabolism, folding and transport). The increased abundance of proteins associated with energy metabolism (ATP synthase subunit beta), stress response (94 kDa glucose-regulated protein) and cytoskeleton structure (actins and tubulins) may represent the first signs of cellular oxidative stress induced by AuNPs. Although higher gold accumulation was found in the liver of S. aurata exposed to 7 nm PVP-AuNPs, the 7 nm cAuNPs were more bioactive, inducing more effects in liver proteome. Gold accumulated more in the spleen than in the other assessed tissues of S. aurata exposed to AuNPs, highlighting its potential role on the elimination of these NPs.

Mental flexibility and problem solving in adult patients who present non-suicidal self-injury

Introduction

Non-Suicidal Self-Injury (NSSI) is considered a dysfunctional way of dealing with problem situations.

Objective

This study aimed to investigate the problem solving capacity in adults with NSSI compared to controls.

Methods

Thirty-three patients who sought treatment for NSSI (NSSI group) were compared with 33 individuals without psychiatric disorder (control group). We also investigated Axis I disorders, executive functions and problem solving capacity.

Results

In both groups, the majority were women (77.25%) with a mean age of 30 years, and the beginning of NSSI behavior of 16 years. The most common NSSI behaviour was skin cutting, and the most common reason given for engaging in that behaviour was “to stop negative feelings”. The most common psychiatric comorbidities were major depressive disorder (60.6%). Compared to controls, the group with NSSI showed lower results in relation to problem solving capacity (P = 0.000) and mental flexibility (P = 0.007). Deficits in problem solving capacity may be a reflection of low mental flexibility of adults with NSSI. This may be a risk factor for the beginning of NSSI and the persistence of it in adulthood.

Conclusion

Early identification and treatment focused on problem solving capacity during the adolescence may prevent the chronicity of NSSI.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

9 Pregnancy loss in Holstein lactating recipient cows diagnosed pregnant by pregnancy-associated glycoprotein test in blood

The objective of this study was to evaluate the pregnancy loss (PL) between Day 30 (P30) and Day 80 (P80) of pregnancy in lactating Holstein recipients that received an invivo- (flush) or invitro-produced (IVF) embryo. The recipient cows were located at Maddox Dairy in Riverdale, CA, USA, a Holstein herd that milks 3500 cows with a 305-day mature-equivalent milk production of 12 800 kg. First-lactation cows were enrolled in a Presynch-Ovsynch oestrus-synchronization program and scheduled to be artificially bred for the first time at 80 days after calving or to receive an embryo 7 or 8 days after the expected heat (recipients). The data from 590 pregnancies (1045 embryo transfers) from embryos transferred between January 2018 and March 2019 was analysed. Only grade 1 embryos (from morula to hatched blastocyst stage) produced invivo or invitro from Holstein donor heifers, lactating or dry cows, were transferred fresh (invivo or invitro) or frozen-thawed (invivo), and pregnancy rates are shown in Table 1. The ruminant trophoblast produces pregnancy-associated glycoproteins (PAG) that can be detected by enzyme-linked immunoassay (ELISA) in the blood of pregnant cattle as early as 28 days after insemination. Various dairy herds in the USA have been using this test to supplement or replace the use of transrectal ultrasonography for early pregnancy diagnosis. Blood was sampled on P30 after expected heat day (23 days after embryo transfer) from the recipient cows and sent to IDEXX for the PAG Bovine Pregnancy Test, which was reconfirmed on P80 of pregnancy by transrectal ultrasonography. Pregnancy loss was considered to have occurred when a cow was pregnant on P30 but not pregnant on P80. The variable PL was analysed by binary logistic regression in the MINITAB program, and the model included effects of donor status (heifer vs. milk vs. dry) and embryo type. The total PL was 12.2% (72/590) and the details are shown in Table 1. No effect of donor status (P=0.80) was detected. However, there was effect of embryo type (P=0.004). The IVF embryos had a PL of 18.0% compared with 9.5% for the invivo-produced embryos. Further research should be performed to study heifer embryos PL, because currently more embryos are being produced from very young donor cows and sires due to intensive use of genomic testing. In conclusion, there is a higher PL in lactating dairy recipients receiving IVF fresh embryos compared with fresh or frozen invivo-produced embryos. Table 1.Embryo transfer (ET) pregnancy rates (PR, P30) in first-lactation Holstein cows (top) and pregnancy loss (PL) from Day 30 (P30) to 80 (P80) in first-lactation recipient Holstein cows (bottom) Item Heifer donor Lactating donor Dry donor Total ET P30 PR% ET P30 PR% ET P30 PR% ET P30 PR% Invivo - fresh 6 3 50.0 43 25 58.1 329 206 62.6 378 234 61.9 Invivo - frozen 75 38 50.7 221 129 58.4 296 167 56.4 IVF - fresh 123 61 49.6 91 42 46.2 157 86 54.8 371 189 50.9 Total 129 64 49.6 209 105 50.2 707 421 59.5 1045 590 56.5 P30 P80 PL% P30 P80 PL% P30 P80 PL% P30 P80 PL% Invivo - fresh 3 3 0.0 25 24 4.0 206 186 9.7 234 213 9.0 Invivo - frozen 38 35 7.9 129 115 10.9 167 150 10.2 IVF - fresh 61 48 21.3 42 35 16.7 86 72 16.3 189 155 18.0 Total 64 51 20.3 105 94 10.5 421 373 11.4 590 518 12.2

P672 Predictors of ventricular arrythmias and mortality after implantation of primary prevention antitachycardia devices

Background

Patients (pts) with reduced left ventricular (LV) systolic function have high risk of sudden cardiac death and benefit from implantable cardioverter-defibrillators (ICDs/CRT-Ds). However, the risk for arrhythmic events and device therapies is extremely heterogeneous in this population, so more accurate tools for risk stratification are required.

Purpose

To assess predictors of mortality and arrhythmic events in pts receiving primary prevention ICDs/ CRTs.

Methods

Retrospective analysis of 150 pts submitted to primary prevention ICD/ CRT-D implantation with remote monitoring between 2014-2018. Demographic, clinical and echocardiographic data from implantation and follow-up period were retrieved. Arrhythmic events and device therapies were retrieved from remote monitoring and clinic visits. Univariate analysis was performed followed by a multivariate Cox analysis to evaluate predictors of events. p < 0.05 were considered significant.

Results

150 pts, 80.7% male, with a mean age of 64.30 ± 12.9 years (Y) and a mean follow-up (FU) time of 38 ± 15 months. 66% of pts implanted an ICD. 52.0% of pts presented with an ischemic cardiomyopathy and 41.3% had atrial fibrillation. 35.3% had chronic kidney disease (GFR < 60mL/min) and 24.0% were diabetic. Mean BNP value of 449.6 ± 631.3pg/mL and mean peak VO2 of 15.3mL/kg/min. Mean LV ejection fraction (LVEF) during FU of 35.9 ± 12.1% and a mean average global longitudinal strain (GLS) of -8.7 ± 5.5%. 63pts (42.0%) suffered a ventricular arrhythmia, mostly non-sustained ventricular tachycardia, of which 47.6% received appropriate therapies. Mortality rate of 13.3% during follow-up (20 pts). Baseline diabetes (p = 0.040) and post-procedural pulmonary artery systolic pressure (PASP) (p = 0.002) were independent predictors of overall mortality in the follow-up. Male gender (p = 0.041), baseline diabetes (p = 0.011) and atrial fibrillation (p = 0.038) were associated with ventricular events. In patients with CRT-D, a percentage of biventricular pacing superior to 95% was found to be protective against ventricular arrhythmias. Interestingly despite being associated with a higher overall mortality (p = 0.028), a reduced LVEF wasn’t related to the arrhythmic burden of our population, neither the GLS nor the LV mechanical dispersion were predictors of ventricular arrhythmias.

Conclusion

Baseline diabetes and PASP were independent predictors of mortality in our population of ICD/CRT-D pts implanted in primary prevention setting. An increased percentage of biventricular pacing was associated to improved clinical outcomes in patients receiving cardiac resynchronization therapy. Identification of predictors of events in this population can help individualize its management.

P1260 Chagas disease, a new challenge to the old continent

Case Report

A 53-year-old female patient from the North Region of Brazil with a past medical history of Chagas Disease (CD) with esophageal involvement and permanent atrial fibrillation (AF) presented to the Emergency Department (ED) due to complaints of retrosternal discomfort and dizziness. The patient reported multiple recent syncopal episodes and had performed a recent 24-hour Holter monitoring revealing AF with predominantly slow ventricular rate and frequent ventricular premature beats. Her sister had recently been diagnosed with obstructive hypertrophic cardiomyopathy. During the ED stay, the patient developed a syncopal monomorphic ventricular tachycardia, requiring synchronized electrical cardioversion. Post cardioversion EKG revealed a sinus rhythm with a right bundle branch block, left anterior fascicular block and 1st degree AV block. The patient was admitted in the Cardiology Department for further investigation. Transthoracic echocardiogram revealed a dilated left ventricle with a reduced systolic function (LVEF of 38%, GLS of -7.1%), with an aneurysm of the basal inferior and posterior walls and a markedly dilated left atrium (68mL/m2). Cardiac magnetic resonance imaging showed a marked dilation of both atriums and ventricles, with biventricular systolic dysfunction, hypertrabeculation of the left ventricular wall and the presence of diffuse intramural and subepicardic fibrosis. These features were compatible with chagasic cardiomyopathy. Due to biventricular systolic dysfunction, the documentation of AV conduction disturbance, the natural history of the disease and the need for antiarrhythmic therapy, the patient underwent cardiac resynchronization therapy–defibrillator implantation. 1 week after the procedure, the patient experienced an arrhythmic storm with a total of 6 CRT-D shocks. Amiodarone was initiated and beta-blocker was titulated to the maximum tolerated dose, with no recurrence of ventricular tachycardia. On the 3 month follow-up visit the patient denied symptoms of congestive heart failure. Device interrogation revealed a high percentage of biventricular pacing and no arrhythmic events.

Conclusion

This case describes the most remarkable and characteristic features of chagasic cardiomyopathy. It is almost always progressive and is associated with a worse outcome comparing with other cardiomyopathies. The prevalence of CD is growing in traditionally nonendemic areas and its timely recognition is fundamental.

P1262 If anything can go wrong, it will: management of a pericardial effusion in a young patient

Case Report

A 25 year-old male patient with an unremarkable past medical history presented to the Emergency Department due to a hemodynamically stable wide complex tachycardia at 260bpm with no response to adenosine, which was successfully treated with synchronized electrical cardioversion. Post cardioversion EKG revealed a pre excitation pattern and the transthoracic echocardiogram showed a large pericardial effusion with diastolic right atrial collapse. The patient was admitted in the Cardiology Department for emergent pericardiocentesis and further investigation. A total of 800 mL of bloody pericardial fluid was removed, compatible with an exudate, but fluid culture and cytology were inconclusive. Due to a rapid reaccumulation of pericardial fluid, the patient underwent a pericardial window, after which he developed an intractable pleuritic thoracalgia, refractory to the combination of ibuprofen, colchicine and oral steroid, despite the resolution of the pericardial effusion. He was also submitted to an electrophysiologic study with successful ablation of a right sided accessory pathway. Analysis of the pericardial fluid and biopsy were inconclusive once again, including a low level of adenosine deaminase and negative acid-fast bacilli test and nucleic acid amplification test for Mycobacterium tuberculosis. The patient was afebrile and denied any constitutional symptoms or relevant epidemiological context. The remainder etiological study was unremarkable, with the exception of fluctuating antibody titers for adenovirus, Borrelia burgdorferi and Mycoplasma pneumoniae, which were interpreted as a result of cross-reactivity. Nevertheless, a course of 21 days of doxycycline was tried without any significant improvement. Thoracic-abdominal-pelvic CT and PET scan were normal. Direct inoculation in guinea pig led to positive results for Mycobacterium tuberculosis and antituberculous therapy was started. Despite pathogen directed antibiotic treatment, there was no clinical improvement and the pericardial effusion gradually relapsed, evolving to cardiac tamponade requiring emergent drainage. Histologic examination of pericardial fragments finally revealed massive infiltration by an undifferentiated malignant tumor compatible with a malignant epithelioid hemangioendothelioma. Due to the patient’s poor performance status and rapidly deteriorating clinical course, it was decided not to start chemotherapy. The patient eventually died, 6 months after his admission to the ED and 2 weeks after the neoplasm’s diagnosis.

Conclusion

In regions with a high Tuberculosis incidence, there should be a high degree of suspicion for tuberculous pericarditis, especially in cases of recurrent pericardial effusion. Immunosuppressed individuals, such as oncologic patients, are at an increased risk for tuberculosis. The management of relapsing pericardial effusion remains a diagnostic challenge as described in this clinical case.

227 Is the antral follicle count on a random day of the oestrous cycle correlated with superovulatory responses in Santa Inês ewes?

Antral follicle count (AFC) performed after an oestrus synchronization protocol has been studied as a tool to select ewes with high potential for invivo embryo production (Pinto et al. 2018 Theriogenology 113, 146-152). However, it would be interesting to know whether AFC assessed on a random day of the oestrous cycle correlates with the superovulatory response. The present study was conducted to evaluate the correlation between AFC at the beginning of progesterone (P4)-based oestrus synchronization protocol used as basis of superovulatory treatment and the number of corpora lutea (CL) 12h before recovery of embryos in Santa Inês ewes. The study was conducted during September and October in northeast Brazil (03°40′26″S and 40°14′20″W) using 8 adult Santa Inês ewes. On a random day of oestrous cycle (Day 0) all ewes received an intravaginal device (CIDR) of progesterone (0.3g, Eazi-breed, Zoetis), which remained for 9 days. On Day 7, the pFSH (133mg, Folltropin V, Vetoquinol) treatment began, with 6 decreasing doses (25, 25, 15, 15, 10, and 10%) injected IM at 12-h intervals. On Day 9, 2 equal doses of D-cloprostenol were injected at a 12-h interval (37.5µg, Prolise, Agener União). All ewes showed oestrus and were mated by fertile rams. Flunixin meglumine (24.9 mg; Banamine, MSD Animal Health) was administered IM on Days 12, 13, and 15. On Day 16, non-surgical embryo recovery (NSER) was performed after cervical dilation using D-cloprostenol and oestradiol benzoate at 16h and oxytocin 20min before. Transrectal B-mode ultrasound evaluations (Z5 Vet, Mindray), frequency 7.5MHz, were performed on Day 0 and 7 and 12h before NSER to evaluate the ovarian population present. Pearson correlation analysis (P<0.05) was performed using Bioestat 5.3 software. The number of AFC per ewe at the beginning of the protocol and on Day 7 were 9.9±2.7 and 11±3.2, respectively. The numbers of CL, recovered embryos, and viable embryos were 14.0±3.5, 8.2±10.9, and 6.0±11.0, respectively. There was no correlation of AFC on a random day of oestrous cycle with the number of AFC on Day 7 (P=0.42), number of corpora lutea (P=0.44), number of recovered embryos (P=0.18), or number of viable embryos (P=0.11) in superovulated ewes. In conclusion, we did not find significant correlations between AFC on a random day of oestrous cycle and the superovulatory/embryos response in Santa Inês ewes. Financial support for this study was provided by Embrapa (02.13.06.026.00.02 and 02.13.06.026.00.04) and FAPEMIG (PPM 00201-17).

11 Invivo-derived embryo pregnancy rates at Maddox Dairy from 2008 to 2018

Maddox Dairy, located in Riverdale, CA, USA, is a Holstein herd that milks 3500 cows with a 305-day mature-equivalent milk production of 12 800 kg, and they have been producing high genetic animals by embryo transfer (ET) since the early 1980s. Invivo-derived embryos from Holstein donors were transferred fresh (grade 1 or 2) or frozen (grade 1), at morula (4), early blastocyst (5), or blastocyst (6) stage, to virgin heifers (VH, natural oestrus, 13-15 months old) or lactating cows (LC, Presynch-Ovsynch, 86 days in milk, first or second lactation) 6 to 9 days after oestrus. Pregnancy diagnosis was done by transrectal ultrasonography at 32-46 days in VH and by the IDEXX PAG test at 30 days in LC. June, July, August, September, and October were called critical months (first service AI conception rate drops below 44%) and compared with the other months. The data from 32 503 ETs between January 2008 and December 2018 are summarised on Table 1. Pregnancy rates (PR) are lower for LC recipients than for VH. Embryo transfers performed 7 or 8 days after oestrus had higher PR in both types of recipients and embryos, but Day 6 and 9 oestrus are also used with fair results. The season does not seem to affect PR. There is not enough difference in the combination of stage and days from oestrus for invivo-derived embryos. These numbers do not belong to a planned experiment. Several management changes during the years were made, which make it very difficult to apply statistical methods to analyse the data correctly. They are used as a tool to make decisions in an attempt to improve future results. Table 1.Pregnancy rate (PR) of virgin heifers (top) and lactating cows (bottom)-fresh (SH) and frozen (OZ) invivo-derived embryo transfer1 Heat-months SH-ST4 SH-ST5 SH-ST6 SH-All OZ-ST4 OZ-ST5 OZ-ST6 OZ-All PR% n PR% n PR% n PR% n PR% n PR% n PR% n PR% n Heifers 6 d-CM 62 934 66 243 68 69 63 1246 56 473 58 219 62 42 57 734 6 d-OM 62 1623 67 489 69 211 64 2323 56 600 55 296 48 137 55 1033 6 d-T 62 2557 67 732 69 280 63 3569 56 1073 57 515 51 179 56 1767 7 d-CM 64 1506 68 495 67 221 65 2222 60 822 62 340 63 156 61 1318 7 d-OM 66 2723 68 1021 69 510 67 4254 57 1120 59 581 57 231 58 1932 7 d-T 66 4229 68 1516 69 731 67 6476 58 1942 60 921 60 387 59 3250 8 d-CM 65 1348 64 518 67 322 65 2188 59 595 64 258 63 108 61 961 8 d-OM 66 2166 68 886 70 510 67 3562 61 770 60 364 51 130 60 1264 8 d-T 66 3514 67 1404 69 832 66 5750 60 1365 62 622 56 238 60 2225 9 d-CM 60 109 56 43 70 20 60 172 60 5 33 6 50 4 47 15 9 d-OM 58 129 63 57 60 40 60 226 63 16 50 18 75 4 58 38 9 d-T 59 238 60 100 63 60 60 398 62 21 46 24 63 8 55 53 All-CM 64 3897 66 1299 67 632 65 5828 58 1895 61 823 63 310 60 3028 All-OM 65 6641 67 2453 69 1271 66 10 365 58 2506 58 1259 53 502 58 4267 All-T 65 10 538 67 3752 69 1903 66 16 193 58 4401 60 2082 57 812 59 7295 Lactating cows 6 d-CM 54 265 48 86 50 12 53 363 38 141 31 77 50 10 36 228 6 d-OM 49 463 52 203 45 56 50 723 46 101 48 54 59 27 48 182 6 d-T 51 728 51 289 46 68 51 1086 41 242 38 131 57 37 42 410 7 d-CM 54 755 59 274 56 103 55 1137 43 928 48 450 43 192 45 1570 7 d-OM 55 914 66 367 54 109 58 1393 46 1052 45 564 47 353 46 1969 7 d-T 55 1669 63 641 55 212 57 2530 45 1980 46 1014 46 545 45 3539 8 d-CM 63 252 68 82 76 33 65 368 48 219 56 80 42 33 50 332 8 d-OM 61 257 64 161 53 47 61 466 50 191 53 77 56 16 51 284 8 d-T 62 509 65 243 63 80 63 834 49 410 55 157 47 49 50 616 All-CM 56 1272 58 442 60 148 57 1868 44 1288 47 607 43 235 45 2130 All-OM 55 1634 62 731 51 212 56 2582 47 1344 46 695 48 396 47 2435 All-T 55 2906 60 1173 55 360 57 4450 45 2632 47 1302 46 631 46 4565 1ST=stage; CM=critical months (June, July, August, September, and October); OM=other months.

10 Pregnancy rates following artificial insemination or embryo transfer in lactating Holstein cows

Excessive heat affects the fertility of high production lactating cows, and reduced pregnancy rates (PR) are observed during summer and early fall. Embryo production programs are used to produce more calves from high genetic merit animals, but could it also increase fertility by bypassing all the negative variables affecting the embryo development before Day 7 (oocyte development, ovulation, fertilization, early embryo development)? The data from AIs and embryo transfers (ET) between June 2017 and May 2019 were analysed. June, July, August, September, and October were called critical months (first-service AI conception rate dropped below 44%). The cows were located at Maddox Dairy in Riverdale, CA, USA, a Holstein herd that milks 3500 cows with a 305-day mature-equivalent milk production of 12 800 kg. First- and second-lactation cows were enrolled in a Presynch-Ovsynch oestrus-synchronization program and scheduled for the first AI at 86 days after calving or to receive an embryo 7 or 8 days after the expected heat. The embryos were produced invivo or invitro from Holstein donors and were transferred fresh or frozen. Blood was sampled on Day 30 after expected heat day (23 days after embryo transfer), and pregnancy was detected by the IDEXX PAG Bovine Pregnancy Test. Table 1 summarises the results, where ET PR% is the number of pregnant cows divided by the number of cows that received and embryo. All the cows synchronized for AI were bred, but only cows with the presence of a corpus luteum (CL) on ET day received an embryo. The presence of a CL was not detected in 28.7% (471/1642) of the cows (32.2% in the critical months and 25.7% in the others). Unfortunately, we could not detect the presence of a CL by ultrasonography every time we transferred embryos, so the nonovulation rate might be overestimated. The cows without a CL were considered open and used to calculate the adjusted PR (AdjPR%). Embryo transfer PR is superior to that of AI, especially during the critical months. Fresh invivo embryos have the most impact. When the cows without CLs are considered open, the difference between AI and ET is still evident for fresh invivo embryos. Besides producing animals with higher genetic merit, depending on the type of embryo used, ET can increase fertility in lactating Holstein cows, especially during the critical months. The other benefit of using ET is that cows that do not ovulate are synchronized right away, which is not the case for AI cows. Table 1.AI×embryo transfer in lactating Holstein cows1 from June 2017 to May 20192 Item Critical months (June to October) Other months (November to May) All year %PR n Adj PR% n %PR n Adj PR% n %PR n Adj PR% n Artificial insemination 41.2% 896 41.2% 896 47.7% 1767 47.7% 1767 45.5% 2663 2663 Fresh invivo embryo 62.7% 373 47.5% 493 69.5% 262 55.3% 329 65.5% 635 50.6% 822 Frozen invivo embryo 59.3% 221 44.8% 292 59.4% 256 47.3% 322 59.3% 477 46.1% 614 IVF fresh embryo 47.9% 167 36.2% 221 54.0% 363 43.0% 456 52.1% 530 40.8% 677 Total embryos 58.5% 761 44.2% 1006 60.2% 881 47.9% 1107 59.4% 1642 46.1% 2113 1Lactating Holstein cows, first and second lactation, first service, Presynch-Ovsynch, 85 DIM. 2PR%=the number of pregnant cows divided by the number of cows that received and embryo; AdjPR%=adjusted pregnancy rate.

P175 Cardiac device infection: to extract or not to extract, that is the question

Introduction

The incidence of infectious complications related to intracardiac devices has been increasing in recent year and is associated with a poor prognosis, which is determined not only by the infectious process but also by the severity of the underlying cardiac pathology and the spectrum of comorbidities presented. Appropriate antibiotic therapy and extraction of the devices are fundamental in the management of these patients.

Case report

We describe the case of a 66-year-old patient on a waiting list for transplantation due to non-ischemic dilated cardiomyopathy with poor left ventricular systolic function (LVEF of 10%), with severe functional mitral regurgitation and severe pulmonary hypertension, who received a CRT-D for secondary prevention (non-responder). He was admitted for decompensated heart failure (NYHA functional class IV and "dry-cold" profile) requiring inotropic support becoming dependent on dobutamine. During hospitalization, there was a progressive increase in inflammatory markers accompanied by recurrent febrile peak and inflammatory signs of the central venous catheter, with catheter-tip and serial hemocultures positive for Morganella morganii. Piperacillin / tazobactam was started. Due to the lack of response to pathogen directed antibiotic therapy, he underwent a transesophageal echocardiogram (TEE) that revealed several filiform images associated with the electrodes, with no image of valvular vegetations, which led to the association of gentamicin and device extraction (DE), according to the Pisa technique, that occurred without complications. On the 7th day after DE, there was a progressive clinical deterioration in spite of increasing doses of inotropes and vasopressors. It was considered that patient would not be candidate for cardiac transplantation or mechanical ventricular assist, and died on the 118th day of hospitalization in refractory cardiogenic shock.

Conclusion

Device endocarditis is a class I indication for intracardiac DE and TEE is fundamental in its diagnosis. Despite being a considered a non-responder to cardiac resynchronization therapy based on clinical and echocardiographic criteria, this case illustrates how the loss of cardiac resynchronization may have contributed to the patient’s hemodynamic deterioration and have played a fundamental role in the clinical outcome.

The impact of the winery's wastewater treatment system on the winery water footprint

In the Mediterranean region, water scarcity has already prompted concern in the wine sector due to the strong impact it has on vineyard productivity and wine quality. Water footprint is an indicator that takes account of all the water involved in the creation of a product and may help producers to identify hotspots, and reduce water consumption and the corresponding production costs. In recent years several studies have been reported on wine water footprint determination, but mostly focused on the viticulture phase or assuming no grey water footprint at the winery since it has a treatment system. In the framework of the WineWaterFootprint project a medium-size winery was monitored, with direct measurements, regarding determination of the blue and grey components of water footprint. The determined winery water footprint ranged from 9.6 to 12.7 L of water per wine bottle of 0.75 L, the wastewater produced being responsible for about 98%, which means that the grey component cannot be disregarded. The developed scenarios show that a potential reduction of 87% in winery water footprint can be obtained with almost no investment. The challenge of reducing the grey footprint is not in technology development, but rather in the proper maintenance and monitoring of treatment systems.

P3800Defibrillation for right ventricular dysfunction - An echocardiographic method for therapy selection

Introduction

Cardiac resynchronization therapy (CRT) is recommended for heart failure (HF) patients with left ventricular ejection fraction (LVEF) <35% and QRS>130 mseg. We aim to identify if baseline transthoracic echocardiographic (TTE) data can predict the need for defibrillation therapies in a primary prevention HF population referred for CRT implant.

Methods

We analyzed 119 consecutive HF patients in primary prevention referred for CRT implantation between 2004 and 2016. All patients underwent TTE before implantation. During a mean follow-up time of 58.4±33.9 months, all patients were evaluated with device interrogation every 6 months. In order to determine which parameters can predict sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) occurrence, a multivariate analysis was performed including previous medical history, baseline laboratorial, electro and echocardiographic data.

Results

We included 86.6% (n=106) males, mean age at implant 65.5±9.7 years. A CRT-defibrillator (CRT-D) was implanted in 82 (64.2%) patients and a VT or VF was documented in 16 patients (13.4%). Baseline characteristics are presented in the table. After multivariate analysis, baseline right ventricular dysfunction (defined as TAPSE≤18mm) was an independent predictor for VT or VF occurrence (OR=4.83, 95CI 1.67–6.25, p=0.002).

Baseline characteristics VT/VF (n=16) No VT/VF (n=103) P-value Age (years, mean ± SD) 62,4±7,9 66,2±9,5 0,135 Female gender (n, %) 2 (12,5) 14 (15,1) 0,572 Ischemic cardiomyopathy (n, %) 7 (43,8) 21 (22,6) 0,073 NYHA III + IV (n, %) 13 (81,3) 76 (73,8) 0,984 QRS width (mseg, mean ± SD) 168,5±19,5 177,6±22,2 0,142 Atrial fibrillation (n, %) 5 (31,3) 17 (18,3) 0,089 LVEF (%, mean ± SD) 24,6±4,8 26,3±6,3 0,302 TAPSE (mm, mean ± SD) 14,9±4,9 17,9±4,3 0,034 PASP (mmHg, mean ± SD) 48,5±9,4 43,5±14,6 0,419 Mitral regurgitation (moderate or greater, n, %) 5 (31,3) 24 (28,9) 0,077 iVol (mL/m2, mean ± SD) 134,2±36,6 128,7±44,1 0,690 CRT-D implantation (n, %) 16 (100,0) 60 (64,5) 0,002

Conclusion

In a real-world HF population, right ventricular dysfunction defined by echocardiography was an independent predictor for VT or VF occurrence. This may help more accurate patient selection for CRT-D implantation.

P4408Cardiovascular response in diabetic patients submitted to treadmill electrocardiographic exercise stress test

Introduction

Diabetes mellitus (DM) is an entity commonly associated with neuropathy, a factor that may have repercussions on the cardiovascular system, specifically in its capacity to respond to stimuli.

Objectives

To evaluate the cardiovascular response to exercise in diabetic patients, comparing it with a control group.

Methods

Patients who underwent treadmill eletrocardiographic exercise stress test (EST) between January 2016 and November 2018 without the influence of negative chronotropic medication were included.

Results

A total of 187 patients were identified, having a mean age of 57±13 years, of whom 120 (64%) were of the male gender. Eighty-four (45%) were diabetic. The group of diabetic patients had a higher prevalence of arterial hypertension, however the number of classes of antihypertensive drugs was not significantly different between diabetic and non-diabetic patients. There were no significant differences in the remaining demographic variables. Patients with DM presented lower maximal heart rates (HR) (141±14 vs 148±19 beats/minute, p=0.015), lower HT reserve (59±16 vs 67±21 beats/minute, p=0.005), as well as a lower rate of HR fall in the recovery period (13±5 vs 16±5 beats/minute2, p<0.001). Total EST time was also lower in diabetic patients (median 7.0 IQR=3 vs 7.3 IQR=3.5 minutes, p=0.044). Additionally, the number of years since the time of diagnosis of DM was inversely correlated with the degree of increase in systolic blood pressure (SBP) with exercise (r=−0.22, p=0.045), and the pre-test SBP (median 135 IQR=24 vs 130 IQR=20 mmHg, p=0.048) and post-test SBP (median 150 IQR=20 vs 140 IQR=25 mmHg, p=0.007) were higher in patients with DM.

Discussion

In this study it was found that patients with DM present an impaired chronotropic response, both in exercise and recovery periods, and it was observed that the capacity to increase SBP is inversely correlated to the duration of DM. These data may reflect the neuropathic involvement in DM and its influence in the cardiovascular response to exercise.

P6579Genetic profile and predictors of positive genetic test in Brugada syndrome

Introduction

Brugada syndrome (BS) is a channelopathy with autosomal dominant transmission, incomplete penetrance and variable expression. There are 18 different gene mutations described in association with this syndrome, however 70% of patients remain without identifiable genetic cause. Genetic testing is appropriated for patients with clinical diagnosis but it is also a very important tool in familiar screening.

Aim

We aim to characterize genetic profile of patients with clinical diagnosis of BS and identify differences between patients with and without causative mutation.

Methods

We included patients followed by the arrhythmology department of our hospital with diagnosis of BS and that have performed genetic test (or patients who were identified through familiar screening and with negative genetic test in the index case). Patients identified through familiar screening with positive genetic test but no spontaneous electrocardiographic pattern, still awaiting pharmacologic provocative test at the time of enrolment – no clinical diagnosis - were excluded. Genetic test was considered positive when we found a pathogenic or probably pathogenic mutation. Mutations in PKP, SLMAP, CACNA, CACNB, SCN10A and CLASP genes considered of uncertain clinical relevance were not included as positive genetic test. We analysed differences between subset of patients with and without causative mutation regarding clinical and electrocardiographic variables. We performed multivariate analysis to find predictors of positive genetic test.

Results

From our 173 patients, 140 met the inclusion criteria and none exclusion criteria so they were enrolled. Patients were 61% male with mean age of 50±15 years old. Mean follow-up was 26±28 months; 24,4% of index cases were positive for causative mutation, 6,8% patients with pathogenic mutation in SCN5A gene and 17,6% with probably pathogenic mutation in SCN5A.

We haven't found significant differences between the 2 groups (negative and positive genetic test) in any clinical variable included. Regarding electrocardiographic variables, patients in whom a mutation was identified had longer PR interval (192±36 vs 170±28, p=0.001), longer QRS (121±19 VS 111±18 p=0.017), particularly when QRS>110ms (p=0,002), and longer QT (398±25 VS 370±45 p=0.015) In multivariate analysis, PR interval (p=0.032) and QRS>110ms (p=0,041) were independent predictors for positive genetic test.

Conclusion

In our BS population, there were no clinical differences between patients with and without causative mutation, also concerning events rate. Patients with positive genetic test have significantly longer PR interval and QRS>110ms than in patients with genetic test negative. Those results can be interpreted in relation to sodium channel disfunction in patients with SCN5A mutation.