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Rocha R, Conceição C, Gonçalves L, Carvalho AC, Maia A, Martins A, Carujo A, Maio A, Forra C, Melita C, Couto D, Fernandes D, Pereira D, Leal E, Sarmento H, Sousa I, Gonçalves JP, Marinho J, Vasconcelos J, Cunha J, Rodrigues J, Silva JM, Caley L, Malheiro L, Santos L, Garcia M, Cunha M, Lima M, Andrade MM, Marques M, Alpalhão M, Silva M, Ferraz R, Soares R, Fernandes S, Llobet S, Cruz S, Guimarães T, Branco T, Robalo-Nunes T, Almeida V, Maia C. Epidemiological and Clinical Aspects of Cutaneous and Mucosal Leishmaniases in Portugal: Retrospective Analysis of Cases Diagnosed in Public Hospitals and Reported in the Literature between 2010 and 2020. Microorganisms 2024; 12:819. [PMID: 38674763 PMCID: PMC11052487 DOI: 10.3390/microorganisms12040819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/14/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Leishmania infantum, a zoonotic vector-born parasite, is endemic in the Mediterranean region, presenting mostly as visceral (VL), but also as cutaneous (CL) and mucosal leishmaniasis (ML). This study aimed to describe the epidemiological and clinical aspects of the CL and ML cases diagnosed in mainland Portugal between 2010 and 2020. Collaboration was requested from every hospital of the Portuguese National Health System. Cases were screened through a search of diagnostic discharge codes or positive laboratory results for Leishmania infection. Simultaneously, a comprehensive literature search was performed. Descriptive statistics and hypothesis testing were performed using IBM® SPSS® Statistics. A total of 43 CL and 7 ML cases were identified, with a predominance of autochthonous cases (86%). In CL, immunosuppressed individuals constituted a significant proportion of patients (48%), and in this group, disseminated CL (22%) and simultaneous VL (54%) were common. In autochthonous cases, lesions, mostly papules/nodules (62%), were frequently observed on the head (48%). The approach to treatment was very heterogeneous. ML cases were all autochthonous, were diagnosed primarily in older immunosuppressed individuals, and were generally treated with liposomal amphotericin B. The findings suggest a need for enhanced surveillance and reporting, clinical awareness, and diagnostic capacity of these forms of leishmaniasis to mitigate underdiagnosis and improve patient outcomes. A holistic One Health approach is advocated to address the multifaceted challenges posed by leishmaniases in Portugal and beyond.
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Affiliation(s)
- Rafael Rocha
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira N°100, 1349-008 Lisboa, Portugal; (R.R.); (C.C.)
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira N°100, 1349-008 Lisboa, Portugal
- Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Cláudia Conceição
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira N°100, 1349-008 Lisboa, Portugal; (R.R.); (C.C.)
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira N°100, 1349-008 Lisboa, Portugal
| | - Luzia Gonçalves
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira N°100, 1349-008 Lisboa, Portugal; (R.R.); (C.C.)
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira N°100, 1349-008 Lisboa, Portugal
- Centro de Estatística e Aplicações da Universidade de Lisboa, Faculdade de Ciências, Universidade de Lisboa, Campo Grande, 1749-016 Lisboa, Portugal
- Z-Stat4life, Espaço Cowork Baldaya, Palácio Baldaya, Estrada de Benfica N° 701ª, 1549-011 Lisboa, Portugal
| | | | - André Maia
- Centro Hospitalar de Trás-os-Montes e Alto Douro, Avenida da Noruega, 5000-508 Vila Real, Portugal
| | - André Martins
- Hospital da Senhora da Oliveira Guimarães, Rua dos Cutileiros, Creixomil, 4835-044 Guimarães, Portugal
| | - António Carujo
- Centro Hospitalar Universitário de Santo António, Rua Prof. Vicente José de Carvalho N° 37, 4050-366 Porto, Portugal
| | - António Maio
- Centro Hospitalar do Baixo Vouga, Av. Artur Ravara, 3810-501 Aveiro, Portugal
| | - Catarina Forra
- Unidade Local de Saúde de Castelo Branco, Avenida Pedro Álvares Cabral, 6000-085 Castelo Branco, Portugal
| | - Catarina Melita
- Hospital Professor Doutor Fernando Fonseca, IC 19, 2720-276 Amadora, Portugal
| | - Daniela Couto
- Centro Hospitalar Universitário Cova da Beira, Alameda Pêro da Covilhã, 6200-251 Covilhã, Portugal
| | - Diana Fernandes
- Centro Hospitalar de Leiria, Rua das Olhalvas, 2410-197 Leiria, Portugal
| | - Dulce Pereira
- Centro Hospitalar Tondela-Viseu, Avenida Rei D. Duarte, 3504-509 Viseu, Portugal
| | - Ema Leal
- Centro Hospitalar Universitário de Lisboa Central, Rua José António Serrano, 1150-199 Lisboa, Portugal
| | - Helena Sarmento
- Hospital da Senhora da Oliveira Guimarães, Rua dos Cutileiros, Creixomil, 4835-044 Guimarães, Portugal
| | - Inês Sousa
- Centro Hospitalar Universitário Lisboa Norte, Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal
| | - Jean-Pierre Gonçalves
- Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Basto, 1099-023 Lisboa, Portugal
| | - Joana Marinho
- Centro Hospitalar Universitário de Coimbra, Praceta Professor Mota Pinto, 3004-561 Coimbra, Portugal
| | - Joana Vasconcelos
- Centro Hospitalar de Lisboa Ocidental, Rua da Junqueira N° 126, 1349-019 Lisboa, Portugal;
| | - João Cunha
- Hospital Distrital de Santarém, Avenida Bernardo Santareno, 2005-177 Santarém, Portugal
| | - João Rodrigues
- Unidade Local de Saúde da Guarda, Avenida Rainha Dona Amélia, 6300-858 Guarda, Portugal
| | - José Miguel Silva
- Unidade Local de Saúde do Norte Alentejano, Avenida de Santo António, Apartado 234, 7301-853 Portalegre, Portugal
| | - Lídia Caley
- Centro Hospitalar do Médio Tejo, Avenida Maria de Lourdes de Mello Castro, Ap. 118, 2304-909 Tomar, Portugal
| | - Luís Malheiro
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Rua Conceição Fernandes, 4434-502 Vila Nova de Gaia, Portugal
| | - Luís Santos
- Centro Hospitalar Universitário de Lisboa Central, Rua José António Serrano, 1150-199 Lisboa, Portugal
| | - Margarida Garcia
- Centro Hospitalar Universitário de Lisboa Central, Rua José António Serrano, 1150-199 Lisboa, Portugal
| | - Maria Cunha
- Centro Hospitalar Universitário Lisboa Norte, Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal
- Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Maria Lima
- Centro Hospitalar de Setúbal, Rua Camilo Castelo Branco, Apartado 140, 2910-446 Setúbal, Portugal
| | - Maria Margarida Andrade
- Hospital de Cascais Dr. José de Almeida, Avenida Brigadeiro Victor Novais Gonçalves, 2755-009 Alcabideche, Portugal
| | - Marta Marques
- Centro Hospitalar Tondela-Viseu, Avenida Rei D. Duarte, 3504-509 Viseu, Portugal
| | - Miguel Alpalhão
- Centro Hospitalar Universitário Lisboa Norte, Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal
| | - Mónica Silva
- Centro Hospitalar Barreiro Montijo, Avenida Movimento das Forças Armadas, 2834-003 Barreiro, Portugal
| | - Rita Ferraz
- Centro Hospitalar do Tâmega e Sousa, Avenida do Hospital Padre Américo, N° 210, Guilhufe, 4560-136 Penafiel, Portugal;
| | - Rui Soares
- Instituto Português de Oncologia de Coimbra Francisco Gentil, Avenida Bissaya Barreto N° 98, 3000-075 Coimbra, Portugal
| | - Salomão Fernandes
- Hospital Beatriz Ângelo, Avenida Carlos Teixeira, N° 3, 2674-514 Loures, Portugal
| | - Samuel Llobet
- Centro Hospitalar Universitário Lisboa Norte, Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal
| | - Sofia Cruz
- Hospital de Vila Franca de Xira, Estrada Carlos Lima Costa N°2, 2600-009 Vila Franca de Xira, Portugal
| | - Teresa Guimarães
- Unidade Local de Saúde do Nordeste, Avenida Abade de Baçal, 5301-852 Bragança, Portugal
| | - Tiago Branco
- Centro Hospitalar Universitário do Algarve, Rua Leão Penedo, 8000-386 Faro, Portugal
| | - Tomás Robalo-Nunes
- Hospital Garcia de Orta, Avenida Torrado da Silva, 2805-267 Almada, Portugal
| | - Vasco Almeida
- Centro Hospitalar Universitário de Lisboa Central, Rua José António Serrano, 1150-199 Lisboa, Portugal
| | - Carla Maia
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira N°100, 1349-008 Lisboa, Portugal; (R.R.); (C.C.)
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira N°100, 1349-008 Lisboa, Portugal
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Freitas FP, Reis J, Oliveira J, Veiga PM, Raquel Paiva A, Soares R. The dilution evaluation as a corrective measure for interference in the white blood cell scattergram in Beckman Coulter DxH 900. J Clin Lab Anal 2024; 38:e25007. [PMID: 38594837 PMCID: PMC11073809 DOI: 10.1002/jcla.25007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/15/2023] [Accepted: 01/07/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND The Beckman Coulter DxH 900 is a haematological analyser capable of counting and sizing blood cells, and obtaining a complete blood cell count (CBC). This analyses different parameters of red blood cells (RBC), platelets and white blood cells/leukocytes. Some automated CBC counters present limitations due to specimen characteristics, abnormal cells or both factors. In the presence of abnormalities, the DxH 900 has a flagging system, warning the laboratory technician that something needs to be verified. In the present work, we evaluated samples from oncologic patients, presenting a population erroneously perceived as being lymphocytes. The most common explanations for this situation are RBC resistant to lysis or serum hyperbilirubinaemia. METHODS In an attempt to solve and understand what the cause of this problem might be, we diluted our samples (1:3) and analysed the serum total bilirubin. To identify cells' abnormalities, the samples were also analysed by manual DLC counts. During the study, we also checked the different flags presented by the equipment. RESULTS The results evidenced that the major interference was due to RBC lysis resistance, corresponding to 94.7% of the cases, while hyperbilirubinaemia was only present in 73.4%. Besides, we determined that some samples with normal bilirubin levels also presented interference, suggesting that hyperbilirubinaemia was not the main cause of the error. The most recurrent flag observed was "High event rate". CONCLUSION The dilution solved all of the observed interferences. The results between diluted and manual counts showed a strong correlation, leading us to introduce dilution in our laboratory routine.
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Affiliation(s)
- Filipa P. Freitas
- Clinical Pathology Service, Portuguese Institute of Oncology of Coimbra Francisco GentilEPECoimbraPortugal
| | - Jorge Reis
- Clinical Pathology Service, Portuguese Institute of Oncology of Coimbra Francisco GentilEPECoimbraPortugal
| | - Joana Oliveira
- Clinical Pathology Service, Portuguese Institute of Oncology of Coimbra Francisco GentilEPECoimbraPortugal
| | - Pedro Mota Veiga
- University of MaiaMaiaPortugal
- NECE – Research Center for Business SciencesUniversidade da Beira InteriorCovilhãPortugal
| | - Ana Raquel Paiva
- Clinical Pathology Service, Portuguese Institute of Oncology of Coimbra Francisco GentilEPECoimbraPortugal
| | - Rui Soares
- Clinical Pathology Service, Portuguese Institute of Oncology of Coimbra Francisco GentilEPECoimbraPortugal
- Institute of Medical Microbiology, Faculty of MedicineUniversity of CoimbraCoimbraPortugal
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Rodrigues RS, Moreira JB, Mateus JM, Barateiro A, Paulo SL, Vaz SH, Lourenço DM, Ribeiro FF, Soares R, Loureiro-Campos E, Bielefeld P, Sebastião AM, Fernandes A, Pinto L, Fitzsimons CP, Xapelli S. Cannabinoid type 2 receptor inhibition enhances the antidepressant and proneurogenic effects of physical exercise after chronic stress. Transl Psychiatry 2024; 14:170. [PMID: 38555299 PMCID: PMC10981758 DOI: 10.1038/s41398-024-02877-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 03/05/2024] [Accepted: 03/14/2024] [Indexed: 04/02/2024] Open
Abstract
Chronic stress is a major risk factor for neuropsychiatric conditions such as depression. Adult hippocampal neurogenesis (AHN) has emerged as a promising target to counteract stress-related disorders given the ability of newborn neurons to facilitate endogenous plasticity. Recent data sheds light on the interaction between cannabinoids and neurotrophic factors underlying the regulation of AHN, with important effects on cognitive plasticity and emotional flexibility. Since physical exercise (PE) is known to enhance neurotrophic factor levels, we hypothesised that PE could engage with cannabinoids to influence AHN and that this would result in beneficial effects under stressful conditions. We therefore investigated the actions of modulating cannabinoid type 2 receptors (CB2R), which are devoid of psychotropic effects, in combination with PE in chronically stressed animals. We found that CB2R inhibition, but not CB2R activation, in combination with PE significantly ameliorated stress-evoked emotional changes and cognitive deficits. Importantly, this combined strategy critically shaped stress-induced changes in AHN dynamics, leading to a significant increase in the rates of cell proliferation and differentiation of newborn neurons, overall reduction in neuroinflammation, and increased hippocampal levels of BDNF. Together, these results show that CB2Rs are crucial regulators of the beneficial effects of PE in countering the effects of chronic stress. Our work emphasises the importance of understanding the mechanisms behind the actions of cannabinoids and PE and provides a framework for future therapeutic strategies to treat stress-related disorders that capitalise on lifestyle interventions complemented with endocannabinoid pharmacomodulation.
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Affiliation(s)
- R S Rodrigues
- Instituto de Farmacologia e Neurociências, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Université de Bordeaux, INSERM, Neurocentre Magendie, Bordeaux, France
| | - J B Moreira
- Instituto de Farmacologia e Neurociências, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - J M Mateus
- Instituto de Farmacologia e Neurociências, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - A Barateiro
- Central Nervous System, blood and peripheral inflammation, Research Institute for Medicines (iMed.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, Lisboa, Portugal
- Department of Pharmaceutical Sciences and Medicines, Faculdade de Farmácia, Universidade de Lisboa, Lisboa, Portugal
| | - S L Paulo
- Instituto de Farmacologia e Neurociências, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - S H Vaz
- Instituto de Farmacologia e Neurociências, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - D M Lourenço
- Instituto de Farmacologia e Neurociências, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - F F Ribeiro
- Instituto de Farmacologia e Neurociências, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - R Soares
- Instituto de Farmacologia e Neurociências, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - E Loureiro-Campos
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - P Bielefeld
- Swammerdam Institute for Life Sciences, Faculty of Science, University of Amsterdam, Amsterdam, The Netherlands
| | - A M Sebastião
- Instituto de Farmacologia e Neurociências, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - A Fernandes
- Central Nervous System, blood and peripheral inflammation, Research Institute for Medicines (iMed.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, Lisboa, Portugal
- Department of Pharmaceutical Sciences and Medicines, Faculdade de Farmácia, Universidade de Lisboa, Lisboa, Portugal
| | - L Pinto
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - C P Fitzsimons
- Swammerdam Institute for Life Sciences, Faculty of Science, University of Amsterdam, Amsterdam, The Netherlands
| | - S Xapelli
- Instituto de Farmacologia e Neurociências, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
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Donnelly P, Soares R, Eynon A, Grundy P, Durnford A. Animal products in neurosurgery - navigating informed consent. Br J Neurosurg 2023:1-4. [PMID: 37735919 DOI: 10.1080/02688697.2023.2256875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 09/05/2023] [Indexed: 09/23/2023]
Abstract
Informed consent is an ethical and legal requirement integral to modern surgical practice. Clinicians have a duty to consider, disclose and discuss risks and concerns relevant to an individual patient. With medical advances there are now a significant number of animal-derived products and adjuncts available for use in modern neurosurgical practice, which may be relevant when consenting patients for specific procedures if such products are used. This paper highlights commonly used products in neurosurgery that contain animal-derived constituents with the aim of facilitating an informed discussion between the neurosurgeon and patient. We have reviewed the commonly used products in the centres of the authors and their commercial equivalents. The product information is taken from the manufacturer's instructions or the Federal Drug Administration documents regarding the product. Animal products commonly available to neurosurgeons can be broadly categorised into haemostatic agents, dural substitutes, dural sealants and bone cements. Many products contain a variety of animal (or human) derived products. In order to ensure informed consent and shared decision making, it is important to establish any relevant patient beliefs or views regarding the use of animal-derived products. Given the wide availability and use of neurosurgical adjuncts containing human or animal derived products, coupled with the heterogeneity within ethnic, religious, and social groups, each patient must be approached individually to ensure patient-specific concerns are identified and alternatives offered when appropriate.
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Affiliation(s)
- Patrick Donnelly
- Department of Neurosurgery, Mater Hospital Brisbane, South Brisbane, Queensland, Australia
| | - Rui Soares
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Andy Eynon
- University Hospital Southampton, Southampton, UK
| | - Paul Grundy
- University Hospital Southampton, Southampton, UK
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Silva R, dos Santos MD, Madureira R, Soares R, Neto R, Vieira ÂA, Gonçalves PAR, Leite PMSM, Vieira L, Viana F. Scratch and Wear Behaviour of Co-Cr-Mo Alloy in Ringer's Lactate Solution. Materials (Basel) 2023; 16:2923. [PMID: 37049218 PMCID: PMC10096074 DOI: 10.3390/ma16072923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/15/2023] [Accepted: 03/30/2023] [Indexed: 06/19/2023]
Abstract
Cobalt-chromium-molybdenum (Co-Cr-Mo) alloy is a material recommended for biomedical implants; however, to be suitable for this application, it should have good tribological properties, which are related to grain size. This paper investigates the tribological behaviour of a Co-Cr-Mo alloy produced using investment casting, together with electromagnetic stirring, to reduce its grain size. The samples were subjected to wear and scratch tests in simulated body fluid (Ringer's lactate solution). Since a reduction in grain size can influence the behaviour of the material, in terms of resistance and tribological response, four samples with different grain sizes were produced for use in our investigation of the behaviour of the alloy, in which we considered the friction coefficient, wear, and scratch resistance. The experiments were performed using a tribometer, with mean values for the friction coefficient, normal load, and tangential force acquired and recorded by the software. Spheres of Ti-6Al-4V and 316L steel were used as counterface materials. In addition, to elucidate the influence of grain size on the mechanical properties of the alloy, observations were conducted via scanning electron microscopy (SEM) with electron backscatter diffraction (EBSD). The results showed changes in the structure, with a reduction in grain size from 5.51 to 0.79 mm. Using both spheres, the best results for the friction coefficient and wear volume corresponded to the sample with the smallest grain size of 0.79 mm. The friction coefficients obtained were 0.37 and 0.45, using the Ti-6Al-4V and 316L spheres, respectively. These results confirm that the best surface finish for Co-Cr-Mo alloy used as a biomedical implant is one with a smaller grain size, since this results in a lower friction coefficient and low wear.
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Affiliation(s)
- Raimundo Silva
- Department of Materials Engineering, University of the State of Amazonas (UEA), Darcy Vargas, Manaus 69050-020, Brazil
- Department of Metallurgical and Materials Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal;
| | - Marcos Dantas dos Santos
- Department of Materials Engineering, University of the State of Amazonas (UEA), Darcy Vargas, Manaus 69050-020, Brazil
| | - Rui Madureira
- LAETA/INEGI—Institute of Science and Innovation in Mechanical and Industrial Engineering, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - Rui Soares
- LAETA/INEGI—Institute of Science and Innovation in Mechanical and Industrial Engineering, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - Rui Neto
- LAETA/INEGI—Institute of Science and Innovation in Mechanical and Industrial Engineering, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
- Department of Mechanical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - Ângela Aparecida Vieira
- Department of Materials, Institute of Research and Development (IP&D), University of Paraíba Valley, São José dos Campos 12244-000, Brazil
| | - Polyana Alves Radi Gonçalves
- Department of Materials, Institute of Research and Development (IP&D), University of Paraíba Valley, São José dos Campos 12244-000, Brazil
| | - Priscila Maria Sarmeiro M. Leite
- Department of Materials, Institute of Research and Development (IP&D), University of Paraíba Valley, São José dos Campos 12244-000, Brazil
| | - Lúcia Vieira
- Department of Materials, Institute of Research and Development (IP&D), University of Paraíba Valley, São José dos Campos 12244-000, Brazil
| | - Filomena Viana
- Department of Metallurgical and Materials Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal;
- LAETA/INEGI—Institute of Science and Innovation in Mechanical and Industrial Engineering, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
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Gonçalves AV, Reis JP, Timóteo AT, Soares R, Pereira-da-Silva T, Gomes V, Moreira RI, Pombo D, Carvalho T, Correia C, Santos C, Ferreira RC. Outpatient 6-Hour Levosimendan Treatment as a Bridge to Heart Transplant. Arq Bras Cardiol 2023; 120:e20220205. [PMID: 36856238 PMCID: PMC9972780 DOI: 10.36660/abc.20220205] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 09/01/2022] [Indexed: 02/16/2023] Open
Affiliation(s)
- António Valentim Gonçalves
- Departamento de CardiologiaHospital de Santa MartaCentro Hospitalar Universitário de Lisboa CentralLisboaPortugalDepartamento de Cardiologia – Hospital de Santa Marta – Centro Hospitalar Universitário de Lisboa Central, Lisboa – Portugal
| | - João Pedro Reis
- Departamento de CardiologiaHospital de Santa MartaCentro Hospitalar Universitário de Lisboa CentralLisboaPortugalDepartamento de Cardiologia – Hospital de Santa Marta – Centro Hospitalar Universitário de Lisboa Central, Lisboa – Portugal
| | - Ana Teresa Timóteo
- Departamento de CardiologiaHospital de Santa MartaCentro Hospitalar Universitário de Lisboa CentralLisboaPortugalDepartamento de Cardiologia – Hospital de Santa Marta – Centro Hospitalar Universitário de Lisboa Central, Lisboa – Portugal
| | - Rui Soares
- Departamento de CardiologiaHospital de Santa MartaCentro Hospitalar Universitário de Lisboa CentralLisboaPortugalDepartamento de Cardiologia – Hospital de Santa Marta – Centro Hospitalar Universitário de Lisboa Central, Lisboa – Portugal
| | - Tiago Pereira-da-Silva
- Departamento de CardiologiaHospital de Santa MartaCentro Hospitalar Universitário de Lisboa CentralLisboaPortugalDepartamento de Cardiologia – Hospital de Santa Marta – Centro Hospitalar Universitário de Lisboa Central, Lisboa – Portugal
| | - Valdemar Gomes
- Departamento de CardiologiaHospital de Santa MartaCentro Hospitalar Universitário de Lisboa CentralLisboaPortugalDepartamento de Cardiologia – Hospital de Santa Marta – Centro Hospitalar Universitário de Lisboa Central, Lisboa – Portugal
| | - Rita Ilhão Moreira
- Departamento de CardiologiaHospital de Santa MartaCentro Hospitalar Universitário de Lisboa CentralLisboaPortugalDepartamento de Cardiologia – Hospital de Santa Marta – Centro Hospitalar Universitário de Lisboa Central, Lisboa – Portugal
| | - Delmira Pombo
- Departamento de CardiologiaHospital de Santa MartaCentro Hospitalar Universitário de Lisboa CentralLisboaPortugalDepartamento de Cardiologia – Hospital de Santa Marta – Centro Hospitalar Universitário de Lisboa Central, Lisboa – Portugal
| | - Tiago Carvalho
- Departamento de CardiologiaHospital de Santa MartaCentro Hospitalar Universitário de Lisboa CentralLisboaPortugalDepartamento de Cardiologia – Hospital de Santa Marta – Centro Hospitalar Universitário de Lisboa Central, Lisboa – Portugal
| | - Catarina Correia
- Departamento de CardiologiaHospital de Santa MartaCentro Hospitalar Universitário de Lisboa CentralLisboaPortugalDepartamento de Cardiologia – Hospital de Santa Marta – Centro Hospitalar Universitário de Lisboa Central, Lisboa – Portugal
| | - Claudia Santos
- Departamento de CardiologiaHospital de Santa MartaCentro Hospitalar Universitário de Lisboa CentralLisboaPortugalDepartamento de Cardiologia – Hospital de Santa Marta – Centro Hospitalar Universitário de Lisboa Central, Lisboa – Portugal
| | - Rui Cruz Ferreira
- Departamento de CardiologiaHospital de Santa MartaCentro Hospitalar Universitário de Lisboa CentralLisboaPortugalDepartamento de Cardiologia – Hospital de Santa Marta – Centro Hospitalar Universitário de Lisboa Central, Lisboa – Portugal
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7
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Nunes H, Emadinia O, Soares R, Vieira MF, Reis A. Adding Value to Secondary Aluminum Casting Alloys: A Review on Trends and Achievements. Materials (Basel) 2023; 16:895. [PMID: 36769902 PMCID: PMC9918070 DOI: 10.3390/ma16030895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/21/2022] [Accepted: 12/28/2022] [Indexed: 06/18/2023]
Abstract
Aluminum is a critical element of the circular economy as it can be recycled several times. Moreover, Al recycling is a more economically and environmentally efficient procedure than the primary Al production from ores. Secondary aluminum alloys are mostly used in casting applications since it is possible to accommodate their chemical composition through secondary manufacturing processes. However, the quality of the alloys may be considerably altered during the different steps of the recycling process. Inadequate waste sorting might result in excessive contamination. Iron is the most dangerous contaminant because it causes brittle and fragile intermetallic phases, which significantly impacts the mechanical characteristics of alloys. In addition, the microstructure of the alloy changes significantly after multiple cycles of remelting. These issues lead to the downcycling of aluminum, i.e., in other words, the reduction in the overall quality of the alloys. Thus, it has been shown that a number of procedures, including ultrasonic melt treatment and microalloying with rare earths, can somewhat alter the shape of the Fe-rich phases in order to reduce the shortcomings of downcycling. However, a solid mechanical characterization is still missing in order to improve the Fe-rich phase alteration.
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Affiliation(s)
- Helder Nunes
- LAETA/INEGI, Institute of Science and Innovation in Mechanical and Industrial Engineering, 4200-465 Porto, Portugal
- Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal
| | - Omid Emadinia
- LAETA/INEGI, Institute of Science and Innovation in Mechanical and Industrial Engineering, 4200-465 Porto, Portugal
| | - Rui Soares
- LAETA/INEGI, Institute of Science and Innovation in Mechanical and Industrial Engineering, 4200-465 Porto, Portugal
| | - Manuel F. Vieira
- LAETA/INEGI, Institute of Science and Innovation in Mechanical and Industrial Engineering, 4200-465 Porto, Portugal
- Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal
| | - Ana Reis
- LAETA/INEGI, Institute of Science and Innovation in Mechanical and Industrial Engineering, 4200-465 Porto, Portugal
- Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal
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8
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Correia G, Rodrigues L, Afonso M, Mota M, Oliveira J, Soares R, Tomás AL, Reichel A, Silva PM, Costa JJ, da Silva MG, Santos NC, Gonçalves T. SARS-CoV-2 air and surface contamination in residential settings. Sci Rep 2022; 12:18058. [PMID: 36302823 PMCID: PMC9610309 DOI: 10.1038/s41598-022-22679-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/18/2022] [Indexed: 01/24/2023] Open
Abstract
SARS-CoV-2 transmission occurs mainly indoors, through virus-laden airborne particles. Although the presence and infectivity of SARS-CoV-2 in aerosol are now acknowledged, the underlying circumstances for its occurrence are still under investigation. The contamination of domiciliary environments during the isolation of SARS-CoV-2-infected patients in their respective rooms in individual houses and in a nursing home was investigated by collecting surface and air samples in these environments. Surface contamination was detected in different contexts, both on high and low-touch surfaces. To determine the presence of virus particles in the air, two sampling methodologies were used: air and deposition sampling. Positive deposition samples were found in sampling locations above the patient's height, and SARS-CoV-2 RNA was detected in impactation air samples within a size fraction below 2.5 μm. Surface samples rendered the highest positivity rate and persistence for a longer period. The presence of aerosolized SARS-CoV-2 RNA occurred mainly in deposition samples and closer to symptom onset. To evaluate the infectivity of selected positive samples, SARS-CoV-2 viability assays were performed, but our study was not able to validate the virus viability. The presented results confirm the presence of aerosolized SARS-CoV-2 RNA in indoor compartments occupied by COVID-19 patients with mild symptoms, in the absence of aerosol-generating clinical procedures.
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Affiliation(s)
- Gil Correia
- grid.8051.c0000 0000 9511 4342FMUC, Faculty of Medicine, Univ Coimbra, Rua Larga, 3004-504 Coimbra, Portugal ,grid.8051.c0000 0000 9511 4342Medical Microbiology Research Group, CNC-Center for Neurosciences and Cell Biology, 3004-504 Coimbra, Portugal ,ARS Centro, IP, Alameda Júlio Henriques, 3000-457 Coimbra, Portugal
| | - Luís Rodrigues
- grid.8051.c0000 0000 9511 4342Universitary Clinic of Nephrology, Faculty of Medicine University of Coimbra Nephrology Service, Hospital and University Center of Coimbra, Coimbra, Portugal
| | - Mariana Afonso
- grid.8051.c0000 0000 9511 4342FMUC, Faculty of Medicine, Univ Coimbra, Rua Larga, 3004-504 Coimbra, Portugal ,grid.8051.c0000 0000 9511 4342Medical Microbiology Research Group, CNC-Center for Neurosciences and Cell Biology, 3004-504 Coimbra, Portugal
| | - Marta Mota
- grid.8051.c0000 0000 9511 4342FMUC, Faculty of Medicine, Univ Coimbra, Rua Larga, 3004-504 Coimbra, Portugal ,grid.8051.c0000 0000 9511 4342Medical Microbiology Research Group, CNC-Center for Neurosciences and Cell Biology, 3004-504 Coimbra, Portugal
| | - Joana Oliveira
- grid.8051.c0000 0000 9511 4342FMUC, Faculty of Medicine, Univ Coimbra, Rua Larga, 3004-504 Coimbra, Portugal ,grid.8051.c0000 0000 9511 4342Medical Microbiology Research Group, CNC-Center for Neurosciences and Cell Biology, 3004-504 Coimbra, Portugal
| | - Rui Soares
- grid.8051.c0000 0000 9511 4342FMUC, Faculty of Medicine, Univ Coimbra, Rua Larga, 3004-504 Coimbra, Portugal ,grid.8051.c0000 0000 9511 4342Medical Microbiology Research Group, CNC-Center for Neurosciences and Cell Biology, 3004-504 Coimbra, Portugal ,grid.418711.a0000 0004 0631 0608Department of Clinical Pathology, Instituto Português de Oncologia de Coimbra Francisco Gentil EPE, 3000-075 Coimbra, Portugal
| | - Ana Luísa Tomás
- grid.9983.b0000 0001 2181 4263Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisbon, Portugal
| | - Anna Reichel
- grid.9983.b0000 0001 2181 4263Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisbon, Portugal
| | - Patrícia M. Silva
- grid.9983.b0000 0001 2181 4263Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisbon, Portugal
| | - José J. Costa
- grid.8051.c0000 0000 9511 4342ADAI, Department of Mechanical Engineering, Univ Coimbra, Rua Luís Reis Santos, Pólo II, 3030-788 Coimbra, Portugal
| | - Manuel Gameiro da Silva
- grid.8051.c0000 0000 9511 4342ADAI, Department of Mechanical Engineering, Univ Coimbra, Rua Luís Reis Santos, Pólo II, 3030-788 Coimbra, Portugal
| | - Nuno C. Santos
- grid.9983.b0000 0001 2181 4263Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisbon, Portugal
| | - Teresa Gonçalves
- grid.8051.c0000 0000 9511 4342FMUC, Faculty of Medicine, Univ Coimbra, Rua Larga, 3004-504 Coimbra, Portugal ,grid.8051.c0000 0000 9511 4342Medical Microbiology Research Group, CNC-Center for Neurosciences and Cell Biology, 3004-504 Coimbra, Portugal
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Pinheiro S, Klontzas M, Vassalou E, Pimenta M, Soares R, Karantanas A. US-guided Hydrodistension for Adhesive Capsulitis: The Effect of Diabetes on Treatment Outcomes. Semin Musculoskelet Radiol 2022. [DOI: 10.1055/s-0042-1750625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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10
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Silva RP, Soares R, Neto R, Reis A, Paiva R, Madureira R, Silva J. Grain Refinement of Inconel 718 Superalloy-The Effect of Rotating Magnetic Field. Materials (Basel) 2022; 15:ma15062038. [PMID: 35329498 PMCID: PMC8956002 DOI: 10.3390/ma15062038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 11/22/2022]
Abstract
The effect of the application of a rotating magnetic field on the average grain size of IN718 castings was experimentally studied. For the purpose, four parts were produced by investment casting and characterized. The first casting was produced without application of RMF for comparison. The remaining ones were submitted to different RMF frequencies for 15 min and subsequently to the pouring of the nickel-based superalloy. In these three castings, the RMF frequencies applied were, respectively, 15 Hz, 75 Hz and 150 Hz. All the other process parameters were kept constant during the execution of the experimental procedure. The average grain size of the samples was determined according to the ASTM E112-13 standard, using intercept methods. Macro hardness measurements, tensile testing and SEM-EDS analysis were conducted in order to evaluate the casting’s mechanical properties and microstructures. The results demonstrate a noticeable grain size reduction in the samples submitted to rotating magnetic field. An average grain area reduction, greater than 96%, was achieved in the castings where RMF frequencies of 75 Hz and 150 Hz were applied. The application of RMF also caused a morphological change in the casting’s dendrites from cellular to almost equiaxed. Additionally, it originated the decrease of the size and amount of needle-like δ phase. Regarding mechanical properties of the cast parts, no major differences were verified.
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Affiliation(s)
- Rui Pedro Silva
- INEGI—Institute of Science and Innovation in Mechanical and Industrial Engineering, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal; (R.S.); (R.N.); (A.R.); (R.P.); (R.M.); (J.S.)
- Correspondence: ; Tel.: +351-229578710
| | - Rui Soares
- INEGI—Institute of Science and Innovation in Mechanical and Industrial Engineering, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal; (R.S.); (R.N.); (A.R.); (R.P.); (R.M.); (J.S.)
| | - Rui Neto
- INEGI—Institute of Science and Innovation in Mechanical and Industrial Engineering, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal; (R.S.); (R.N.); (A.R.); (R.P.); (R.M.); (J.S.)
- Department of Mechanical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - Ana Reis
- INEGI—Institute of Science and Innovation in Mechanical and Industrial Engineering, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal; (R.S.); (R.N.); (A.R.); (R.P.); (R.M.); (J.S.)
- Department of Mechanical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - Ricardo Paiva
- INEGI—Institute of Science and Innovation in Mechanical and Industrial Engineering, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal; (R.S.); (R.N.); (A.R.); (R.P.); (R.M.); (J.S.)
| | - Rui Madureira
- INEGI—Institute of Science and Innovation in Mechanical and Industrial Engineering, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal; (R.S.); (R.N.); (A.R.); (R.P.); (R.M.); (J.S.)
| | - José Silva
- INEGI—Institute of Science and Innovation in Mechanical and Industrial Engineering, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal; (R.S.); (R.N.); (A.R.); (R.P.); (R.M.); (J.S.)
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11
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Dias Ferreira Reis JP, Bras P, Ferreira V, Goncalves A, Pereira Da Silva T, Soares R, Timoteo AT, Galrinho A, Branco L, Ferreira R. Evaluation of RV-arterial coupling in advanced heart failure. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
The ratio of echocardiography-derived tricuspid annular plane systolic excursion (TAPSE) and pulmonary arterial systolic pressure (PASP) - TAPSE/PASP ratio - is a noninvasive measure of RV-arterial coupling. TAPSE/PASP ratio is a potent independent predictor of prognosis in heart failure and pulmonary arterial hypertension, with a prognostic cutoff value of 0.36 mm/mmHg.
Objective
To assess the prognostic impact of TAPSE/PASP ratio in a population of advanced HF patients.
Methods
Prospective evaluation of adult patients with advanced HFrEF referred to our Institution for evaluation with HF team and possible indication for urgent heart transplantation (HT) or MCS. Patients were followed up for 2 years for the primary endpoint of cardiac death and HT. Echocardiographically determined TAPSE/PASP ratio was used to assess RV-arterial coupling and a survival analysis was performed to evaluate the prognostic impact of the suggested cutoff of 0.36 mm/mmHg.
Results
A total of 450 Heart Failure with Reduced Ejection Fraction (HFrEF) patients with a mean age of 56 ± 12 years, of which 80% are male, and with a mean LVEF of 29 ± 4%, mean TAPSE of 19 ± 3 mm and PASP of 38 ± 11mmHg. The mean TAPSE/PASP was 0.80 ± 0.28. Fifty-four patients (12%) met the primary endpoint. Patients with RV-arterial uncoupling (TAPSE/PASP < 0.36 mm/mmHg) were more likely to have a non-ischaemic etiology for HF (66.7% vs 40%, p = 0.047), had a lower prevalence of diabetes (53.3% vs 77.9%, p = 0.041), a higher prevalence of moderate-to-severe mitral regurgitation (33.3% vs 13.0%, p = 0.035), a lower LVEF (26.2 ± 6.1 vs 29.9 ± 5.9, p = 0.038), a higher prevalence of RV dysfunction (73.3% vs 26.7%, p < 0.001) and worse cardiopulmonary fitness (pVO2: 12.7 ± 5.1 vs 15.8 ± 6.0 ml/kg/min, p = 0.047; VE/VCO2 slope: 49.5 ± 17.2 vs 37.6 ± 9.7, p < 0.001; cardiorespiratory optimal point: 36.9 ± 11.3 vs 29.0 ± 6.4, p < 0.001). More patients in the group of TAPSE/PASP < 0.36 mm/mmHg met the primary endpoint (33.3% vs 9.6%, p = 0.034) and more patients underwent urgent HT (13.3% vs 1.4%, p = 0.44). RV-arterial coupling was associated with a lower survival free of events during follow-up (log-rank p = 0.010).
Conclusion
RV-arterial coupling predicts a worse prognosis in advanced HF patients, with those below a cutoff of 0.36 mm/mmHg having lower survival. This variable may improve risk stratification in this setting. Abstract Figure.
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Affiliation(s)
| | - P Bras
- Hospital de Santa Marta, Lisbon, Portugal
| | - V Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
| | | | | | - R Soares
- Hospital de Santa Marta, Lisbon, Portugal
| | - AT Timoteo
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Galrinho
- Hospital de Santa Marta, Lisbon, Portugal
| | - L Branco
- Hospital de Santa Marta, Lisbon, Portugal
| | - R Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
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12
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Dias Ferreira Reis JP, Bras P, Goncalves A, Pereira Da Silva T, Soares R, Galrinho A, Timoteo AT, Branco L, Ferreira R. Prognostic impact of right ventricular function in advanced heart failure. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
In patients with heart failure with reduced ejection fraction (HFrEF), the presence of coexistent right ventricular (RV) systolic dysfunction is associated with a worse functional capacity and outcome. However, the measurement of RV function is often overshadowed by its left counterpart.
Purpose
To assess the prognostic impact of RV dysfunction in a population of advanced HF patients.
Methods
Prospective evaluation of adult patients with advanced HFrEF referred to our Institution for evaluation with HF team for possible indication for urgent heart transplantation (HT) or MCS. Patients were followed up for 1 year for the primary endpoint of cardiac death and HT. RV systolic dysfunction was defined by a tricuspid annular plane systolic excursion (TAPSE) < 17 mm and/ or fractional area change (FAC) < 35%. A survival analysis was performed to evaluate the prognostic impact of RV dysfunction and survival curves were compared using the log-rank test.
Results
A total of 450 HFrEF patients (mean age of 56 ± 12 years, 80% male, mean LVEF of 29 ± 4%, mean TAPSE of 19 ± 3 mm and RV FAC of 37 ± 6%), of which 30.4% had RV dysfunction. Thirty patients (6.7%) met the primary endpoint. Patients with RV dysfunction had a higher NT-proBNP value (3278.9 ± 296.7 pg/mL, p = 0.005) and a lower LVEF (26.7 ± 6.4 vs 31.4 ± 5.1, p < 0.001), as well as a worse cardiopulmonary fitness (CPET duration: 7.2 ± 3.8 vs 8.6 ± 4.1, p = 0.019; pVO2: 13.6 ± 4.9 vs 16.2 ± 6.1 ml/kg/min, p = 0.006; VE/VCO2 slope: 41.8 ± 11.9 vs 37.0 ± 10.6, p = 0.015; cardiorespiratory optimal point: 33.0 ± 8.9 vs 28.4 ± 6.2, p < 0.001). RV dysfunction was associated with a lower survival free of events during the first follow-up year (log-rank p = 0.046).
Conclusion
RV is associated with a poor survival in advanced HF patients and it may improve risk stratification in this population. Abstract Figure.
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Affiliation(s)
| | - P Bras
- Hospital de Santa Marta, Lisbon, Portugal
| | | | | | - R Soares
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Galrinho
- Hospital de Santa Marta, Lisbon, Portugal
| | - AT Timoteo
- Hospital de Santa Marta, Lisbon, Portugal
| | - L Branco
- Hospital de Santa Marta, Lisbon, Portugal
| | - R Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
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13
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Dias Ferreira Reis JP, Bras P, Goncalves A, Pereira Da Silva T, Soares R, Timoteo AT, Galrinho A, Branco L, Ferreira R. Functional mitral regurgitation in advanced heart failure. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Moderate-to-severe functional mitral regurgitation (fMR) is present in about one-third of patients with heart failure (HF) with reduced left ventricular (LV) ejection fraction (HFrEF) and contributes to progression of the symptoms of HF and is and independent predictor of worse clinical outcomes.
Objective
To characterize the population of advanced HF patients with severe fMR and assess its prognostic impact.
Methods
Prospective evaluation of adult patients with advanced HFrEF were referred to our Institution for evaluation with HF team and possible indication for urgent heart transplantation (HT) or MCS. Patients were followed up for 1 year for the primary endpoint of cardiac death and HT. Severe fMR was defined by an EROA ≥ 20 mm2 and/or a regurgitant volume (RVol) ≥ 30 mL either taken from TTE or TOE. A survival analysis was performed to evaluate the prognostic impact of fMR and survival curves were compared using the log-rank test.
Results
A total of 450 HFrEF patients (mean age of 56 ± 12 years, 80% male, mean LVEF of 29 ± 4%) of which 14.4% had severe fMR, with a mean EROA of 29.2 ± 3.1 mm2 and a mean RVol of 43.6 ± 4.7 mL. Thirty patients (6.7%) met the primary endpoint. Patients with severe fMR were more likely to be female (69.2% vs 81.5%, p = 0.026) and to have atrial fibrillation (27.0% vs 14.1%, p = 0.028), had a higher NT-proBNP value (3625.8 ± 496.9 vs 1940 ± 212.4 pg/mL, p = 0.001), a lower LVEF (25.9 ± 6.8 vs 29.0 ± 6.7, p = 0.001), more dilated LV (LV end-diastolic diameter: 72.8 ± 13.3 vs 66.9 ± 9.0 P = 0.036), a lower HFSS value (8.1 ± 1.0 vs 8.6 ± 1.0). There was no difference regarding HF etiology, NYHA class or cardiopulmonary fitness (pVO2: 16.6 ± 5.6 vs 16.5 ± 6.3 ml/kg/min, p = 0.19; VE/VCO2 slope: 35.4 ± 9.9 vs 34.0 ± 9.7, p = 0.328). EROA was an independent predictor of the primary outcome (OR 1.23, 95% CI 1.08-1.54, p = 0.039) and patients with severe fMR had a lower survival free of events during the first follow-up year (log-rank p = 0.012).
Conclusion
Severe fMR was associated with worse clinical outcomes in advanced HF population. Abstract Figure.
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Affiliation(s)
| | - P Bras
- Hospital de Santa Marta, Lisbon, Portugal
| | | | | | - R Soares
- Hospital de Santa Marta, Lisbon, Portugal
| | - AT Timoteo
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Galrinho
- Hospital de Santa Marta, Lisbon, Portugal
| | - L Branco
- Hospital de Santa Marta, Lisbon, Portugal
| | - R Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
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14
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Murata Y, Pierpoint L, DeClercq M, Lockard C, Martin M, Fukase N, Soares R, Quinn P, Ho CP, Uchida S, Philippon MJ. Cotyloid Fossa Coverage Percentages May Be Associated With Alpha Angle, Labral Tear, and Clinical Outcomes in Patients With Femoroacetabular Impingement. Am J Sports Med 2022; 50:50-57. [PMID: 34813404 DOI: 10.1177/03635465211056958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Within the hip joint, the anatomy of the acetabulum and cotyloid fossa is well established. There is little literature describing the association between the size of the cotyloid fossa relative to the acetabulum and characteristics of patients with femoroacetabular impingement (FAI). PURPOSE/HYPOTHESIS The purpose was to calculate the cotyloid fossa coverage percentage in the acetabulum and determine its association with patient characteristics, radiographic parameters, intra-articular findings, and preoperative patient-reported outcomes in patients with FAI. We hypothesized there is an association between the cotyloid fossa coverage percentage of the acetabulum and characteristics of patients with FAI. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Patients were included who underwent standard clinical 3-T magnetic resonance imaging of the hip and primary arthroscopic FAI correction surgery during 2015 and 2016. Exclusion criteria were age <18 or >40 years, osteoarthritis, labral reconstruction, previous ipsilateral hip surgery, and hip dysplasia. Measurements of the cotyloid fossa and surrounding lunate cartilage were performed to calculate cotyloid fossa width (CFW) and cotyloid fossa height (CFH) coverage percentages. The relationships between coverage percentages and patient characteristics and intraoperative findings were assessed using independent t tests or Pearson correlations. RESULTS An overall 146 patients were included. Alpha angle negatively correlated with CFH coverage percentage (r = -0.19; P = .03) and positively correlated with labral tear size (r = 0.28; P < .01). CFH coverage percentage was negatively correlated with labral tear size (r = -0.24; P < .01). Among patients with degenerative tears, CFH was negatively correlated with labral tear size (r = -0.31; P < .01). However, this association was no longer significant after adjusting for sex (partial r = -0.10; P = .39). Cotyloid fossa coverage was not associated with the condition of the cotyloid fossa synovium (synovitis vs no synovitis). CFW coverage percentage was negatively correlated with the 12-Item Short Form Health Survey (SF-12) physical component summary score (r = -0.23; P < .01). CONCLUSION The CFW and CFH coverage percentages may be associated with alpha angle, labral tear size, and SF-12 physical component summary score in patients with FAI. We may be able to predict the labral condition based on preoperative measurements of CFH and CFW coverage percentages.
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Affiliation(s)
- Yoichi Murata
- Steadman Philippon Research Institute and The Steadman Clinic, Vail, Colorado, USA
| | - Lauren Pierpoint
- Steadman Philippon Research Institute and The Steadman Clinic, Vail, Colorado, USA
| | - Madeleine DeClercq
- Steadman Philippon Research Institute and The Steadman Clinic, Vail, Colorado, USA
| | - Carly Lockard
- Steadman Philippon Research Institute and The Steadman Clinic, Vail, Colorado, USA
| | - Maitland Martin
- Steadman Philippon Research Institute and The Steadman Clinic, Vail, Colorado, USA
| | - Naomasa Fukase
- Steadman Philippon Research Institute and The Steadman Clinic, Vail, Colorado, USA
| | - Rui Soares
- Steadman Philippon Research Institute and The Steadman Clinic, Vail, Colorado, USA
| | - Patrick Quinn
- Steadman Philippon Research Institute and The Steadman Clinic, Vail, Colorado, USA
| | - Charles P Ho
- Steadman Philippon Research Institute and The Steadman Clinic, Vail, Colorado, USA
| | - Soshi Uchida
- Department of Orthopaedic Surgery and Sports Medicine, Wakamatsu Hospital of University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Marc J Philippon
- Steadman Philippon Research Institute and The Steadman Clinic, Vail, Colorado, USA
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Jesus C, Soares R, Cunha E, Grilo M, Tavares L, Oliveira M. Influence of Nisin-Biogel at Subinhibitory Concentrations on Virulence Expression in Staphylococcus aureus Isolates from Diabetic Foot Infections. Antibiotics (Basel) 2021; 10:antibiotics10121501. [PMID: 34943712 PMCID: PMC8698857 DOI: 10.3390/antibiotics10121501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 01/22/2023] Open
Abstract
A new approach to diabetic foot infections (DFIs) has been investigated, using a nisin-biogel combining the antimicrobial peptide (AMP) nisin with the natural polysaccharide guar-gum. Since in in vivo conditions bacteria may be exposed to decreased antimicrobial concentrations, known as subinhibitory concentrations (sub-MICs), effects of nisin-biogel sub-MIC values corresponding to 1/2, 1/4 and 1/8 of nisin's minimum inhibitory concentration (MIC) on virulence expression by six Staphylococcus aureus DFI isolates was evaluated by determining bacteria growth rate; expression of genes encoding for staphylococcal protein A (spA), coagulase (coa), clumping factor A (clfA), autolysin (atl), intracellular adhesin A (icaA), intracellular adhesin D (icaD), and the accessory gene regulator I (agrI); biofilm formation; Coa production; and SpA release. Nisin-biogel sub-MICs decreased bacterial growth in a strain- and dose-dependent manner, decreased agrI, atl and clfA expression, and increased spA, coa, icaA and icaD expression. Biofilm formation increased in the presence of nisin-biogel at 1/4 and 1/8 MIC, whereas 1/2 MIC had no effect. Finally, nisin-biogel at sub-MICs did not affect coagulase production, but decreased SpA production in a dose-dependent manner. Results highlight the importance of optimizing nisin-biogel doses before proceeding to in vivo trials, to reduce the risk of virulence factor's up-regulation due to the presence of inappropriate antimicrobial concentrations.
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Dias Ferreira Reis J, Goncalves A, Bras P, Moreira R, Rio P, Pereira Silva T, Timoteo A, Soares R, Cruz Ferreira R. Predictive ability of cardiopulmonary exercise test parameters in heart failure patients with cardiac resynchronization therapy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
There is evidence suggesting that a peak oxygen uptake (pVO2) cut-off of 10ml/kg/min provides a more precise risk stratification in Cardiac Resynchronization Therapy (CRT) patients. Our aim was to compare the prognostic power of several cardiopulmonary exercise testing (CPET) parameters in patients with CRT and assess the discriminative ability of the guideline-recommended pVO2 cut-off values.
Methods
Prospective evaluation of consecutive heart failure (HF) patients with left ventricular ejection fraction ≤40%. The primary endpoint was a composite of cardiac death and urgent heart transplantation (HT) in the first 24 follow-up months and was analyzed by several CPET parameters for the highest area under thecurve (AUC) in the CRT group. A survival analysis was performed to evaluate the risk stratification provided by several different cut-offs.
Results
A total of 450 HF patients, of which 114 had a CRT device. These patients had a higher baseline risk profile, but there was no difference regarding the primary outcome (13.2% vs 11.6%, p=0.660). End-tidal carbon dioxide pressure at the anaerobic threshold (PETCO2AT) had the highest AUC value, which was significantly higher than that of pVO2 in the CRT group (0.951 vs 0.778, p=0.046). The currently recommended pVO2 cut-off provided accurate risk stratification in this setting (p<0.001),and the suggested cut-off value of 10 ml/min/kg did not improve risk discrimination in device patients (p=0.772).
Conclusion
PETCO2AT outperforms pVO2's prognostic power for adverse events in CRT patients. The current guideline-recommended pVO2 cut-off can precisely risk-stratify this population.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | | | - P Bras
- Hospital de Santa Marta, Lisbon, Portugal
| | - R Moreira
- Hospital de Santa Marta, Lisbon, Portugal
| | - P Rio
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - A Timoteo
- Hospital de Santa Marta, Lisbon, Portugal
| | - R Soares
- Hospital de Santa Marta, Lisbon, Portugal
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17
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Philippon MJ, Ruzbarsky JJ, Johannsen AW, Soares R, Pierpont LA, Briggs KK. No Correlation Between Depth of Acetabuloplasty or Postoperative Lateral Center-Edge Angle on Midterm Outcomes of Hip Arthroscopy With Acetabuloplasty and Labral Repair: Response. Am J Sports Med 2021; 49:NP57-NP58. [PMID: 34520274 DOI: 10.1177/03635465211030227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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18
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Duarte F, Sousa T, Funke V, Colturato V, Hamerschlak N, Vilela N, Macedo M, Vigorito A, Soares R, Paz A, Stevenazzi M, Neto A, Bettarello G, Gusmão B, Salvino M, Calixto R, Moreira M, Teixeira G, Silva C, Lemes R, Garcia YO, Paton E, Rocha V, Enrico A, Bonfim C, Chiattone R, Simioni A, Arrais C, Coelho E, Diaz L. Topic: AS08-Treatment/AS08h-Allogeneic hematopoietic cell transplantation -Bridging to transplantation. Leuk Res 2021. [DOI: 10.1016/j.leukres.2021.106681.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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19
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Arner JW, Ruzbarsky JJ, Soares R, Briggs K, Philippon MJ. Salvage Revision Hip Arthroscopy Including Remplissage Improves Patient-Reported Outcomes After Cam Over-Resection. Arthroscopy 2021; 37:2809-2816. [PMID: 33887406 DOI: 10.1016/j.arthro.2021.03.061] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/15/2020] [Accepted: 03/17/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate outcomes of arthroscopic hip remplissage with folded iliotibial band allograft to treat cam over-resection. METHODS Patients who underwent arthroscopic iliotibial band hip remplissage from May 2013 to April 2018 were prospectively evaluated. Pre- and postoperative patient-reported outcome scores were compared and included the 12-Item Short Form Survey (SF12) Physical Health Composite Score (PCS), SF12 Mental Health Composite Score (MCS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), modified Harris Hip Score (mHHS), and Hip Outcome Score (HOS) (Activities of Daily Living [ADL] and Sport). Postoperative Tegner Activity Scale and patient satisfaction (1-10) were also evaluated. RESULTS Thirteen patients (2 men, 11 women) with an average age of 39.8 ± 9 years underwent arthroscopic hip remplissage with minimum 2-year and mean 3.1-year follow-up (range, 2.1-4.1 years). One hundred percent follow-up was achieved. The average number of previous surgeries was 1.38 (range, 1-3). One patient underwent total hip arthroplasty 2 years after remplissage. All 12 patients who did not undergo total hip arthroplasty had improved patient-reported outcomes after remplissage (mean scores: SF12 PCS 36 vs 42, P = .02; SF12 MCS 45 vs 51, P = .14; mHHS 45 vs 66, P < .001; minimal clinically important difference [MCID] 83%; WOMAC 42 vs 28, P < .001; HOS ADL 52 vs 69, P = .003; MCID, 67%; HOS Sport 27 vs 46, P = .015; MCID, 67%). All improvements met statistical significance, besides the SF12 MCS. Median postoperative Tegner score was 2.9. Median postoperative patient satisfaction was 7 out of 10 (range, 5-10). CONCLUSIONS Arthroscopic hip remplissage is a successful salvage treatment option for hip instability caused by previous cam over-resection. Care must be taken during primary surgery not to over-resect the cam as patient-reported outcomes after remplissage are inferior to those undergoing primary hip arthroscopy. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Justin W Arner
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | | | - Rui Soares
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Karen Briggs
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
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20
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Murata Y, Fukase N, Dornan G, Martin M, Soares R, Pierpoint L, Philippon MJ. Arthroscopic Treatment of Femoroacetabular Impingement in Patients With and Without Borderline Developmental Dysplasia of the Hip: A Systematic Review and Meta-analysis. Orthop J Sports Med 2021; 9:23259671211015973. [PMID: 34395680 PMCID: PMC8358532 DOI: 10.1177/23259671211015973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/07/2020] [Indexed: 12/03/2022] Open
Abstract
Background: Based on previous studies, it is difficult to discern whether patients who have femoroacetabular impingement (FAI) with borderline developmental dysplasia of the hip (BDDH) would benefit from arthroscopy when compared with patients without BDDH. Purpose: To evaluate the existing comparative literature on arthroscopic findings, procedures, patient-reported outcomes (PROs), and failures in patients who have FAI with BDDH compared with those without BDDH. Study Design: Systematic review; Level of evidence, 3. Methods: The PubMed, Embase, and Ovid databases were searched for studies published up to August 31, 2019, that reported outcomes after arthroscopy to treat patients who had FAI with BDDH. Included studies were required to have patients diagnosed with FAI and BDDH who were treated arthroscopically and compared with control patients (FAI without BDDH). Arthroscopic findings, PROs, and revision or total hip arthroplasty (THA) conversion rates were compared between groups. Results: Included in the review were 4 articles (933 patients). Patients who had FAI with BDDH were defined as having a lateral center-edge angle (LCEA) of either 18° to 25° or 20° to 25°; for control patients, the maximum LCEA was 40°. Across the studies, there were 224 patients who had FAI with BDDH compared with 709 control patients; the mean follow-up time ranged from 21.6 to 31.3 months among the groups. Improvements were shown across all PROs in each study. Random-effects meta-analysis indicated no statistically significant differences in postoperative PROs, the risk for revision surgery, or conversion to THA between the patients who had FAI with versus without BDDH. Conclusion: The results of the current review indicated that hip arthroscopy produced similar short-term outcomes between patients who had FAI with versus without BDDH.
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Affiliation(s)
- Yoichi Murata
- The Steadman Philippon Research Institute and the Steadman Clinic, Vail, Colorado, USA
| | - Naomasa Fukase
- The Steadman Philippon Research Institute and the Steadman Clinic, Vail, Colorado, USA
| | - Grant Dornan
- The Steadman Philippon Research Institute and the Steadman Clinic, Vail, Colorado, USA
| | - Maitland Martin
- The Steadman Philippon Research Institute and the Steadman Clinic, Vail, Colorado, USA
| | - Rui Soares
- The Steadman Philippon Research Institute and the Steadman Clinic, Vail, Colorado, USA
| | - Lauren Pierpoint
- The Steadman Philippon Research Institute and the Steadman Clinic, Vail, Colorado, USA
| | - Marc J Philippon
- The Steadman Philippon Research Institute and the Steadman Clinic, Vail, Colorado, USA
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21
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Murata Y, Fukase N, Martin M, Soares R, Pierpoint L, Dornan GJ, Uchida S, Philippon MJ. Comparison Between Hip Arthroscopic Surgery and Periacetabular Osteotomy for the Treatment of Patients With Borderline Developmental Dysplasia of the Hip: A Systematic Review. Orthop J Sports Med 2021; 9:23259671211007401. [PMID: 33997083 PMCID: PMC8113971 DOI: 10.1177/23259671211007401] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/08/2020] [Indexed: 12/24/2022] Open
Abstract
Background: The treatment for borderline developmental dysplasia of the hip (BDDH) has
historically been arthroscopic surgery or periacetabular osteotomy (PAO). As
orthopaedic surgery is constantly evolving, a lack of comparison of outcomes
for these 2 treatment methods could potentially be stalling the progression
of treatment for patients with BDDH. Purpose: To evaluate the existing literature on patient characteristics, procedures,
clinical outcomes, and failure rates for patients with BDDH and to determine
whether PAO or hip arthroscopic surgery is a better treatment method for
patients with BDDH. Study Design: Systematic review; Level of evidence, 4. Methods: Studies included were found using the following search words: “hip” and
“borderline dysplasia,” “osteotomy” or “arthroscopy,” and “outcome” or
“procedure.” Articles were included if they detailed participants of all
sexes and ages, reported on isolated hips, and had patients diagnosed with
BDDH. Results: A search was conducted across 3 databases, resulting in 469 articles for
consideration, from which 12 total studies (10 on arthroscopic surgery and 2
on PAO) were chosen for a review. There were 6 studies that included
patients with a lateral center-edge angle of 18° to 25°, while the remainder
included patients with a lateral center-edge angle of 20° to 25°. All the
studies reviewing arthroscopic surgery reported concomitant/accessory
procedures, while the articles on the topic of PAO did not. It was
determined that, whether treated using arthroscopic surgery or PAO, outcomes
improved across all patient-reported outcome measures. Revision surgery was
also common in both procedures. Conclusion: There is a lack of consensus in the literature on the best treatment option
for patients with BDDH. Preoperative patient characteristics and concomitant
injuries should be considered when evaluating which surgical procedure will
result in the most favorable outcomes.
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Affiliation(s)
- Yoichi Murata
- Steadman Philippon Research Institute and The Steadman Clinic, Vail, Colorado, USA
| | - Naomasa Fukase
- Steadman Philippon Research Institute and The Steadman Clinic, Vail, Colorado, USA
| | - Maitland Martin
- Steadman Philippon Research Institute and The Steadman Clinic, Vail, Colorado, USA
| | - Rui Soares
- Steadman Philippon Research Institute and The Steadman Clinic, Vail, Colorado, USA
| | - Lauren Pierpoint
- Steadman Philippon Research Institute and The Steadman Clinic, Vail, Colorado, USA
| | - Grant J Dornan
- Steadman Philippon Research Institute and The Steadman Clinic, Vail, Colorado, USA
| | - Soshi Uchida
- Department of Orthopaedic Surgery and Sports Medicine, Wakamatsu Hospital, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Marc J Philippon
- Steadman Philippon Research Institute and The Steadman Clinic, Vail, Colorado, USA
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Uzai G, Monteiro C, Soares R, Silva M, Oliveira A, Santos D, Santos R, Nunes L. Morphological and molecular diagnosis of diseases of free-ranging crab-eating foxes (Cerdocyon thous). ARQ BRAS MED VET ZOO 2021. [DOI: 10.1590/1678-4162-12267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT The aim of this study was to investigate the occurrence of diseases in free-ranging wild canids that were roadkill on highways in the State of Espírito Santo, Brazil. PCR tests were performed for the detection of Brucella sp., Babesia sp., Rangelia sp., and Hepatozoon sp. in the spleen. Morphological evaluation and identification of parasites was performed in the liver and lung. Twenty specimens of C. thous were necropsied at the Animal Pathology Sector of the Veterinary Hospital of the Universidade Federal do Espírito Santo. Tissue samples were processed for histopathological examination and polymerase chain reaction (PCR) analysis. There was no PCR amplification of genomic DNA sequences of Brucella sp., Babesia sp., Rangelia sp., and Hepatozoon sp. using DNA extracted from the spleen as template. Histologically, lesions associated with parasitism by Platynosomum sp. and Angiostrongylus sp. were observed in the liver and lung, respectively. This is the first report of Platynosomum sp. and Angiostrongylus sp. parasitism in C. thous in the state of Espírito Santo, Brazil. Therefore, this study demonstrated parasitism of crab-eating foxes by Platynosomum sp. and Angiostrongylus sp. Importantly, no evidence of infection with Brucella sp., Babesia sp., Rangelia sp., and Hepatozoon sp. was obtained by PCR analysis.
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Affiliation(s)
- G.J.S. Uzai
- Universidade Federal do Espírito Santo, Brazil
| | | | - R. Soares
- Universidade Federal do Espírito Santo, Brazil
| | - M.A. Silva
- Universidade Federal do Espírito Santo, Brazil
| | | | - D.O. Santos
- Universidade Federal de Minas Gerais, Brazil
| | - R.L. Santos
- Universidade Federal de Minas Gerais, Brazil
| | - L.C. Nunes
- Universidade Federal do Espírito Santo, Brazil
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Valentim Goncalves A, Pereira-da-Silva T, Soares R, Feliciano J, Abreu A, Rio P, Moreira RI, Cruz Ferreira R. Prognostic value of VE/VCO 2 slope in overweight heart failure patients. Am J Cardiovasc Dis 2020; 10:578-584. [PMID: 33489461 PMCID: PMC7811917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/14/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND A decreased hypercapnic ventilatory response of the overweight patients would lower the ventilation equivalent of carbon dioxide (VE/VCO2) slope but worsen prognosis. The aim of this study was to compare the prognostic ability of the VE/VCO2 slope and peak oxygen consumption (pVO2) between normal and overweight heart failure (HF) patients. METHODS Prospective evaluation of ambulatory patients with reduced left ventricular ejection fraction who underwent baseline assessment with a cardiopulmonary exercise test. The primary endpoint was cardiac death or urgent heart transplantation in the 5-year period of follow-up. The predictive power of VE/VCO2 slope and pVO2 were compared (area under the curve (AUC) analysis and Hanley & McNeil test), in the subgroups of patients with body mass index (BMI) of 18.5-24.9 kg/m2 and ≥ 25 kg/m2. Statistical differences with a p value < 0.05 were considered significant. RESULTS There were 270 enrolled patients, with a mean BMI of 27 ± 4 kg/m2. No differences between normal and overweight patients (38.0% vs 29.8%, P=0.170) were found during the 5-year period for the primary endpoint. The VE/VCO2 slope was non-inferior to pVO2 in both groups at 1, 3 and 5 years of follow-up. The comparison of VE/VCO2 slope between groups revealed a significant lower AUC at 3 (0.921 vs 0.787, P=0.022) and 5 years (0.898 vs 0.787, P=0.044) of follow-up for overweight patients. CONCLUSION Despite VE/VCO2 slope provides a discriminative power at least as good as pVO2 for predicting adverse events in both normal and overweight HF patients, a significant lower predictive power was found in overweight patients.
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Affiliation(s)
- António Valentim Goncalves
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central Lisbon, Portugal
| | - Tiago Pereira-da-Silva
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central Lisbon, Portugal
| | - Rui Soares
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central Lisbon, Portugal
| | - Joana Feliciano
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central Lisbon, Portugal
| | - Ana Abreu
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central Lisbon, Portugal
| | - Pedro Rio
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central Lisbon, Portugal
| | - Rita Ilhao Moreira
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central Lisbon, Portugal
| | - Rui Cruz Ferreira
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central Lisbon, Portugal
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Soares R, Santos-Carvalho A, Santos-Carvalho A, Cravo-Roxo I, Ribeiro L, Marques R, Alarico S, Ferreira S. Infection control through education: HIV prevention. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Dias Ferreira Reis J, Goncalves A, Bras P, Ferreira V, Viegas J, Rio P, Moreira R, Pereira Silva T, Timoteo A, Soares R, Cruz Ferreira R. Prognostic value of the cardiorespiratory optimal point during submaximal exercise testing. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Peak oxygen consumption (pVO2) is a key parameter in assessing the prognosis of heart failure with reduced ejection fraction (HFrEF) patients (pts). However, it is a less reliable parameter when the cardiopulmonary exercise test (CPET) is not maximal. It is crucial to identify the submaximal exercise variables with the best prognostic power (PP), in order to improve the management of pts that cannot attain a maximal CPET.
Purpose
The aim of this study was to evaluate and compare the PP of several exercise parameters in submaximal CPET for risk stratification in pts with HFrEF.
Methods
Prospective evaluation of adult pts with HFrEF submitted to CPET in a tertiary center. A submaximal CPET was defined by a respiratory exchange ratio (RER) ≤1.10. Pts were followed up for at least 1 year for the primary endpoint of cardiac death and urgent heart transplantation/ ventricular assist device implantation. Several CPET parameters were analyzed as potential predictors of the combined endpoint and their PP (area under the curve - AUC) was compared to that of pVO2, using the Hanley and McNeil test.
Results
CPET was performed in 487 HF pts, of which 317 (66%) performed a submaximal CPET. Pts averaged 57±12 years of age, 77% were male, 45.7% had ischemic cardiomyopathy, with a mean LVEF of 30.4±7.6%, a mean heart failure survival score of 8.6±1.1. The mean pVO2 was 17.1±5.5 ml/kg/min and the mean RER 1.01±0.08. During a mean follow-up (FU) time of 11±1 months, 18 pts (6%) met the primary endpoint. Cardiorespiratory optimal point (OP - VE/VO2) had the highest AUC value (0.915, p=0.001), followed by the partial pressure of end-tidal CO2 at the anaerobic threshold - PETCO2L (0.814, p<0.001). pVO2 presented an AUC of 0.730 (p=0.001). OP≥31 and PETCO2L ≤37mmHg had a sensitivity of 100 and 76.9% and a specificity of 71.1 and 67%, respectively, for the primary outcome. OP presented a significantly higher PP than pVO2 (p=0.048), whether PETCO2L didn't achieve any statistical significance (p=0.164). Pts with anOP≥31 presented a significantly lower survival free of HT during FU (log rank p=0.002).
Conclusion
OP had the highest PP for HF events of all parameters analyzed for a submaximal CPET. This parameter can help stratify the HF pts physiologically unable to reach a peak level of exercise.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | | | - P Bras
- Hospital de Santa Marta, Lisbon, Portugal
| | - V Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
| | - J Viegas
- Hospital de Santa Marta, Lisbon, Portugal
| | - P Rio
- Hospital de Santa Marta, Lisbon, Portugal
| | - R Moreira
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - A Timoteo
- Hospital de Santa Marta, Lisbon, Portugal
| | - R Soares
- Hospital de Santa Marta, Lisbon, Portugal
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Moreira RI, Silva TP, Gonçalves AV, Feliciano J, Rio P, Soares R, Ferreira RC. Impact of Cardiorespiratory Fitness on the Obesity Paradox in Heart Failure with Reduced Ejection Fraction. Arq Bras Cardiol 2020; 115:639-645. [PMID: 33111862 PMCID: PMC8386967 DOI: 10.36660/abc.20190337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 10/23/2019] [Indexed: 12/19/2022] Open
Abstract
Fundamento: Índice de massa corporal (IMC) elevado tem sido associado a desfechos melhores em pacientes com insuficiência cardíaca com fração de ejeção reduzida. Este achado tem levado ao conceito do paradoxo da obesidade. Objetivo: Investigar o impacto de tolerância ao exercício e capacidade cardiorrespiratória no paradoxo da obesidade. Método: Pacientes ambulatoriais com insuficiência cardíaca sintomática e fração de ejeção ventricular esquerda (FEVE) ≤ 40%, acompanhados no nosso centro, foram prospectivamente submetidos à avaliação abrangente de linha de base incluindo parâmetros clínicos, laboratoriais, eletrocardiográficos, ecocardiográficos e de exercício cardiopulmonar. A população do estudo foi dividida de acordo com o IMC (< 25, 25 – 29,9 e ≥ 30 kg/m2). Todos os pacientes foram acompanhados durante 60 meses. O desfecho composto foi definido como morte cardíaca, transplante cardíaco urgente ou necessidade de suporte circulatório mecânico. Valores de p < 0,05 foram considerados significativos. Resultados: Dos 282 pacientes incluídos (75% masculino, 54 ± 12 anos, IMC 27 ± 4 kg/m2, FEVE 27% ± 7%), o desfecho composto ocorreu em 24,4% durante o acompanhamento. Os pacientes com IMC elevado eram mais velhos e apresentavam FEVE e níveis séricos de sódio mais elevados, bem como menor inclinação de eficiência ventilatória (VE/VCO2). VE/VCO2 e consumo de oxigênio de pico (VO2p) eram fortes preditores prognósticos (p < 0,001). Na análise univariada de regressão de Cox, o IMC elevado foi associado a desfechos melhores (razão de risco 0,940, intervalo de confiança 0,886 – 0,998, p 0,042). Porém, após ajustar para ou inclinação VE/VCO2 ou VO2p, o papel protetor do IMC sumiu. O benefício de sobrevida do IMC não foi evidente quando os pacientes foram agrupados de acordo com a classe de aptidão cardiorrespiratória (VE/VCO2, valor de corte de 35, e VO2p, valor de corte de 14 mL/kg/min). Conclusão: Estes resultados sugerem que a aptidão cardiorrespiratória supera a relação entre o IMC e a sobrevida em pacientes com insuficiência cardíaca.
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Affiliation(s)
| | | | | | | | - Pedro Rio
- Hospital de Santa Marta, Lisboa - Portugal
| | - Rui Soares
- Hospital de Santa Marta, Lisboa - Portugal
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Gonçalves AV, Pereira-da-Silva T, Galrinho A, Rio P, Soares R, Feliciano J, Moreira RI, Silva S, Alves S, Capilé E, Ferreira RC. Melhora no Consumo Máximo de Oxigênio e na Ventilação após Tratamento com Sacubitril-Valsartana. Arq Bras Cardiol 2020; 115:821-827. [PMID: 33084746 PMCID: PMC8452225 DOI: 10.36660/abc.20190443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/23/2019] [Indexed: 12/11/2022] Open
Abstract
Fundamento O tratamento com sacubitril-valsartana teve seu benefício prognóstico confirmado no ensaio PARADIGM-HF. No entanto, dados sobre alterações no teste de esforço cardiopulmonar (TECP) com o uso de sacubitril-valsartana são escassos. Objetivo O objetivo deste estudo foi comparar os parâmetros do TECP antes e depois do tratamento com sacubitril-valsartana. Métodos Avaliação prospectiva de pacientes com insuficiência cardíaca (IC) crônica e fração de ejeção do ventrículo esquerdo ≤40%, mesmo sob terapia padrão otimizada, que iniciaram tratamento com sacubitril-valsartana, sem expectativa de tratamentos adicionais para a IC. Os dados do TECP foram coletados na semana anterior e 6 meses depois do tratamento com sacubitril-valsartana. Diferenças estatísticas com valor p <0,05 foram consideradas significativas. Resultados De 42 pacientes, 35 (83,3%) completaram o seguimento de 6 meses, uma vez que 2 (4,8%) morreram e 5 (11,9%) interromperam o tratamento devido a eventos adversos. A média de idade foi de 58,6±11,1 anos. A classe NYHA (classificação da New York Heart Association) melhorou em 26 (74,3%) pacientes. O consumo máximo de oxigênio (VO2max) (14,4 vs. 18,3 ml/kg/min, p<0,001), a inclinação VE/VCO2 (36,7 vs. 31,1, p<0,001) e a duração do exercício (487,8 vs. 640,3 s, p<0,001) também melhoraram com o uso de sacubitril-valsartana. O benefício foi mantido mesmo com a dose de 24/26 mg (13,5 vs. 19,2 ml/kg/min, p=0,018) de sacubitril-valsartana, desde que esta tenha sido a maior dose tolerada. Conclusões O tratamento com sacubitril-valsartana está associado a uma melhora acentuada do VO2max, da inclinação VE/VCO2 e da duração do exercício no TECP. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)
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Valentim Goncalves A, Pereira-da-Silva T, Galrinho A, Rio P, Moura Branco L, Soares R, Ilhao Moreira R, Cruz Ferreira R. C-reactive protein reduction with sacubitril-valsartan treatment in heart failure patients. Am J Cardiovasc Dis 2020; 10:174-181. [PMID: 32923098 PMCID: PMC7486532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/04/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE C-Reactive Protein (CRP) has emerged as an accessible measured product of inflammation. Whether systemic inflammation, a common feature of Heart Failure (HF), can be reduced by HF treatments in not well established. Sacubitril/Valsartan had prognosis benefit demonstrated in the PARADIGM-HF trial and was able to reduce proinflammatory cytokines in preclinical animal studies. However, no human studies evaluated if the benefits of this therapy are mediated by anti-inflammatory effects too. The aim of this study was to prospectively compare CRP values before and six months after Sacubitril-Valsartan therapy. METHODS Prospective evaluation of chronic HF patients with left ventricular ejection fraction ≤ 40% despite optimized standard of care therapy, in which Sacubitril/Valsartan therapy was started and no additional HF treatment was expected to change. Clinical, laboratorial (including CRP values), electrocardiographic, transthoracic echocardiography and cardiopulmonary exercise test (CPET) data were gathered in the week before starting Sacubitril/Valsartan therapy and six months thereafter. RESULTS There were 42 patients with a mean age of 59 ± 11 years, of which 35 completed the six months of follow-up, since 2 patients died and 5 discontinued treatment for adverse events. Patients with baseline CRP values above the median (> 2.5 mg/L) had a significantly higher percentage of New York Heart Association class ≥ III (65% vs. 33%, P=0.028) and a reduced exercise time in CPET (361 ± 297 vs. 575 ± 265 seconds, P=0.034). After 6 months of Sacubitril-Valsartan therapy, 24 (69%) patients had an improvement in CRP values with a significantly reduction as compared to baseline (median 2.5 mg/L (Interquartile range (IQR) 1.3-5.0) vs. 2.2 mg/L (IQR 0.9-4.0), P=0.014 in the Wilcoxon test). In the group of 17 (49%) patients with at least 25% improvement in CRP values with Sacubitril/Valsartan therapy, the benefit of several clinical, CPET and echocardiographic parameters were not significantly different from the benefit of patients with no improvement or an improvement inferior to 25% in CRP values. CONCLUSION Sacubitril/Valsartan therapy was able to reduce CRP values in a chronic HF population. Whether this reduction was only a consequence of clinical improvement with Sacubitril/Valsartan or an anti-inflammatory effect is also present should be further evaluated.
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Affiliation(s)
- Antonio Valentim Goncalves
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central Lisbon, Portugal
| | - Tiago Pereira-da-Silva
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central Lisbon, Portugal
| | - Ana Galrinho
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central Lisbon, Portugal
| | - Pedro Rio
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central Lisbon, Portugal
| | - Luísa Moura Branco
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central Lisbon, Portugal
| | - Rui Soares
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central Lisbon, Portugal
| | - Rita Ilhao Moreira
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central Lisbon, Portugal
| | - Rui Cruz Ferreira
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central Lisbon, Portugal
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Timóteo AT, Silva TP, Moreira RI, Gonçalves A, Soares R, Ferreira RC. Heart failure units: State of the art in disease management. Rev Port Cardiol 2020; 39:341-350. [PMID: 32600930 DOI: 10.1016/j.repc.2020.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/17/2020] [Accepted: 02/01/2020] [Indexed: 10/24/2022] Open
Abstract
The prevalence of heart failure has increased over the past decades and is a major social and economic burden on healthcare services. Patient quality of life is severely impaired and heart failure is one of the main causes of death in Portugal. The functional organization of multidisciplinary teams engaged in the treatment of these patients is essential to improve health care provision and outcomes, specifically reducing mortality, hospital admissions, and improving quality of life. We describe current approaches to heart failure management and discuss the organization of heart failure units and cooperation among these units and also with other healthcare professionals.
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Affiliation(s)
- Ana Teresa Timóteo
- Unidades de Insuficiência Cardíaca e Transplantação Cardíaca, Serviço de Cardiologia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal; Nova Medical School, Lisboa, Portugal.
| | - Tiago Pereira Silva
- Unidades de Insuficiência Cardíaca e Transplantação Cardíaca, Serviço de Cardiologia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Rita Ilhão Moreira
- Unidades de Insuficiência Cardíaca e Transplantação Cardíaca, Serviço de Cardiologia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - António Gonçalves
- Unidades de Insuficiência Cardíaca e Transplantação Cardíaca, Serviço de Cardiologia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Rui Soares
- Unidades de Insuficiência Cardíaca e Transplantação Cardíaca, Serviço de Cardiologia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Rui Cruz Ferreira
- Unidades de Insuficiência Cardíaca e Transplantação Cardíaca, Serviço de Cardiologia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
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Abstract
PURPOSE OF REVIEW Hip arthroscopy and its indications continue to expand. Understanding the durability of hip arthroscopic procedures remains important not only for counseling patients, but also for determining the success of certain procedures or in certain populations. Survivorship is defined as the proportion of hip arthroscopy patients who have not yet gone on to periacetabular osteotomy (PAO), total hip arthroplasty (THA), and/or revision surgery. The purpose of this review is to summarize the recent literature pertaining to survivorship after certain hip arthroscopic procedures and certain special populations. RECENT FINDINGS There is yet to be level 1 evidence published with relation to survivorship following hip arthroscopy. The best evidence in the recent literature is contained in just rew long-term prospective studies demonstrating good to excellent survivorship following hip arthroscopy for femoroacetabular impingement (FAI). Unfortunately, the follow-up for other conditions treated by hip arthroscopy is more limited. In summary, hip arthroscopy indications continue to expand. The most common indication for surgery is FAI, and its recently published long-term survivorship demonstrates excellent durability. Other hip arthroscopic procedures, including labral reconstruction, adjunctive procedures such as capsular closure, and special populations such as athletes, also demonstrate excellent survivorship in shorter term follow-up. Further prospective research is needed to further define survivorship of various hip conditions, associated procedures, and special populations commonly treated with hip arthroscopy.
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Affiliation(s)
- Joseph J Ruzbarsky
- The Steadman Clinic and United States Coalition for the Prevention of Illness and Injury in Sport, Vail, CO, USA
| | - Rui Soares
- Steadman Philippon Research Institute, 181 W Meadow Dr, Ste 400, Vail, CO, 81657, USA
| | - Adam Johannsen
- The Steadman Clinic and United States Coalition for the Prevention of Illness and Injury in Sport, Vail, CO, USA
| | - Marc J Philippon
- The Steadman Clinic and United States Coalition for the Prevention of Illness and Injury in Sport, Vail, CO, USA.
- Steadman Philippon Research Institute, 181 W Meadow Dr, Ste 400, Vail, CO, 81657, USA.
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Pires AS, Batista J, Murtinho D, Nogueira C, Karamysheva A, Luísa Ramos M, Milne BF, Tavares NT, Gonçalves J, Gonçalves AC, Abrantes AM, Soares R, Gonçalves T, Botelho MF, Silva Serra ME. Synthesis, Characterization and Evaluation of the Antibacterial and Antitumor Activity of HalogenatedSalen Copper (II) Complexes derived from Camphoric Acid. Appl Organomet Chem 2020. [DOI: 10.1002/aoc.5569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Ana Salomé Pires
- Biophysics Institute, Coimbra Institute for Clinical and Biomedical Research (iCBR) area of Environment Genetics and Oncobiology (CIMAGO), Faculty of MedicineUniversity of Coimbra 3000‐548 Coimbra Portugal
- CNC.IBILI Consortium/Center for Innovative Biomedicine and Biotechnology (CIBB)University of Coimbra 3000‐548 Coimbra Portugal
| | - João Batista
- Biophysics Institute, Coimbra Institute for Clinical and Biomedical Research (iCBR) area of Environment Genetics and Oncobiology (CIMAGO), Faculty of MedicineUniversity of Coimbra 3000‐548 Coimbra Portugal
- Centro de Química, Department of ChemistryUniversity of Coimbra 3004‐535 Coimbra Portugal
| | - Dina Murtinho
- Centro de Química, Department of ChemistryUniversity of Coimbra 3004‐535 Coimbra Portugal
| | - Célia Nogueira
- CNC ‐ Centre for Neuroscience and Cell BiologyUniversity of Coimbra 3004‐535 Coimbra Portugal
- Institute of Microbiology, Faculty of MedicineUniversity of Coimbra 3004‐535 Coimbra Portugal
| | - Anna Karamysheva
- Institute of Microbiology, Faculty of MedicineUniversity of Coimbra 3004‐535 Coimbra Portugal
| | - M. Luísa Ramos
- Centro de Química, Department of ChemistryUniversity of Coimbra 3004‐535 Coimbra Portugal
| | - Bruce F. Milne
- CFisUC, Department of PhysicsUniversity of Coimbra Rua Larga 3004‐516 Coimbra Portugal
- Nano‐Bio Spectroscopy Group and ETSF Scientific Development Centre, Departamento de Física de MaterialesUniversidad del País Vasco UPV/EHU E‐20018 San Sebastián Spain
| | - Nuno Tiago Tavares
- Biophysics Institute, Coimbra Institute for Clinical and Biomedical Research (iCBR) area of Environment Genetics and Oncobiology (CIMAGO), Faculty of MedicineUniversity of Coimbra 3000‐548 Coimbra Portugal
| | - José Gonçalves
- Biophysics Institute, Coimbra Institute for Clinical and Biomedical Research (iCBR) area of Environment Genetics and Oncobiology (CIMAGO), Faculty of MedicineUniversity of Coimbra 3000‐548 Coimbra Portugal
| | - Ana Cristina Gonçalves
- Biophysics Institute, Coimbra Institute for Clinical and Biomedical Research (iCBR) area of Environment Genetics and Oncobiology (CIMAGO), Faculty of MedicineUniversity of Coimbra 3000‐548 Coimbra Portugal
- CNC.IBILI Consortium/Center for Innovative Biomedicine and Biotechnology (CIBB)University of Coimbra 3000‐548 Coimbra Portugal
- Laboratory of Oncobiology and Hematology and University Clinic of Hematology/Faculty of MedicineUniversity of Coimbra 3000‐548 Coimbra Portugal
| | - Ana Margarida Abrantes
- Biophysics Institute, Coimbra Institute for Clinical and Biomedical Research (iCBR) area of Environment Genetics and Oncobiology (CIMAGO), Faculty of MedicineUniversity of Coimbra 3000‐548 Coimbra Portugal
- CNC.IBILI Consortium/Center for Innovative Biomedicine and Biotechnology (CIBB)University of Coimbra 3000‐548 Coimbra Portugal
| | - Rui Soares
- Institute of Microbiology, Faculty of MedicineUniversity of Coimbra 3004‐535 Coimbra Portugal
- Department of Clinical Pathology ServiceInstituto Português de Oncologia de Coimbra Francisco Gentil EPE 3000‐075 Coimbra Portugal
| | - Teresa Gonçalves
- CNC ‐ Centre for Neuroscience and Cell BiologyUniversity of Coimbra 3004‐535 Coimbra Portugal
- Institute of Microbiology, Faculty of MedicineUniversity of Coimbra 3004‐535 Coimbra Portugal
| | - Maria Filomena Botelho
- Biophysics Institute, Coimbra Institute for Clinical and Biomedical Research (iCBR) area of Environment Genetics and Oncobiology (CIMAGO), Faculty of MedicineUniversity of Coimbra 3000‐548 Coimbra Portugal
- CNC.IBILI Consortium/Center for Innovative Biomedicine and Biotechnology (CIBB)University of Coimbra 3000‐548 Coimbra Portugal
| | - M. Elisa Silva Serra
- Centro de Química, Department of ChemistryUniversity of Coimbra 3004‐535 Coimbra Portugal
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Gonçalves AV, Pereira-da-Silva T, Soares R, Feliciano J, Moreira RI, Rio P, Abreu A, Ferreira RC. Prognostic Prediction of Cardiopulmonary Exercise Test Parameters in Heart Failure Patients with Atrial Fibrillation. Arq Bras Cardiol 2020; 114:209-218. [PMID: 32215486 PMCID: PMC7077586 DOI: 10.36660/abc.20180193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 04/10/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is associated with increased mortality in heart failure (HF) patients. OBJECTIVE To evaluate whether the risk of AF patients can be precisely stratified by relation with cardiopulmonary exercise test (CPET) cut-offs for heart transplantation (HT) selection. METHODS Prospective evaluation of 274 consecutive HF patients with left ventricular ejection fraction ≤ 40%. The primary endpoint was a composite of cardiac death or urgent HT in 1-year follow-up. The primary endpoint was analysed by several CPET parameters for the highest area under the curve and for positive (PPV) and negative predictive value (NPV) in AF and sinus rhythm (SR) patients to detect if the current cut-offs for HT selection can precisely stratify the AF group. Statistical differences with a p-value <0.05 were considered significant. RESULTS There were 51 patients in the AF group and 223 in the SR group. The primary outcome was higher in the AF group (17.6% vs 8.1%, p = 0.038). The cut-off value of pVO2 for HT selection showed a PPV of 100% and an NPV of 95.5% for the primary outcome in the AF group, with a PPV of 38.5% and an NPV of 94.3% in the SR group. The cut-off value of VE/VCO2 slope showed lower values of PPV (33.3%) and similar NPV (92.3%) to pVO2 results in the AF group. CONCLUSION Despite the fact that AF carries a worse prognosis for HF patients, the current cut-off of pVO2 for HT selection can precisely stratify this high-risk group.
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Affiliation(s)
- António Valentim Gonçalves
- Centro Hospitalar Universitário Lisboa Central, Hospital de Santa Marta, Lisbon - Portugal,Mailing Address: António Valentim Gonçalves, Rua de Santa Marta, 50. 1169-1024, Lisbon - Portugal. E-mail:
| | - Tiago Pereira-da-Silva
- Centro Hospitalar Universitário Lisboa Central, Hospital de Santa Marta, Lisbon - Portugal
| | - Rui Soares
- Centro Hospitalar Universitário Lisboa Central, Hospital de Santa Marta, Lisbon - Portugal
| | - Joana Feliciano
- Centro Hospitalar Universitário Lisboa Central, Hospital de Santa Marta, Lisbon - Portugal
| | - Rita Ilhão Moreira
- Centro Hospitalar Universitário Lisboa Central, Hospital de Santa Marta, Lisbon - Portugal
| | - Pedro Rio
- Centro Hospitalar Universitário Lisboa Central, Hospital de Santa Marta, Lisbon - Portugal
| | - Ana Abreu
- Centro Hospitalar Universitário Lisboa Central, Hospital de Santa Marta, Lisbon - Portugal
| | - Rui Cruz Ferreira
- Centro Hospitalar Universitário Lisboa Central, Hospital de Santa Marta, Lisbon - Portugal
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Valentim Goncalves AA, Galrinho A, Pereira-Da-Silva T, Moura Branco L, Rio P, Teresa Timoteo A, Abreu J, Soares R, Ilhao Moreira R, Mendonca T, Coutinho Cruz M, Reis J, Mano T, Cruz Ferreira R. P1433 Antiarrhythmic effects of sacubitril-valsartan therapy assessed by mechanical dispersion index. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Sacubitril/Valsartan (LCZ696) significantly reduced sudden cardiac death in the PARADIGM-HF trial. However, there is little published data regarding the possible explanations for the antiarrhythmic effects found with LCZ696 therapy.
Previous trials have shown that mechanical dispersion by strain echocardiography can predict arrhythmic events in Heart Failure (HF) patients.
The aim of this study was to compare electrocardiographic (ECG) parameters and mechanical dispersion index with left ventricular (LV) global longitudinal strain (GLS) analysis before and after LCZ696 therapy.
Methods
Prospective evaluation of chronic HF patients with LV ejection fraction ≤ 40% despite optimized standard of care therapy, in which LCZ696 therapy was started and no additional HF treatment was expected to change.
ECG and transthoracic echocardiographic data were gathered in the week before starting LCZ696 therapy and 6 months after therapy. A semiautomated analysis of LV GLS was made and mechanical dispersion index was defined as the standard deviation from the 16 time intervals corresponding to each LV segment.
Results
Of the 42 patients, 35 (83.3%) completed the 6 months of follow-up, since 2 (4.8%) patients died and 5 (11.9%) discontinued treatment for adverse events. Mean age was 58.6 ± 11.1 years.
QTc interval (451.9 vs 426.0msec, p < 0.001) and QRS interval (125.1 vs 120.8msec, p = 0.033) were reduced after 6 months of LCZ696 therapy. Mechanical dispersion index (88.4 vs 78.1msec, p = 0.036) was also significantly reduced after therapy.
Conclusion
LCZ696 therapy is associated with antiarrhythmic effects with a reduction in QTc and QRS intervals in ECG and a reduction in mechanical dispersion index as assessed by LV GLS.
Abstract P1433 Figure.
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Affiliation(s)
| | - A Galrinho
- Hospital de Santa Marta, Lisbon, Portugal
| | | | | | - P Rio
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - J Abreu
- Hospital de Santa Marta, Lisbon, Portugal
| | - R Soares
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - T Mendonca
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - J Reis
- Hospital de Santa Marta, Lisbon, Portugal
| | - T Mano
- Hospital de Santa Marta, Lisbon, Portugal
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Valentim Goncalves AA, Galrinho A, Pereira-Da-Silva T, Moura Branco L, Rio P, Teresa Timoteo A, Abreu J, Soares R, Feliciano J, Ilhao Moreira R, Cruz Ferreira R. 1037 Differences in reverse remodelling between ischemic and non-ischemic left ventricular segments as assessed by myocardial work after sacubitril-valsartan therapy. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Myocardial work (MW) is a new transthoracic echocardiographic (TTE) parameter that enhances the information provided through left ventricular (LV) global longitudinal strain (GLS), allowing to investigate LV performance even in cases of changes in afterload.
None is known about the effects of Sacubitril-Valsartan (LCZ696) therapy in MW parameters.
Purpose
Compare the changes in MW parameters between ischemic and non-ischemic segments after LCZ696 therapy.
Methods
The study was a prospective evaluation of chronic Heart Failure (HF) patients with optimized standard of care therapy and LV ejection fraction ≤40%, in which LCZ696 therapy was started and no other HF treatment was expected to change.
A TTE study was performed before and 6 months after LCZ696 therapy, using the GE Vivid E95 ultrasound system. A semiautomated analysis of GLS was performed after two-dimensional images were acquired in the standard apical 4-, 3- and 2 chamber views. MW and related indices were estimated using custom software.
Two groups were created according to the 17 segment model TTE study before LCZ696 therapy:
G1 (ischemic group): dyskinesia/akinesia/hypokinesia segments in patients with ischemic HF etiology;
G2 (non-ischemic group): normokinesia segments in patients with ischemic and all segments in patients with non-ischemic HF etiology;
Results
Of the 42 patients, 35 (83.3%) completed the six-months follow-up with LCZ696, since 2 patients (4.8%) died and 5 patients (11.9%) discontinued treatment for adverse events. Mean age was 58.6 ± 11.1 years, with ischemic etiology in 15 (42.9%), resulting in a total of 26.5% segments for G1.
Baseline global MW index (GWI) had no statistical difference between G1 and G2 (566.1 VS 584.8mmHg%, p = 0.257), but baseline MW efficiency (GWE) were significantly lower in G1 (71.9 VS 78.8%, p < 0.001).
The table represents the mean values for MW parameters in G1 and G2 before and 6 months after LCZ696 therapy, with a significantly increase in GWI and GWE values in both groups. Despite no difference in the increase in GWE (p = 0.872), the increase in GWI were higher in G2 than G1 (p < 0.001).
Conclusion
MW seems to be a new tool providing signs of reverse remodelling and better cardiac performance in ischemic and non-ischemic segments after LCZ696 therapy.
Table 1 Time 0 6 months p GWI in ischemic segments (mmHg%) 566.1 ± 364.0 696.5 ± 445.2 <0.001 GWE in ischemic segments (%) 71.9 ± 25.0 78.9 ± 19.1 0.009 GWI in non-ischemic segments (mmHg%) 584.8 ± 434.3 812.3 ± 442.0 <0.001 GWE in non-ischemic segments (%) 78.8 ± 21.2 85.7 ± 15.8 0.004 MW data before and after six months of LCZ696 therapy
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Affiliation(s)
| | - A Galrinho
- Hospital de Santa Marta, Lisbon, Portugal
| | | | | | - P Rio
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - J Abreu
- Hospital de Santa Marta, Lisbon, Portugal
| | - R Soares
- Hospital de Santa Marta, Lisbon, Portugal
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Valentim Goncalves AA, Pereira-Da-Silva T, Soares R, De Sousa L, Ilhao Moreira R, Rio P, Feliciano J, Cruz Coutinho M, Reis J, Mano T, Mendonca T, Cruz Ferreira R. P1429 B-Type natriuretic peptide prediction of right catheterization parameters in the first year after heart transplant. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Despite being the gold-standard for hemodynamic assessment, right heart catheterization (RHC) was overcome by plasma B-Type Natriuretic Peptide (BNP) levels in daily clinical routine. However, in the first year after heart transplantation (HT), the relationship between BNP and adverse hemodynamics have yielded conflicting results.
Purpose
The aim of this study was to evaluate whether BNP values can be used to estimate adverse hemodynamics in the first year after HT.
Methods
Prospective study of consecutive RHC performed in the first year after HT (according to the endomyocardial biopsies program). Plasma BNP levels were measured at the same day.
The area under the curve (AUC) was analysed to find the BNP values with higher sensitivity and specificity to detect adverse hemodynamics.
Results
From 2017 to 2018, 50 RHC were performed. Mean age was 48.7 ± 8.3 years, with mean BNP value of 964.4 ± 1114.7pg/ml.
Prediction of adverse hemodynamics by AUC results are represented in the table. BNP values were significantly increased in patients with pulmonary capillary wedge pressure (PCWP) >12mmHg (p < 0.001), cardiac index <2.5L/min/m2 (p = 0.001), mean pulmonary artery pressure (mPAP) ≥25mmHg (p < 0.001), pulmonary vascular resistance > 1,5WU (p = 0.044) and right atrial pressure >5mmHg (p = 0.003).
BNP >500pg/ml had a sensitivity of 78.3% and 87.5% and a specificity of 76.0% and 67.7% to detect PCWP >12mmHg and mPAP ≥25mmHg, respectively.
Conclusion Significant associations were found between BNP values and adverse hemodynamics in RHC, supporting the clinical utility of BNP in the first year after HT.
BNP prediction AUC values SR HEMODYNAMIC PARAMETERS AUC p 95% CI Best BNP value Sensitivity Specificity Pulmonary capillary wedge pressure (PCWP) > 12mmHg 0.798 <0.001 0.671-0.925 > 500pg/ml 78.3% 76.0% Mean pulmonary artery pressure (mPAP) ≥ 25mmHg 0.830 <0.001 0.714-0.946 > 500pg/ml 87.5% 67.7% Cardiac output < 4L/min 0.833 0.002 0.667-1.000 > 1500pg/ml 77.8% 87.5% Cardiac index (CI) < 2.5L/min/m2 0.810 0.001 0.663-0.957 > 1150pg/ml 76.9% 86.1% Pulmonary vascular resistance (PVR) > 1,5WU 0.678 0.044 0.509-0.848 > 200pg/ml 83.3% 47.1% Right atrial pressure (RAP) > 5mmHg 0.744 0.003 0.607-0.880 > 500pg/ml 70.8% 65.4% BNP prediction
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Affiliation(s)
| | | | - R Soares
- Hospital de Santa Marta, Lisbon, Portugal
| | - L De Sousa
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - P Rio
- Hospital de Santa Marta, Lisbon, Portugal
| | | | | | - J Reis
- Hospital de Santa Marta, Lisbon, Portugal
| | - T Mano
- Hospital de Santa Marta, Lisbon, Portugal
| | - T Mendonca
- Hospital de Santa Marta, Lisbon, Portugal
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Valentim Goncalves AA, Pereira-Da-Silva T, Soares R, Ilhao Moreira R, De Sousa L, Rio P, Feliciano J, Reis J, Mendonca T, Cruz Coutinho M, Mano T, Cruz Ferreira R. P354 Right heart catheterization parameters, echocardiography parameters and B-Type natriuretic peptide prediction of acute cellular rejection in the first year after heart transplant. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Since the mid-1970s, the diagnosis of acute cellular rejection (ACR) has been made by endomyocardial biopsy (EMB). Whether B-Type Natriuretic Peptide (BNP), transthoracic echocardiography (TTE) parameters and right heart catheterization (RHC) parameters can detect rejection in heart transplant (HT) patients have yielded conflicting results and did not overcome the use of EMB in the first year after HT.
Purpose
The aim of this study was to evaluate whether BNP, TTE and RHC parameters can be used to detect ACR in the first year after HT.
Methods
Prospective study of consecutive EMB performed in the first year after HT. Plasma BNP levels, TTE and RHC were performed at the same day.
Clinical significant ACR was defined as ≥ 2R, according to the ISHLT 2004 grading. The area under the curve (AUC) was analysed for statistically significant associations to detect ACR.
Results
From 2017 to 2018, 50 EMB were performed with the following results: 2R - 5 (10.0%); 1R- 29 (58.0%); 0 – 16 (32%). Mean age was 48.7 ± 8.3 years, with mean BNP value of 964.4 ± 1114.7pg/ml.
AUC results of BNP and several TTE and RHC parameters for the prediction of ACR are represented in the table. Right atrial pressure (RAP) value (p = 0.027) was the only significantly predictor of ACR, while isovolumic relaxation time measured by TTE revealed a borderline significant trend (p = 0.076).
RAP > 10mmHg had a sensitivity of 60.0% and a specificity of 84.4% for detecting ACR.
Conclusion
Detecting ACR without EMB remains a clinical challenge, but RAP measured by RHC was a significant predictor of ACR in the first year after HT, while BNP values did not correlate with ACR.
AUC values PARAMETERS AUC p 95% CI BNP 0.658 0.251 0.405-0.911 Troponin I 0.591 0.507 0.260-0.923 Left ventricular ejection fraction 0.416 0.541 0.218-0.614 E/A 0.480 0.895 0.282-0.678 Deceleration time 0.463 0.463 0.161-0.765 Isovolumic relaxion time 0.745 0.076 0.427-1.000 Cardiac index 0.595 0.488 0.346-0.845 Pulmonary capillary wedge pressure 0.628 0.401 0.329-0.926 Mean pulmonary artery pressure 0.684 0.181 0.511-0.857 Right atrial pressure 0.804 0.027 0.631-0.978 AUC values
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Affiliation(s)
| | | | - R Soares
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - L De Sousa
- Hospital de Santa Marta, Lisbon, Portugal
| | - P Rio
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - J Reis
- Hospital de Santa Marta, Lisbon, Portugal
| | - T Mendonca
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - T Mano
- Hospital de Santa Marta, Lisbon, Portugal
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Dias Ferreira Reis JP, Mano T, Valente B, Monteiro A, Silva Cunha P, Oliveira M, Pereira Da Silva T, Soares R, Rio P, Moura Branco L, Ferreira R. P175 Cardiac device infection: to extract or not to extract, that is the question. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
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.
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Affiliation(s)
| | - T Mano
- Hospital de Santa Marta, Lisbon, Portugal
| | - B Valente
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Monteiro
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - M Oliveira
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - R Soares
- Hospital de Santa Marta, Lisbon, Portugal
| | - P Rio
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - R Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
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Brisbois M, Silva H, Santos A, Canasta H, Feno A, Cabral L, Soares R. A Bridge to Wellness: Gains from a health fair among fishermen in the Port of New Bedford, USA. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Globally, it has been noted that fishermen have a higher mortality from cardiovascular disease, cancer, and injury from work-related accidents when compared to the general population. A potential increase in unemployment in fishermen in New Bedford could result in a lower income level which relates to an increase in risk behaviors, less health screenings, and negative health behaviors. While there is a lack of health-related data among fishermen across the globe, there is little information regarding the health among fishermen, who are predominantly immigrants, in the US.
Objectives
The objectives include designing a health promotion fair to prepare nursing students with the skills to educate fishermen associated with nutrition, diabetes mellitus, cancer and hypertension as identified by key informants in the community.
Results
Students expressed gains in achieving nursing competencies related to collaboration, communication, and teaching/learning by designing a fair with stations related to the four health topics with posters and activities. Educational materials were available in both Portuguese and English to support this aggregate who expressed learning new knowledge. Networking among local fishing agencies, nursing students and the fishermen supported this project from start to finish.
Conclusions
Despite limited access to this vulnerable group, learning nursing competencies and increased fishermen’s knowledge were realized. Connecting students with vulnerable populations is an effective way to promote learning for both groups.
Key messages
Multiple gains are noted when nursing students are paired with vulnerable community aggregates. Learning to work in the community with local agencies and groups is an effective teaching/learning pedagogy.
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Affiliation(s)
- M Brisbois
- Community Nursing, University of Mass Dartmouth, Dartmouth, USA
| | - H Silva
- School of Health, University of the Azores, Ponta Delgada, Portugal
| | - A Santos
- School of Health, University of the Azores, Ponta Delgada, Portugal
| | - H Canasta
- Community Nursing, University of Mass Dartmouth, Dartmouth, USA
| | - A Feno
- Community Nursing, University of Mass Dartmouth, Dartmouth, USA
| | - L Cabral
- School of Health, University of the Azores, Ponta Delgada, Portugal
| | - R Soares
- School of Health, University of the Azores, Ponta Delgada, Portugal
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Brisbois M, Silva H, Soares R, Cabral L, Canasta H, Feno A, Santos A. Bridging Generations: Sharing stories from the past with the future. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
As the immigration population continues to grow; little is known about this phenomenon from the immigrants’ perspective. In recent years, nurses have embraced narrative inquiry to better understand the human experience. When relaying their stories, vulnerable groups legitimize their behavior, share their emotional experiences, and amplify their voices that may have otherwise remained silent.
Objective
Eight elderly Portuguese women who immigrated to the United States (US) were interviewed about their experience of immigration by nursing students from Portugal and U.S., as part of a student exchange. The objective of this project was to better understand the impact of immigration through narrative inquiry.
Results
On average, the women lived in the US for approximately fifty years; immigrating in their early twenties. Most women arrived alone or accompanied by spouse and/or children. Their first memories were related to snow, and solitude of being in a new country. The participants attended classes to obtain documents or learn English. All worked in the textile industry; their greatest accomplishment was buying their own house. Challenges faced were related to language and difficult jobs. Overall, they had no regrets except in leaving family members behind. Their message to the students was that love and family are most important in the world. Students were able to realize emigration and immigration from their respective countries.
Conclusions
Rich descriptions provided an in-depth understanding of the details of the women’s experience. Student nurses gained valuable skills and knowledge to understand the impact of immigration among Portuguese women using narrative inquiry.
Key messages
The use of narrative inquiry proved to be a valuable method to interview Portuguese immigrant women. Every immigrant has a unique narrative to share that allowed for nursing student’s appreciation of the experience across generations.
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Affiliation(s)
- M Brisbois
- Community Nursing, University of Mass Dartmouth, Dartmouth, USA
| | - H Silva
- School of Health, University of the Azores, Ponta Delgada, Portugal
| | - R Soares
- School of Health, University of the Azores, Ponta Delgada, Portugal
| | - L Cabral
- School of Health, University of the Azores, Ponta Delgada, Portugal
| | - H Canasta
- Community Nursing, University of Mass Dartmouth, Dartmouth, USA
| | - A Feno
- Community Nursing, University of Mass Dartmouth, Dartmouth, USA
| | - A Santos
- School of Health, University of the Azores, Ponta Delgada, Portugal
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Zaglia T, Prando V, Bertoli S, Favaro G, Di Mauro V, Guescini M, Di Bona A, Lo Verso F, Soares R, Da Costa Martins P, Catalucci D, Mongillo M, Sandri M. 262Circulating muscle-derived mir-206 links skeletal muscle dysfunction to cardiac autonomic denervation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Purpose
Recent studies and our preliminary data demonstrate that muscle-specific ablation of the autophagy-related protein Atg7, leads to block of autophagy, sarcopenia and destabilization of the neuro-muscular junction (NMJ). In addition, Atg7 knock-out (Atg7 KO) muscle fibers release exosomes containing the muscle specific, miR-206, which is consistently elevated in the plasma. Interestingly, we found that miR-206 content was elevated in the heart, suggesting cardiac uptake of the miR-carrying circulating exosomes. We thus aimed at defining the effects of miR-206 on heart homeostasis.
Methods
Here, we analyzed the cardiac phenotype of adult (12mo.) and aged (24mo.) Atg7 KO mice, as well as of adult C57BL/6J mice injected, via tail vein, with scramble- or miR-206-loaded exosomes. Exosomes were isolated from EDL muscle of control and Atg7 KO mice, as well as from HEK293 cells. Heart function was assessed by echocardiography and ECG-telemetry. Confocal IF, whole-mount IF on heart blocks and multiphoton imaging were used to assess heart structure and sympathetic innervation. Bioinformatics, molecular and biochemical analyses were performed to identify novel targets of miR-206. IF, BRET assay and imaging of TrKA translocation were performed in cultured sympathetic neurons (SNs).
Results
We demonstrate that circulating exosomes, containing miR-206, are taken up by the heart leading to sympathetic dysinnervation, accompanied to reduction in the neurogenic control of cardiac rhythm and increased arrhythmogenesis. In vitro assays demonstrated that exosome-carried miR-206 targets cardiac SNs (cSNs), compromising cell structure and function. Indeed, increased miR-206 expression is accompanied by cSN atrophy, irregular axonal distribution of the active neurotransmitter release sites, and reduction in axonal sprouting. These effects are likely attributed to the miR-206-mediated down-regulation of the NGF receptor p75, as demonstrated by bioinformatics, luciferase assay, molecular and biochemical analyses in vitro and ex vivo. BRET assay, performed in cultured SNs treated with exosomes carrying miR-206, showed reduced formation of p75/TrkA complexes, which generate high-affinity binding sites for NGF and enhance neurotrophin responsiveness. Consistent with impaired NGF retrograde transport, miR-206 over-expressing SNs displayed reduced NGF protein content and decreased phosphorylation of Akt, which is an NGF downstream target, regulating neuronal survival. Interestingly, these latter results were confirmed in the stellate ganglia from Atg KO and miR-206 treated mice.
miR-206 causes heart dysinnervation
Conclusions
We identify miR-206 as a key molecular player in the “muscle-to-heart” communication. miR-206 may participate to the pathogenesis of secondary cardiac dysfunction in skeletal muscle diseases associated to increased circulating levels of miR-206, ranging from ageing to neurodegenerative disorders (i.e. ALS, DMD).
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Affiliation(s)
- T Zaglia
- University of Padova, Dept of Cardiac, Thoracic and Vascular Sciences and Public Health, Padova, Italy
| | - V Prando
- Department of Biomedical Sciences, Padova, Italy
| | - S Bertoli
- Department of Biomedical Sciences, Padova, Italy
| | - G Favaro
- Venetian Institute of Molecular Medicine, Padova, Italy
| | - V Di Mauro
- UOS of Milan and Humanitas Clinical and Research Center, Milan, Italy
| | - M Guescini
- University of Urbino, Department of molecular Sciences, Urbino, Italy
| | - A Di Bona
- University of Padova, Dept of Cardiac, Thoracic and Vascular Sciences and Public Health, Padova, Italy
| | - F Lo Verso
- Venetian Institute of Molecular Medicine, Padova, Italy
| | - R Soares
- Venetian Institute of Molecular Medicine, Padova, Italy
| | - P Da Costa Martins
- Maastricht University, Department of Cardiology, Faculty of Health, Medicine and Life Sciences, Maastricht, Netherlands (The)
| | - D Catalucci
- UOS of Milan and Humanitas Clinical and Research Center, Milan, Italy
| | - M Mongillo
- Department of Biomedical Sciences, Padova, Italy
| | - M Sandri
- Department of Biomedical Sciences, Padova, Italy
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Valentim Goncalves A, Galrinho A, Pereira-Da-Silva T, Ilhao Moreira R, Soares R, Moura Branco L, Rio P, Feliciano J, Abreu J, Timoteo AT, Mendonca T, Reis J, Mano T, Cruz Coutinho M, Cruz Ferreira R. 4940Early reverse remodelling assessed by myocardial work after sacubitril-valsartan therapy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Sacubitril/Valsartan (LCZ696) had prognosis benefit demonstrated in PARADIGM-HF trial, however less is known about his effects in cardiac dimensions and function.
Myocardial work (MW) is a new transthoracic echocardiographic (TTE) parameter. None is known about the effects of LCZ696 therapy in MW parameters.
Purpose
The aim of this study was to prospectively compare several TTE parameters, including MW, before and after LCZ696 therapy.
Methods
Prospective evaluation of chronic HF patients with optimized standard of care therapy and LVEF≤40%, in which LCZ696 therapy was started.
TTE study was performed before and 6 months after LCZ696 therapy. A semiautomated analysis of GLS was performed and MW were estimated using custom software of GE Vivid E95 ultrasound system.
Results
Of the 42 patients, 35 (83.3%) completed the 6 months follow-up, since 2 patients (4.8%) died and 5 patients (11.9%) discontinued treatment for adverse events. Mean age was 58.6±11.1 years with 82.9% of male patients.
LV dimensions and atrial volumes were significantly lower at 6 months of treatment. LVEF had a mean absolute raise of 8.9% and GLS a relative decrease of 27.8%. MW had a significant increase in constructive work (720.2mmHg VS 900.6mmHg, p=0.016) and work efficiency (78.6% VS 86.6%, p=0.027), with a non-significant decrease in the wasted work (150.2mmHg VS 136.8mmHg, p=0.441).
TTE data before and after 6 months of LCZ696 treatment Time 0 6 months p LV end-diastolic diameter (mm) 71.3±8.4 66.9±7.6 0.001 LV end-systolic diameter (mm) 57.8±9.4 53.1±9.3 0.002 Interventricular septum (mm) 9.6±1.7 9.9±1.9 0.280 LVEF (%) 29.3±6.4 38.2±8.9 <0.001 GLS (%) −7.0±2.9 −8.9±2.8 0.001 MW – Constructive (mmHg) 720.2±230.5 900.6±343.2 0.016 MW – Wasted (mmHg) 150.2±83.3 136.8±54.2 0.441 MW – Efficiency (%) 78.6±10.8 86.6±12.0 0.027 E/e' 13.7±4.5 12.8±4.9 0.449 Pulmonary artery systolic pressure (mmHg) 38.3±12.2 30.9±10.6 <0.001 Left atrium volume (ml/m2) 51.5±22.6 43.7±15.8 0.004 Right atrium volume (ml/m2) 33.1±4.4 28.5±13.5 0.036 TAPSE (mm) 19.2±4.4 20.0±4.9 0.404
Conclusion
LCZ696 therapy is associated with signs of reverse remodelling in TTE, including an increase in constructive work and work efficiency.
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Affiliation(s)
| | - A Galrinho
- Hospital de Santa Marta, Lisbon, Portugal
| | | | | | - R Soares
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - P Rio
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - J Abreu
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - T Mendonca
- Hospital de Santa Marta, Lisbon, Portugal
| | - J Reis
- Hospital de Santa Marta, Lisbon, Portugal
| | - T Mano
- Hospital de Santa Marta, Lisbon, Portugal
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Valentim Gonçalves A, Pereira-da-Silva T, Galrinho A, Rio P, Moura Branco L, Soares R, Feliciano J, Ilhão Moreira R, Cruz Ferreira R. Antiarrhythmic Effect of Sacubitril-Valsartan: Cause or Consequence of Clinical Improvement? J Clin Med 2019; 8:jcm8060869. [PMID: 31216679 PMCID: PMC6616876 DOI: 10.3390/jcm8060869] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/01/2019] [Accepted: 06/14/2019] [Indexed: 12/11/2022] Open
Abstract
Sacubitril/Valsartan (LCZ696) reduced sudden cardiac death in the PARADIGM-HF trial. However, the mechanism by which LCZ696 reduces ventricular arrhythmias remains unclear. The aim of this study was to compare electrocardiographic (ECG) parameters and mechanical dispersion index, assessed by left ventricular (LV) global longitudinal strain (GLS), before and after LCZ696 therapy. We prospectively evaluated chronic Heart Failure (HF) patients with LV ejection fraction ≤40%, despite optimal medical and device therapy, in which LCZ696 therapy was started, while no additional HF treatment was expected to change. ECG and transthoracic echocardiographic data were gathered in the week before starting LCZ696 and at six months of therapy. A semiautomated analysis of LV GLS was performed and mechanical dispersion index was defined as the standard deviation from 16 time intervals corresponding to each LV segment. Of the 42 patients, 35 completed the six month follow-up, since two patients died and five discontinued treatment for adverse events. QTc interval (451.9 vs. 426.0 ms, p < 0.001), QRS duration (125.1 vs. 120.8 ms, p = 0.033) and mechanical dispersion index (88.4 vs. 78.1 ms, p = 0.036) were significantly reduced at six months. LCZ696 therapy is associated with a reduction in QTc interval, QRS duration and mechanical dispersion index as assessed by LV GLS.
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Affiliation(s)
- António Valentim Gonçalves
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, 1169-024 Lisbon, Portugal.
| | - Tiago Pereira-da-Silva
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, 1169-024 Lisbon, Portugal.
| | - Ana Galrinho
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, 1169-024 Lisbon, Portugal.
| | - Pedro Rio
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, 1169-024 Lisbon, Portugal.
| | - Luísa Moura Branco
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, 1169-024 Lisbon, Portugal.
| | - Rui Soares
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, 1169-024 Lisbon, Portugal.
| | - Joana Feliciano
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, 1169-024 Lisbon, Portugal.
| | - Rita Ilhão Moreira
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, 1169-024 Lisbon, Portugal.
| | - Rui Cruz Ferreira
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, 1169-024 Lisbon, Portugal.
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Cunha N, Marques B, Soares R, Raquel M, Couto J, Santos J, Martins T, Rodrigues F, Valido F. Thyrotropin receptor stimulating immunoglobulin: Clinical utility in graves’ disease diagnosis. Clin Chim Acta 2019. [DOI: 10.1016/j.cca.2019.03.743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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44
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Silva-Cardoso J, Brás D, Canário-Almeida F, Andrade A, Oliveira L, Pádua F, Fonseca C, Bragança N, Carvalho S, Soares R, Santos JF. Neurohormonal modulation: The new paradigm of pharmacological treatment of heart failure. Rev Port Cardiol 2019; 38:175-185. [PMID: 31029493 DOI: 10.1016/j.repc.2018.10.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 07/30/2018] [Accepted: 10/29/2018] [Indexed: 12/15/2022] Open
Abstract
The current paradigm of medical therapy for heart failure with reduced ejection fraction (HFrEF) is triple neurohormonal blockade with an angiotensin-converting enzyme inhibitor (ACEI), a beta-blocker (BB) and a mineralocorticoid receptor antagonist (MRA). However, three-year mortality remains over 30%. Stimulation of counter-regulatory systems in addition to neurohormonal blockade constitutes a new paradigm, termed neurohormonal modulation. Sacubitril/valsartan is the first element of this new strategy. PARADIGM-HF was the largest randomized clinical trial conducted in HFrEF. It included 8442 patients and compared the efficacy and safety of sacubitril/valsartan versus enalapril. The primary endpoint was the composite of cardiovascular mortality and hospitalization due to HF, which occurred in 914 (21.8%) patients receiving sacubitril/valsartan and in 1117 (26.5%) patients receiving enalapril (HR 0.8, 95% CI 0.73-0.87, p=0.0000002; NNT 21). Sacubitril/valsartan reduced both primary endpoint components, as well as sudden cardiac death, death due to worsening HF, and death from all causes. Patients on sacubitril/valsartan reported less frequent deterioration of HF and of quality of life, and discontinued study medication less frequently because of an adverse event. PARADIGM-HF demonstrated the superiority of sacubitril/valsartan over enalapril, with a 20% greater impact on cardiovascular mortality compared to ACEIs. Accordingly, in 2016, the European (ESC) and American (ACC/AHA/HFSA) cardiology societies simultaneously issued a class I recommendation for the replacement of ACEIs by sacubitril/valsartan in patients resembling PARADIGM-HF trial participants.
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Affiliation(s)
- J Silva-Cardoso
- Unidade de Doenças Cardiovasculares, Faculdade de Medicina da Universidade do Porto, Portugal; Centro de Pesquisa em Tecnologias e Serviços de Saúde, Universidade do Porto, Portugal; Clínica de Insuficiência Cardíaca e Transplante do Serviço de Cardiologia do Centro Hospitalar de S. João, Porto, Portugal.
| | - D Brás
- Medical Advisor, Departamento Médico, Novartis Farma-Produtos Farmacêuticos S.A., Lisboa, Portugal
| | - F Canário-Almeida
- Serviço de Cardiologia do Hospital Senhora da Oliveira, Guimarães, Portugal
| | - A Andrade
- Clínica de Insuficiência Cardíaca, Serviço de Cardiologia do Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - L Oliveira
- Serviço de Cardiologia do Centro Hospitalar Cova da Beira, Covilhã, Portugal
| | - F Pádua
- Hospital Dr. José Maria Grande (Unidade Local de Saúde do Norte Alentejano), Portalegre, Portugal
| | - C Fonseca
- Unidade de Insuficiência Cardíaca, Serviço de Medicina III e Hospital Dia, Hospital São Francisco Xavier - Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - N Bragança
- Serviço de Medicina III, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - S Carvalho
- Serviço de Cardiologia do Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - R Soares
- Serviço de Cardiologia do Hospital de Santa Marta, Lisboa, Portugal
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Soares R, Reis T, Valido F, Chaves C. Bartholin's gland abscess caused by Streptococcus pneumoniae in a sexually active young woman. BMJ Case Rep 2019; 12:12/4/e228492. [PMID: 31023734 DOI: 10.1136/bcr-2018-228492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Gynaecological infections are frequent in women, particularly in young women during their reproductive time. Anatomophysiologically, Bartholin's gland is greatly susceptible to infections and is characterised by an inherent polymicrobial population. In fact, gynaecological microbiota has a set of agents coming from the perianal region that colonise the vagina and, in particular, Bartholin's gland. Taking this into account, infections caused by agents that do not belong to the genital microbiota are less frequent. Here, we describe a case of a 23-year-old young woman with an abscess in Bartholin's gland caused by Streptococcus pneumoniae.
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Affiliation(s)
- Rui Soares
- Department of Clinical Pathology Service, Instituto Portugues de Oncologia de Coimbra Francisco Gentil EPE, Coimbra, Portugal.,Microbiology Department, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Teresa Reis
- Department of Clinical Pathology Service, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Coimbra, Portugal
| | - Frederico Valido
- Department of Clinical Pathology Service, Instituto Portugues de Oncologia de Coimbra Francisco Gentil EPE, Coimbra, Portugal
| | - Catarina Chaves
- Department of Clinical Pathology Service, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Coimbra, Portugal
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Marques B, Cunha N, G. Martins R, Couto J, Santos J, Martins T, Soares R, Valido F, Rodrigues F. MON-593 Thyrotropin Receptor Stimulating Immunoglobulin: Clinical Utility in Graves' Disease Diagnosis. J Endocr Soc 2019. [PMCID: PMC6551079 DOI: 10.1210/js.2019-mon-593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Bernardo Marques
- Instituto Português de Oncologia de Coimbra FG, EPE, Coimbra, , Portugal
| | - Nuno Cunha
- Instituto Português de Oncologia de Coimbra FG, EPE, Coimbra, , Portugal
| | - Raquel G. Martins
- Instituto Português de Oncologia de Coimbra FG, EPE, Coimbra, , Portugal
| | - Joana Couto
- Instituto Português de Oncologia de Coimbra FG, EPE, Coimbra, , Portugal
| | - Jacinta Santos
- Instituto Português de Oncologia de Coimbra FG, EPE, Coimbra, , Portugal
| | - Teresa Martins
- Instituto Português de Oncologia de Coimbra FG, EPE, Coimbra, , Portugal
| | - Rui Soares
- Instituto Português de Oncologia de Coimbra FG, EPE, Coimbra, , Portugal
| | - Frederico Valido
- Instituto Português de Oncologia de Coimbra FG, EPE, Coimbra, , Portugal
| | - Fernando Rodrigues
- Instituto Português de Oncologia de Coimbra FG, EPE, Coimbra, , Portugal
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Silva-Cardoso J, Brás D, Canário-Almeida F, Andrade A, Oliveira L, Pádua F, Fonseca C, Bragança N, Carvalho S, Soares R, Santos JF. Neurohormonal modulation: The new paradigm of pharmacological treatment of heart failure. Revista Portuguesa de Cardiologia (English Edition) 2019. [DOI: 10.1016/j.repce.2019.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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48
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Almeida J, Costa J, Coelho P, Cea V, Galesio M, Noronha JP, Diniz MS, Prudêncio C, Soares R, Sala C, Fernandes R. Adipocyte proteome and secretome influence inflammatory and hormone pathways in glioma. Metab Brain Dis 2019; 34:141-152. [PMID: 30302719 DOI: 10.1007/s11011-018-0327-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 09/27/2018] [Indexed: 01/09/2023]
Abstract
Gliomas represent the most common primary malignant brain tumors in adults, with an extremely poor prognosis. Among several risk factors, lifestyle was also recently identified as a major risk factor for the development of primary glioma. In the present study, we explore the relationship between obesity and glioma in a cellular model. Thus, we have study the influence of adipocytes secretome on glioma cell line GL261. Using the 3T3-L1 adipocyte cell line, and its conditioned medium (adipokines-enriched medium), we showed that adipocyte-released factors relate with glioma angiogenic, growth, hormones and metabolic behavior by MALDI-TOF-MS and proteomic array analysis. In a first view, STI1, hnRNPs and PGK1 are under expressed on CGl. Similarly, both carbonic anhydrase and aldose reductase are even suppressed in glioma cells that grown under adipokines-enriched environment. Contrariwise, RFC1, KIF5C, ANXA2, N-RAP and RACK1 are overexpressed in GL261 cell the in the presence of the adipokines-enriched medium. We further identified the factors that are released by adipocyte cells, and revealed that several pro-inflammatory and angiogenic factors, such as IL-6, IL-11, LIF, PAI-1, TNF-α, endocan, HGF, VEGF IGF-I, were secreted to the medium into a high extent, whereas TIMP-1 and SerpinE1 were under expressed on CGl. This study discloses an interesting in vitro model for the study of glioma biology under a "obesity" environment, that can be explored for the understanding of cancer cells biology, for the search of biomarkers, prognostic markers and therapeutic approaches.
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Affiliation(s)
- J Almeida
- School of Health, Polytechnic of Porto, Porto, Portugal
- Department of Functional Biology and Health Sciences, University of Vigo, Vigo, Spain
| | - J Costa
- School of Health, Polytechnic of Porto, Porto, Portugal
| | - P Coelho
- School of Health, Polytechnic of Porto, Porto, Portugal
- Unit of Metabolism, Nutrition and Endocrinology, i3S, University of Porto, Porto, Portugal
| | - V Cea
- CNR Neuroscience Institute Milan, and Department of Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - M Galesio
- REQUIMTE, Department of Chemistry, Faculty of Sciences and Technology, Centre for Fine Chemistry and Biotechnology, NOVA University, Fort Lauderdale, FL, USA
| | - J P Noronha
- REQUIMTE, Department of Chemistry, Faculty of Sciences and Technology, Centre for Fine Chemistry and Biotechnology, NOVA University, Fort Lauderdale, FL, USA
| | - M S Diniz
- REQUIMTE, Department of Chemistry, Faculty of Sciences and Technology, Centre for Fine Chemistry and Biotechnology, NOVA University, Fort Lauderdale, FL, USA
| | - C Prudêncio
- School of Health, Polytechnic of Porto, Porto, Portugal
- Department of Functional Biology and Health Sciences, University of Vigo, Vigo, Spain
| | - R Soares
- Unit of Metabolism, Nutrition and Endocrinology, i3S, University of Porto, Porto, Portugal
- Department of Biomedicine, Unit of Biochemistry, Faculty of Medicine, University of Porto, Porto, Portugal
| | - C Sala
- CNR Neuroscience Institute Milan, and Department of Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - Rúben Fernandes
- School of Health, Polytechnic of Porto, Porto, Portugal.
- Unit of Metabolism, Nutrition and Endocrinology, i3S, University of Porto, Porto, Portugal.
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Wallis MC, Wilson MD, Mete M, Koroshetz L, Soares R, Goyal M. Bedside End-tidal Carbon Dioxide in Evaluation for Pulmonary Embolism. Acad Emerg Med 2019; 26:263-266. [PMID: 30084149 DOI: 10.1111/acem.13546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Marianne C. Wallis
- Emergency Department Medstar Washington Hospital Center Georgetown University School of Medicine Washington DC
| | - Matthew D. Wilson
- Emergency Department Medstar Washington Hospital Center Georgetown University School of Medicine Washington DC
| | - Mihriye Mete
- Epidemiology and Biostatistics Medstar Research Institute Hyattsville MD
| | | | - Rui Soares
- Georgetown University School of Medicine Washington DC
| | - Munish Goyal
- Emergency Department Medstar Washington Hospital Center Georgetown University School of Medicine Washington DC
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50
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Valentim Gonçalves A, Pereira-da-Silva T, Soares R, Feliciano J, Ilhão Moreira R, Rio P, Abreu A, Cruz Ferreira R. Previsão Prognóstica dos Parâmetros do Teste de Esforço Cardiopulmonar em Pacientes com Insuficiência Cardíaca e Fibrilação Atrial. Arq Bras Cardiol 2019. [DOI: 10.36660/abc.20190193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
| | | | - Rui Soares
- Centro Hospitalar Universitário Lisboa Central, Hospital de Santa Marta
| | - Joana Feliciano
- Centro Hospitalar Universitário Lisboa Central, Hospital de Santa Marta
| | | | - Pedro Rio
- Centro Hospitalar Universitário Lisboa Central, Hospital de Santa Marta
| | - Ana Abreu
- Centro Hospitalar Universitário Lisboa Central, Hospital de Santa Marta
| | - Rui Cruz Ferreira
- Centro Hospitalar Universitário Lisboa Central, Hospital de Santa Marta
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