Determinants and prognostic impact of afterload mismatch after MitraClip implantation

Introduction

Mitral transcatheter edge-to-edge repair (TEER) is a widespread option to treat mitral regurgitation in high-risk patients. The sudden reduction of mitral regurgitation (MR) following TEER abruptly eliminates the low-impedance regurgitant flow into the left atrium, leading to an increase in left ventricle (LV) afterload with possible impairment of LV systolic function, defined afterload mismatch (AM).

Purpose

To explore a new definition of AM and to analyze the determinants and prognostic role of AM in patients with functional MR (FMR) undergoing TEER.

Methods

This was an international multicenter case-control study including adult patients with severe FMR and LVEF ≤35% undergoing TEER between 2012 and 2020. AM was defined as the acute need to initiate or increase inotropic support by a vasoactive inotropic score ≥3 or the need for a mechanical circulatory support following TEER.

Results

80 patients with AM were compared to 80 consecutive patients undergoing TEER not meeting the criteria for AM. Median age was 67 years, 79% of patients were male, had a median LVEDV of 240 ml with severely reduced LVEF (median 26%) and pulmonary hypertension (median 48 mmHg). Median EROA/LVEDV ratio was 0.17 (IQR 0.12–0.24) based on which 37% of the total population presented with proportionate MR. Levosimendan was administered before TEER in 42% of patients while intravenous vasodilators in 43%. In most patients more than 1 clip were needed (2 clips in 88 patients, 3 clips in 11). Patients presenting AM more commonly had a lower EROA/LVEDV ratio (0.14 vs. 0.18, p<0.001) leading to a higher percentage of patients with proportionate MR (55% vs. 22%, p<0.001; Figure 1) and had more clips implanted (p=0.008). AM was graded as mild in 74% of patients, moderate in 15% and severe in 11%. At multivariate analysis, patients with proportionate MR were more likely to develop AM after TEER (OR 2.95, 95% CI: 1.32–6.60, p=0.008), while those treated with levosimendan (OR 0.32, 95% CI: 0.15–0.71, p=0.005) and/or IV vasodilators (OR 0.44, 95% CI: 0.21–0.96, p=0.040) before TEER were less likely to suffer from AM. In-hospital death occurred in 7 cases, all being part of AM group. Patients were more likely to die in-hospital if AM was more severe (OR 2.56, 95% CI: 1.19–5.54, p=0.017), and for higher grades of residual MR (OR 3.35, 95% CI: 1.27–8.79, p=0.014). The 2-year survival rate did not differ significantly between groups (66% vs 75%, HR 1.51, 95% CI: 0.73–3.12, p=0.270; Figure 2). At 2 years 51 patients (32%) were re-hospitalized for HF, independently from post-procedural AM (HR 1.36, 95% CI: 0.70–2.67, p=0.363).

Conclusions

In patients with LVEF ≤35% and severe FMR undergoing TEER, the development of AM predicted in-hospital mortality, while long-term outcomes were not affected by acute AM. The use of levosimendan or intravenous vasodilators during the pre-procedural phase reduced the risk of acute AM.

Funding Acknowledgement

Type of funding sources: None.

Clinical outcomes following isolated transcatheter tricuspid valve repair: a meta-analysis and meta-regression study

Background

Significant tricuspid regurgitation (TR) is a common valvular heart disease worldwide.

Purpose

We aimed to assess the pooled clinical and echocardiographic outcomes of different isolated transcatheter tricuspid valve repair (ITTVR) strategies for significant (≥ moderate) TR.

Methods

We systematically searched the literature for studies evaluating the efficacy and safety of ITTVR for significant TR in adult. The primary outcomes were the improvement of New York Heart Association (NYHA) functional class and 6-minutes walking distance (6MWD) and the presence of severe or greater TR at the last available follow-up of each individual study. Random-effect meta-analysis was performed comparing outcomes before and after ITTVR.

Results

14 studies with 771 patients were included. Mean age was 77±8 years and mean EuroScore II was 6.8%±5.4%. At a weighted mean follow-up of 212 days, 209 (35%) patients had a NYHA III to IV functional class compared to 586 (84%) patients at baseline (risk ratio: 0.23, 95% CI 0.13 to 0.40, P-value<0.001). 6MWD significantly improved from 237±113 meters to 294±105 meters (mean difference: +50 meters, 95% CI +34 to +66 meters, P-value<0.001). 147 (24%) patients showed severe or greater TR after ITTVR compared to 616 (96%) at baseline (risk ratio: 0.29, 95% CI 0.20 to 0.42, P-value<0.001).

Conclusion

Patients undergoing ITTVR for significant TR experienced a significant improvement in NYHA functional status and 6MWD and a significant reduction in TR severity at mid-term follow-up.

Funding Acknowledgement

Type of funding sources: None.

Fractional flow reserve (FFR) guided vs angiography guided coronary artery bypass graft (CABG): a systematic review and meta-analysis

Background

A strategy of percutaneous coronary intervention (PCI) driven by FFR (Fractional Flow Reserve) has demonstrated to reduce adverse events through the “deferring” of unnecessary stenting procedures compared to PCI guided by angiographic evaluation of stenosis. Coronary Artery Bypass Graft (CABG) represents another option for revascularization, being superior to PCI in patients with diffuse disease. In this setting, some evidence has been provided about physiological driven CABG procedures, but studies reported contrasting results regarding clinical benefits and outcomes at follow up.

The aim of this meta-analysis is to evaluate clinical and procedural impact of FFR versus angiographic guided surgical revascularization and assess outcomes at follow up.

Methods

All randomized controlled trials (RCTs) or observational studies with multivariable adjustment or propensity matching were included. MACE (Major Adverse Cardiac Events) was the primary end point, while its single components (death, myocardial infarction and revascularization) along with number of grafts and percent of off-pump CABG were the secondary ones. Of 86 studies identified, 4 articles were included in this review, representing a combined total of 777 patients (426 angio-guided and 351 FFR-guided). Mean age was 66±2.1, 80% man, 74% hypertension, 71% hyperlipidemia, 33% diabetes, 39% smokers. Mean EuroSCORE I was 2.7. 18% a prior MI, and 25% a prior PCI. Coronary lesions were allocated as follow: 36% left anterior descending artery, 32% circumflex artery, 27% right coronary artery. Mean follow up was 30 months. At the follow up, rates of MACE did not differ (MACE OR 1.31:0.88–1.96), as those of death (OR 1.47:0.86–2.51), of MI (OR 1.80:0.89–3.63), and of target vessel revascularization (1.03: 0.54–1.97.). FFR-guided CABG was associated with more off-pump surgical procedure (OR 0.58, IC 0.34–0.97) and shorter hospitalization time (8.2±2.49 vs 8,87±3,25 p<0.01). FFR- guided CABG was associated more frequently with off-pump surgical procedure (OR 0.58:0.34–0.97) with fewer anastomes (2.5 vs 3), leading to higher rates of global arteria revascularization in FFR group (56% vs. 45%) and higher rates of venous grafts in angio-guided group (55% vs. 44%). Shorter hospitalization time was recorded in FFR patients (8.2±2.49 vs 8,87±3,25 days, p<0.01). Graft patency at follow up was not statistically higher in the FFR guided group (OR 0.67, CI 95% 0.32–1,39, all CI 95%).

Conclusions

FFR-guided surgical revascularization is associated with more off-pump procedures, a lower number of surgical anastomoses and more arterial grafts compared to angiography guided CABG. These differences lead to a shorter hospitalization time in the FFR-guided group compared to the angiography-guided group. No difference between two groups in MACE, overall death and MI was observed during the follow up. RCT with longer follow up are needed to evaluate long term outcomes.

Funding Acknowledgement

Type of funding source: None

Primary percutaneous coronary intervention in nonagenarian patients

Background

Given the continuous increase in life expectancy, elderly patients with ST segment elevation myocardial infarction (STEMI) are becoming a growing proportion of those referred for primary percutaneous coronary intervention (pPCI). However, this population is usually excluded from randomized trials and limited data are available to guide clinical decisions. The aim of this study-level meta-analysis was to describe and analyze the determinants of outcomes in this population.

Methods

We searched the literature for studies reporting ischemic and hemorrhagic outcomes and/or mortality in nonagenarian patients undergoing pPCI. An analysis of the heterogeneity between studies in outcome reports was performed with I2 test. A univariate meta-regression analysis was conducted to explore the relationship between outcomes of interest and classic cardiovascular risk factors, gender, previous myocardial infarction (MI), MI location, PCI characteristics, hemodynamic instability, vascular access, intra-aortic balloon pump (IABP) and Glycoprotein IIb/IIIa inhibitor (GPI) use.

Results

Overall, 15 observational studies met our inclusion criteria, with a total of 6787 patients; mean age was 92.4 and 35% were male.

The incidence of in-hospital death was 21.3%, 1.4% of our population suffered an in-hospital ischemic stroke and 11.1% faced acute renal failure; in-hospital major bleedings affected 1.7% of the population, but blood-transfusion was needed in 6.9%. Long-term mortality rate was 21.5%.

Killip III-IV at admission was related with increased in-hospital mortality (β: 0.2%; p: 0.041), but lower incidence of ARF (β: −0.6%; p: 0.004). Angiographic success was associated with a lower incidence of long-term all-cause mortality (β: −1.7%; p: 0.017) and higher incidence of ARF (β: 1.7%, p<0.001). A higher number of coronary stents implanted was associated with a lower incidence of long-term all-cause mortality (β: −73%; p: 0.01). A higher long-term all-cause mortality was related with male gender (β: 0.9%; p: 0.027) and previous MI (β: 1.5%; p: 0.007). Diabetes was associated with a lower incidence of long-term all-cause mortality (β: −0.8%; p: 0.014) despite a higher incidence of in-hospital blood transfusion (β: 0.5%, p: 0.05), while a history of MI (β: 0.1%; p: 0.049), as well as the use of GPI (β: 0.04) was related with a higher incidence of in-hospital major bleeding. The use of IABP was related with a lower incidence of long-term all-cause death (β: 6.5%; p<0.001) and in-hospital major bleeding (β: −0.4%; p: 0.038).

Discussion

Our meta-analysis, pooling the largest cohort of nonagenarians undergoing pPCI confirms the feasibility of urgent percutaneous coronary intervention also in this frail population. In particular, although angiographic success increased the incidence of in-hospital ARF, it was associated with a higher long-term survival underling the pivotal role of myocardial reperfusion.

Funding Acknowledgement

Type of funding source: None

Percutaneous vs. surgical revascularization for patients with unprotected left main stenosis: a meta-analysis of 5 years follow-up RCTs

Introduction

5-year survival of patients with ULM (Unprotected Left Main) stenosis according to the choice of revascularization (percutaneous vs. surgical) remains to be defined.

Methods and results

Randomized Controlled Trials (RTCs) comparing Percutaneous Coronary Intervention (PCI) vs. Coronary Artery Bypass Graft (CABG) with a follow-up of at least 5 years were included. All-cause death was the primary endpoint. MACCE (a composite endpoint of all-cause mortality, myocardial infarction [MI], stroke and repeat revascularization) along with its single components and cardiovascular (CV) death were the secondary ones. Analyses were stratified according to use of first vs. last generation coronary stents. Subgroup comparisons were performed according to Syntax Score (below or above 33) and to age (using cutoffs of each trial's subgroup analysis). 4 RCTs with 4394 patients were identified: 2197 were treated with CABG, 657 with first generation and 1540 with last generation stents. At 5 years rates of all-cause death did not differ (OR 0.93: 0.71–1.21), as those of CV death and stroke. CABG reduced rates of MACCE (OR 0.69: 0.60–0.79), mainly driven by MI (OR 0.48: 0.36–0.65) and revascularization (OR 0.53: 0.45–0.64). Benefit of CABG for MACCE was consistent, although with different extent, across values of Syntax Score (OR 0.76: 0.59–0.97 for values <32 and OR 0.63: 0.47–0.84 for values ≥33) while was not evident for “younger” patients (OR 0.83: 0.65–1.07 vs. OR 0.65: 0.51–0.84 for “older” patients, all CI 95%).

Conclusion

For patients with ULM disease, PCI and CABG yielded same survival benefit at 5 years. CABG reduced risk of MI, revascularization and MACCE especially in older patients and in those with diffuse coronary disease.

Funding Acknowledgement

Type of funding source: None

Application of response surface methodology (RSM) for the optimization of supercritical CO2 extraction of oil from patè olive cake: Yield, content of bioactive molecules and biological effects in vivo

The two-phase technology for olive oil extraction generates large amounts of patè olive cake (POC), a by-product that is rich in bioactive health-promoting compounds. Here, response surface methodology (RSM) was used to maximize supercritical-CO₂ oil extraction from POC, while minimizing operative temperature, pressure and time. Under the optimal parameters (40.2 °C, 43.8 MPa and time 30 min), the oil yield was 14.5 g·100 g^-1 dw (~65% of the total oil content of the freeze-dried POC matrix), as predicted by RSM. Compared with freeze-dried POC, the oil contained more phytosterols (13-fold), tocopherols (6-fold) and squalene (8-fold) and was a good source of pentacyclic triterpenes. When the biological effects of POC oil intake (20-40 µL·die^-1) were evaluated in the livers of BALB/c mice, no significant influence on redox homeostasis was observed. Notably, a decline in liver triglycerides alongside increased activities of NAD(P)H:Quinone Oxidoreductase 1, Carnitine Palmitoyl-CoA Transferase and mitochondrial respiratory complexes suggested a potential beneficial effect on liver fatty acid oxidation.

P1375 Echocardiographic estimation of right ventricle wall tension: hemodynamic comparison and long term follow up

Introduction

Natural history of pulmonary hypertension (PH) is linked to right ventricle (RV) failure; in first phases of PH, coupling is preserved at the price of augmented RV wall tension (RVWT), which may represent an early sign of disease.

Methods

Patients with suspected PH, in absence of RV failure, underwent right heart catheterization and nearly-simultaneous echocardiography. We extrapolated RVWT from Laplace’s law as RV length × tricuspid regurgitation peak gradient (TRPG), and we correlated it with RV haemodynamic profile. Its impact on survival was tested.

Results

190 patients were enrolled; RVWT correlated with invasive measure of RV telediastolic pressure, mean pulmonary artery (PA) pressure, PA compliance, transpulmonary gradient, pulmonary vascular resistance, right atrial pressure and RV stroke work index (all p < 0.001). At a mean follow-up of five years and three months, RVWT predicted all-cause mortality at univariate and multivariate analysis (p 0.036, p 0,023); tricuspid annular plane systolic excursion (TAPSE) (p 0.536), RV fractional area change (p 0.383), RV S’ (p 0.076) and TAPSE/TRPG (p 0.181) did not.

Conclusions

We identified a novel echocardiographic predictor of precocious RV impairment, able to predict all-cause mortality at a long-term follow-up.

Regression: RVWT and invasive parameters Characteristics R - R2 p value mPAP 0.742 - 0.550 <0.001 PA pulsatory pressure 0.740 - 0.547 <0.001 RV differential pressure 0.794 - 0.630 <0.001 Mean RAP 0.326 - 0.106 <0.001 CI/RAP 0.209 - 0.044 0.012 RVSWI 0.326 - 0.106 <0.001 PA compliance 0.449 - .202 <0.001 PVR 0.531 - 0.282 <0.001 RV basal diameter 0.326 - 0.106 <0.001 RV medium diameter 0.403 - 0.162 <0.001 Right atrium area 0.204 - 0.042 0.013 RV FAC 0.382 - 0.146 <0.001 RV telediastolic area 0.347 - 0.120 <0.001 Correlation between RVWT and invasive haemodynamic parameters of RV function. mPAP, mean pulmonary artery pressure. RAP, right atrial pressure. CI, cardiac index. RVSWI, right ventricle stroke work index. PVR, pulmonary vascular resistance. RV, right ventricle. FAC, fractional area change.

Abstract P1375 Figure. RVWT and invasive hemodynamic profile

P2552Triple vs. double antithrombotic therapy in patients needing oral anticoagulation undergoing percutaneous coronary intervention: a meta-analysis

Background

The optimal antithrombotic therapy strategy in patients undergoing PCI who need OAC is currently debated.

Purpose

To determine the best regimen in terms of safety and efficacy.

Methods

We performed a meta-analysis of RCT and adjusted results reporting outcomes of patients who underwent PCI and were on TT or DAPT or DT. All-cause death was the primary end point, while MACE was the secondary outcome, along with its individual components, and major bleedings.

Results

15 studies encompassing 27070 patients were included. After a follow up of 12 (11–14) months, TT reduced all-cause death compared to DAPT (OR 0.52, 0.35–0.78), mainly driven by a lower incidence of MI (OR 0.81, 0.69–0.85) and stroke (OR 0.76, 0.56–1.03) despite higher rates of major bleedings (OR 2.81, 1.54–5.12). Comparing TT vs. DT with warfarin, all-cause death was non-significantly different (OR 1.23, 0.60–2.53), nor MI (OR 0.77, 0.23–2.59) and stroke (OR 4.01, 0.80–20.07), while major bleeding was increased with TT (OR 2.40, 1.34–4.38). When compared to DT with NOACs, TT did not reduce risk of MI (OR 0.96, 0.67–1.36) or stroke (OR 0.82, 0.55–1.24), but increased major bleedings (OR 1.98, 1.43–2.73). The non-randomized comparison between DT with warfarin and DT with NOACs showed a neutral effect on death and major bleedings, with similar rates also of MI (OR 0.47, 0.20–1.11, all CI 95%).

Conclusion

Double therapy with warfarin or with NOAC plus a single antiplatelet agent reduces the risk of major bleeding compared to triple therapy, with a neutral impact of subsequent ischemic events.

P4355Echocardiographic estimation of right ventricle wall tension: hemodynamic comparison and long term follow up

Introduction

Prognosis in pulmonary hypertension (PH) is strictly linked to right ventricle (RV) failure, which results from uncoupling between RV and the superimposed pressure load; in first phases, coupling between these two actors still be preserved, at the price of augmented right ventricle wall tension (RVWT).

Purpose

We sought to describe how to estimate RVWT with echocardiography, how it correlates with RV hemodynamics and if it may predict prognosis.

Methods

A total of 190 patients without overt RV failure, with suspected pulmonary hypertension (PH) to a previous echocardiography, underwent to right heart catheterization (RHC) and nearly-simultaneous echocardiography. We estimated RVWT according to Laplace law (RV length × tricuspid regurgitation peak gradient [TRPG]), in order to predict initial RV stress, and was correlated with RV hemodynamic profile; its potential prognostic impact was tested along with canonical RV function parameters.

Results

In patients enrolled in our study, RVWT correlated significantly with invasive estimation of right ventricle end diastolic pressure (R 0.343, p<0.001); a significant relationship between RVWT and several hemodynamic variables was observed (mean pulmonary artery pressure, pulmonary artery compliance, transpulmonary gradient, pulmonary vascular resistance, RV telediastolic pressure, right atrial pressure, RV stroke work index; all p<0.001). At a mean follow up of five years and three months, only RVWT predicted all-cause mortality (p 0.036), while TAPSE, TAPSE/TRPG, RV fractional area change and RV S' wave did not.

Correlation: RWVT and RV hemodynamic Hemodynamic variable R R2 p value Mean pulmonary artery pressure 0.742 0.550 <0.001 RV differential pressure 0.794 0.630 <0.001 Pulmonary artery pulsatory pressure 0.740 0.547 <0.001 Mean right atrium pressure 0.326 0.106 <0.001 Cardiac index/right atrial pressure 0.209 0.044 0.012 RV stroke work index 0.588 0.346 <0.001 Pulmonary artery compliance 0.449 0.202 <0.001 Pulmonary vascular resistance 0.531 0.282 <0.001

Prognosis: different RV variables

Discussion

We identified a novel bedside echocardiographic predictor of altered RV hemodynamic, which results precociously altered in patients without overt RV failure, and able to predict all cause mortality at a long term follow up. Further studies are needed to confirm its role in PH patients.

Evaluation of the antioxidant response in the plasma of healthy or hypertensive subjects after short-term exercise

Reactive oxygen species are produced during exercise. The antioxidants prevent or limit tissue damages by these species in physiological conditions. In particular, ascorbate and urate scavenge peroxynitrite, which can alter the function of many molecules, including the lecithin-cholesterol acyltransferase (LCAT) enzyme involved in reverse cholesterol transport. The aims of the present study were to compare the plasma antioxidant response to an ergometric test (ET) in hypertensive and healthy subjects, evaluate the exercise-dependent nitrosative stress in plasma, and assess whether the LCAT activity is altered by the exercise. Plasma samples, prepared before and after ET from hypertensive or healthy volunteers, were analysed for their levels of ascorbate, urate, alpha-tocopherol, retinol, nitrotyrosine, and LCAT activity. The alpha-tocopherol and retinol levels did not significantly change in both groups during exercise, while the ascorbate level changed displaying higher increase in controls (+38.8%) than in hypertensives (+17.2%). In these patients, during ET, the urate and nitrotyrosine levels changed more than in normotensives (+13.5 and +40.6% vs -3.1 and +25.2%, respectively). The antioxidants effectively prevented loss or reduction of LCAT activity, as it was similar in hypertensives and normotensives, and did not change after ET. The results demonstrate that exercise is associated with enhanced protein nitrosation, and suggest that the ascorbate or urate levels increase to limit oxidative damage.

[Treatment of ischemic cardiopathy in the elderly: risk and benefits]

Epidemiological data have shown a "demographic revolution" in our society which induced a progressive increase in the elderly population, and coronary heart disease occurs more frequently in this group of subjects. Moreover, the presence of other pathologies entails specific diagnostic and therapeutic aspects in the elderly. In acute coronary syndromes percutaneous coronary angioplasty and thrombolytic agents are ever more employed despite the higher morbidity and mortality rates in the elderly. Chronic ischemic heart disease therapy, even if not different from that in younger patients, requires careful evaluation of the risk/benefit ratio.

[Partially hydrolyzed guar gum: a fiber as coadjuvant in the irritable colon syndrome]

PURPOSE

Partially hydrolyzed guar gum (PHGG) is a water-soluble dietary fiber, possessing non-gelling properties. The objective of this clinical experience was to evaluate the progress of symptoms and the modifications in the frequency of evacuation in subjects affected by IBS and regularly taking PHGG.

PATIENTS AND METHODS

The group was made up of 134 out-patients of both sexes, average age 43.12, suffering from IBS, both obese and of normal weigh, with a mean number of weekly evacuations between 2 and 35. The subjects, divided in 2 groups on the basis of Body Mass Index (BMI), were submitted for 24 weeks to a balanced, low or normal calorie diet supplemented by 5 g a day of PHGG. The following information was gathered: number of weekly evacuation, typical symptoms of IBS, cholesterol, triglycerides and glucose levels. In a few subjects (n. = 34) also the plasmatic electrolyte levels, before and during PHGG intake, were evaluated.

RESULTS

Both groups showed positive results in the evacuation frequency (p < 0.01 at 12th week) and a decrease, after 3 weeks of PHGG intake, in frequency of IBS symptoms such as flatulence (-55.6%), abdominal tension (-4.7%) and abdominal spasm (-35%). On the other hand an increased number of subjects showed normal levels of cholesterol (+12.2%), lipids (+26.9%) and glucose (+16%). Concentrations of plasmatic electrolytes didn't change during PHGG intake, except for a marked increase of selenium levels, compared to pre-intake levels.

CONCLUSIONS

The observations obtained from this clinical experience reassert that dietary fiber supplementation is useful in cases of altered intestinal motility. PHGG, due to its water-solubility and non-gelling properties, can be useful also in IBS.

Synthesis of cell-wall glycoproteins and their characterization in oat coleoptiles

D-[U-14C]Glucosamine was rapidly taken up by oat coleoptile segments and metabolized to radioactive UDP-N-acetylglucosamine, which acted as specific glycosyl donor for the synthesis of glycolipids and cytosolic, membrane-bound and cell-wall glycoproteins. Cell-wall glycoproteins were solubilized from the walls by either cell-wall-degrading enzymes or chemical extractants. The solubilized cell-wall glycoproteins in the presence of peptide N-glycosidase F released oligosaccharide chains higher than seven glycosidic residues. The combined action of peptide N-glycosidase F and N-acetyl-beta-D-glucosaminidase on cell-wall glycoproteins indicated the presence of N-acetylglucosamine residues beta-1,2-linked to mannose. Less than 9% of the radioactive oligosaccharide chains was released from the solubilized cell-wall glycoproteins when treated with 0.5 M NaOH at 20 degrees, whereas more than 45% of the radioactivity was released in the presence of 1 M NaOH at 50 degrees. The high hydrolytic sensitivity of cell-wall glycoproteins to peptide N-glycosidase F, N-acetyl-beta-D-glucosaminidase and NaOH at 50 degrees indicated that most N-acetylglucosamine residues were incorporated into N-linked cell-wall glycoproteins. Further evidence of this was obtained by the use of inhibitors of biosynthesis and processing of N-linked glycoproteins.

[Infection by intestinal protozoa and helminths in schoolchildren from riverside sectors, with different fecal contamination levels, of Valdivia River, Chile]

During 1993, the prevalences of infection by intestinal protozoa and helminths (IPH) in the riverside schoolchildren population of two sectors of Valdivia river, with different levels of fecal contamination, were compared in relation to their contact with river water (swimming, bathing) and basic sanitation elements (BSE) of their houses: feces and garbage disposal, and water supply. Populations of children from sectors A (n = 418), with significatively greater (SG) total coliform most probable number (MPN), and sector B (n = 400), were examined. PAFS test was used for the stool examination of one sample, from each child. The global prevalence of infection by IPH was similar in A (74.8%) and B (72.5%) sectors. From 10 identified IPH, only Entamoeba histolytica and Hymenolepis nana showed prevalences of infection SG in sector A, than in sector B. The contact of the children with the water of the river showed association with SG prevalences for E. histolytica, Entamoeba coli and Endolimax nana in sector B and for E. histolytica in sector A. No sanitary condition for the different BSE contributed to SG prevalences for E. histolytica, Ascaris lumbricoides and Trichuris trichiura in both sectors, and for E. coli in sector B. The contact with the river water and the different BSE contributed to prevalences SG in 5 and 3 IPH in sectors B and A, respectively. The results suggest that a project in study for the development of a treatment plant of wastewater in sector A, could contribute to control infection by IPH. But, this measure must be associated with improvement of the BSE, health education, and application of chemotherapy measures for geohelminthosis in both sectors.

[Seasonal infection by metacercaria of Diplostomum (Austrodiplostomum) mordax (Szidat and Nani, 1951) and Tylodelphys destructor Szidat and Nani, 1951 in the Chilean Silverside, Basilichthys australis Eigenmann, 1927 (Pisces:Atherinidae) in Lake Riñihue]

Between 1993 and 1994, 129 specimens of Basilichthys australis from Lake Riñihue (39 degrees 50 minutes S; 72 degrees 20 minutes W) in the south of Chile were examined, in order to determine the prevalence and mean intensity of infections by Diplostomum mordax and Tylodelphys destructor metacercariae in the brain of fishes. Prevalence and mean intensity of D. mordax and mean intensity of T. destructor not showed seasonal significant differences. Prevalence of T. destructor was higher in summer than in winter, spring and autumn. No association between intensity of infection by D. mordax and T. destructor and body condition of the host was observed.

[Prevalence of protozoa infections in synanthropic rodents in Valdivia City, Chile]

In order to determine the prevalence of infection by blood and intestinal protozoa in 57 synanthropic rodents from Valdivia city, a study was carried out in the period march-september 1986. The group of rodents studied was constituted by 31 Mus musculus, 19 Rattus rattus and 7 Oryzomys longicaudattus, being 42 males and 15 females. Diagnostic forms of protozoa were found in 70.2% of the investigated animals. The presence of five species of enteroprotozoa and one species of hemoflagelate was detected. The number and the corresponding percentages of infected animals were the following: Giardia muris, 21 (36.8%), Hexamita muris, 22 (38.6%), Trichomonas muris, 27 (47.4%), Entamoeba muris 9 (15.8%), Eimeria sp. 15 (26.3%) and Trypanosoma lewisi 9 (15.8%). Not significant differences were observed when considering host or sex of the species found infected. Furthermore, the yielding of fecal examination considering direct examination, sugar solution flotation and SAFS were compared. The sugar solution flotation technique showed the highest percentage diagnosis of coccidia, whereas SAFS was more efficient for detecting G. muris and E. muris.

[Intestinal geohelminthosis in man and domestic animals in the riverside sections of the Valdivia River Basin, Chile]

In March-October 1987 were analyzed 1295 coprological specimens in a sample of the human population who lives in riverside localities in the Valdivia River Basin, Chile. A 23.6% of examined persons presented infection by one or more helminth species. The prevalence of infection by Ascaris lumbricoides, Trichuris trichiura and Trichostrongylidae gen. sp. were 15.5, 12.7 and 0.2%, respectively. The prevalence of human ascariosis and trichuriosis were greater in pre-school and school children. The sex of the host and prevalence of geohelminthosis did not show any relationship. Prevalences of ascariosis and trichuriosis were higher in persons from houses with no sanitary fecal and water disposal. Over 35% and 20.7% of family groups showed infection by A. lumbricoides and T. trichiura, respectively in over 40% of the members of each group. Fecal samples from domestic mammals revealed the following prevalences rates for helminth infections: in dogs 19.0 and 15.2% for Toxocara canis and Uncinaria stenocephala respectively, in cats 65.1% for Toxocara cati, and in pigs 25.4 and 3.2% for Ascaris suum and Trichuris suis respectively. Some of these species are clearly demonstrated agents of zoonoses.

Gastrointestinal helminths of fish-eating birds from Chiloe Island, Chile

Of four species of fish-eating birds from Chiloé Island (Chile), three were infected with eight species of helminths. Tetrabothrius sp. was found in Larus scoresbii. Tetrabothrius cylindraceus, Profilicollis antarcticus, Anomotaenia dominicanus, Stephanoprora denticulata, Capillaria sp. and P. antarcticus were found in Larus dominicanus. Contracaecum rudolphii and Corynosoma sp. infected Phalacrocorax olivaceus. With the exception of S. denticulata, C. rudolphii and Capillaria sp., the above helminths are reported for the first time from Chile.

[Parasitism in fishes and human riverside communities of the Huillinco and Natri lakes (Great Island of Chiloé), Chile]

In April and December 1989, 35 fish from Lake Huillinco (42 degrees 48'S, 74 degrees 02'W) and 36 fish from Lake Natri (42 degrees 48'S, 73 degrees 50'W), in the Great Island of Chiloé (Chile) were examined. Coprological samples from 159 persons, 17 dogs, 19 pigs and 4 cats from around both lakes were examined for Diphyllobothrium spp. infection. In the Lake Huillinco the following helminths of fishes were determined: Contracaecum sp. and Hysterothylacium sp. in Salmo trutta, Cauque mauleanum and Eleginops maclovinus; Dichelyne (Cucullanellus) dichelyneformis in S. trutta and E. maclovinus and Scolex pleuronectis in S. trutta. One specimen of Mugil cephalus did not show helminth parasites. Prevalence of infection were greater for Contracaecum sp. in S. trutta (75.0%) and C. mauleanum (76.0%); and Hysterothylacium sp. in E. maclovinus (75.0%). Mean intensity was higher for D. (C.) dichelyneformis in E. maclovinus. Contracaecum sp. in S. trutta, Oncorhynchus mykiss, Oncorhynchus kisutch and Galaxias maculatus; Acanthocephalus sp. in S. trutta and G. maculatus, S. pleuronectis in O. mykiss and Cystidicoloides sp. in G. maculatus were determined at Lake Natri. Prevalence and intensity of infection were higher for Contracaecum sp. in S. trutta and O. kisutch. Infection by Diphyllobothrium sp. was determined in one domestic cat. Prevalence of infection by intestinal protozoan and helminths in human population only showed significative differences for Ascaris lumbricoides and Trichuris trichiura that were higher in the Lake Huillinco. Importance of natural infection by helminth parasites for fish in cultured condition and possible mechanisms of infections in relation to the diet of fishes are discussed.

[The use of electropherogram in a clinical setting (author's transl)]

The AA. have spent several years working on the correlation between EPG patterns and diagnosis upon discharge. They then attempted to codify those abnormalities which were statistically related to different illnesses. This codification should not be considered definitive; however, it can be suggestive of further studies especially for those hospitals equipped with a computer which can correlate EPG patterns with the initial diagnosis or the diagnosis on discharge.

[A proposed hepatic pie chart]

The AA. have chosen 12 tests to organize an "hepatic flash" after a selection out of 180 cases scheduled as the table no. I through a set of tests showing step by step any modifications in compliance with the sensibility, reliability, statistical clinical and physio-pathological meaning of each test. The 12 tests are set out by circular abscissae of a circus according to the pathogenetic mechanisms leading to their modifications. By the radial ordinates, instead, it is shown the decreasing and increasing values which every test may assume. An hypothetic line (hepatogram) links then the values set out during the process of the disease in such a manner that the particular shapes assumed by the line itself show quickly and visually the spreading rate of the disease process.