Non-deflating balloon during pulmonary valvuloplasty

A 3-year-old, 4.8 kg, male intact, mixed breed dog was referred for balloon pulmonary valvuloplasty (BPV). Echocardiography was consistent with severe type A pulmonic stenosis and BPV was recommended. During BPV, the balloon catheter failed to deflate despite multiple attempts at repositioning and the use of different deflation syringes. After approximately two minutes of cardiopulmonary arrest, forceful retrograde traction resulted in removal of the fully inflated balloon. Cardiopulmonary resuscitation was unsuccessful. Post-mortem evaluation by a board-certified pathologist identified rupture of the cranial vena cava and hemothorax, suspected to be secondary to forceful removal of the fully inflated balloon. Manufacturer's evaluation of the balloon catheter used in the procedure identified multiple kinks and a segment of stretched catheter shaft suspected to be the cause for the inability to deflate. A manufacturing defect present prior to use or predisposing to stretching of the catheter segment could not be ruled out. Kinking and/or stretching of the catheter during BPV were possible causes as well. Although the inability to deflate a balloon catheter seems to be a very rare occurrence, it should be considered as a potential complication of BPV.

Characterization and long-term follow-up of children with brugada syndrome: experience from a tertiary paediatric referral centre

Introduction

Brugada syndrome (BrS) is an autosomal dominant channelopathy, which typically presents in young adults. It can also be diagnosed in children, but data in this age group is scarce.

Purpose

To describe the clinical features, management and long-term follow-up of children with BrS history followed-up in a tertiary paediatric referral centre.

Methods

Single centre retrospective study of consecutive patients with history of BrS, defined as having a BrS positive phenotype (BrS(+)), or a negative phenotype-positive genotype (BrS(−)). They were all followed up in a paediatric heart rhythm clinic. Clinical and demographical data were collected and analysed according to the phenotype.

Results

30 patients were included, with a median age at diagnosis of 7 years (IQR 1–13) and a mean follow-up time of 7±3 years. Sixteen patients were BrS(+), predominantly male (n=13, 81%). 88% (n=14) performed a genetic test, which was positive in 57% (n=8); the most frequent mutation was SCN5A (n=5). Family history of BrS was present in 56% (n=9) and almost one third had family history of sudden cardiac death (SCD). Most of the patients had a type 1 Brugada ECG pattern (n=14) and 2 patients presented a fever and drug induced pattern, respectively. Fourteen patients were BrS(−), mostly female (n=11, 79%) with a loss-of-function mutation in the SCN5A gene (n=10). They all had family members with BrS, mainly from the paternal side, and 43% (n=6) mentioned SCD history. Although most of the patients were asymptomatic, the prevalence of rhythm or conduction disturbances was not infrequent, particularly in BrS(+) patients (n=12, 75%). Also, in this group and during follow-up, 3 patients had documented supraventricular tachyarrhythmias, and 2 patients had syncope episodes, one of which required an implantable cardioverter-defibrillator. No events were reported in the BrS(−) patients. Nine patients (n=9/30, 30%) were hospitalized, 3 due to an arrhythmic event (all in the BrS(+) group). Overall, no sudden cardiac death event was reported during follow-up.

Conclusion

In our study, although the majority of the patients were asymptomatic, the occurrence of arrhythmic events was not negligible, especially in the BrS(+) patients. Despite the significant family history, patients with BrS(−) had no events reported during follow-up. Nevertheless, the management of these patients is not clear cut, and a personalized therapeutic strategy with close follow-up is essential.

Funding Acknowledgement

Type of funding sources: None.

Heart rate distribution in dogs with third degree atrioventricular block and rate responsive pacemakers

INTRODUCTION

In dogs, single lead ventricular pacing, ventricular sensing, inhibition response, rate adaptive (VVIR) pacemakers are routinely used to treat third degree atrioventricular block. The objectives of this study were to investigate the heart rate distribution in dogs with VVIR pacemakers, and report changes when activity settings were adjusted.

ANIMALS

Eighteen client-owned dogs with VVIR pacemakers for third degree atrioventricular block.

MATERIALS AND METHODS

This observational study consisted of a review of medical records of dogs with VVIR pacemakers. For dogs with >50% of paced beats at the lower pacing rate, the activity daily living (ADL) and exertion responses were increased. Re-evaluations were performed after 6-12 months.

RESULTS

Heart rate distribution similar to healthy dogs was absent for all dogs. In nine dogs, the ADL and exertion responses were increased to the highest level. Of these, three dogs showed no improvement in heart rate distribution; for two dogs, one with an epicardial pacemaker, several activity settings were adjusted and pacing at higher heart rates was observed at re-evaluation. Four dogs died or were lost to follow-up. Clinical signs had resolved for all dogs after pacemaker implantation.

CONCLUSION

Default activity settings of VVIR pacemakers do not result in heart rate distribution equivalent to healthy dogs. Increasing the ADL and exertion response settings to the highest levels did not improve the pacemaker rate response. Further investigations into the role of dog size, generator positioning, pacemaker settings, and whether rate responsiveness is required for dogs' quality and quantity of life are warranted.

Psychosocial risks among the healthcare workforce working in COVID services: findings from a cross-sectional study on psychosocial risks

Introduction

Poor management in healthcare can have significant consequences in the workers’ health, performance, and quality of care. Several risks worsened during the COVID-19 pandemic, namely among the workforce caring for patients with suspected/confirmed COVID-19 infection.

Objectives

We aimed to assess psychosocial risks among a sample of 235 healthcare workers deployed in COVID-19-related services in Portugal’s Lower Alentejo.

Methods

Participants filled out with ten sociodemographic questions and the Euro-Portuguese medium version of the COPSOQ II questionnaire. Data collection occurred February 2021. Tertiles were used to render a traffic light risk categorization. Results were processed with qualitative and quantitative descriptive statistical analysis. To compare groups relative to each outcome, t-tests were used for variables with two categories. Whenever data was not normally distributed, Mann-Whitney tests were used. For variables with more than two groups non-parametric Kruskal-Wallis was applied. Bonferroni correction was also applied, testing each individual hypothesis at the level of significance of α_i=0.05/29. A statistically significant difference between two groups did not necessarily yield a different risk colour.

Results

Overall, cognitive demands, emotional demands and influence at work showed the highest risk, while 19 domains showed intermediate risk. The burnout domain showed to be highest among nurses and operational assistants working in the Intensive Care Unit. Several associations between COPSOQ domains and sociodemographic variables are also discussed.

Conclusions

Assessment of psychosocial stressors in healthcare units is needed to promote risk reduction policies and workplace reforms. Accessible occupational services, therapeutic and rehabilitative strategies should play a role in improving health hazards in unhealthy workplaces.

Disclosure

No significant relationships.

Development and validation of a simple and practical method for differentiating MS from other neuroinflammatory disorders based on lesion distribution on brain MRI

There is an unmet need to develop practical methods for differentiating multiple sclerosis (MS) from other neuroinflammatory disorders using standard brain MRI. To develop a practical approach for differentiating MS from neuromyelitis optica spectrum disorder (NMOSD) and MOG antibody-associated disorder (MOGAD) with brain MRI, we first identified lesion locations in the brain that are suggestive of MS-associated demyelination ("MS Lesion Checklist") and compared frequencies of brain lesions in the "MS Lesion Checklist" locations in a development sample of patients (n = 82) with clinically definite MS, NMOSD, and MOGAD. Patients with MS were more likely than patients with non-MS to have lesions in 3 locations only: anterior temporal horn (p < 0.0001), periventricular ("Dawson's finger") (p < 0.0001), and cerebellar hemisphere (p = 0.02). These three lesion locations were used as predictor variables in a multivariable regression model for discriminating MS from non-MS. The model had area under the curve (AUC) of 0.853 (95% confidence interval: 0.76-0.945), sensitivity of 87.1%, and specificity of 72.5%. We then used an independent validation sample with equal representation of MS and NMOSD/MOGAD cases (n = 97) to validate our prediction model. In the validation sample, the model was 76.3% accurate in discriminating MS from non-MS. Our simple method for predicting MS versus NMOSD/MOGAD only requires a neuroradiologist or clinician to ascertain the presence of lesions in three locations on conventional MRI sequences. It can therefore be readily applied in the real-world setting for training and clinical practice.

Cardiovascular outcomes in women with the highest classification of maternal cardiovascular risk in pregnancy

Introduction

The modified world health organization (mWHO) classification of maternal risk is used to estimate morbidity and mortality in pregnant women with cardiovascular disease. Those in the highest risk category (mWHO Risk Class IV) are at greatest risk. Pregnancy is contraindicated in this patients.

Methods

This was a retrospective review of pregnant women classified as mWHO risk class IV, who were managed in a tertiary joint cardiac-obstetric pathway between 2008 and 2018.

Results

In total, there were 35 pregnancies in 30 women with the highest cardiovascular risk for adverse maternal outcomes. The mean maternal age at delivery was 29.3±5.2 years. Eleven (36%) patients were diagnosed with cardiovascular disease during pregnancy. Fourteen had a form of pulmonary arterial hypertension (46%), 6 (20%) had severe systemic ventricular dysfunction, 4 (13%) had severe mitral or aortic stenosis, 4 (13%) had aortic dilatation or inherited aortopathy, 1 (3%) had a history of peri-partum cardiomyopathy and 1 (3%) had severe native coarctation of the aorta. In the 30 pregnancies followed up in our centre, 29 (96%) were single foetus pregnancies and 1 (4%) was a twin pregnancy. There were 30 live births, 1 foetus was lost in the twin pregnancy. Of these 29 (96%) patients underwent elective caesarean section and 1 (4%) emergency caesarean section. Cardiovascular complications occurred in 18 (60%) women. Of these, 5 (28%) had atrial arrhythmias during pregnancy, 6 (33%) had worsening of pulmonary hypertension, 6 (33%) had decompensated heart failure. Three women had interventions during pregnancy: 1 had percutaneous intervention for coarctation of aorta due to foetal and maternal compromise, 1 had electrophysiological ablation for atrial arrhythmias to improve systemic ventricular function and 1 had an electrical cardioversion for atrial fibrillation. There were no deaths during pregnancy or in the peripartum period. One patient who presented at 34 weeks gestation with severe peripartum cardiomyopathy required early inotropic support followed by extracorporeal membrane oxygenation (ECMO) support post-delivery, died at 2 months post-partum.

Conclusions

With appropriate pre-pregnancy optimization, antepartum surveillance individualised peripartum care plans and multidisciplinary care throughout pregnancy, women at the highest risk for cardiovascular outcomes can have successful pregnancies, although the risk of cardiovascular complications remains high.

Funding Acknowledgement

Type of funding sources: None.

Differentiation of Jugular Foramen Paragangliomas versus Schwannomas Using Golden-Angle Radial Sparse Parallel Dynamic Contrast-Enhanced MRI

BACKGROUND AND PURPOSE

Accurate differentiation of paragangliomas and schwannomas in the jugular foramen has important clinical implications because treatment strategies may vary but differentiation is not always straightforward with conventional imaging. Our aim was to evaluate the accuracy of both qualitative and quantitative metrics derived from dynamic contrast-enhanced MR imaging using golden-angle radial sparse parallel MR imaging to differentiate paragangliomas and schwannomas in the jugular foramen.

MATERIALS AND METHODS

A retrospective study of imaging data was performed on patients (n = 30) undergoing MR imaging for jugular foramen masses with the golden-angle radial sparse parallel MR imaging technique. Imaging data were postprocessed to obtain time-intensity curves and quantitative parameters. Data were normalized to the dural venous sinus for relevant parameters and analyzed for statistical significance using a Student t test. A univariate logistic model was created with a binary output, paraganglioma or schwannoma, using a wash-in rate as a variable. Additionally, lesions were clustered on the basis of the wash-in rate and washout rate using a 3-nearest neighbors method.

RESULTS

There were 22 paragangliomas and 8 schwannomas. All paragangliomas demonstrated a type 3 time-intensity curve, and all schwannomas demonstrated a type 1 time-intensity curve. There was a statistically significant difference between paragangliomas and schwannomas when comparing their values for area under the curve, peak enhancement, wash-in rate, and washout rate. A univariate logistic model with a binary output (paraganglioma or schwannoma) using wash-in rate as a variable was able to correctly predict all observed lesions (P < .001). All 30 lesions were classified correctly by using a 3-nearest neighbors method.

CONCLUSIONS

Paragangliomas at the jugular foramen can be reliably differentiated from schwannomas using golden-angle radial sparse parallel MR imaging-dynamic contrast-enhanced imaging when imaging characteristics cannot suffice.

Does every woman require a post-lumpectomy mammogram and ultrasound before radiotherapy when negative margins?

PURPOSE

Most studies regarding the value of post lumpectomy imaging (PLI) studies rely on mammography alone and are often focused on patients that present with suspicious microcalcifications or in situ disease. This way, its true benefit remains controversial, which explained the heterogeneity between centers. This is the first study to evaluate the role of mammography with breast and axillary ultrasound undertaken before radiotherapy in patients with conservatively managed invasive and/or in situ carcinoma with negative margins.

MATERIALS AND METHODS

In this retrospective study, medical records for patients referred to our External Radiotherapy Unit between January 2018 and December 2019 were reviewed.

RESULTS

A total of 1251 patients (1262 breasts) were analyzed. A total of 3.4% had suspicious findings for local residual breast disease, with 1.0% having a re-excision positive for residual malignancy. Presentation with microcalcifications alone (OR=4.854), extension of microcalcifications>3cm (OR=13.500), histologic subtype pure ductal carcinoma in situ (OR=12.348), presence of invasive carcinoma≤1mm of the pathological margins (OR=4.630), stage pTis (5.630), and absence of invasive component (OR=4.629), were associated with an increased risk for residual malignancy. Only one patient (0.1%) had nodal residual involvement.

CONCLUSION

PLI detected residual local cancer in 1.0% of the patients. PLI plays an important role in the evaluation of patients undergoing breast-conserving therapy with negative margins. The major question that remains is whether it changes survival outcomes.

Long term follow-up after pregnancy in Fontan patients

Background

Patients with single ventricle physiology who have benefited from the Fontan procedure are reaching childbearing age. In this population, complications are common around pregnancy, but the long term effect of pregnancy is unclear.

Purpose

To evaluate functional and structural changes several years after pregnancy in patients with Fontan circulation.

Methods

Women with Fontan circulation who had a pregnancy beyond the 20 weeks of gestation followed at our centre between 2005–2019 were included. The following data were collected before pregnancy and at the last follow up (f-up): cardiac anatomy, type of Fontan procedure, resting O2 saturation (O2sat), NYHA class, systemic atrioventricular valve (SAVV) regurgitation, ventricular function, history of arrhythmias, heart failure (HF), thromboembolism, Fontan-related liver disease (FLD), protein-losing enteropathy (PLE), plastic bronchitis and cardiopulmonary test data.

Results

12 patients had 18 pregnancies, giving birth to 17 live newborns (1 newborn death at 24 weeks of gestation). 7 (58.3%)patients had a total cavo-pulmonary connection, 3 (25%)an atrio-pulmonary connection and 2 (16.7%)a Bjork type Fontan. Tricuspid atresia was the most common anatomy (6, 50%). Before pregnancy, O2sat was 95.4±1.9%and all patients were in NYHA class I or II. All patients (12, 100%)had a normal or mildly impaired ventricular function and 3 (25%)had a moderate or severe SAAV regurgitation. 6 (50%)patients had 2 pregnancies. Mean age at first pregnancy was 29.9±4.4 years. Cardiac events occurred in 7 (38%)pregnancies, most commonly atrial arrhythmia (4, 57%), 2 (16.6%)patients developed new cyanosis and 1 had a thromboembolic event. No maternal death occurred and 1 patient had severe haemorrhage. After a mean f-up of 84±48 months, there was no significant worsening in O2sat (94.3±3.1 at f-up, p=1) and all patients remained in NYHA class I or II (12, 100%, p=1). At f-up all patients (12, 100%)continued to have a normal or mildly impaired ventricular function (p=1) and there was no significant worsening in the SAAV regurgitation (3 patients with moderate or severe regurgitation, p=1). 3 (25%)patients developed FLD (p=0.3), 3 (25%) a new episode of atrial arrhythmia (p=0.3). There were no significantly differences in peak VO2 (22.5±3.8 pre-pregnancy, 22.8±5.5 at f-up, p=0.4) and VE/VCO2 slope (34.9±11.2 pre-pregnancy, 36.3±11.8 at f-up, p=0.2)before pregnancy and during f-up.

Conclusions

In this small cohort of Fontan patients who successfully completed at least 1 pregnancy, there was no significant decline in functional or structural cardiac parameters long term after delivery.

Funding Acknowledgement

Type of funding source: None

Peak oxygen uptake on cardio pulmonary exercise testing predicts mortality in adult Fontan patients

Introduction

The Fontan operation has revolutionized the outcome of patients with univentricular hearts. However, long-term morbidity and mortality remain high and exercise intolerance in common in this population. Previous studies have failed to demonstrate a clear relation between exercise capacity, expressed as peak oxygen consumption (pVO2), and the risk of death in contrast with other congenital and non-congenital cohorts.

Aims

To investigate the correlates of pVO2 in the Fontan population and its relation to mortality.

Methods

Data were collected retrospectively on consecutive patients with a Fontan circulation who underwent a cardiopulmonary exercise test (CPET) between 2005–2019. Clinical and exercise data were collected at the time of CPET and patients were followed thereafter. Cox regression analysis was used to assess the association between exercise parameters and mortality. Different methods of estimating predicted pVO2 were compared in their impact on the prognostic value of pVO2.

Results

A total of 152 patients were included. Mean age at CPET was 28.9±9.3 years and 74 (48.7%) were female. The majority of patients had a total cavo-pulmonary connection (TCPC; 53.3%) followed by atrio-pulmonary (2.1%) and other Fontan variants 4.6%. The majority of patients reported no limitation on physical activity [AC1] (NYHA class I, 91, 62.3%). Baseline oxygen saturation was 93±5% and 26 (17.6%) patients had a persistent fenestration. On exercise, pVO2 was 21.9±7.4ml/min and was significantly reduced in the majority of asymptomatic patients (56.1±17.4% predicted according to the Wasserman/Hansen (WH) formula). The VE/VCO2 slope was raised (&gt;33) in 92 (60.9%) patients. A total of 88 (58.7%) patients had an impaired heart rate reserve, and were unable to achieve a heart rate of at least 70% predicted.

Over a median follow-up of 4.6 [2.5–8.9] years, 25 (16.4%) patients died. pVO2 expressed as ml/min was the only exercise parameter related to mortality in this cohort (HR 0.93, 95% CI: 0.87–0.99, p=0.03).pVO2 was even more strongly related to mortality when expressed as percentage of predicted using the WH formula (HR 0.76, 95% CI: 0.59–0.98, p=0.03), but not the Jones formula for predicted pVO2 (HR 0.83, 95% CI: 0.67–1.02, p=0.08). Additional predictors of outcome included NYHA class (no asymptomatic patients died), use of loop diuretics and a non-TCPC circulation, but not age or sex were not (Figure 1). On multivariable analysis, percent predicted pVO2 (WH) remained a predictor of outcome (HR per 10 unit increase 0.65, 95% CI: 0.46–0.93, p=0.017) with NYHA class and diuretic treatment, and with the type of Fontan operation.

Conclusion

A clear relation between pVO2 and mortality could be demonstrated in this Fontan population by using unadjusted pVO2, or appropriate estimates of predicted pVO2. CPET can thus be used for the risk stratification of Fontan patients, providing that care is taken in the way that pVO2 is reported and interpreted.

Figure 1

Funding Acknowledgement

Type of funding source: None

Using methylcholanthrene-induced fibrosarcomas to study tumor immunology

Mouse models of cancer are essential in furthering our understanding both of the mechanisms that drive tumor development and the immune response that develops in parallel, and also in providing a platform for testing novel anti-cancer therapies. The majority of solid tumor models available rely on the injection of existing cancer cell lines into naïve hosts which, while providing quick and reproducible model systems, typically lack the development of a tumor microenvironment that recapitulates those seen in human cancers. Administration of the carcinogen 3-methylcholanthrene (MCA), allows tumors to develop in situ, forming a tumor microenvironment with an established stroma and vasculature. This article provides a detailed set of protocols for the administration of MCA into mice and the subsequent monitoring of tumors. Protocols are also provided for some of the routinely used downstream applications that can be used for MCA tumors.

Atlantic and Mediterranean populations of the widespread serpulid Ficopomatus enigmaticus: Developmental responses to carbon nanotubes

Ficopomatus enigmaticus was adopted as model species for ecotoxicological bioassay, with its larval development as endpoint. Two different populations of the same species, collected in areas far from each other (Mediterranean Sea and Atlantic Ocean), were exposed to multi-walled carbon nanotubes, a class of emerging pollutants with a constantly increasing relevance in the landscape of nanomaterials production. Moreover, a molecular analysis based on Cyt b amplification and sequencing, was carried out to confirm that both populations belong to the same species. The aim of the present work was to strengthen existing results about F. enigmaticus relevance in ecotoxicological bioassays, adding the variable of population effect. For both populations the concentration-response curve of effect at different toxicant concentrations was similar and, at certain concentrations, overlapping, confirming the ecological relevance of the assay. These results posed an interesting acceptance on the introduction of this species as model in ecotoxicological bioassay scenery, underlining the relevance of a widespread wild species to compare effects of chemicals and environmental samples over large distances using the same bioassay.

79Experience from heart or heart/lung transplantation from a single centre for adult congenital heart disease: too little, too late?

Introduction

Heart failure is the leading cause of death in adults with congenital heart disease (ACHD). Heart or heart and lung transplantation (H/HLTx) can be effective therapy for these patients, but unfavourable anatomy, end-organ damage, pulmonary vascular disease, HLA sensitization and lack of robust selection criteria currently limit its application.

Methods

Consecutive ACHD patients >16 years of age who were considered for H/HLTx at our tertiary centre between 2006 and 2018 constitute our study population. Baseline characteristics and outcome, including H/HLTx and death were obtained for all from designated databases, medical records and the UK Office for National Statistics.

Results

Of a total of more than 9,000 active ACHD patients, 130 (53.1% male, mean age 42.2, IQR 32.6–50.2 years) fulfilled inclusion criteria with a broad spectrum of underlying ACHD and considerable mortality across all anatomic subgroups [Table 1].

82% of patients had previous cardiac surgery (55.5% with ≥2 sternotomies or thoracotomies). Cardinal presenting features were poor functional capacity, low cardiac output, cyanosis and/or end-organ disease; “only” 47% had moderate or severe dysfunction of the systemic and 37% of the subpulmonary ventricle. Frequent comorbidities were atrial arrhythmia 68.7%, PH 30.4%, CKD 23.5%, liver dysfunction or cirrhosis 11.3%; 36.8% of patients had an ICD and 16.5% a CRT, whereas 79.8% were on diuretics, 70.5% MRA, 51.6% beta blockers, 32.6% ACEI, 18.9% ARB, 10.5% Digoxin and 29.5% on pulmonary vasodilators. HLA antibodies were positive in 47.3% (high sensitization >90% in 13.2%).

There was high overall mortality with 35.4% of patients dying over a median of 2.7 years (IQR 1.1–4.9). Only 13.6% from our cohort were transplanted, with a survival of 76.5% at a mean of 5.9 years from H/HLTx.

ACHD subgroup % of total % transplanted Mortality (%) Median follow-up (years) Univentricular heart 25.4 6.1 30.3 2.5 Systemic RV 21.5 7.4 35.7 2.6 Shunts with PAH / Eissenmenger 13.9 5.9 27.8 3 Tetralogy of Fallot with Pulmonary atresia 12.3 14.3 50 3.5 Left sided valvar disease, CoA, Marfan 10.8 14.3 50 0.6 CHD associated with cardiomyopathy 9.2 50 33.3 5.3 Other 6.9 22.2 22.2 2.2 RV: right ventricle; PAH: Pulmonary arterial hypertension; CoA: aortic coarctation.

Survival in end-stage heart failure

Conclusion

Of the small number of patients with heterogenous ACHD considered for H/HLTx in our contemporary practice, there was high overall mortality, whereas only a fraction of patients was actually transplanted. Better patient selection and timing are clearly warranted so that more ACHD patients benefit from this effective therapy.

Acknowledgement/Funding

None

P4693Contemporary survival of adults with a systemic right ventricle

Background

In complete transposition of the great arteries (TGA) with previous atrial switch operation and congenitally corrected transposition of the great arteries (ccTGA), the morphological right ventricle and its tricuspid valve support the systemic circulation. This results in late complications, including systemic right ventricle (sRV) failure, systemic atrioventricular valve regurgitation, and rhythm disturbances, affecting long-term outcome. We aimed to describe contemporary survival and determine predictive factors of death in an adult cohort with a sRV.

Methods and results

All adult patients (>16 years of age) with a sRV under active follow-up between January 2000 and December 2018 in our tertiary center were included. Demographic and clinical details were obtained from records. Baseline clinical status, transthoracic echocardiography, cardiopulmonary exercise testing and BNP were taken at the earliest available assessment during the study period.

Two hundred thirty-six patients, 141 with TGA/ 95 ccTGA, were included (mean age at baseline 31±12 years, 45% female sex). Over a median follow-up of 10.2 years IQR [5.6–14.9], 27 patients died, and 2 patients underwent heart transplantation. Cause of death was heart failure in 13 patients, sudden cardiac death in 2, and unspecified in 12. Survival at 5, 10 and 15 years of follow-up was 97.5%, 90.0% and 81.0%, respectively (Figure 1A).

On univariate Cox regression analysis, history of atrial arrhythmia, heart failure, and pulmonary arterial hypertension, baseline NYHA functional class ≥2, BNP≥120ng/L, peak VO2 and moderate/severe sRV function were predictive of death/heart transplantation. In contrast, previous permanent pacing, moderate or severe pulmonary stenosis, and use of beta-blockers were not associated with an increased risk of death. On multivariate analysis, NYHA ≥2 (HR=5.3 95% CI [1.1–25.6], p=0.03) and peak VO2 (HR=0.95 95% CI [0.91–0.99], p=0.01) were the strongest independent predictors of death. Patients with NYHA class≥2 and/or a pVO2<60% of predicted had a 3.6-fold higher risk of death compared to the remainder, even after adjustment for cardiac treatment at baseline (p=0.03, Figure 1B)

Figure 1. (A) Long term survival with 95% confidence intervals. (B) Survival according to the presence of symptoms (NYHA functional class ≥2) and/or a peak VO2 <60% predicted.

Conclusions

Mortality remains considerable in a contemporary cohort of adults with a sRV. Heart failure appears to be the leading cause of death, whereas only a few patients benefit from transplantation. Symptomatic patients with moderate or severe reduction in peak VO2 are at increased risk of adverse outcome in this setting and merit a more proactive approach and management.

Acknowledgement/Funding

Fundaciόn Alfonso Martín Escudero

Legacy of Multiple Stressors: Responses of Gastropod Larvae and Juveniles to Ocean Acidification and Nutrition

Ocean acidification poses a significant threat to calcifying invertebrates by negatively influencing shell deposition and growth. An organism's performance under ocean acidification is not determined by the susceptibility of one single life-history stage, nor is it solely controlled by the direct physical consequences of ocean acidification. Shell development by one life-history stage is sometimes a function of the pH or pCO₂ levels experienced during earlier developmental stages. Furthermore, environmental factors such as access to nutrition can buffer organismal responses of calcifying invertebrates to ocean acidification, or they can function as a co-occurring stressor when access is low. We reared larvae and juveniles of the planktotrophic marine gastropod Crepidula fornicata through combined treatments of nutritional stress and low pH, and we monitored how multiple stressors endured during the larval stage affected juvenile performance. Shell growth responded non-linearly to decreasing pH, significantly declining between pH 7.6 and pH 7.5 in larvae and juveniles. Larval rearing at pH 7.5 reduced juvenile growth as a carryover effect. Larval rearing at pH 7.6 reduced subsequent juvenile growth despite the absence of a negative impact on larval growth, demonstrating a latent effect. Low larval pH magnified the impact of larval nutritional stress on competence for metamorphosis and increased carryover effects of larval nutrition on juvenile growth. Trans-life-cycle effects of larval nutrition were thus modulated by larval exposure to ocean acidification.

Magnetoliposomes containing magnesium ferrite nanoparticles as nanocarriers for the model drug curcumin

Magnesium ferrite nanoparticles, with diameters around 25 nm, were synthesized by coprecipitation method. The magnetic properties indicate a superparamagnetic behaviour, with a maximum magnetization of 16.2 emu g-1, a coercive field of 22.1 Oe and a blocking temperature of 183.2 K. These MgFe2O4 nanoparticles were used to produce aqueous and solid magnetoliposomes, with sizes below 130 nm. The potential drug curcumin was successfully incorporated in these nanosystems, with high encapsulation efficiencies (above 89%). Interaction by fusion between both types of drug-loaded magnetoliposomes (with or without PEGylation) and models of biological membranes was demonstrated, using FRET or fluorescence quenching assays. These results point to future applications of magnetoliposomes containing MgFe2O4 nanoparticles in cancer therapy, allowing combined magnetic hyperthermia and chemotherapy.

Sustainability Assessment of indicators for integrated water resources management

The scientific community strongly recommends the adoption of indicators for the evaluation and monitoring of progress towards sustainable development. Furthermore, international organizations consider that indicators are powerful decision-making tools. Nevertheless, the quality and reliability of the indicators depends on the application of adequate and appropriate criteria to assess them. The general objective of this study was to evaluate how indicators related to water use and management perform against a set of sustainability criteria. Our research identified 170 indicators related to water use and management. These indicators were assessed by an international panel of experts that evaluated whether they fulfil the four sustainability criteria: social, economic, environmental, and institutional. We employed an evaluation matrix that classified all indicators according to the DPSIR (Driving Forces, Pressures, States, Impacts and Responses) framework. A pilot study served to test and approve the research methodology before carrying out the full implementation. The findings of the study show that 24 indicators comply with the majority of the sustainability criteria; 59 indicators are bi-dimensional (meaning that they comply with two sustainability criteria); 86 are one-dimensional indicators (fulfilling just one of the four sustainability criteria) and one indicator do not fulfil any of the sustainability criteria.

Magnetoliposomes as carriers for promising antitumor thieno[3,2-b]pyridin-7-arylamines: photophysical and biological studies

Magnetoliposomes containing MnFe₂O₄ nanoparticles were used as nanocarriers for new potent antitumor thieno[3,2-b]pyridin-7-arylamines, inhibiting the growth of human tumor cells.

Right subclavian artery aneurysm in an adolescent with a bicuspid aortic valve

Bicuspic aortic valve is the most common congenital cardiac anomaly (Fedak et al. 106:900-904, 2002), and it is associated with other structural anomalies of the aorta, such as coarctation, suggesting a common embryologic developmental mechanism (Mergan et al. 104:118-119, 2004). In more than a half of patients, it is associated with progressive dilation and aneurysm formation of the aorta (Warnes 89:965-966, 2003) despite normally functioning bicuspid aortic valves. In this context, aneurysms of the right subclavian artery are extremely rare, and even more so when associated with a right-sided aortic arch that has a left aberrant subclavian artery with a Kommerell diverticulum, as found in the reported case. These aneurysms represent a significant risk for thromboembolism and rupture, and elective surgical management should be advised, even for asymptomatic cases.

A mathematical model of calcium and phosphorus metabolism in two forms of hyperparathyroidism

Parathyroid hormone (PTH) plays a critical role in calcium and phosphorus metabolism. Interestingly, in two forms of hyperparathyroidism (excessive amount of PTH in the serum), the metabolic disturbances in patients with chronic kidney disease (CKD) significantly differ from those with primary hyperparathyroidism (PHP). Since an intuitive understanding of these PTH-linked regulatory mechanisms are hardly possible, we developed a mathematical model using clinical data (1586 CKD and 40 PHP patients). The model was composed of a set of ordinary differential equations, in which the regulatory mechanism of PTH together with other key factors such as 1,25-Dihydroxyvitamin D (1,25(OH)₂D) and calcium was described in the tissues including bone, the kidney, the serum, and the parathyroid glands. In this model, an increase in PTH was induced by its autonomous production in PHP, while PTH in CKD was elevated by a decrease in feedback inhibition of 1,25(OH)₂D in the serum, as well as an increase in stimulation by phosphorus in the serum. The model-based analysis revealed characteristic differences in the outcomes of hyperparathyroidism in CKD and PHP. The calcium exchange in bone, for instance, was predicted significantly higher in PHP than CKD. Furthermore, we evaluated the observed and predicted responses to the administration of calcimimetics, a recently developed synthetic drug that modulated efficacy of calcium-sensing receptors. The results herein support the notion that the described model would enable us to pose testable hypotheses about the actions of PTH, providing a quantitative analytical tool for evaluating treatment strategies of PHP and CKD.

Severe malaria--clinical case

We report a clinical case of severe malaria, where the rate of initial parasitaemia by Plasmodium falciparum was 43 %. Multiple organ dysfunction, including ARDS, forced admission in a close surveillance unit, with survival of the same. A brief review of the subject is made, focusing on severity and general conduct, alerting and awareness for this entity, whose expression, among us, could take on increasing importance.

A direct and active influence of gravity on the behavior of a marine invertebrate larva

Larvae of the bryozoans Bugula neritina and Bugula stolonifera exhibit an apparent negative geotaxis under conditions of darkness and constant temperature. This behavior cannot be accounted for by buoyancy since the larvae are negatively bouyant, nor is it a consequence of gradients in the partial pressures of dissolved gases since the response occurs under conditions where the gradient is reversed or when experiments are conducted in chambers with interfaces of only glass and water. Pressure bomb experiments indicate that the behavior is not a barokinesis. Centrifuge experiments, however, showed that larvae of Bugula stolonifera orient directly and actively to gravity, while those of Bugula neritina have some other measure of geographic up. Since bryozoan larvae lack statocysts, the sensory apparatus mediating the gravity response in Bugula stolonifera is still unknown.

Effect of traction sutures in the distal esophagus of the rat: a model for esophageal elongation by Foker's method

This study aimed to evaluate a rat model of esophageal elongation using traction sutures by the Foker's method. After esophageal division and closure of the distal segment at approximately 4 mm from the cardia, traction sutures were placed for progressive stretching until the 7(th) postoperative day in the experimental group (n = 10), whilst no traction sutures were placed in the esophagus of the control group (n = 10). Clinical outcome as well as macroscopic and microscopic esophageal morphology were evaluated in both groups. All rats survived the surgical procedure and the anesthetic recovery period. Disruption of sutures during the traction period occurred in 20% of the rats, which required reoperation. Integrity of the stretched esophagus was confirmed at autopsy in all animals. In contrast to the control group, the experimental group showed a significantly more elongated (average length 6.10 +/- 1.10 mm versus 3.91 +/- 0.17 mm, (P = 0.0001)) and thicker esophagus (average mass 35.9 +/- 3.31 mg versus 15.6 +/- 1.71 mg in the control group, P = 0.0001). Histopathological examination showed a relatively well preserved morphology of the stretched esophagus. These observations suggest that esophageal stretching by traction sutures can be undertaken reliably in a rat model, resulting in elongation and mass increase of the stretched esophagus without important tissue damage. As this model mimics Foker's method, it may serve as a useful model in further research studies and may be used to train in surgical technique.

Esophageal replacement in rat using porcine intestinal submucosa as a patch or a tube-shaped graft

This study compares the efficacy of porcine intestinal submucosa (SIS) patch graft versus SIS-tube graft in esophageal replacement, using a novel esophageal regeneration model. Clinical function, as well as macroscopic and microscopic morphology were evaluated in both SIS-treated groups. We performed semi-circumferential esophageal excision followed by repair of the defect using either a SIS-patch graft (group I) or segmental esophageal excision followed by a SIS-tube interposition graft (group II) in rats. The 28-day survival rate was significantly different between the SIS-treated groups (100% in group I vs. 0% in group II). Unlike the rats in group II, which died within the first postoperative month due to esophageal dysfunction, all surviving animals in group I resumed a normal solid diet within a few days after surgery, without signs of esophageal dysfunction and gained weight. Barium swallow studies showed no evidence of fistula, significant stenosis or diverticula. No hematological or serum biochemistry abnormalities were found. By day 150 the SIS patch was replaced by esophageal-derived tissues. In the rat model, a patch graft technique using SIS appeared to induce esophageal regrowth and provided an initial and long-term satisfactory function, while a tube-shaped graft technique using SIS was unsuccessful.

Mycobacterial immune reconstitution inflammatory syndrome in HIV-1 infection after antiretroviral therapy is associated with deregulated specific T-cell responses: beneficial effect of IL-2 and GM-CSF immunotherapy

BACKGROUND

With the advent of antiretroviral therapy (ART) cases of immune reconstitution inflammatory syndrome (IRIS) have increasingly been reported. IRIS usually occurs in individuals with a rapidly rising CD4 T-cell count or percentage upon initiation of ART, who develop a deregulated immune response to infection with or without reactivation of opportunistic organisms. Here, we evaluated rises in absolute CD4 T-cells, and specific CD4 T-cell responses in 4 HIV-1+ individuals presenting with mycobacterial associated IRIS who received in conjunction with ART, IL-2 plus GM-CSF immunotherapy.

METHODS

We assessed CD4 T-cell counts, HIV-1 RNA loads, phenotype for naïve and activation markers, and in vitro proliferative responses. Results were compared with those observed in 11 matched, successfully treated asymptomatic clinical progressors (CP) with no evidence of opportunistic infections, and uninfected controls.

RESULTS

Median CD4 T-cell counts in IRIS patients rose from 22 cells/microl before initiation of ART, to 70 cells/microl after 8 months of therapy (median 6.5 fold increase). This coincided with IRIS diagnosis, lower levels of naïve CD4 T-cells, increased expression of immune activation markers, and weak CD4 T-cell responses. In contrast, CP had a median CD4 T-cell counts of 76 cells/microl at baseline, which rose to 249 cells/microl 6 months post ART, when strong T-cell responses were seen in > 80% of patients. Higher levels of expression of immune activation markers were seen in IRIS patients compared to CP and UC (IRIS > CP > UC). Immunotherapy with IL-2 and GM-CSF paralleled clinical recovery.

CONCLUSION

These data suggest that mycobacterial IRIS is associated with inadequate immune reconstitution rather than vigorous specific T-cell responses, and concomitant administration of IL-2 and GM-CSF immunotherapy with effective ART may correct/augment T-cell immunity in such setting resulting in clinical benefit.

Human herpes virus-8 serology and DNA analysis in recipients of renal allografts showing Kaposi's sarcoma and their respective donors

Kaposi's sarcoma (KS) developed among 11 of 416 renal allograft recipients transplanted between 1985 and 2000. Only 3 among 364 Caucasian recipients developed KS, while it affected 8 of 52 Black patients, all of whom had been born in African countries (P <.001). All patients had their immunosuppression reduced; two also received daunorubicin and one received electrotherapy. Three patients developed accelerated renal allograft dysfunction, probably due to the reduced immunosuppression. Remission of KS was observed in seven patients, while lesions stabilized or improved partially in the other four. After resuming dialysis 2 of 11 patients died; both were in KS remission. Human herpes virus-8 (HHV-8) serology and DNA analysis was evaluated in sera obtained from seven donors: all were negative. Conversely, among eight sera collected pretransplant from the nine living recipients, HHV-8 IgG was detected in six and DNA was present in one. HHV-8 IgG was expressed in all patients (9/9) at some point posttransplant; DNA was detected in three patients. Therefore, the robust ethnic predisposition to KS was associated with a high pretransplant prevalence of HHV-8 among African recipients. Although some seroconversions were detected posttransplant, there was no evidence for donor-to-recipient transmission.

A pilot study of the safety and efficacy of thymosin alpha 1 in augmenting immune reconstitution in HIV-infected patients with low CD4 counts taking highly active antiretroviral therapy

To study the safety and efficacy of thymosin alpha1 in stimulating immune reconstitution in combination with highly active antiretroviral therapy (HAART), a phase II randomized, controlled open-label trial of subcutaneous thymosin alpha1 was undertaken for 12 weeks. Twenty clinically stable patients with viral loads <400 copies/ml and CD4 counts less than 200 cells/microl were randomized to receive 3.2 mg thymosin alpha 1 subcutaneous injections twice weekly or no injections for 12 weeks. CD4 and CD8 counts, CD45 RO+ and RA+ subsets and signal joint T cell receptor excision circles (sjTREC) in peripheral blood mononuclear cells (PBMCs) were measured every 2 weeks. Thirteen patients received thymosin alpha 1 and seven were controls. Thymosin alpha 1 was well tolerated and there were no serious adverse events. There was no significant difference between the thymosin alpha1 and control groups in CD4, CD8 and CD45 lymphocyte subset changes at week 12; however, PBMC sjTREC levels increased significantly in the thymosin alpha 1-treated patients compared to controls at week 12. In conclusion, the increase in PBMC sjTREC levels in patients taking thymosin alpha1 may represent enhanced immune reconstitution; however, the clinical benefits and long-term consequences remain to be determined.

Treatment of primary HIV-1 infection with nonnucleoside reverse transcriptase inhibitor-based therapy is effective and well tolerated

OBJECTIVES

Highly active antiretroviral therapy (HAART) has been advocated for the management of primary HIV-1 infection. We investigated the use of a nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimen in this setting.

METHODS

Twenty-one antiretroviral-naïve individuals with early HIV-1 disease were treated with a combination of efavirenz and Combivir (GlaxoSmithKline, Uxbridge, Middlesex, UK). They were evaluated for immune and lymphocyte function by standard immunological assays.

RESULTS

The median time to an undetectable HIV-1 viral load was 12 weeks (range 4-36 weeks). CD4 and CD16/56 counts increased during treatment and CD8 counts decreased minimally. The main side-effects observed were transient sleep disturbances (five patients). In addition, we observed a decrease in lymphocyte activation as assessed by CD38 surface expression.

CONCLUSIONS

This study demonstrates that primary HIV-1 infection can be treated with NNRTI-based HAART.

Reconstitution of CD4+ T cell responses in HIV-1 infected individuals initiating highly active antiretroviral therapy (HAART) is associated with renewed interleukin-2 production and responsiveness

Reconstitution of functional CD4(+) T cell responsiveness to in vitro stimuli is associated with continuous highly active antiretroviral therapy (HAART). Thirty-six antiretroviral naive patients received HAART over 16 weeks. Antigen-specific, mitogen and interleukin (IL)-2 induced lymphocyte proliferative responses and specific IL-2 and IL-4 production were assessed at each time-point, together with quantification of HIV-1 RNA load and lymphocyte populations. Reconstitution of recall responses was limited largely to persistent antigens such as Herpes simplex virus and Candida, rather than to HIV-1 or neo-antigens. Recall antigens, mitogens and IL-2-induced renewed responses were associated with in-vitro production of IL-2, but not IL-4. Differential responsiveness to low versus high concentration IL-2 stimulus increases in a stepwise manner, suggesting normalization of IL-2 receptor expression and improved functionality. These increases in in-vitro proliferative responses thus probably reflect short lived effector clones, driven by ongoing antigenic stimulus associated with persisting long-term organisms. In this context non-responsiveness to HIV-1 antigens suggests ongoing HIV-1 specific clonal T cell anergy.

Thymic activity in late-stage HIV-1 infected individuals receiving highly active antiretroviral therapy: potential effect of steroid therapy

OBJECTIVE

Our objective was to monitor the effect of steroid therapy on the thymic output and function of late-stage HIV-1-infected patients undergoing highly active antiretroviral therapy (HAART).

DESIGN

The indirect measurement of T cells that have recently emigrated from the thymus as a means of quantifying thymic output, and therefore thymic function, was achieved through use of the polymerase chain reaction-based signal joint T cell receptor rearrangement excision circles (sjTREC) assay. Proliferative capacity and interleukin (IL)-2 and IL-4 production by T cells after antigenic, mitogenic and IL-2 stimulation were also analysed.

METHOD

Measurements were made of sjTREC levels in peripheral blood mononuclear cell DNA samples from five HIV-1 infected patients (one on steroid therapy prior to and at the time of sample extraction) receiving HAART. IL-2 and IL-4 production and proliferative capacity were also measured in three patients, including the patient receiving steroids.

RESULT

The sjTREC assay gave an extremely weak result for the patient on steroids but, under the same assay conditions, provided clear, positive readings for the four patients not on steroids. Comparison of the patients' cytokine profiles revealed that IL-2 production was generally low or absent in all three patients tested but that IL-4 production was significantly higher in the patient given steroids. Functional potential as revealed by proliferation assays showed very low or absent cellular proliferation.

CONCLUSION

The thymic contribution to the restoration of T lymphocyte numbers, particularly during the treatment of HIV-1 infection, may become compromised if thymic inhibitory factors such as steroids are used. Furthermore, the use of steroids may also favour the development of a T helper 2 response, which could prove particularly undesirable during HIV-1 infection.

Immune responses and reconstitution in HIV-1 infected individuals: impact of anti-retroviral therapy, cytokines and therapeutic vaccination

Most patients with chronic HIV-1 infection lack functional CD4(+) and CD8(+) HIV-1-specific T cells with proliferative and cytolytic capacity, respectively. This is despite being able to produce intracellular cytokines in response to viral antigens. Protease inhibitor (PI)-based highly active anti-retroviral therapy (HAART) is unable to completely eradicate virus and fails to enable total restoration of immunity including induction of anti-HIV-1 responses. We have taken novel approaches towards the treatment of chronic HIV-1 disease with the aim of instigating long-term non-progressor status and depletion of virus reservoirs. HIV-1-specific CD4(+) and CD8(+) T cell responses were measured following the administration of cytokines, during therapeutic vaccination, and following treatment interruption (TI) or drug therapy change. Administration of cytokines, with or without therapeutic vaccination, in HAART treated patients, improved both CD4(+) and CD8(+) HIV-1-specific T cell responses even in late-stage disease. Virus-specific T cell responses were also seen during TI or when transient viraemia was apparent, and following therapy change from a PI- to a non-nucleoside-based HAART regimen. Reconstitution of HIV-1-specific immune responses was found to be transient and reversal to the previous anergic state was rapid. Viral reservoirs in the latently infected resting CD4(+) T cells, on follicular dendritic cells of germinal centers or even in infected thymic epithelium may be involved in clonal suppression and anergy. These may present major obstacles to the maintenance of HIV-1-specific responses and the eventual eradication of HIV-1.

Detection and quantification of HIV-1 specific CD4 helper and CD8 cytotoxic cells: their role in HIV-1-infected individuals and vaccine recipients

There is a strong link between virus specific CD8 T-cell function and the efficiency of regulatory CD4 helper T cells. Controlling viraemia in HIV-1-infected individuals requires the maintenance of strong CD4 and CD8 T-cell responses. These responses should be elicited by prophylactic vaccination and by postexposure immunotherapy. This review will examine the methods that are available for the detection and quantification of HIV-1 specific CD4 and CD8 T-cell responses. We will also discuss the methods that should be used to identify these responses in HIV-1-infected individuals, seropositive recipients of immunotherapy and seronegative vaccinees. Finally, we will give examples of how responses observed in vitro relate to those known to occur in vivo.

Thromboangiitis obliterans: a rare cause of a reversible Raynaud's phenomenon

A 25-year-old woman with progressive Raynaud's phenomenon and digital necrosis is presented. Systemic sclerosis and other connective tissue disorders as well as atherosclerosis and arterial emboli were excluded with appropriate laboratory examinations. Arteriography revealed multiple palmar and digital occlusions with corkscrew-shaped vessels. Based on these characteristic arteriographic and clinical findings, the diagnosis of thromboangiitis obliterans was finally retained. With intravenous perfusion of the prostacyclin analogue iloprost (2 ng/kg/min, 6 h daily during 21 days), a complete healing of Raynaud's phenomenon and of the digital necrosis was observed. There was no recurrence during the 1-year follow-up. This observation demonstrates that thromboangiitis obliterans is a potential reversible cause of severe Raynaud's phenomenon in young women even in the absence of lower limb involvement. Early recognition is important to avoid irreversible complications such as loss of digits.

Catecholamines in larvae and juveniles of the prosobranch gastropod, Crepidula fornicata

We investigated roles of catecholamines in metamorphosis of the prosobranch gastropod, Crepidula fornicata. Levels of DOPA, norepinephrine (NE) and dopamine (DA) were measured by high-pressure liquid chromatography (HPLC) in competent larvae and juvenile siblings that metamorphosed in response to the natural adult-derived cue or to elevated K+. Competent larvae contained 1.58 +/- 0.26 (S.E.M.) x 10(-2) pmol DOPA, 0.91 +/- 0.45 x 10(-2) pmol NE, and 0.290 +/- 0.087 pmol DA (mean values per microg total protein, n = 4 batches of larvae). Levels of DA per individual were not different between larvae and juvenile siblings; levels of NE were higher in juveniles. The tyrosine hydroxylase (TH) inhibitor alpha-methyl-DL-m-tyrosine (alpha-MMT) depleted DOPA and DA to approximately half of control values without affecting levels of NE. Depletion of DOPA and DA was accompanied by inhibition of metamorphosis in response to the natural cue but not to elevated K+. The dopamine-beta-hydroxylase inhibitor diethyldithiocarbamate (DDTC) induced high frequencies of metamorphosis at concentrations of 0.1-10 microM. In juveniles induced by 10 microM DDTC, levels of both NE and DA averaged approximately 80% of those in control larvae. Catecholamines may function as endogenous regulators of metamorphosis in C. fornicata.

Catecholamines modulate metamorphosis in the opisthobranch gastropod Phestilla sibogae

Larvae of the nudibranch Phestilla sibogae are induced to metamorphose by a factor from their adult prey, the coral Porites compressa. Levels of endogenous catecholamines increase 6 to 9 days after fertilization, when larvae become competent for metamorphosis. Six- to nine-day larvae, treated with the catecholamine precursor L-DOPA (0.01 mM for 0.5 h), were assayed for metamorphosis in response to coral inducer and for catecholamine content by high-performance liquid chromatography. L-DOPA treatment caused 20- to 50-fold increases in dopamine, with proportionally greater increases in younger larvae, so that L-DOPA-treated larvae of all ages contained similar levels of dopamine. A much smaller (about twofold) increase in norepinephrine occurred in all larvae. The treatment significantly potentiated the frequency of metamorphosis of 7- to 9-d larvae at low concentrations of inducer. In addition, L-DOPA treatment at 9 d increased aldehyde-induced fluorescence in cells that were also labeled in the controls, and revealed additional cells. However, all labeled cells were consistent with the locations of cells showing tyrosine-hydroxylase-like immunoreactivity. Catecholamines are likely to modulate metamorphosis in P. sibogae, but rising levels of catecholamines around the time of competence are insufficient alone to account for sensitivity to inducer in competent larvae.

Correlation of genotypes and route of transmission with histologic activity and disease stage in chronic hepatitis C

Our objective was to evaluate the histopathological features of chronic hepatitis C of 64 liver biopsies and to correlate this with the route of transmission of hepatitis C virus, the genotype of HCV, and the patient's age. Moderate chronic hepatitis was the most frequently observed (62.5%). Cirrhosis was observed in 14 patients (21.9%) and was more frequently found among patients over 40 years of age (34.3% vs. 6.9%, P = 0.025). The mean histopathological activity index (HAI) was significantly higher in the sporadic (10+/-3.1) than the posttransfusional (7.5+/-3.7) and the intravenous drug use (IVDU) groups (6.3+/-2.8) (P<0.02). Moreover the sporadic group showed more fibrosis (P<0.04) than the posttransfusional group. No liver cirrhosis was found in the IVDU group. The overall prevalence of HCV variants was: 54.7% type 1b, 4.6% type 1a, 37.5% type 2c, 1.6% type 2b, 1.6% type 2. The genotype distribution showed no relation to the HAI, hepatitis activity (grade), and fibrosis (stage) of the liver disease. In conclusion, the sporadic route of transmission of HCV was related to a more severe chronic hepatic disease, a finding that could influence future antiviral therapies. The predominance of HCV type 1b in this study reflects the higher frequency of this variant in our area. Our data suggests that the ultimate consequence of HCV chronic infection depends on patient age rather than on HCV genotype.