Evaluation of sperm and hormonal assessments in Wagyu, Nellore, and Angus bulls

Wagyu bulls are known to have a highly exacerbated libido, as shown by the intense sexual interest of young calves. Therefore we believe that Wagyu male animals have specialized Sertoli and Leydig cells that are directly involved with the sexual precocity in this breed as mature bulls have a small scrotal circumference. This study aimed to evaluate whether there were differences in the hormone and sperm characteristics of Wagyu bulls compared with the same characteristics of subspecies Bos indicus and Bos taurus sires. Frozen-thawed semen from Wagyu, Nellore, and Angus sires were analyzed for sperm kinetics (computer-assisted sperm analysis), plasma membrane integrity, chromatin integrity, acrosome status, mitochondrial activity, lipid peroxidation and hormone [luteinizing hormone (LH) and testosterone] serum concentration. The results showed that Wagyu had lower total motility and an increased number of sperm with no motility when compared with Nellore and Angus bulls. Wagyu breed did not differ from those breeds when considering plasma and acrosome membranes integrity, mitochondrial potential, chromatin resistance, sperm lipid peroxidation or hormone (LH and testosterone) concentrations. We concluded that Wagyu sires had lower total motility when compared with Nellore and Angus bulls. Wagyu breed did not differ from these breeds when considering plasma and acrosome membranes integrity, mitochondrial potential, chromatin resistance, sperm lipid peroxidation, or hormone (LH and testosterone) concentrations.

Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry

AIMS

The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation.

METHODS AND RESULTS

Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin.

CONCLUSION

The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.

Progression of aerobic and anaerobic thresholds in cardiac rehabilitation: heart failure vs coronary artery disease

Background

Cardiac rehabilitation (CR) aims at the maintenance and potential recovery of cardiovascular function through an exercise program. Programs may be started with cardiopulmonary exercise test (CPET) in order to assess aerobic and anaerobic thresholds (VT1 and VT2), and to optimize the exercise prescription. In our center, most CR programs are in-hospital for the first 3–6 months, after which patients undertake another CPET to evaluate the progression and follow up with a home-based training schedule.

Aim

To compare the progression in aerobic and anaerobic thresholds after CR program in patients with heart failure (HF) or post-acute event in coronary artery disease (CAD). Stratify the results based on ejection fraction to see which patients show the most benefit.

Methods

A retrospective single center study using data from patients that were included in a CR program between January 2016 and December 2020. Patients without measurable ventilatory thresholds 1 and 2 (VT 1 and VT2) at both CPET were excluded as were those that didn't complete the CR program. VT 1 and VT2 progression was compared among patients referred to the CR program due to HF and CAD.

A sub-analysis was performed based on having reduced ejection fraction (rEF) (<50% on echocardiogram).

Results and discussion

A total of 136 patients were included (57,51±13,47 YO; 80,9% (n=110) male; 44,2% (n=60) had reduced ejection fraction. 46 patients were referred to CR due to HF and 90 due to CAD. Most patients referred to CR due to CAD underwent complete revascularization (82,2%) beforehand. The average time between the acute coronary event and the beginning of the CR program was 208 days. Even though the stunned myocardial phase would be expected to be resolved by the time the CR program was started, patients with CAD showed the steepest progression in VT1 and VT2 thresholds. Patients with CAD with preserved ejection fraction are the subgroup with the most robust progression in VT1 and VT2 when compared with rEF. This difference was statistically significant when the two etiologies were compared (p value = 0,047 for VT1 and 0,031 for VT2) – Table 1.

Conclusion

Patients with CAD and preserved ejection fraction exhibit the faster progression in aerobic and anaerobic thresholds in CR when compared to HF patients.

Funding Acknowledgement

Type of funding sources: None.

Characterization and quality of care indicators in patients with acute myocardial infarction without ST segment elevation

Introduction

The definition of the quality of care in healthcare services is paramount to implement the resources necessary to grant the best quality of care according to the current guidelines. Recently, the European Society of Cardiology's guidelines for the management of acute coronary syndromes without ST segment elevation (NSTEMI) were published, and defined the quality indicators to be evaluated in such patients.

Purpose

To characterize the level of care given to the population of patients with NSTEMI included in the a national registry since 2011, according to the new guidelines directives.

Population and methods

We evaluated 12193 patients with NSTEMI. For each year the following variables were analyzed: age, gender, cardiovascular and non-cardiovascular comorbidities, clinical presentation (rhythm, blood pressure, Killip-Kimball Class), left ventricular ejection fraction (LVEF), treatment during admission and discharge, and time to invasive coronary angiography (ICA). Besides this, a comparing between years was made to analyze differences according to the quality indicators established in the guidelines.

Results

In 2019, 83.9% of patient with LVEF <40% were treated with IECA/ARA II and 80.6% were prescribed a betablocker at discharge. No statistically significant differences were found across the year with respect to IECA/ARA II at discharge (p=0.495), and beta-blocker at discharge (p=0.812). In terms of P2Y12 inhibitors during the hospital admission, there was a statistically significant increase in its use when comparing 2019 to 2014, 2015, 2016 and 2017 (p=0.019 for 2014 and p<0,001 the following years), with prescription in 90.4% of the patients in 2019. At discharge 88.3% of the patients were prescribed a P2Y12 inhibitor in 2019 and there was also a statistically significant increase in its prescription when compared to the previous years (from 2011 to 2017 with a p<0.001). When it comes to the prescription of statins at discharge there was a statistically significant difference between groups, driven mostly by an increase compared to the year 2012 (95.6% vs 90.8%, p=0.005). Only 16% of patients were subjected to ICA within 24h of admission during the year 2019. No statistically significant difference was found between other years (p>0.100 when comparing between years).

Discussion

The most striking feature that can be improved is the amount of patients subject to ICA within the first 24h after diagnosis. When it comes to the P2Y12 inhibitors it is also clear that there has been an increase in its prescription during the admission and at discharge. To sum up, it is clear that there is still some margin to improve care, of at least 10–20% in most parameters. This data portrays a picture of the measures and steps to take in order to provide the adequate care according to the latest guidelines.

Funding Acknowledgement

Type of funding sources: None.

AMI causing cardiogenic shock in patients with severely depressed left ventricular function

Introduction

Left ventricular function is assumed to be the main predictor of cardiogenic shock (CS), however trials and registries show that in average left ventricular function is only moderately depressed in CS after acute myocardial infarction.

Purpose

Characterize population of patients (Pts) with CS after acute myocardial infarction (AMI) and with severe left ventricular dysfunction (defined as ejection fraction (EF) <30%).

Methods

From a national multicenter registry, we evaluated 729ptswith CS after AMI.We considered 2 groups: Group 1 – pts with CS and EF <30% and Group 2 – pts with CS and EF >30%. We registered age, gender, cardiovascular and non-cardiovascular comorbidities, electrocardiographic presentation, vital signs at admission, reperfusion strategy and coronary anatomy. We also evaluated in-hospital complications, such as re-infarction, mechanical complications, high-grade atrial ventricular block, sustained ventricular tachycardia (VT), atrial fibrillation (AF) and stroke. We compared in-hospital mortality and multivariate analysis was performed to assess the impact of EF in in-hospital mortality and to identify predictors of severe left ventricular function.

Results

Severe dysfunction in Cardiogenic shock due to AMI was present in 28.9% (n=211) of pts (68% male, mean age of 72±12 years old). Group 1 had higher incidence of previous heart disease, such as AMI, previous PCI and congestive heart failure (27% vs 14%, p<0.001; 17.7% vs 9.6% p=0.002 and 16% vs 10%, p=0.022, respectively). STEMI pts were 71% (n=149), and timing from symptoms until first contact was longer (185 min (90; 437) vs 123 (60; 300), p<0.001). Undetermined location AMI was more often in group 1 (8% vs 2%, p<0.001), particularly due to left or right bundle brunch block (13% vs 4.7%, p<0.001, and 15% vs 10%, p=0.041 respectively). Anterior STEMI was also more prevalent in this groups (81% vs 46%, p<0.001). No differences were observed on coronariography rate, rate or type of reperfusion nor multivessel disease. Group 1 pts presented more with left main (LM) (25% vs 12%, p<0.001) and anterior descending (AD) (9.4% vs 2.4%, p<0.001) arteries lesions (88% vs 72.4%, p<0.001) or occlusion (65.5% vs 33.7%, p<0.001). Group 1 presented more with in-hospital VT (16% vs 10.8%, p=0.048). In-hospital mortality was also higher (56.5% vs 29.5%, p<0.001). After multivariate analysis we found that severe left ventricular dysfunction was a mortality predictor (OR 3.37; 95% CI 2.05–5.54, p<0.001). LM (OR 3.41; 95% CI 1.86–6.26, p<0.001) and AD (OR 2.74; 95% CI 1.51–4.96, p=0.001) arteries disease and previous AMI (OR 2.36; 95% CI 1.28–4.37, p=0.006) were predictors of severe LV dysfunction.

Conclusions

Severely depressed EF is a predictor of in-hospital mortality. Left main and anterior descending artery disease and previous AMI were identified as predictors of an EF <30%.

Funding Acknowledgement

Type of funding sources: None.

Culture of rat mesenchymal stem cells on PHBV-PCL scaffolds: analysis of conditioned culture medium by FT-Raman spectroscopy

Mesenchymal stem cells (MSCs) have great potential for application in cell therapy and tissue engineering procedures because of their plasticity and capacity to differentiate into different cell types. Given the widespread use of MSCs, it is necessary to better understand some properties related to osteogenic differentiation, particularly those linked to biomaterials used in tissue engineering. The aim of this study was to develop an analysis method using FT-Raman spectroscopy for the identification and quantification of biochemical components present in conditioned culture media derived from MSCs with or without induction of osteogenic differentiation. All experiments were performed between passages 3 and 5. For this analysis, MSCs were cultured on scaffolds composed of bioresorbable poly(hydroxybutyrate-co-hydroxyvalerate) (PHBV) and poly(ε-caprolactone) (PCL) polymers. MSCs (GIBCO®) were inoculated onto the pure polymers and 75:25 PHBV/PCL blend (dense and porous samples). The plate itself was used as control. The cells were maintained in DMEM (with low glucose) containing GlutaMAX® and 10% FBS at 37oC with 5% CO2 for 21 days. The conditioned culture media were collected and analyzed to probe for functional groups, as well as possible molecular variations associated with cell differentiation and metabolism. The method permitted to identify functional groups of specific molecules in the conditioned medium such as cholesterol, phosphatidylinositol, triglycerides, beta-subunit polypeptides, amide regions and hydrogen bonds of proteins, in addition to DNA expression. In the present study, FT-Raman spectroscopy exhibited limited resolution since different molecules can express similar or even the same stretching vibrations, a fact that makes analysis difficult. There were no variations in the readings between the samples studied. In conclusion, FT-Raman spectroscopy did not meet expectations under the conditions studied.

Cardiac magnetic resonance evaluation of takotsubo cardiomyopathy

Funding Acknowledgements

Type of funding sources: None.

Introduction

Takotsubo Cardiomyopathy(TCM)is a reversible pathology with clinical features practically indistinguishable from AMI.Cardiac magnetic resonance(CMR)is uniquely suited in differentiating TCM from other forms of acute ventricular dysfunction.CMR can also identify potential complications.

Purpose

The aim of this study was to characterize TCM features,as well as to evaluate diagnostic and prognostic impact of CMR in these patients.

Methods

A 7-years prospective study,which included patients of our center proposed to CMR with presumptive diagnosis of MINOCA based on acute chest pain,troponin raise and absence of angiographically significant coronary disease (luminal stenosis <50%).We analysed clinical characteristics, electrocardiograms, echo and coronariography.A presumptive diagnosis was elaborated and comparison was made with the TCM definitive one after CMR.We applied a protocol to evaluate TCM patients’ left and right ventricles(LV;RV)both anatomically and functionally, and search for late gadolinium enhancement(LGE).

Results

A total of 93 patients were evaluated,of which 16 had the final diagnosis of TCM.Takotsubo-cardiomyopathy patients were all female,with a mean age of 69 ± 14years old.At admission,75% had ST segment elevation, so emergent coronariography was performed. The median highest troponin I was 2,235[1,30-4,27]ng/mL.CMR confirmed 25%(n = 4) of presumptive diagnosis of TCM. On the other 75%initial diagnosis was changed to TCM after CMR:50%(n = 6) and 17%(n = 2)of patients had an initial presumptive diagnoses of reperfunded STEMI and NSTEMI,respectively. In 33% the initial diagnosis was myocarditis.From CMR evaluation of TCM patients, left atrial dilation was found in 31%(mean indexed area 18 ± 1,5cm2/m2).A majority (81%) presented with preserved ejection fraction(EF)(mean LV EF 59 ± 10%).Regional contractility abnormalities were described in 19%,being hypokinesia in all mid and apical segments in 2 cases, and diffuse in one.LV dysfunction was present in 13%(mean LV EF 32 ± 2%) and RV"s in 2cases (mean RV EF 42%),with only one with biventricular EF depression.Mean LV end diastolic indexed volume(EDIV)was 72 ± 23mL/m2,with only 2 with LV dilation(LV EDIV 120 ± 7mL/m2),non had dilated RV.Mild pericardial effusion was found in 38%,mild mitral regurgitation in 8patients and moderate in 1.A complication was registered:LV outflow tract protomesossystolic acceleration with mild anterior leaflet prolapse,without SAM.No LV thrombus was identified.LGE was observed in 2(13%)of patients:in one it was found on the apex,on the other one the pattern was linear intramyocardial on mid segment of inferior septum.

Conclusion

CMR provides a noninvasive and multidimensional assessment for evaluation of Takotsubo cardiomyopathy.In our population,performing CMR allowed an initial diagnosis modification in 3/4 of the cases and identification of one complication,both with therapeutic and prognostic implications.

Cardiac Magnetic Resonance as a diagnostic tool in arrhythmias

Funding Acknowledgements

Type of funding sources: None.

Introduction

Etiology of cardiac arrhythmias is often difficult to determine.As the gold standard to anatomical and functional cardiac evaluation,Cardiac Magnetic Resonance(CMR)can be a fundamental technique for accurate assessment of myocardial arrhythmic substrates or for arrhythmias management.

Purpose

The aim of this study is to determine diagnostic and arrhythmic risk stratification impact of CMR performed in patients with suspected or confirmed arrhythmias.

Methods

We performed a six-years prospective study of patients with suspected or confirmed arrhythmias which evaluation with other techniques did not provide a definitive diagnosis.These patients underwent CMR for diagnostic and risk stratification assessment.We applied a protocol to evaluate both ventricles’ morphology and functional and late gadolinium enhancement (LGE) presence.

Results

A total of 93 patients were included,of which 66% were male, with a mean age of 45 ± 17 years old. The indications for patients with suspected or confirmed arrhythmias performing CMR evaluation were the following: 33% (n = 31) of the patients had very frequent premature ventricular complexes, 23% (n = 21) had sustained ventricular tachycardia (VT), 5%(n = 5) non-sustained VT, 17%(n = 16) suspected structural heart disease with high arrhythmic potential,10%(n = 9) unexplained recurrent syncope,9 %(n = 8) supraventricular tachycardia and 3% (n = 3) aborted sudden cardiac death. Depressed ejection fraction (EF)(<50%) was present in 10% (n = 9) for LV(mean EF 38 ± 9%) and 15%(n = 14) for RV (mean EF 42 ± 7%). Dilation of LV was found in 25% of patients (n = 23, mean LV volume: 115 ± 7ml/m²), with RV dilation being present in only 1 patient, who had right ventricle arrhythmogenic dysplasia (RVAD) (RV volume: 152ml/m²). In total, 16%had interventricular septum hypertrophy (mean 15 ± 4mm/m2).We found slight anterior leaflet prolapse of mitral valve in 10% (n = 9) of the cases and mild mitral regurgitation in 15% (n = 14). Left atrium dilation was observed in 17% (n = 16) of patients (mean area of 18 ± 2cm2/m2), as right atrium was dilated in only two. In 20% of the patients, CMR contributed to establish a previously unknown diagnosis: 6% (n = 5) have hypertrophic cardiomyopathy,4%(n = 4)a myocarditis sequelae and 2%(n = 2)had RVAD. LV non-compaction,a silent myocardial infarction scar and non-ischemic dilated cardiomyopathy were diagnosed in 3%of the cases each. In 15%(n = 14)we found nonspecific variations, which deserve follow-up. On the remaining patients, CMR was considered normal.

Conclusion

 As a high reproducible, accurate and versatile technique, CMR allowed an increase on diagnosis in 20% of the patients with suspected or confirmed arrhythmias. Consequently, it contributed to the risk stratification of our study population with suspected high arrhythmic potential when the first-line complementary exams were inconclusive.

First report of colonization by Panstrongylus megistus (Burmeister, 1835) (Hemiptera, Reduviidae, Triatominae) in the Metropolitan Region of São Paulo, Brazil

We report the first known occurrence of Panstrongylus megistus (Burmeister, 1835) (Hemiptera, Reduviidae, Triatominae) in the Metropolitan Region of São Paulo, Brazil. In 2018, adult specimens were sent by residents to the competent authorities and, in the inspection of the property, a large focus associated with a marsupial nest was found. This finding reinforces the importance of the species in the state of São Paulo, serves as an alert for epidemiological surveillance and extends the species colonization area in the state of São Paulo.

Use of on-farm milk progesterone information to predict fertility outcomes in dairy cows subjected to timed artificial insemination

The objectives of this study were to evaluate the use of a qualitative on-farm milk progesterone test to predict non-pregnancy in dairy cows. Lactating Jersey cows (n = 752) were subjected to the 5-d Cosynch-72 protocol for timed artificial insemination (AI; d -8 GnRH, d -3 and -2 PGF_2α, d 0 GnRH and timed AI). Milk was sampled on d -3, 0, 7, and 28 relative to timed AI, and progesterone concentrations were assessed using a lateral flow immunochromatographic test. Samples were classified into 3 groups indicative of high (hP4; test line not visible or lighter than reference), intermediate (iP4; test line similar to reference), and low (lP4; test line darker than reference) progesterone concentrations. Blood was sampled from a subset of cows (n = 50) on d -3, 0, 7, and 28 relative to timed AI, and plasma progesterone concentrations were determined by RIA. Cows were observed daily for signs of estrus based on removal of tail paint. Pregnancy was diagnosed by ultrasonography on d 34 and 62 after AI. Plasma progesterone concentrations across all time points were greater for hP4 (3.13 ± 0.20 ng/mL) followed by iP4 (1.12 ± 0.27 ng/mL) and lP4 (0.38 ± 0.23 ng/mL). Cows in lP4 on d -3 had lesser pregnancy per AI (P/AI) compared with iP4 and hP4 (17.4, 38.3, and 37.2%, respectively). For measurements performed on the day of AI (d 0), lP4 cows had greater P/AI compared with hP4 and iP4 (34.8, 0.0, and 15.6%, respectively), and the risk of pregnancy loss tended to be greater for iP4 compared with lP4. Cows in lP4 on d 7 after AI had lesser P/AI than those in iP4 and hP4 (12.0, 34.0, and 37.7%, respectively). Cows classified as lP4 on d 28 had the least P/AI on d 62 followed by iP4 and then hP4 (0.8, 9.2, and 59.4%, respectively) and were at the greatest risk for pregnancy loss (lP4 = 74.6%, iP4 = 8.4%, hP4 = 7.1%). Sensitivity and specificity to predict non-pregnancy on d 62 were 0.86 and 0.32 (d -3), 0.95 and 0.15 (d 0), 0.93 and 0.23 (d 7), and 0.99 and 0.53 (d 28), respectively. On-farm milk progesterone profiling using a lateral flow immunochromatographic test was able to identify cows without functional corpus luteum and to predict fertility outcomes following timed AI.

P260 Left ventricular pseudoaneurysm manifesting as syncope

Introduction

Left ventricular (LV) pseudoaneurysms form when cardiac rupture is contained by adherent pericardium or scar tissue. LV pseudoaneurysm is one of the mechanical complications of myocardial infarctions (MI), particularly inferior wall MI.

Although LV pseudoaneurysms are not common, the diagnosis is difficult and they are prone to rupture. Transthoracic echocardiography is commonly used in clinical practice and is usually sufficient to make the diagnosis of LV pseudoaneurysm. Regardless of treatment, patients with LV pseudoaneurysms had a high mortality rate, especially those who did not undergo surgery.

Description of the clinical case

74 years-old woman, with previous history of hypertension, dyslipidaemia and type 2 diabetes and stable coronary disease. In June 2018 the patient underwent coronary angiography that revealed left main and 3 vessels coronary disease, Cardiac revascularization surgery was proposed that the patient refused. The patient was stable during 6 months. Four days before presenting to emergency department the patient mentioned intermittent pre-cordial pain associated with exertion. At admission day she felt intense pre-cordial pain, accompanied by sudoresis and nausea, relieving with sublingual nitrate. The patient was hemodynamically stable at admission. Electrocardiogram showed sinus rhythm 65 bpm with 2mm ST-elevation of inferior leads. Troponin I was positive 30 ng/dL. Echocardiogram revealed marked hypokinesia of inferior and lateral wall with moderate depression of global systolic function ans presence of slight circumferential pericardial effusion (6mm in diastole on lateral wall)

Emergent coronariography was performed and revealed progression of coronary disease of the right coronary artery with sub-occlusion of the mid segment. Cardiac revascularization surgery was proposed and the patient accepted this time. Echocardiogram was repeated during hospitalization revealed a stable pericardial effusion with reduced dimension comparing to admission. After 3 weeks, while waiting surgery in the ward, the patient was a syncope that resulted in fracture of the distal peroneum. Ecocardiogram was performed and revealed a LV posterior wall pseudoaneurysm through a narrow neck in parasternal long axis view and the presence of large pericardial effusion (Fig 1). The patient was submitted to definitive reparative cardiac surgery with pericardium patch and coronary artery bypass graft from left internal mammary to anterior descending coronary artery. The patient recovered well from the cardiac surgery and at 2 months follow up is alive and without signs of heart failure.

This case illustrates the complexity in the management of patients with LV pseudoaneurysm. These patients require substantial critical care, imaging and surgical expertise.

A high clinical index of suspicion is needed to avoid missing the diagnosis LV pseudoaneurysm and transthoracic echocardiography is essential to establish the diagnosis.

Abstract P260 Figure. Fig 1 - LV pseudoaneurysm

P1722A new predictive score for mortality and cardiogenic shock in patients with ST-elevation myocardial infarction

Introduction

Acute Myocardial Infarction with ST elevation (STEMI) presents a high rate of potentially fatal complications and in-hospital mortality.

Objective

To test the predictive capacity for Cardiogenic Shock (CS) and In-hospital Mortality (MIH) of a new risk score in patients (Pts) with STEMI.

Population and methods

Evaluated 5765 Pts with STEMI without CS at admission. The new score, was derived by previous studies in this population, and was calculated according to the following criteria: age ≥65 years (1 point), heart rate ≥100bpm (2 points), systolic blood pressure <100mmHg (2 points), blood glucose at admission above 180 mg/dL (1 point) and creatinine at admission >1.5mg/dL (2 points). The population was divided into three subgroups: group A low score (0–2 points), group B intermediate score (3–5 points) and group C score (6–8 points). The endpoints defined were CS during hospitalization, in-hospital mortality and combined end-point of MIH and CS. The relationship between each of the possible scores (from 0 to 8) and the various end-points was determined, and the sensitivity and specificity of the score as a predictor of MIH and CS was defined as the area under the ROC curve (ASC).

Results

After the application of the score, 3 subgroups were obtained: group A with 4819 Pts (83,6%), group B with 884 Pts (15,3%) and group C 62 Pts (1,1%). Patients of group C had a higher MIH (Group C: 45,2% vs B: 11,4% vs A: 2,0%, p<0,001), higher CS (C: 29,5% vs B: 12,0% vs A: 2,3%, p<0,001) and a higher combined end-point of MIH and CC (C: 53,2% vs B: 17,8% vs A: 3,4%, p<0,001) during hospitalization. The proposed score revealed a high predictive capacity of MIH (ASC 0,802, 95% CI 0,775–0,830, p=0,001), of CS (ASC 0,763, 95% CI 0,731–0,795, p=0,001) and for the combined endpoint (MIH and CC) ASC 0,781, 95% CI 0,756–0,806, p=0,001). The logistic regression models showed that Pts with a high score (group C) presented a 41-fold higher risk of MIH (OR 41,3; p<0,001) and 18-fold higher CS (OR 18,0; p<0.001) than patients with low score (group A). It was also found that the risk associated with an increase in one point score unit was 100% (OR 2,0 p<0.001) for MIH and 82% (OR 1,82, p<0,001) for CS.

Conclusion

This new score, with the use of practical and friendly variables, demonstrated a high predictive capacity of MIH and CS.

P2265Cardiogenic shock without severe left ventricular dysfunction after ST-elevation acute myocardial infarction: population characterization and impact in prognosis

Background

The presence of cardiogenic shock (CS) after ST-elevation acute myocardial infarction (STEMI) is associated with a high mortality. Traditionally, severe left ventricular dysfunction is assumed to be the main predictor of CS, however trials and registries show that in average left ventricular function is only moderately depressed in CS after acute myocardial infarction.

Purpose

To characterize the population of patients (Pts) with CS after STEMI but without severe left ventricular dysfunction and assess their impact in mortality.

Methods

From a national multicenter registry, we evaluated 7181 Pts with STEMI and ejection fraction (EF) >30%, and excluded all pts with STEMI and an EF<30%. We considered 2 groups: Group 1 – Pts who developed CS and Group 2 - Pts who didn't developed CS. We registered age, gender, cardiovascular and non-cardiovascular co-morbidities, electrocardiographic presentation, vital signs at admission, reperfusion strategies, reperfusion times and coronary anatomy. We evaluated the following in-hospital complications: Re-Infarction, mechanical complications, high-grade atrial ventricular block, sustained ventricular tachycardia (VT) atrial fibrillation (AF) and stroke. We compared the in-hospital mortality.

Results

The presence of CS without severe left ventricular dysfunction was observed in 5,2% pts (n=376), being CS present at admission in 51,2% of these pts. The mean EF was lower in group 1 pts (44% ± 11 vs 51±11%, p<0,001). Patients in group 1 were older (70±14 vs 63±13 years, p<0,001), more females (39,4% vs 23,3%, p<0,001), had a higher prevalence of previous valvular heart disease (2,7% vs 1,0%, p=0,005), heart failure (4,8% vs 1,4%, p<0,001, peripheral artery disease (5,5% vs 2,9%, p=0,004), chronic kidney disease (6,4% vs 2,7%, p<0,001) and chronic pulmonary obstructive disease (8,2% vs 3,1%, p<0,001). At admission, Group 1 pts had more atrial fibrillation (10,4% vs 4,4%, p<0,001) and received less reperfusion (77,7% vs 83,0%, p=0,008), without differences in the type of reperfusion or times to reperfusion. The presence of multivessel disease (60,0% vs 45,7%, p<0,001) and left main disease (6,6% vs 2,4%, p<0,001) were more prevalent in Group 1 pts. Group 1 pts had more in-hospital complications: Re-Infarction (3,5% vs 0,7%, p<0,001), AF (22,1% vs 5,0%, p<0,001), mechanical complications (9,6% vs 0,5%, p<0,001), high atrial ventricular block (26,7% vs 3,7%, p<0,001), VT (10,6% vs 1,9%, p<0,001), stroke (1,9% vs 0,6%, p=0,01) and major bleeding (10,4% vs 1,5%, p<0,001). In-hospital mortality was much higher in Group 1 pts (26,6% vs 1,4%, p<0,001).

Conclusions

Cardiogenic shock is present in 5,2% of STEMI pts without severe ventricular dysfunction. These pts were older, more frequent female, had higher morbidities and in-hospital complications. Even without severe ventricular dysfunction, cardiogenic shock in these patients was associated with much higher in-hospital mortality.

P1764Quality criteria for STEMI care - a national perspective

Introduction

The definition of quality criteria in health care is essential to implement structural organization strategies that ensure that patients (P) receive the best care according to the most updated recommendations available at the time they are treated. Quality indicators have recently been defined with regard to the approach and treatment of STEMI in the European Guidelines published in 2017.

Objective

The authors intend to characterize the level of care provided to P with STEMI inserted into a national multicenter registry since 2011 in order to establish a relationship with international recommendations.

Population and methods

Descriptive study based on a national multicenter registry. A total of 2051 P admitted to the hospital with the diagnosis of STEMI were included, 1266 P for the year 2011 and 785 P for the year 2016.

Results

The P of the year 2011 and 2016 presented similar age (64±14 vs 63±13). There was a higher percentage of P admitted by STEMI fast track managed care system in 2016 (36.9% vs 22.2%, p<0,001) and less from the Emergency Department (31.6% vs 56.8%; p<0,001). Regarding the transport to the Hospital, there was an increase in patients transported by prehospital medical teams (28% vs 21%; p<0,001) and less by own means (35.7% vs 45.6%; p<0,001). Regarding in-hospital therapy, it was found that in 2016 more patients received loading doses of P2Y12 inhibitors – Clopidogrel (78.1% vs 70.3% P<0,001) and Ticagrelor (54.7% vs 0.7% P<0,001). In post-discharge therapy, there was also a slight improvement in care in 2016, with more P being treated with P2Y12 inhibitor (96.2% vs 92.4%; p=0.03) and beta-blocker (84.4% vs 78.7%; p<0,001). Regarding the type of reperfusion, there was an increase in angioplasty (95.5% vs 92.2%; p<0,001) and a decrease in fibrinolysis (4.5% vs 7.8%; p=0.03) in 2016. There was a slight worsening of the prehospital delay in 2016 (median 163min vs 120min) and an improvement in door to reperfusion time (median 60min vs 70min). There was also an increase in angioplasties performed in 2016 (87.1% vs 85.1%; p<0,001) as well as an increase in the percentage of left ventricular function evaluation before discharge (98.2% vs 93.9%; p<0,001).

Conclusion

The results presented demonstrate a slight improvement in the quality of the care provided to STEMI P. However, there are areas for improvement, in accordance with international recommendations, in particular with regard to reperfusion times.

P5018Prognosis of pulmonary embolism 30-day mortality risk based on five admission parameters: the PoPE score

Background

Pulmonary embolism (PE) is a serious and potentially fatal form of venous thromboembolism. The Pulmonary Embolism Severity Index (PESI), and its simplified version (sPESI), are widely used for risk stratification and mortality prediction, however, the elevated number of parameters make them difficult to use an apply in everyday practice.

Purpose

To provide a simple and easy-to-perform sensible score based on five clinical and metabolic parameters obtained in arterial blood gas (ABG) at admission: Altered Mental State (AMS), Shock Index (SI), Partial Pressure of Oxygen/Fraction of Inspired Oxygen ratio (PaO2/FiO2), blood pH and arterial lactate concentration (Lac), and to compare its performance to predict 30-day (early) mortality.

Material and methods

In retrospective multicentric observational case-control study, 1037 patients with confirmed PE were admitted in a 24-month period. We evaluated medical charts in order to calculate PESI and sPESI risk scores. Multivariate analysis was performed to identify clinical and ABG independent predictors of all-cause mortality. Discriminative power was accessed by Receiver Operating Characteristic (ROC) curve.

Results

A total of 1037 patients were included in the final analysis. Mean age was 69.5 +16.6 years, 39.5% (n=410) were males. Median length of stay was 11.0 [IQR 7.0–18.0] days. Early mortality was 12.6% (n=131). SI and Lac were significantly higher in patients with early mortality (0.81 [IQR 0.66–1.01] vs 0.68 [IQR 0.57–0.82], and 2.63 [IQR 1.60–4.64] mmol/L vs 1.32 [IQR 1.00–1.90] mmol/L, respectively, p<0.0001 for both). PaO2/FiO2and pH were significantly lower in patients with early mortality (231 +120 vs 303 +103, and 7.39 +0.14 vs 7.43 +0.07, respectively, p<0.0001 for both). There was a significantly higher proportion of patients with altered mental status (Glasgow Coma Scale <15) in patients with early mortality (55.0% vs 18.5%, c2(1)=85.3, p<0.0001). Multivariate analysis is summarized in Table 1. Stratified analysis was based on the approximate cut-off value for the last quartile of SI (0.85) and Lac (2.50 mmol/L) and for the first quartile of PaO2/FiO2 (250) and pH (7.35). Based on the similar beta coefficient values for each variable, we attributed 1 point in the presence of each following conditions: GCS <15, SI >0.85, PaO2/FiO2<250, pH <7.35 and Lac >2.50 mmol/L with a total PoPE scorerange 0–5. The PoPE score yielded a good prognostic performance in predicting in-hospital death using ROC analysis (AUC 0.806, 95% CI 0.767–0.845, p<0.0001). The PoPE score performance was superior when compared with PESI (AUC 0.806 vs 0.695, AUC difference 0.111, p<0.0001) and sPESI (AUC 0.806 vs 0.622, p<0.0001) – Figure 1. A PoPEscore of 1 has a sensitivity of 93% and a specificity of 48% in predicting early all-cause mortality.

Conclusions

The PoPE scoreproves an easy and simple tool with good performance which can predict early eraly 30-day mortality in patients admitted for PE.

P1720Survival analysis in a population of patients with cardiogenic shock after acute myocardial infarction: characterization of the population and identification of mortality predictors

Introduction

The presence of cardiogenic shock (CC) after acute myocardial infarction (AMI) is associated with high mortality.

Purpose

To compare the clinical characteristics, cardiac and non-cardiac complications among survivors and non-survivors of CC after AMI in order to identify predictors of in-hospital mortality.

Population and methods

An observational study involving 467 patients (P) with CC after AMI included in a national multicenter registry. Considered 2 groups: Group 1 - P with CC who died (n=190) and Group 2 - P with CC who survived (n=277). We recorded age, gender, personal history, coronary angiography and angioplasty performed, in-hospital therapy and ejection fraction, cardiac complications (Re-infarction, mechanical complications, high-grade atrial ventricular block, sustained ventricular tachycardia) and non-cardiac complications [acute renal injury (ARI), major bleeding and stroke]. Multivariate analysis was performed to identify predictors of in-hospital mortality.

Results

Mortality in patients with CC after AMI was 40.6%. Group 1 P were older (77±10 vs 68±13 years, p<0.001), presented higher prevalence of diabetes mellitus (41.8% vs 28.2%, p=0.003), previous AMI (23.8% vs. 12%, p<0.001) 7%, p=0.002), previous angor (31.9% vs 14.1%, p=0.001), heart failure (18.6% vs 8.7%, p=0.002) and peripheral arterial disease (11.8% vs 6.2%, p=0.03). There were fewer coronary angiographies (64.2% vs 87.7%, p<0.001), with no difference in the number or type of vessels with lesions in both groups, as well as inotropic therapy. With the exception of mechanical complications, more prevalent in group 1 (12.6% vs 5.4%, p=0.006), there were no differences in the prevalence of the remaining cardiac complications. Among the non-cardiac complications considered, only the presence of ARI was more prevalent in Group 1 (72.1% vs 37.5%, p<0.001). After multivariate analysis the presence of age>75 years [OR: 2.21 (CI: 1.39–3.51)], previous angor [OR: 1.91 (CI: 1.09–2.92)], LRA [OR: 3.14 (CI: 4.0–7.04)] and mechanical complications [OR: 3.82 (CI: 2.39–6.10] were independent predictors of in-hospital mortality of P with CC post-AMI.

Conclusions

Mortality in patients with CC after AMI remains high. Age>75 years, prior angor, ARI and mechanical complications are independent predictors of in-hospital mortality in P with CC post-AMI.

Environmental risk assessment of triclosan and ibuprofen in marine sediments using individual and sub-individual endpoints

The guidelines for the Environmental Risk Assessment (ERA) of pharmaceuticals and personal care products (PPCP) recommend the use of standard ecotoxicity assays and the assessment of endpoints at the individual level to evaluate potential effects of PPCP on biota. However, effects at the sub-individual level can also affect the ecological fitness of marine organisms chronically exposed to PPCP. The aim of the current study was to evaluate the environmental risk of two PPCP in marine sediments: triclosan (TCS) and ibuprofen (IBU), using sub-individual and developmental endpoints. The environmental levels of TCS and IBU were quantified in marine sediments from the vicinities of the Santos submarine sewage outfall (Santos Bay, São Paulo, Brazil) at 15.14 and 49.0 ng g^-1, respectively. A battery (n = 3) of chronic bioassays (embryo-larval development) with a sea urchin (Lytechinus variegatus) and a bivalve (Perna perna) were performed using two exposure conditions: sediment-water interface and elutriates. Moreover, physiological stress through the Neutral Red Retention Time Assay (NRRT) was assessed in the estuarine bivalve Mytella charruana exposed to TCS and IBU spiked sediments. These compounds affected the development of L. variegatus and P. perna (75 ng g^-1 for TCS and 15 ng g^-1 for IBU), and caused a significant decrease in M. charruana lysosomal membrane stability at environmentally relevant concentrations (0.08 ng g^-1 for TCS and 0.15 ng g^-1 for IBU). Chemical and ecotoxicological data were integrated and the risk quotient estimated for TCS and IBU were higher than 1.0, indicating a high environmental risk of these compounds in sediments. These are the first data of sediment risk assessment of pharmaceuticals and personal care products of Latin America. In addition, the results suggest that the ERA based only on individual-level and standard toxicity tests may overlook other biological effects that can affect the health of marine organisms exposed to PPCP.

Adenosine A2A receptor regulation of microglia morphological remodeling-gender bias in physiology and in a model of chronic anxiety

Developmental risk factors, such as the exposure to stress or high levels of glucocorticoids (GCs), may contribute to the pathogenesis of anxiety disorders. The immunomodulatory role of GCs and the immunological fingerprint found in animals prenatally exposed to GCs point towards an interplay between the immune and the nervous systems in the etiology of these disorders. Microglia are immune cells of the brain, responsive to GCs and morphologically altered in stress-related disorders. These cells are regulated by adenosine A_2A receptors, which are also involved in the pathophysiology of anxiety. We now compare animal behavior and microglia morphology in males and females prenatally exposed to the GC dexamethasone. We report that prenatal exposure to dexamethasone is associated with a gender-specific remodeling of microglial cell processes in the prefrontal cortex: males show a hyper-ramification and increased length whereas females exhibit a decrease in the number and in the length of microglia processes. Microglial cells re-organization responded in a gender-specific manner to the chronic treatment with a selective adenosine A_2A receptor antagonist, which was able to ameliorate microglial processes alterations and anxiety behavior in males, but not in females.

Autism Spectrum Disorders: Translating human deficits into mouse behavior

Autism Spectrum Disorders are a heterogeneous group of neurodevelopmental disorders, with rising incidence but little effective therapeutic intervention available. Currently two main clinical features are described to diagnose ASDs: impaired social interaction and communication, and repetitive behaviors. Much work has focused on understanding underlying causes of ASD by generating animal models of the disease, in the hope of discovering signaling pathways and cellular targets for drug intervention. Here we review how ASD behavioral phenotypes can be modeled in the mouse, the most common animal model currently in use in this field, and discuss examples of genetic mouse models of ASD with behavioral features that recapitulate various symptoms of ASD.

Histopathological assessment of liver and gonad pathology in continental slope fish from the northeast Atlantic Ocean

The deep-sea environment is a sink for a wide variety of contaminants including heavy metals and organic compounds of anthropogenic origin. Life history traits of many deep-water fish species including longevity and high trophic position may predispose them to contaminant exposure and subsequent induction of pathological changes, including tumour formation. The lack of evidence for this hypothesis prompted this investigation in order to provide data on the presence of pathological changes in the liver and gonads of several deep-water fish species. Fish were obtained from the north east region of the Bay of Biscay (north east Atlantic Ocean) by trawling at depths between 700 and 1400 m. Liver and gonad samples were collected on board ship and fixed for histological processing and subsequent examination by light microscopy. Hepatocellular and nuclear pleomorphism and individual cases of ovotestis and foci of cellular alteration (FCA) were detected in black scabbardfish (Aphanopus carbo). Six cases of FCA were observed in orange roughy (Hoplostethus atlanticus) (n = 50) together with a single case of hepatocellular adenoma. A wide variety of inflammatory and degenerative lesions were found in all species examined. Deep-water fish display a range of pathologies similar to those seen in shelf-sea species used for international monitoring programmes including biological effects of contaminants. This study has confirmed the utility of health screening in deep-water fish for detecting evidence of prior exposure to contaminants and has also gained evidence of pathology potentially associated with exposure to algal toxins.

Environmental assessment of dredged sediment in the major Latin American seaport (Santos, São Paulo-Brazil): an integrated approach

This work offers an environmental assessment of a dredged sediment disposal area in Santos bay, situated on the central coast of the São Paulo State, Brazil. Sediment quality was evaluated through physicochemical analysis and toxicity tests of sediments collected in the disposal site and adjacent area. The physicochemical characterization of the sediments involved grain size distribution, concentrations of polycyclic aromatic hydrocarbons (PAHs), chlorinated and aromatic hydrocarbons, polychlorinated biphenyls (PCBs), pesticides, phthalates, metals and nutrients. Acute and chronic toxicity tests were employed, using amphipods (Tiburonella viscana) and sea urchins (Lythechinus variegatus), respectively. Results revealed toxicity by all the methods applied here, suggesting that the area of disposal of dredged material is significantly altered with respect to sediment quality and probably capable of generating deleterious effects on the local biota. Aiming to elucidate the association between the distinct environmental variables and the biological effects measured in laboratory, Factor Analysis was performed. Results revealed that despite most contaminant concentrations were found below the limits established by Brazilian legislation, biological effects were related to metals (chronic toxicity) and organic compounds (acute toxicity). The application of multivariate analysis proved to be particularly useful to assess and interpret the results in an integrated way, particularly due to the large number of parameters analyzed in environmental assessments, and should be applied in future studies.

Blood flow restricted resistance training attenuates myostatin gene expression in a patient with inclusion body myositis

Inclusion body myositis is a rare idiopathic inflammatory myopathy that produces extreme muscle weakness. Blood flow restricted resistance training has been shown to improve muscle strength and muscle hypertrophy in inclusion body myositis. Objective: The aim of this study was to evaluate the effects of a resistance training programme on the expression of genes related to myostatin (MSTN) signalling in one inclusion body myositis patient. Methods: A 65-year-old man with inclusion body myositis underwent blood flow restricted resistance training for 12 weeks. The gene expression of MSTN, follistatin, follistatin-like 3, activin II B receptor, SMAD-7, MyoD, FOXO-3, and MURF-2 was quantified. Results: After 12 weeks of training, a decrease (25%) in MSTN mRNA level was observed, whereas follistatin and follistatin-like 3 gene expression increased by 40% and 70%, respectively. SMAD-7 mRNA level was augmented (20%). FOXO-3 and MURF-2 gene expression increased by 40% and 20%, respectively. No change was observed in activin II B receptor or MyoD gene expression. Conclusions: Blood flow restricted resistance training attenuated MSTN gene expression and also increased expression of myostatin endogenous inhibitors. Blood flow restricted resistance training evoked changes in the expression of genes related to MSTN signalling pathway that could in part explain the muscle hypertrophy previously observed in a patient with inclusion body myositis.

PANNOTATOR: an automated tool for annotation of pan-genomes

Due to next-generation sequence technologies, sequencing of bacterial genomes is no longer one of the main bottlenecks in bacterial research and the number of new genomes deposited in public databases continues to increase at an accelerating rate. Among these new genomes, several belong to the same species and were generated for pan-genomic studies. A pan-genomic study allows investigation of strain phenotypic differences based on genotypic differences. Along with a need for good assembly quality, it is also fundamental to guarantee good functional genome annotation of the different strains. In order to ensure quality and standards for functional genome annotation among different strains, we developed and made available PANNOTATOR (http://bnet.egr.vcu.edu/iioab/agenote.php), a web-based automated pipeline for the annotation of closely related and well-suited genomes for pan-genome studies, aiming at reducing the manual work to generate reports and corrections of various genome strains. PANNOTATOR achieved 98 and 76% of correctness for gene name and function, respectively, as result of an annotation transfer, with a similarity cut-off of 70%, compared with a gold standard annotation for the same species. These results surpassed the RAST and BASys softwares by 41 and 21% and 66 and 17% for gene name and function annotation, respectively, when there were reliable genome annotations of closely related species. PANNOTATOR provides fast and reliable pan-genome annotation; thereby allowing us to maintain the research focus on the main genotype differences between strains.

In silico prediction of conserved vaccine targets in Streptococcus agalactiae strains isolated from fish, cattle, and human samples

Streptococcus agalactiae (Lancefield group B; group B streptococci) is a major pathogen that causes meningoencephalitis in fish, mastitis in cows, and neonatal sepsis and meningitis in humans. The available prophylactic measures for conserving human and animal health are not totally effective and have limitations. Effective vaccines against the different serotypes or genotypes of pathogenic strains from the various hosts would be useful. We used an in silico strategy to identify conserved vaccine candidates in 15 genomes of group B streptococci strains isolated from human, bovine, and fish samples. The degree of conservation, subcellular localization, and immunogenic potential of S. agalactiae proteins were investigated. We identified 36 antigenic proteins that were conserved in all 15 genomes. Among these proteins, 5 and 23 were shared only by human or fish strains, respectively. These potential vaccine targets may help develop effective vaccines that will help prevent S. agalactiae infection.

Bone histomorphometry revisited

Bone histomorphometry is defined as a quantitative evaluation of bone micro architecture, remodelling and metabolism. Bone metabolic assessment is based on a dynamic process, which provides data on bone matrix formation rate by incorporating a tetracycline compound. In the static evaluation, samples are stained and a semi-automatic technique is applied in order to obtain bone microarchitectural parameters such as trabecular area, perimeter and width. These parameters are in 2D, but they can be extrapolated into 3D, applying a stereological formula. Histomorphometry can be applied to different areas; however, in recent decades it has been a relevant tool in monitoring the effect of drug administration in bone. The main challenge for the future will be the development of noninvasive methods that can give similar information. In the herein review paper we will discuss the general principles and main applications of bone histomorphometry.

Specificity and sensitivity of screening for anti-HLA antibodies in kidney allograft dysfunction

BACKGROUND

Prospective testing for posttransplant circulating anti-HLA antibodies seems to be a critical noninvasive tool, but confirmatory data are lacking.

MATERIALS AND METHODS

Over the last 3 years, peritubular capillary (PTC) C4d deposition was prospectively sought by an immunofluorescence technique applied to frozen tissue in biopsies obtained for allograft dysfunction. Screening for circulating anti-HLA class I/II alloantibodies (AlloAb) by the flow cytometric test was performed simultaneously.

RESULTS

We evaluated 132 sets of biopsies and simultaneous serum samples. PTC C4d deposition was demonstrated in 15.9% (21/132) of biopsies. Circulating anti-HLA I/II AlloAb were detected in 25% (33/132) of serum samples. Employing receiver-operator characteristic (ROC) curves for all C4d-positive biopsies, screening for AlloAb showed a global specificity of 82% and sensitivity of 61.9%. When this analysis was restricted to biopsies obtained in the first month posttransplantation, the sensitivity increased to 81.8%, but the specificity decreased to 76.9%. After the first month posttransplantation, we observed sensitivity of 40.0% and a specificity of 86.4%. In the first month posttransplantation, all patients with a diagnosis of acute antibody-mediated rejection displayed circulating anti-HLA class I/II, but not always at the same time as the C4d-positive biopsy.

CONCLUSIONS

In the first month posttransplantation, prospective monitoring of anti-HLA antibodies may be useful. The high sensitivity allows the identification of patients at risk, affording an earlier diagnosis of antibody-mediated rejection. After the first month, the test can be used to evaluate allograft dysfunction episodes, since positivity is highly suggestive of an antibody-mediated process.

Association of slow N-acetyltransferase 2 profile and anti-TB drug-induced hepatotoxicity in patients from Southern Brazil

PURPOSE

To determine the frequency of N-acetyltransferase 2 (NAT2) polymorphisms, the NAT2 acetylation profile and its relation to the incidence of gastrointestinal adverse drug reactions (ADRs), anti-tuberculosis (TB) drug-induced hepatotoxicity, and the clinical risk factors for hepatotoxicity in a population from Brazil.

METHODS

Two hundred and fifty-four Brazilian TB patients using isoniazid (INH), rifampicin (RMP), and pirazinamide (PZA) were tested in a prospective cohort study. NAT2 genotyping was performed by direct PCR sequencing. The association between gastrointestinal ADRs/hepatotoxicity and the NAT2 profile genotype was evaluated by univariate analysis and multiple logistic regression.

RESULTS

Of the 254 patients analyzed, 69 (27.2%) were slow acetylators and 185 (72.8%) were fast acetylators. Sixty-five (25.6%) patients were human immunodeficiency virus (HIV)-positive. Thirty-three (13%) and 14 (5.5%) patients developed gastrointestinal ADR and hepatotoxicity, respectively. Of the 14 hepatotoxicity patients, nine (64.3%) were slow acetylators and five (35.7%) were fast acetylators. Sex, age, presence of hepatitis C virus, alcohol abuse, and baseline aminotransferases were not found to be risk factors for hepatotoxicity. However, logistic regression analysis revealed that slow acetylator status and the presence of HIV (p < 0.05) were independent risk factors for hepatotoxicity.

CONCLUSIONS

Our findings show that HIV-positive patients that have the slow acetylation profile are significantly associated with a higher risk of developing hepatotoxicity due to anti-TB drugs.

Comparative sediment quality assessment in different littoral ecosystems from Spain (Gulf of Cadiz) and Brazil (Santos and São Vicente estuarine system)

The goal of this work was to establish comparisons among environmental degradation in different areas from Southern Spain (Gulf of Cádiz) and Brazil (Santos and São Vicente estuary), by using principal component analyses (PCA) to integrate sediment toxicity (amphipods mortality) and chemical-physical data (Zn, Cd, Pb, Cu, Ni, Co, V, PCBs, PAHs concentrations, OC and fines contents). The results of PCA extraction of Spanish data showed that Bay of Cádiz, CA-1 did not present contamination or degradation; CA-2 exhibited contamination by PCBs, however it was not related to the amphipods mortality. Ría of Huelva was the most impacted site, showing contamination caused principally by hydrocarbons, in HV-1 and HV-2, but heavy metals were also important contaminants at HV-1, HV-2 and HV-3. Algeciras Bay was considered as not degraded in GR-3 and -4, but in GR-3' high contamination by PAHs was found. In the Brazilian area, the most degraded sediments were found in the stations situated at the inner parts of the estuary (SSV-2, SSV-3, and SSV-4), followed by SSV-6, which is close to the Submarine Sewage Outfall of Santos - SSOS. Sediments from SSV-1 and SSV-5 did not present chemical contamination, organic contamination or significant amphipod mortality. The results of this investigation showed that both countries present environmental degradation related to PAHs: in Spain, at Ría of Huelva and Gudarranque river's estuary areas; and in Brasil, in the internal portion of the Santos and São Vicente estuary. The same situation is found for heavy metals, since all of the identified metals are related to toxicity in the studied areas, with few exceptions (V for both Brazil and Spain, and Cd and Co for Brazilian areas). The contamination by PCBs is more serious for Santos and São Vicente estuary than for the investigated areas in Gulf of Cádiz, where such compound did not relate to the toxicity.

Endometrioma suburetral

Endometriosis is a common disease affecting mostly women in childbearing age. It usually involves the internal pelvic organs but occasionally can present in unusual locations. We report on a 32-year-old nulliparos female presenting with a suburethral painful mass causing obstructive voiding symptoms; she had also a long history of dismenorreia, perimenstrual pelvic pain, urinary tract infections, disúria and dispareunia. The diagnostic work-up revealed a suburethral cystic lesion consistent with a complicated urethral diverticulum or a suburethral endometrioma. Complete surgical excision confirmed an endometriotic cyst. The differential diagnosis of this rare suburethral location of endometriosis with other vaginal cysts is discussed.

Use of blends of bioabsorbable poly(L-lactic acid)/poly(hydroxybutyrate- co-hydroxyvalerate) as surfaces for Vero cell culture

Vero cells, a cell line established from the kidney of the African green monkey (Cercopithecus aethiops), were cultured in F-10 Ham medium supplemented with 10% fetal calf serum at 37 degrees C on membranes of poly(L-lactic acid) (PLLA), poly(hydroxybutyrate-co-hydroxyvalerate) (PHBV) and their blends in different proportions (100/0, 60/40, 50/50, 40/60, and 0/100). The present study evaluated morphology of cells grown on different polymeric substrates after 24 h of culture by scanning electron microscopy. Cell adhesion was also analyzed after 2 h of inoculation. For cell growth evaluation, the cells were maintained in culture for 48, 120, 240, and 360 h. For cytochemical study, the cells were cultured for 120 or 240 h, fixed, processed for histological analysis, and stained with Toluidine blue, pH 4.0, and Xylidine ponceau, pH 2.5. Our results showed that cell adhesion was better when 60/40 and 50/50 blends were used although cells were able to grow and proliferate on all blends tested. When using PLLA/PHBV (50/50) slightly flattened cells were observed on porous and smooth areas. PLLA/PHBV (40/60) blends presented flattened cells on smooth areas. PLLA/PHBV (0/100), which presented no pores, also supported spreading cells interconnected by thin filaments. Histological sections showed that cells grew as a confluent monolayer on different substrates. Cytochemical analysis showed basophilic cells, indicating a large amount of RNA and proteins. Hence, we detected changes in cell morphology induced by alterations in blend proportions. This suggests that the cells changed their differentiation pattern when on various PLLA/PHBV blend surfaces.

Biological activity of plant extracts: novel analgesic drugs

The plant-derived secondary metabolites have, over the years, greatly contributed to our current understanding of the important mechanisms related to the process of pain transmission and treatment. Furthermore, they have permitted us to characterise receptor types and identify endogenous ligands involved in the mechanism of nociception. In this review, we discuss the recent advances that have occurred regarding plant-derived substances in the process of development of new analgesic drugs. Plants, such as Papaver somniferum, Cannabis sativa and those of the Capsicum and Salix species, have greatly accounted for the development of clinically relevant drugs which are useful for the management of pain disorders. The recent advances in our understanding of the mechanisms of action of the above plant-derived substances, together with use of molecular biology techniques, have greatly accelerated attempts to identify promising targets for the discovery of new, safe and efficient analgesic drugs. Despite the great progress which has occurred in the elucidation of pain transmission and despite decades of use, leaving aside its known undesirable sides effects, morphine continues to be one of the most used drugs in clinical practice for the treatment of pain disorders. Thus, safer and more efficacious analgesic drugs are urgently needed. A search through the literature reveals that many potentially active antinociceptive plant-derived compounds have been identified. However, studies aiming to investigate their cellular and molecular mechanisms of action and well-controlled clinical trials to prove their efficacy in humans are still lacking. Nevertheless, natural or synthetic substances that bind to vanilloid or cannabinoid receptors, or even those that are capable of modulating the endogenous ligands which bind to these receptors, are expected to soon appear to assist in the treatment of several pain disorders, including those of neuropathic or neurogenic origin.

A7445G mtDNA mutation present in a Portuguese family exhibiting hereditary deafness and palmoplantar keratoderma

Mitochondrial DNA (mtDNA) A7445G point mutation has been shown to be responsible for familial nonepidermolytic palmoplantar keratoderma (NEPPK) associated with deafness without any additional features. To date, only a few cases have been described. We report a Portuguese pedigree presenting an inherited combination of NEPPK and sensorineural deafness compatible with maternal transmission. Clinical expression and age of onset of NEPPK and deafness were variable. Normal expression patterns of epidermal keratins and filaggrin, intercellular junction proteins including connexin 26, loricrin and cornified envelope proteins, were observed. Molecular analysis revealed that all the affected members, previously screened for Cx26 mutations with negative results, presented the mtDNA A7445G point mutation in the homoplasmic form. To our knowledge, this is the fifth family in whom inherited NEPPK and hearing loss are related to this mitochondrial mutation.

Porous and dense poly(L-lactic acid) and poly(D,L-lactic acid-co-glycolic acid) scaffolds: in vitro degradation in culture medium and osteoblasts culture

The use of bioresorbable polymers as a support for culturing cells has received special attention as an alternative for the treatment of lesions and the loss of tissue. The aim of this work was to evaluate the degradation in cell culture medium of dense and porous scaffolds of poly(L-lactic acid) (PLLA) and poly(D,L-lactic acid-co-glycolic acid) (50:50) (PLGA50) prepared by casting. The adhesion and morphology of osteoblast cells on the surface of these polymers was evaluated. Thermal analyses were done by differential scanning calorimetry and thermogravimetric analysis and cell morphology was assessed by scanning electron microscopy. Autocatalysis was observed in PLGA50 samples because of the concentration of acid constituents in this material. Samples of PLLA showed no autocatalysis and hence no changes in their morphology, indicating that this polymer can be used as a structural support. Osteoblasts showed low adhesion to PLLA compared to PLGA50. The cell morphology on the surface of these materials was highly dispersed, which indicated a good interaction of the cells with the polymer substrate.

Interleukin-10 promoter single-nucleotide polymorphisms as markers for disease susceptibility and disease severity in leprosy

We have determined IL-10 promoter genotypes of five single-nucleotide polymorphisms (SNPs): T-3575A, A-2849G, C-2763A, -A-1082G and C-819T. The haplotype frequencies were defined in healthy subjects compared to leprosy patients, and analyzed for their occurrence in multi- (MB) vs paucibacillary (PB) as severe and mild forms of leprosy, respectively. Haplotypes defined by three SNP positions (-3575, -2849 and -2763) captured significant differences between controls and patients (P=0.04). The haplotype carrying -3575A, -2849G and -2763C was associated with resistance to leprosy and to the development of severe forms of the disease using either a binomial (controls vs cases, P=0.005, OR=0.35, CI=0.13-0.91) or ordinal (controls vs PB vs MB, P=0.006, OR=0.32, CI=0.12-0.83) model. By contrast, the IL-10 haplotype -3575T/-2849A/-2763C was found to be associated with susceptibility to leprosy per se (P=0.027, OR=2.37, CI=1.04-5.39), but not leprosy type. The data suggest that the IL-10 locus contributes to the outcome of leprosy.

Tumor necrosis factor and interleukin-10 gene promoter polymorphisms in Brazilian population and in Terena Indians

The Terena Amerindians are located in the midwestern region of Brazil. We have previously reported a restricted polymorphism for HLA class I and class II in 99 unrelated Terena using PCR-SSO and more recently for MICA. There are single nucleotide polymorphisms (SNPs) that determine high or low production of certain cytokines. We have now studied the frequencies of mutant allele (A) at position -308 in the promoter of the gene tumor necrosis factor (TNF)-alpha (pro-inflammatory cytokine) and the alleles A and T, at position -1082 and -819, respectively, in the promoter of the interleukin (IL)-10 gene, in 51 of these subjects from the Terena tribe using PCR SSP and in 195 normal unrelated healthy Brazilians using PCR-RLFP. All 51 Terena Indians tested (100%) had the G/G genotype at position TNF-alpha -308, with no mutation found thus far. In contrast, among the Brazilian general population, the allelic frequency of A was 18.9%. When anti-inflammatory cytokine IL-10 was studied at two different positions, -1082 and -819, a high mutation rate was found when Terena were compared with the general Brazilian population (P <.05). The genetic cytokine profile may be required to balance the restricted HLA repertoire for peptide presentation in this native population.

Dexamethasone and fetal calf serum effects in differentiation of Vero cells cultured on type I collagen gel

Vero cells, a fibroblastic cell line, were cultured on a collagen I gel without fetal calf serum (FCS), with the addition of 10% FCS, 10% FCS plus dexamethasone (DEX) or 20% FCS. Our objective was to determine the effects of DEX on the differentiation pattern of fibroblastic cells cultured on a collagen substrate. We found that cells cultured with or without 10% FCS were capable of migrating into the collagen matrix. Near the cells in the gel, we found the deposition of extracellular granulations. Cytochemical data suggests that this material is glycosaminoglycans and/or proteoglycans. Surrounding the cells, a fibronectin deposition was found in the collagen. Thus, these cells make up a structure similar to a loose connective tissue. On the other hand, cells cultured with 10% FCS plus DEX or with 20% FCS did not invade the collagen matrix but formed multiple cell layers poor in fibronectin. On collagen I gel surface, we found an acellular layer rich in collagen IV, which appeared between the cells and the substrate. Thus, DEX or 20% FCS, furnished to the cells cultured on a collagen gel, block cell migration into the substrate and induce them to produce a basement membrane-like structure.