Replenishing NAD+ content reduces aspects of striated muscle disease in a dog model of Duchenne muscular dystrophy

Duchenne muscular dystrophy (DMD) is an X-linked disease caused by mutations in DMD gene and loss of the protein dystrophin, which ultimately leads to myofiber membrane fragility and necrosis, with eventual muscle atrophy and contractures. Affected boys typically die in their second or third decade due to either respiratory failure or cardiomyopathy. Among the developed therapeutic strategies for DMD, gene therapy approaches partially restore micro-dystrophin or quasi-dystrophin expression. However, despite extensive attempts to develop definitive therapies for DMD, the standard of care remains corticosteroid, which has only palliative benefits. Animal models have played a key role in studies of DMD pathogenesis and treatment development. The golden retriever muscular dystrophy (GRMD) dog displays a phenotype aligning with the progressive course of DMD. Therefore, canine studies may translate better to humans. Recent studies suggested that nicotinamide adenine dinucleotide (NAD+) cellular content could be a critical determinant for striated muscle function. We showed here that NAD+ content was decreased in the striated muscles of GRMD, leading to an alteration of one of NAD+ co-substrate enzymes, PARP-1. Moreover, we showed that boosting NAD+ content using nicotinamide (NAM), a natural NAD+ precursor, modestly reduces aspects of striated muscle disease. Collectively, our results provide mechanistic insights into DMD.

Preoperative anaemia is an independent predictor of 30-day mortality post-CABG and improves de predictive accuracy of EuroScore II

Background

The impact of preoperative anaemia on the results of cardiovascular surgery has already been demonstrated by some authors. Some of the studies observed worse surgical results in anaemic patients, however, in others, no difference was observed. In addition, the impact that the inclusion of anaemia or haemoglobin would have as a predictor in a risk model such as EuroScore II is not yet known.

Purpose

To evaluate the impact of preoperative anaemia on 30-day mortality post-CRM and compare the predictive accuracy of EuroScore II with and without the inclusion of haemoglobin levels in the model.

Methods

Single center cohort with 2168 patients consecutively included between January 2010 and December 2020. All procedures were performed with cardiopulmonary bypass. 32 baseline and operative characteristics were assessed. The primary outcomes were 30-day mortality and the EuroScore II predictive accuracy. Patients were stratified into two groups according to anaemia status. WHO Classification – haemoglobin: men <13 g/dL and women <12 g/dL. No Anaemia Group (1301–60.1%) – Anaemia Group (867–39,9%). Univariate analysis was performed to compare the characteristics of the groups, the occurrence of death in 30 days and to verify variables associated with mortality. Logistic regression analyses were used to assess predictors of mortality and generate a set of probabilities for assessing the predictive accuracy of EuroScore II with and without the addition of haemoglobin in the model. The probabilities generated through the regressions were analysed by ROC curves, which in turn were compared using the DeLong test. The level of significance was 5% and the statistical analysis was performed using Python 3.0.

Results

The anaemic patients were older and had higher prevalence of conditions, such as: diabetes, renal impairment, smoking, HF class III or IV, RBC transfusion and highest mean of EuroScore II (p<0.05 for all conditions). When comparing mortality in the groups, a significantly higher rate was observed in the anaemic group (2.2% vs 5.4%; p<0.001). In view of the heterogeneity of the groups, an adjusted logistic regression model was applied. The results of the multivariate model demonstrated that preoperative anaemia was an independent risk predictor for the occurrence of death in 30 days after CABG (B: 0.597; SE: 0.27; Wald: 5.2; OR: 1.82; 95% CI 1.09–3.04; p=0.022). In addition, we were able to verify that the addition of preoperative haemoglobin to EuroScore II resulted in a significantly higher predictive accuracy when compared to the predictive accuracy of the isolated score (AUCs: 0,732 vs 0.709; p=0.032).

Conclusions

Preoperative anaemia was an independent risk predictor for the occurrence of death in 30 days after CABG. We were also able to verify that the addition of the preoperative haemoglobin levels to EuroScore II resulted in a significantly higher predictive accuracy, improving the performance of the surgical risk model.

Funding Acknowledgement

Type of funding sources: None. Figure 1. Haemoglobin vs 30-day mortalityFigure 2. Predictive accuracies – EuroScore II

EuroScore II is the best predictive model for the off pump coronary artery bypass graft surgery

Background

Coronary artery bypass graft surgery (CABG) is the most common cardiac surgery performed in the world and a significant part of these surgeries are performed without cardiopulmonary bypass (off pump). Although none of the main surgical risk scores include pump use in their prediction model, the scores are widely used in risk stratification, including for patients who will be submitted to off pump CABG.

Purpose

To analyse and compare the predictive accuracy of EuroScore I, EuroScore II and STS Score for 30-day mortality after off pump CABG.

Methods

Single-centre cohort with 943 patients consecutively submitted to off pump CABG between January 2010 and December 2020. 31 baseline and operative variables were analysed. The primary outcome was the occurrence of death in the first 30 days after the surgery. Descriptive analysis, normality for quantitative data and univariate inference were performed to compare proportions and means between the survival group (n=930) and death group (n=13). Next, three logistic regression models were performed. Each of them had 30-day mortality as a dependent variable and one of the scores as an independent variable. The probabilities generated by the three models were saved and analysed by ROC curves. Thus, it was possible to assess the predictive accuracy of each of the scores. Finally, the values of the areas under the curves were compared using the DeLong test. The level of significance was 5% and the analysis was performed using the Python 3.0 programming language.

Results

The mean age of the general group was 63 years old and there was a predominance of male patients (68.4%). The means of the three evaluated risk scores were significantly higher in the Death group (p<0,05). This pattern confirmed the findings of higher prevalence of several comorbidities in the death group. The 30-day mortality rate was 1.37%. Through the analysis of regressions and the probabilities generated through them, it was possible to verify that the predictive accuracy of EuroScore II was significantly higher than that of the other two scores. While the predictive accuracy of EuroScore II was 77.3%, the accuracy of two other scores was in the range of 69% (AUC EsI: 0.697; AUC EsII: 0.773; AUC STS: 0.695; p=0.029).

Conclusion

EuroScore II seems to be the most adequate surgical risk score for the assessment of mortality risk of patients who will undergoing to off pump CABG. The score had a predictive accuracy of 77.3%, almost 8% more than the other two scores. Therefore, although EuroScore II does not include in its model the use of cardiopulmonary bypass, it has a satisfactory accuracy to be used in clinical-surgical practice. On the other hand, the EuroScore I and the STS Score showed predictive accuracy not adequate for this type of surgery.

Funding Acknowledgement

Type of funding sources: None. Predictive accuracies of risk scores

Results of on-pump and off-pump coronary artery bypass graft surgery in 30 days: an analysis by propensity score matching

Background

The results of coronary artery bypass graft surgery (CABG) performed with and without the support of cardiopulmonary bypass have already been widely discussed and studied, including through a few large randomized clinical trials. Despite the efforts, the findings of these studies still generate controversy and doubts about the outcomes achieved by the two techniques. One of the contested points is the heterogeneity of the degree of specialization in the off-pump technique in relation to the surgical groups that participated in the studies.

Purpose

To compare the results in 30 days of on-pump and off-pump CABG.

Methods

A single centre cohort with 1,767 patients undergoing isolated CABG was initially evaluated (January 2013 – December 2018). 397 patients undergoing off-pump CABG and 1,370 patients undergoing on-pump surgery were identified. To obtain two completely homogeneous study groups, a propensity score matching was applied. For this, a logistic regression model was built with the variable use of CPB support as dependent variable. In the group of independent variables, 14 baseline and operative characteristics were included. The probabilities generated for each patient were used as scores to establish the match. To establish a pair, it was necessary to have three squares after the comma, with the fourth decimal place being the tiebreaker criterion in the pairing. In this way it was possible to obtain 332 pairs (N=664). The paired groups, on and off-pump, were compared by descriptive and univariate analysis and later a logistic regression model was applied to identify possible risk predictors and to verify the impact of CPB support on 30-day mortality. The level of significance was 5% and the analysis was performed using Python 3.0.

Results

None of the 29 baseline and operative characteristics showed a significant difference between the groups, demonstrating a high degree of homogeneity obtained from the propensity score matching, which enabled a solid comparison between the incidences of outcomes in 30 days. None of the analysed outcomes showed any difference between the groups on and off-pump, including AMI, stroke, major reoperation and death (1.5% vs 2.4%; p=0.401). Through regression analysis it was possible to establish that the use of CPB was not an independent predictor of risk for the occurrence of death (p=0.246).

Conclusion

After matching by propensity score, patients who underwent surgery with and without CPB had similar incidences of 30-day mortality. In addition, it was possible to verify that the use of CPB was not an independent predictor of risk for the occurrence of death in 30 days.

Funding Acknowledgement

Type of funding sources: None. Propensity score adjustment by group30-day outcomes vs CABG technique

The non-muscle ADF/cofilin-1 controls sarcomeric actin filament integrity and force production in striated muscle laminopathies

Cofilins are important for the regulation of the actin cytoskeleton, sarcomere organization, and force production. The role of cofilin-1, the non-muscle-specific isoform, in muscle function remains unclear. Mutations in LMNA encoding A-type lamins, intermediate filament proteins of the nuclear envelope, cause autosomal Emery-Dreifuss muscular dystrophy (EDMD). Here, we report increased cofilin-1 expression in LMNA mutant muscle cells caused by the inability of proteasome degradation, suggesting a protective role by ERK1/2. It is known that phosphorylated ERK1/2 directly binds to and catalyzes phosphorylation of the actin-depolymerizing factor cofilin-1 on Thr25. In vivo ectopic expression of cofilin-1, as well as its phosphorylated form on Thr25, impairs sarcomere structure and force generation. These findings present a mechanism that provides insight into the molecular pathogenesis of muscular dystrophies caused by LMNA mutations.

Effect of the physicochemical properties of zinc oxide sources on their bioavailability in broilers

1. The bioavailability of a trace mineral source is related to its intestinal solubility (bioaccessibility), which in turn is determined by its physicochemical properties. It is still not clear which characteristics are more relevant in affecting solubility and bioavailability of mineral sources. Zinc oxide (ZnO) is a common feed additive used to supplement zinc in the diet of monogastric animals. However, different sources have shown variable responses on animal bioavailability.2. This study hypothesised that different sources of feed grade ZnO have various physicochemical features that lead to distinct bioavailability values. Feed grade ZnO samples collected from the feed industry worldwide were characterised for their physicochemical features and tested in broilers to allow bioavailability determined.3. A total of 135 male Cobb broiler chickens were fed a standard starter diet from day 1 after hatching up to d 7. At d 8, animals were allocated in individual cages and fed one of the following dietary treatments during 15 days: a basal diet with 23.5 ppm of zinc and seven test diets with supplemented ZnO or zinc sulphate (ZnSO₄) at 6 or 12 ppm.4. Different sources of ZnO showed an effect of solubility in the stomach and supplementation influenced total Zn levels in the ileum. The bioavailability of the different sources varied from 49% to 160% in relation to ZnSO₄. Aggregate size of particles seems to explain most of the variability in the bioavailability of the different sources tested in broilers. In conclusion, physicochemical properties of ZnO can partly explain the variability observed in terms of biological value.

Need for NAD+: Focus on Striated Muscle Laminopathies

Laminopathies are a heterogeneous group of rare diseases caused by genetic mutations in the LMNA gene, encoding A-type lamins. A-type lamins are nuclear envelope proteins which associate with B-type lamins to form the nuclear lamina, a meshwork underlying the inner nuclear envelope of differentiated cells. The laminopathies include lipodystrophies, progeroid phenotypes and striated muscle diseases. Research on striated muscle laminopathies in the recent years has provided novel perspectives on the role of the nuclear lamina and has shed light on the pathological consequences of altered nuclear lamina. The role of altered nicotinamide adenine dinucleotide (NAD⁺) in the physiopathology of striated muscle laminopathies has been recently highlighted. Here, we have summarized these findings and reviewed the current knowledge about NAD⁺ alteration in striated muscle laminopathies, providing potential therapeutic approaches.

Hutchinson-Gilford progeria syndrome: Rejuvenating old drugs to fight accelerated ageing

What if the next generation of successful treatments was hidden in the current pharmacopoeia? Identifying new indications for existing drugs, also called the drug repurposing or drug rediscovery process, is a highly efficient and low-cost strategy. First reported almost a century ago, drug repurposing has emerged as a valuable therapeutic option for diseases that do not have specific treatments and rare diseases, in particular. This review focuses on Hutchinson-Gilford progeria syndrome (HGPS), a rare genetic disorder that induces accelerated and precocious aging, for which drug repurposing has led to the discovery of several potential treatments over the past decade.

Cognitive Stimulation in Older Adults: An Innovative Good Practice Supporting Successful Aging and Self-Care

The project Cognitive Stimulation in Older Adults: Intervention on Cognitive Frailty and Promotion of Self-Care (in brief the ECOG project) arises in a context of worldwide demographic aging, and is fostered by the need to provide a sustainable solution to the progressive increase in the prevalence of age-related cognitive impairment. The main goal of the ECOG project is to promote active citizenship in old age through the empowerment for autonomy and self-care. Namely, the ECOG team is working on the development of evidence-based programs and tools that promote gains in health in cognitively frail and cognitively impaired older adults from the community. It is also working on the transfer of ECOG products to the practice of health and social care, promoting active involvement of geriatric care institutions in the implementation of the ECOG programs and tools, and ensuring appropriate training of professionals. Finally, the ECOG team is deploying a digital platform to reach out to the broadest audience possible and support the remote access and scaling up of the ECOG products. The impacts expected at an individual level include improvements in cognition, functionality, and autonomy of older adults, with simultaneous reduction of depressive symptomatology, and increase in quality of life of both person cared and his/her caregiver. Regarding societal gains, we anticipate an increase in life expectancy and significant postponement of institutionalization associated with geriatric problems. We also believe that the wide implementation of the ECOG products will reduce the costs of interventions for cognitively impaired citizens, contributing to sustainability and efficiency of health systems.

The Relation Between Parent Personality Traits and Children Psychopathology: A Pilot Study

Introduction

Personality plays a crucial role in a person's behavior, emotions and cognitive patterns and shows an important relationship with several variables such as marital status, mental disorders or parenting models. However, little is known about the relation between the parental Big Five personality traits (Neuroticism, Extraversion, Openness, Conscientiousness and Agreeableness) and children psychopathology regardless of the diagnostic of their offspring.

Objectives

To analyze the correlation between parents’ Big Five personality traits and their children categorical diagnosis and psychopathology score.

Methods

The authors recruited 105 children in the outpatient unit of the child and adolescent psychiatry department of the pediatric hospital of Coimbra and their 117 parents. Parents were assessed using the Portuguese version of Neo Five-Factor Inventory and children psychopathology scores were rated by child and adolescent psychiatrists using the Brief Psychiatric Rating Scale for Children.

Results

Forty-nine children (46.7%) were male and 56 (53.3%) were female, with a mean age of 12.5 ± 3.2 and 13.6 ± 2.9, respectively. Twenty parents (17.1%) were male and 97 (82.9%) were female, with a mean age of 45.8 ± 4.1 and 41.2 ± 5.4, respectively. After excluding children diagnosed with Schizophrenia, bipolar disorder, autism spectrum disorders and intellectual developmental disorder, Pearson's correlation coefficients were significant between: parents’ neuroticism and children Uncooperativeness (0.211), Manipulativeness (0.238), Hallucinations (0.257), Sleep difficulties (0.296) and Disorientation (0.204); parents’ agreeableness and children hostility (−0.228); and parent's conscientiousness and children disorientation (−0.231), all P < 0.05.

Conclusions

These preliminary results suggest that parental personality traits may influence psychopathological outcomes in their children. Data are still being collected to clarify the nature of this relationship.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Monitoring of the crystallization of zeolite LTA using Raman and chemometric tools

The synthesis of zeolite LTA was monitored using Raman spectroscopy. The PCA shows 3 stages of the reaction: amorphous reactants, the nucleation process and crystallization.

Impact of probing the reproductive tract during early pregnancy on fertility of beef cows

This short communication reports the impact of endometrial biopsies, uterine flushings and follicular fluid aspiration procedures at day 6 post artificial insemination (AI) on pregnancy rates. In Experiment 1, cows were timed AI (TAI) and assigned to the following treatment groups: control (n = 37), uterine flushing (n = 35) and endometrial biopsy (n = 38). On day 30 post AI, pregnancy rates were 40.5%, 33% and 28.5%, respectively (p > 0.1). Pregnancy rate on day 60 was lower (p < 0.004) in flushed cows than in the controls. In Experiment 2, oestrus was detected and cows were assigned to flushing (n = 32) or biopsy (n = 33) treatments 6 days after AI, which resulted in pregnancy rates of 31% and 36%, respectively (p > 0.1). In Experiment 3, cows were, 6 days after TAI, randomly assigned to the following treatments: control (n = 84) or aspiration of the largest follicle (n = 73). Pregnancy rates on day 30 post AI were 63.5% for the control group and 53% for the aspirated group (p > 0.1). In conclusion, uterine flushing and endometrial biopsy negatively affect pregnancy rates, but neither procedure can be considered to be incompatible with pregnancy maintenance. Follicular aspiration during pregnancy does not interact with pregnancy success. The amount and quality of samples obtained are compatible with the use of cellular and molecular analysis of uterine variables from cows that failed or succeeded on maintaining pregnancy.

18 EFFECT OF GnRH TREATMENT IN LH SECRETION IN INTACT AND OVARIECTOMIZED NELLORE HEIFERS

The gonadotropin-releasing hormone (GnRH) and its analogues become control reproductive function in farm animals. The GnRH agonist (GnRHa), which is used in veterinary practice, has a longer half-life and higher affinity to GnRH receptors than the native decapeptide. GnRH or GnRHa effects depend on the species, dose, route, and the moment of administration. As Nellore is the main bovine breed in Brazil, corresponding to 70% of Brazilian herds, more studies on its reproductive physiology are needed. The objective was to study luteinizing hormone (LH) secretion in intact (I, n = 4) and ovariectomized (Ov, n = 4) prepubertal Nellore heifers (18 months) after gonadorelin acetate administration (25 μg, iv; Lecirelina, Gestran Plus, ARSA S.R.L., Buenos Aires, Argentina) from samples collected every 15 min for 10 h. LH was quantified by RIA, with sensitivity of 0.03 ng mL-1 and CV of 11%. Maximum LH amplitude was considered as the peak for each period. Peaks were identified as an increase 2 times higher than intraassay CV and involving at least 3 samples. The time for the highest peak occurrence was determined by GraphPad Prism program (Prism 3.00 for Windows, GraphPad Software, San Diego CA, USA). Results were compared by the ANOVA followed by t-test either paired or not using GraphPad InStat (3.06 version). After GnRH treatment, maximum LH peak amplitude was higher in Ov (12.48 ± 1.41 ng mL-1) (P ≤ 0.05) than in intact heifers (6.42 ± 1.30 ng mL-1), but there was no significant difference (P ≥ 0.05) on LH pulse frequency, with only one peak in both groups during the 10-h period. Although there was a small delay in peak occurrence in I (63.75 ± 21.48 min) compared with Ov heifers (45 ± 16.43 min), there was no difference (P ≥ 0.05) between groups. The results suggested a higher hypothalamus sensitivity to GnRH in absence of gonadal steroids or a higher LH storage during the hypergonatropism period. Support by FAPESP (São Paulo, Brazil); fellowship from CAPES.

Snake bites by the jararacuçu (Bothrops jararacussu): clinicopathological studies of 29 proven cases in São Paulo State, Brazil

The jararacuçu, one of the most dreaded snakes of Brazil, southern Bolivia, Paraguay and northeastern Argentina, is a heavily-built pit viper which may grow to a length of 2.2 m. Up to 1000 mg (dry weight) of highly-lethal venom may be milked from its venom glands on a single occasion. It has accounted for 0.8% to 10% of series of snake bites in São Paulo State, Brazil. We examined 29 cases of proven jararacuçu bites recruited over a 20-year period in two São Paulo hospitals. Severe signs of local and systemic envenoming, (local necrosis, shock, spontaneous systemic bleeding, renal failure) were seen only in patients bitten by snakes longer than 50 cm; bites by shorter specimens were more likely to cause incoagulable blood. Fourteen patients developed coagulopathy, six local necrosis (requiring amputation in one) and five local abscesses. Two became shocked and four developed renal failure. Three patients, aged 3, 11 and 65 years, died 18.75, 27.75 and 83 h after being bitten, with respiratory and circulatory failure despite large doses of specific antivenom and intensive-care-unit management. In two patients, autopsies revealed acute renal tubular necrosis, cerebral oedema, haemorrhagic rhabdomyolysis at the site of the bite and disseminated intravascular coagulation. In one survivor with chronic renal failure, renal biopsy showed bilateral cortical necrosis; the patient remains dependent on haemodialysis. Effects of polyspecific Bothrops antivenom were not impressive, and it has been suggested that anti-Bothrops and anti-Crotalus antivenoms should be given in combination.