Testicle histology of the Epicrates cenchria: a morphological and reproductive biology analysis

ABSTRACT The lack of information about anatomy, physiology and reproductive biology in many snake species makes the understanding of these free-living animals’ reproduction and reproductive biotechnics application in captivity difficult. The present study aims to evaluate the Epicrates cenchria’s testicle morphology and correlate these findings with environmental aspects and reproductive biology. The testicles of five specimens of E. cenchria were histologically evaluated, and it was possible to observe seasonality in sperm production, with the presence of mature spermatozoa in the wettest and warmest periods of the year, as well as the highest testicular volume in these periods. Correlating these findings with that reported in the literature on copulation period presupposes a prenuptial (or associated) pattern in E. cenchria.

Time course of epigenetic modulation in response to concurrent exercise training in patients with schizophrenia

This study aimed to investigate the short and long-term effects of concurrent exercise training on anthropometric variables, HDCA2 activity and cortisol levels of individuals with schizophrenia (SZ). Therefore, 10 patients were submitted to the program (endurance and strength exercises in the same session, 60 min of duration, three times a week) and blood samples were collected before, 30 days and 180 days after the intervention started. Exercise training reduced the body mass index and body mass after 180 days of the intervention. A significant decrease on HDAC2 activity was found 180 days after intervention compared to before the intervention. The cortisol levels remained unchanged in any evaluated time-points. The concurrent exercise training was able to modulate HDAC2 activity in mononuclear cells and improve anthropometric variables in a time-dependent manner in patients with SZ.

Electrocardiographic imaging a valid tool or an inaccurate toy?

Funding Acknowledgements

Type of funding sources: Private hospital(s). Main funding source(s): Learning Health

Background and aim

Electrocardiographic imaging (ECGI) is capable of performing an activation map with a single beat. However, previous studies using the epicardial-only system, have suggested a bad accuracy for the assessment of the epicardial breakthrough. Recent systems using endo-epicardial analysis have shown promising results. The aim of this study was to assess the accuracy and reproducibility of two endo-epicardial ECGI systems using different cardiac sources one based on the extracellular-potential, and the other on the equivalent double layer model, respectively the AMYCARD (EP Solutions SA, Switzerland) and VIVO (Catheter Precision, NJ USA) systems.

Methods

We studied 11 consecutive patients referred for ablation of frequent idiopathic premature ventricular contractions at our center that had an ECGI performed using both systems on the same day. The AMYCARD system uses a dense array of body-surface electrocardiograms with up to 224 leads and VIVO uses just the 12-leads ECG. Both systems use a patient-specific heart torso geometry obtained with a CT-scan or cardiac magnetic resonance. The localisation of the PVCs based on ECGI was done using a segmental model with 22 segments on the left ventricle, to include the classical 17 segment model plus the aortic cusps and the papillary muscles, and 12 segments on the right ventricle including 4 on the right ventricular outflow tract (RVOT): (anterior, lateral, right septum and left septum). A perfect match was defined as a predicted location within the same anatomic segment, whereas a near match as a predicted location within the same segment or a contiguous one.

Results

The median (Q1-Q3) number of leads used for the AMYCARD was 131 (118-144). Seven patients underwent ablation and in 4 ablation is pending. The predicted locations and the ablation site are depicted on the Table. We found a perfect match between both systems in 73% (Figure) and near match in 91% of cases. In patients that underwent ablation the systems localised the site of origin of the PVCs within the same segment or the contiguous segment in all patients with VIVO and in six out of seven with AMYCARD.

Conclusions

ECGI is an accurate diagnostic tool with reproducible results regardless the cardiac source used for analysis.

A cardiac magnetic resonance myocardial strain patterns analysis in left bundle branch block

Funding Acknowledgements

Type of funding sources: None.

Introduction

Recently, a classification with four types of septal longitudinal strain patterns was described using a speckle tracking based strain analysis in echocardiography suggesting pathophysiological continuum of LBBB-induced LV remodeling. Little data exist on feature tracking cardiac magnetic resonance (FT-CMR) in LBBB patients, and whether such patterns could be reproduced in CMR is not established yet.

Purpose

In this study, we aimed to: 1) Assess and reproduce the new strain patterns classification by CMR and 2) Evaluate its association with LV remodeling and myocardial scar in a LBBB cohort.

Methods

Single center registry which included LBBB patients with septal flash (SF) referred to CMR to assess the structural cause of LV dysfunction. LBBB was defined according to Strauss criteria as strict LBBB, non-strict LBBB or nonspecific LV conduction delay.

A semi-automated FT-CMR was used to quantify myocardial strain and detect the four septal longitudinal and radial strain patterns, according to the recent classification (LBBB-1 through LBBB-4) – Figure. Extent of SF was visually scored as mild, moderate, or prominent.

Results

A total of 115 patients were included (mean age 66±11 years; 57% men; 38% with ischemic heart disease). Median duration of QRS was 150± 26ms and majority of the patients (n=90, 78%) were classified as strict LBBB.

In longitudinal strain analyses LBBB-1 was observed in 23 (20%), LBBB-2 in 37 (32.1%), LBBB-3 in 25 (21.7%), and LBBB-4 in 30 (26%) patients. Patients at higher LBBB stages (longitudinal or radial pattern) had more prominent septal flash, greater LV volumes, lower LV ejection fraction and lower absolute global longitudinal, circumferential and radial strain values compared with patients in less advanced stages (p < 0.05 for all) - table.

There was no difference between patterns in clinical characteristics, ischemic etiology, QRS duration and time delay between septal and lateral LV wall.

Late gadolinium enhancement (LGE) was found in 63 patients (54.8%), with a septal location in 34 (29.6%) patients, lateral in 4 (3.5%) patients, septal and lateral in 11 (9.6%) patients. Furthermore, no difference was found for LGE presence, distribution or location between the four strain patterns.

Conclusions

Among patients with LBBB, our study found a good association between longitudinal and radial strain patterns with the degree of LV remodeling and LV dysfunction by FT-CMR analysis. Additionally, myocardial fibrosis didn’t seem to interfere with the staged LBBB classification.

Late gadolinium enhancement is a strong predictor of life threatening arrhythmias in patients with non-ischemic dilated cardiomyopathy undergoing ICD implantation for primary prevention of sudden card

Funding Acknowledgements

Type of funding sources: None.

Background

The usefulness of implantable cardioverter defibrillators (ICD) for primary prevention of arrhythmic sudden cardiac death (SCD) in patients with non-ischemic dilated cardiomyopathy (DCM) has been questioned. Efforts to improve risk stratification have included scores such as the ‘MADIT-ICD benefit score’, and the use of late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR).

The purpose of this study was to evaluate the potential usefulness of these two tools to assess the risk of life-threatening arrhythmias in patients with non-ischemic DCM undergoing ICD implantation for primary prevention of SCD.

Methods

We conducted a single-center retrospective study of consecutive patients who underwent contrast-enhanced CMR before ICD implantation for primary prevention of SCD. Patients with ischemic cardiomyopathy were used as reference. Patients with non-dilated cardiomyopathies were excluded.

The arrhythmic component of the MADIT-ICD benefit score (VT/VF score) was calculated for each patient, and considered high if ≥ 7, as recommended.

The primary endpoint was the occurrence of SCD or life-threatening arrhythmias (VF or VT >200 bpm). Follow-up was performed by device interrogation in all patients except those who suffered SCD.

Results

A total of 151 patients (93 ischemic, mean age 62±13 years, 75% male) with mean left ventricular ejection fraction (LVEF) of 27±8% were included. Overall, 72% (n=67) ischemic and 45% (n=26) non-ischemic patients had scores ≥ 7 and were considered high-risk. LGE was present in all patients with ischemic cardiomyopathy, and in 76% (n=44) of patients with non-ischemic DCM.

During a median follow-up of 21 (8-38) months, 21 patients (13.9%, 11 ischemic and 10 non-ischemic) met the primary endpoint.

Overall, the event-free survival of non-ischemic patients was similar to that of ischemic patients (log rank p=0.269) – Fig 1A. In patients with non-ischemic DCM, there were 7 arrhythmic events (26.9%) in those with MADIT-ICD VT/VF scores ≥7, and 3 events (9.4%) in those with scores <7 (log rank p= 0.104) – Fig 1B.

In the same population, there were 10 arrhythmic events (23%) in patients with LGE, but no events in patients without LGE (log rank p=0.036) – Fig 1C.

LVEF was similar in patients with and without arrhythmic events (26±8% vs. 27±7%, p=0.717), and in those with and without LGE (26±7% vs. 28±9%, p=0.342).

Conclusion

The presence of LGE is a strong predictor of life threatening arrhythmias in patients in non-ischemic DCM undergoing ICD implantation for primary prevention, seemingly outperforming the clinical MADIT-ICD benefit score.

The peri-infarct gray zone of myocardial fibrosis is a better predictor of ventricular arrhythmias than dense core fibrosis in patients with previous myocardial infarction

Funding Acknowledgements

Type of funding sources: None.

Background

Current sudden cardiac death (SCD) risk stratification relies heavily on left ventricular ejection fraction (LVEF), but markers to refine risk assessment are needed. Dense core fibrosis (DCF) and peri-infarct "gray zone" of myocardial fibrosis (GZF) on late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) have been proposed as potential arrhythmogenic substrates. The aim of our study was to determine whether DCF and GZF could predict the occurrence of ventricular arrhythmias in patients with previous myocardial infarction.

Methods

We performed a single centre retrospective study enrolling consecutive patients with previous myocardial infarction undergoing CMR before implantable cardioverter-defibrillator (ICD) implantation. Areas of LGE were subdivided into "core" DCF and "peri-infarct" GZF zones based on signal intensity (>5 SD, and 2-5 SD above the mean of reference myocardium, respectively).

The primary endpoint was a composite of sudden arrhythmic death, appropriate ICD shock, ventricular fibrillation (VF), or sustained ventricular tachycardia (VT) as detected by the device.

Results

A total of 88 patients (median age 61 years [IQR 54-73], 84% male, median LVEF 30% [IQR 23-36%], 14% secondary prevention) were included. During a median follow-up of 23 months [IQR 9-38], 13 patients reached the primary endpoint (10 appropriate ICD shock, 2 sustained VT or VF, and 1 sudden arrhythmic death). Patients who attained the primary endpoint had similar DCF (30.4g ± 14.7 vs. 28.0g ± 15.3; P = 0.601) but a greater amount of GZF (18.1g ± 9.6 vs. 11.9g ± 6.7; P = 0.005). On univariate analysis, GZF was associated with the composite endpoint (HR: 1.09 per gram; 95%CI: 1.02-1.15; P = 0.006), whereas DCF was not (HR: 1.01 per gram; 95%CI: 0.98-1.05; P = 0.571). After adjustment for LVEF, GZF remained independently associated with the primary endpoint (adjusted HR: 1.06 per gram; 95% CI: 1.01-1.12; P = 0.035). Decision tree analysis identified 11.9g of GZF as the best cut-off to predict life-threatening arrhythmic events. The primary endpoint occurred in 11 out of the 35 patients (31.4%) with GZF ≥11.9g, but in only 2 of the 53 patients (3.8%) with GZF <11.9g – Figure.

Conclusions

The extent of peri-infarct GZF seems to be a better predictor of ventricular arrhythmias than DCF. This parameter may be useful to identify a subgroup of patients with previous myocardial infarction at increased risk of life-threatening arrhythmic events.

Assessment of activation duration across the right ventricular outflow tract in patients with premature ventricular contractions using noninvasive electrocardiographic mapping: a validation study

Funding Acknowledgements

Type of funding sources: Private hospital(s). Main funding source(s): Learning Health

Introduction

Previous studies have reported that wavefront propagation speed across the right ventricular outflow tract (RVOT) can distinguish premature ventricular contractions (PVCs) with a RVOT origin from PVCs with a left ventricular outflow tract (LVOT) origin.

Aim

Validate the non-invasive electrocardiographic mapping (ECGI) for assessment of RVOT activation duration (AD) during PVCs and assess its value as a predictor of the origin of the PVCs.

Methods

We studied 18 consecutive patients, 8 males, median age 55 (35-63) years that underwent ablation of frequent (> 10.000 per 24 h) idiopathic PVCs with inferior axis, that had and an ECGI performed before ablation and the RVOT mapped in PVC. The ECGI was performed with the Amycard system, and invasive mapping was performed with the Carto or Ensite system. Isochronal activation maps of the RVOT in PVC were obtained with the activation direction method (ADM) of the ECGI, and with the Carto and Ensite systems. Total RVOT AD was measured as the time interval between the earliest and the latest activated region. Agreement between the two methods was performed using a Bland-Altman plot and linear regression . The cutoff value of AD to predict PVC origin was calculated with ROC curve.

Results

PVCs originated from the RVOT in 11 (61%) patients. The median (Q1-Q3) RVOT AD measured with ECGI was 54 (39-68) ms and with invasive map 57 (36-70) ms. The agreement between both methods was good with an R2 of 0.747, p<0.0001. Figure displays the Bland-Altman plot (panel A), the linear regression plot (panel B). and two examples of the ECGI isochronal map (panel C). The AD was significantly higher in PVCs from the RVOT vs LVOT, both with ECGI and Carto, respectively 62 (58-73) vs 37 (33-40) ms, p<0.0001 and 68 (60-75) vs 34 (30-40) ms, p<0.0001. The cutoff value of 43 ms for AD measured with ECGI, predicted the origin of the PVCs with a sensitivity and specificity of 100%.

Conclusions

We found good agreement between ECGI and Carto. The AD obtained with ECGI was accurate to predict the origin of the PVCs.

Provas de Provocação Oral com Alimentos: Um Risco Necessário

INTRODUÇÃO: A prevalência da alergia alimentar tem vindo a aumentar nos últimos anos. O seu diagnóstico é difícil, dadas as diferentes apresentações e a existência de inúmeros fatores confundidores. A prova de provocação oral (PPO) é o gold standard para diagnóstico de alergia alimentar, no entanto não é isenta de riscos. Os nossos objetivos foram a caracterização de população submetida a prova de provocação oral a alimentos em uni- dade de Imunoalergologia Pediátrica. Assim como, a avaliação do risco inerente às PPO com alimentos e identificação de fatores de risco que podem levar à necessidade de utilizar cateter periférico.MÉTODOS: Estudo descritivo, retrospetivo de provas de provocação oral com alimentos realizadas numa unidade de Imunoalergologia Pediátrica de um hospital nível II entre janeiro de 2018 e dezembro de 2020.RESULTADOS: Foram analisadas 90 PPO a diferentes alimentos: leite (39), peixe (14), ovo (13), frutos secos (6), fruta fresca (6), marisco (6), moluscos (6), amendoim (3) e cacau (1). As manifestações iniciais de alergia alimentar foram diversas, sendo as mais frequentes: urticária/angioedema (24,4%, n=22) e anafilaxia (21%, n=19). Trinta e dois por- cento das provas de provocação orais foram positivas; 51,7% dos doentes com PPO positiva tinha antecedentes de asma, rinite ou dermatite atópica. Durante a realização da PPO ocorreram 8 anafilaxias, 50% das quais em provas de provocação oral ao leite.CONCLUSÃO: As provas de provocação oral realizadas em ambiente hospitalar com supervisão especializada são seguras, no entanto, existem riscos inerentes à sua realização. Na nossa amostra, cerca de um terço dos doentes teve uma prova de provocação oral positiva, no entanto, não foi possível identificar fatores de risco para a necessidade de utilização de cateter venoso periférico. Poderão ser realizados estudos prospetivos com este objetivo.

Prognostic significance of peak atrial longitudinal strain in patients with functional mitral regurgitation

Funding Acknowledgements

Type of funding sources: None.

Background

Chronic mitral regurgitation has been shown to promote left atrial (LA) dysfunction and remodeling. However, the significance of LA dysfunction in this setting has not been fully investigated. The aim of our study was to assess the prognostic impact of peak atrial longitudinal strain (PALS), a surrogate of LA function, in a cohort of patients with LV systolic dysfunction and functional mitral regurgitation (FMR).

Methods

Patients with at least mild FMR and reduced LVEF (< 50%) under optimized medical therapy who underwent transthoracic echocardiography between 2010 and 2018 were retrospectively identified at a single-centre. FMR grading was undertaken according to the new 2021 valvular guidelines. PALS was assessed by 2D speckle tracking in apical 4-chamber view (as per EACVI current recommendations). Cox proportional hazards regression was applied for univariable and multivariable analysis to investigate the association between clinical and echocardiographic parameters, namely PALS, and all-cause mortality.

Results

A total of 307 patients (median age 70 years, 77% male) were included. Median LVEF was 35% (IQR: 27 – 40%) and median mitral regurgitant volume was 25mL (IQR: 14 – 34mL). According to the new ESC 2021 valvular guidelines, 32 patients had severe FMR (10%). During a median follow-up of 3.5 years (IQR 1.4 – 6.6), 148 patients died. Median PALS was 14% (IQR 8 – 20%). The unadjusted mortality incidence per 100 persons-years increased with progressively lower values of PALS (figure 1). On ROC curve analysis, the best PALS cut-off value associated with mortality was < 15%. Kaplan-Meier survival curves according to FMR severity and PALS > or < 15% are depicted in figure 2. PALS remained independently associated with all-cause mortality on multivariable analysis (adjusted hazard ratio [aHR]: 0.94; 95%CI: 0.90 – 0.98; p = 0.004) even after adjustment for several (n = 14) clinical and echocardiographic confounders.

Conclusion

In a cohort of patients with reduced LVEF and functional mitral regurgitation, peak atrial longitudinal strain was associated with all-cause mortality. Abstract Figure 1  Abstract Figure 2

Migration and season explain tick prevalence in Brazilian birds

Neotropical birds are mostly parasitized by immature ticks and act as reservoir hosts of tick-borne pathogens of medical and veterinary interest. Hence, determining the factors that enable ticks to encounter these highly mobile hosts and increase the potential for tick dispersal throughout migratory flyways are important for understanding tick-borne disease transmission. We used 9682 individual birds from 572 species surveyed across Brazil and Bayesian models to disentangle possible avian host traits and climatic drivers of infestation probabilities, accounting for avian host phylogenetic relationships and spatiotemporal factors that may influence tick prevalence. Our models revealed that the probability of an individual bird being infested with tick larvae and nymphs was lower in partial migrant hosts and during the wet season. Notably, infestation probability increased in areas with a higher proportion of partial migrant birds. Other avian ecological traits known to influence tick prevalence (foraging habitat and body mass) and environmental condition that might constrain tick abundance (annual precipitation and minimum temperature) did not explain infestation probability. Our findings suggest that migratory flyways harbouring a greater abundance of migrant bird hosts also harbour a higher prevalence of immature ticks with potential to enhance the local transmission of tick-borne pathogens and spread across regions.

Prevalence of cognitive impairment before treatments for prostate cancer

Background/Objective

Up to 30% of patients with cancer may present cognitive impairment (CI) before treatment but data are scarce regarding prostate cancer (PCa). We aim to estimate the prevalence of CI in patients with PCa, before cancer treatment.

Methods

Between February 2018 and April 2021, the NEON-PC cohort included 609 patients with a recent PCa diagnosis to be treated at Instituto Português de Oncologia do Porto. Previous history of chemotherapy, radiotherapy, androgen deprivation therapy, and neurologic or psychyatric conditions impairing cognitive performance were exclusion criteria. The Montreal Cognitive Assessment (MoCA) was used to assess cognitive performance before any treatment for PCa. Participants with a MoCA at least 1.5 SD below age- and education-specific norms were considered to have probable cognitive impairment (PCI) and were proposed for a comprehensive neuropsychological (NP) assessment. Participants scoring <2.0 SD age-corrected norms in at least one cognitive test, or < 1.5 SD age-corrected norms in ≥ 2 cognitive tests were classified as having CI. Data from the population-based cohort EPIPorto (n = 351 men, evaluated in 2013-2015) were used for comparison.

Results/Discussion

Prevalence of PCI was 17.4% in the EPIPorto and 15.1% in the NEON-PC cohort (age- and education-adjusted OR = 1.02,95% confidence interval: 0.70,1.50). NP assessment was performed in 65 patients with PCa: 38.5% had normal cognitive function; 7.7% had a light deficit (<1.0 SD of age-corrected norms in ≥ 1 cognitive tasks); and 53.9% had CI.

Conclusions

PCI was as frequent in patients recently diagnosed with PCa as in the general population. Prevalence of CI was lower than in previous reports, which may be explained by differences in the assessment and definition of CI and of the type of cancer.

Funding

POCI-01-0145FEDER-032358;PTDC/SAU-EPI/32358/2017;UIDB/4750/2020; SFRH/BD/119390/2016

Key messages

Patients with prostate cancer and the general population had similar odds of having a score below normative values in the MoCA. Differences in the prevalence of CI between this study and others suggest that the type of cancer may affect patients’ cognitive performance differently, which deserves further confirmation.

Gender (in)equality in the labor market: a case study of Environmental Health Officers

 

The female gender has been discriminated, as it is considered inferior, in relation to the male. In the health sector, although the proportion of women has increased, the occupational segregation still persist. The mortality rate reduction, is largely due to the unrecognized contribution of women. Segregation manifests itself in a variety of ways, ranging from a limited set of opportunities to wage disparities. It's paradox since, even in “mostly female” jobs, like Environmental Health (EH), the minority of men usually have an “escalator”, reaching leadership quickly. This abstract addresses the gaps in the challenges of gender inequality in EH, since the fact that women are a health driver is been ignored. We seek to know the attitudes and opinions of the Environmental Health Officers (EHO), about: identity centralities; discrimination in society, profession and organization. This study is observational, descriptive, cross-sectional and level of knowledge II. The target population comprises by EHO (women and men). The sample design adopted was non-probabilistic and technical for convenience. The information was collected through a digital questionnaire. On average, men presented a more conservative view, compared to the female, associating women to mother's role and housewives, revealing a certain conservatism. There was, therefore, a prevalence of gender stereotypes. A correlation was found, about the organizational discrimination, since who revelead a minor difference between genders, were also those who presented a lower index of stereotypes. In other words, an organization that provides a life balance, leads its workers to desconstruct social and professional stereotypes. In conclusion, a gender diagnosis is essential to identify asymmetries and to start the change. This study identifies and analyzes inequalities in the EH area. Most of the results found follow the literature and are relevant to define future strategies.

Key messages

Global health organizations are starting to recognize the importance of gender challenges as a way to achieve universal health coverage which facilitates a new narrative. Recent data from the International Labor Organization estimate that gender pay gaps in the health sector are higher compared to other sectors, although women hold a large number of health jobs.

Androgen deprivation therapy and cognitive decline in the NEON-PC study

Background/Objective

Androgen deprivation therapy (ADT) has been associated with cognitive decline, but results have been heterogenous. We describe changes in cognitive performance in patients with prostate cancer (PCa), according to treatment with ADT, during the 1st year after PCa diagnosis.

Methods

Between February 2018 and March 2021, 348 patients with PCa treated at the Instituto Português de Oncologia do Porto were evaluated with the Montreal Cognitive Assessment (MoCA), before treatment and after one year (1y). ADT was used in 183 participants, and 165 were treated without ADT (total prostatectomy, radiotherapy, brachytherapy, active surveillance). Cognitive decline was defined as the decrease in MoCA from baseline to the 1y-evaluation below 1.5SD of the distribution of the MoCA variation in the whole cohort. Participants scoring below age- and education-based normative reference values in MoCA were considered to have probable cognitive impairment (PCI). Multivariate logistic regression was used to estimate age- and education-adjusted OR (aOR) of the association between ADT and cognitive decline/incident PCI.

Results/Discussion

PCI was observed in 12.4% of the patients at baseline. Mean MoCA scores increased from baseline to the 1y-evaluation (22.4 vs. 22.9, p = 0.001), and 51.2% of PCI cases at baseline had normal MoCA scores at 1y. Cognitive decline was most frequent in the ADT group (9.3% vs. 3.6%, p = 0.034), although the aOR was 2.44 (95%CI:0.89-6.71). The 1yr cumulative incidence of PCI was 10.4% (95%CI:6.2%-16.2%) in the ADT-group and 2.8% (95%CI:0.8-%-7.1%) in the non-ADT group [aOR=3.15 (95%CI:0.97-10.25)].

Conclusions

ADT was associated with a decrease in the cognitive performance of PCa patients during the 1st year after diagnosis. The completion of the 1y-evaluation in the whole cohort (n = 600) is needed to confirm these preliminary results.

Funding

POCI-01-0145FEDER-032358;PTDC/SAU-EPI/32358/2017; UIDB/4750/2020;SFRH/BD/119390/2016

Key messages

Half of the cases with cognitive impairment at baseline improved at one-year. Patients treated with ADT seem to be affected by cognitive decline more frequently.