P724 The mysteries of sinus of Valsalva

Sinus of Valsalva aneurysms are a rare pathology that can be clinically silent during years and/or become suddenly symptomatic. We described 3 cases with different clinical presentation, complications and surgical treatment.

A 26-year-old male, competitive cyclist was admitted with a 1.5 month history of fatigue, palpitations, and nocturnal cough and sweating. At physical examination he was apyretic, blood pressure 157/49mmHg and radial pulse 96 bpm; jugular vein engorgement and continuous heart murmur, were noticed. Blood samples only revealed a mild raised BNP. EKG showed sinus tachycardia and right intraventricular conduction delay and the transthoracic echocardiography (TTE) revealed high velocity systolic-diastolic shunt (image) between a non-dilated right coronary sinus (RCS) and the right atrium (RA); moderate left ventricle dilation, severe right atrium and mild right ventricle enlargement with mild pulmonary hypertension and normal biventricular systolic function. He was referred to angioCT that showed a large communication between a non-dilated RCS and RA with signs of right ventricular overload. He was submitted to surgery, where ruptured aneurysm sac was found. Fistula closure, aneurysm sac suture and tricuspid annuloplasty were performed.

A 45-year-old male asymptomatic, with no relevant medical background went to a Cardiology consultation after detection of a holossistolic murmur in the physical exam. EKG showed sinus rhythm arrhythmia with a nonspecific intraventricular conduction delay and the TTE revealed a communication between a dilated noncoronary sinus (NCS) and RA; the biventricular systolic function was normal. He was referred to angioCT which confirmed the diagnosis. He was submitted to surgery where an exeresis and closure of the fistula was performed.

A 38-year-old male with no relevant medical background was admitted to emergence room for an intermittent anterior thoracic pain radiating to the neck (2 days of evolution). The EKG showed sinus tachycardia, incomplete right bundle branch block and the high-sensitivity troponin assays were negative. The TTE revealed severe sinus of Valsalva aneurysm, particularly of the NCS with mild aortic regurgitation. The patient performed transesophageal echocardiography and angioCT which excluded an acute aortic syndrome. He was oriented to surgery where a contained rupture of the RCS and a non-visualization of the ostium right coronary artery were detected, suggesting an intimal dissection. The patient was submitted to Bentall procedure and a bypass with internal mammary artery to right coronary artery.

In spite of the unclear etiology, all the cases had a good clinical and echocardiographic evolution at follow-up. The difficulty in making a timely diagnosis is related to the variability of clinical presentation and the need of high clinical suspicion. Echocardiography and angioTC have demonstrated its value, in providing a prompt diagnosis and appropriate management guidance.

Abstract P724 Figure. Ruptured aneurysm sac and fistula

Nucleolin is expressed in patient-derived samples and glioblastoma cells, enabling improved intracellular drug delivery and cytotoxicity

One of the major challenges in Glioblastoma (GBM) therapy relates with the existence of glioma stem-like cells (GSCs), known to be chemo- and radio-resistant. GSCs and non-stem GBM cells have the ability to interchange, emphasizing the importance of identifying common molecular targets among those cell sub-populations. Nucleolin overexpression has been recently associated with breast cancer sub-populations with different stem-like phenotype. The goal of this work was to evaluate the potential of cell surface nucleolin as a target in GBM cells. Different levels of nucleolin expression resulted in a 3.4-fold higher association of liposomes targeting nucleolin (functionalized with the nucleolin-binding F3 peptide) in U87, relative to GBM11 glioblastoma cells. Moreover, nucleolin was suggested as a potential marker in OCT4-, NANOG-positive GSC, and in the corresponding non-stem GBM cells, as well as in SOX2-positive GSC. Doxorubicin delivered by liposomes targeting nucleolin enabled a level of cytotoxicity that was 2.5- or 4.6-fold higher compared to the non-targeted counterparts. Importantly, an overexpression of nucleolin was also observed in cells of patient-derived samples, as compared with normal brain. Overall, these results suggested nucleolin as a therapeutic target in GBM.

Prognostic stratification of adult primary glioblastoma multiforme patients based on their tumor gene amplification profiles

Several classification systems have been proposed to address genomic heterogeneity of glioblastoma multiforme, but they either showed limited prognostic value and/or are difficult to implement in routine diagnostics. Here we propose a prognostic stratification model for these primary tumors based on tumor gene amplification profiles, that might be easily implemented in routine diagnostics, and potentially improve the patients management. Gene amplification profiles were prospectively evaluated in 80 primary glioblastoma multiforme tumors using single-nucleotide polymorphism arrays and the results obtained validated in publicly available data from 267/347 cases. Gene amplification was detected in 45% of patients, and chromosome 7p11.2 including the EGFR gene, was the most frequently amplified chromosomal region – either alone (18%) or in combination with amplification of DNA sequences in other chromosomal regions (10% of cases). Other frequently amplified DNA sequences included regions in chromosomes 12q(10%), 4q12(7%) and 1q32.1(4%). Based on their gene amplification profiles, glioblastomas were subdivided into: i) tumors with no gene amplification (55%); ii) tumors with chromosome 7p/EGFR gene amplification (with or without amplification of other chromosomal regions) (38%); and iii) glioblastoma multiforme with a single (11%) or multiple (6%) amplified DNA sequences in chromosomal regions other than chromosome 7p. From the prognostic point of view, these amplification profiles showed a significant impact on overall survival of glioblastoma multiforme patients (p>0.001). Based on these gene amplification profiles, a risk-stratification scoring system was built for prognostic stratification of glioblastoma which might be easily implemented in routine diagnostics, and potentially contribute to improved patient management.

Amniotic fluid lactic acid and matrix metalloproteinase-8 levels at the time of fetal surgery for a spine defect: association with subsequent preterm prelabour rupture of membranes

OBJECTIVE

In utero fetal surgery to correct incomplete closure of the spinal cord lessens the extent of permanent damage but is associated with preterm prelabour rupture of membranes (PPROM). We determined whether compounds in amniotic fluid collected at the time of surgery predicted subsequent development of PPROM.

DESIGN

Prospective study.

SETTING

Hospitals in Sao Paulo, Brazil.

POPULATION

Twenty-four consecutive pregnant women at 24-26 weeks of gestation seen between February and October 2017 with a singleton pregnancy underwent in utero surgery to correct an open spinal defect in their fetus.

METHODS

Amniotic fluid was tested for lactic acid, matrix metalloproteinase 2 (MMP-2), MMP-8, MMP-9 and interleukin-6 (IL-6) by enzyme-linked immunosorbent assay. Clinical data were collected after completion of all laboratory studies.

MAIN OUTCOME MEASURE

Amniotic fluid concentration of compounds in women with or without PPROM.

RESULTS

Preterm prelabour rupture of membranes occurred in seven (29.2%) women. There were no differences in maternal age, gravidity, parity, race, history of caesarean sections or fetal gender between women with or without PPROM. Length of surgery, days of wound healing and length of hospital stay were also indistinguishable. The median concentrations of MMP-8 (1.7 versus 0.6 ng/ml; P = 0.0041) and lactic acid (7.1 versus 5.9 mm; P = 0.0181) were higher in women with PPROM. The amniotic fluid MMP-8 level was also negatively correlated with gestational age at delivery (Spearman r = -0.4217, P = 0.0319).

CONCLUSION

Differences in susceptibility to develop PPROM are present before fetal surgery. An increase in anaerobic glycolysis, evidenced by the intra-amniotic lactic acid level, may enhance MMP-8 production and weaken maternal and fetal membranes.

TWEETABLE ABSTRACT

Matrix metalloproteinase-8 and lactic acid in amniotic fluid predict preterm prelabour rupture of membranes.

Structural and molecular study of the supraspinatus muscle of modern humans (Homo sapiens) and common chimpanzees (Pan troglodytes)

OBJECTIVES

To analyze the muscle architecture and the expression pattern of the myosin heavy chain (MyHC) isoforms in the supraspinatus of Pan troglodytes and Homo sapiens in order to identify differences related to their different types of locomotion.

MATERIALS AND METHODS

We have analyzed nine supraspinatus muscles of Pan troglodytes and ten of Homo sapiens. For each sample, we have recorded the muscle fascicle length (MFL), the pennation angle, and the physiological cross-sectional area (PCSA). In the same samples, by real-time quantitative polymerase chain reaction, we have assessed the percentages of expression of the MyHC-I, MyHC-IIa, and MyHC-IIx isoforms.

RESULTS

The mean MFL of the supraspinatus was longer (p = 0.001) and the PCSA was lower (p < 0.001) in Homo sapiens than in Pan troglodytes. Although the percentage of expression of MyHC-IIa was lower in Homo sapiens than in Pan troglodytes (p = 0.035), the combination of MyHC-IIa and MyHC-IIx was expressed at a similar percentage in the two species.

DISCUSSION

The longer MFL in the human supraspinatus is associated with a faster contractile velocity, which reflects the primary function of the upper limbs in Homo sapiens-the precise manipulation of objects-an adaptation to bipedal locomotion. In contrast, the larger PCSA in Pan troglodytes is related to the important role of the supraspinatus in stabilizing the glenohumeral joint during the support phase of knuckle-walking. These functional differences of the supraspinatus in the two species are not reflected in differences in the expression of the MyHC isoforms.

Psychophysiological Reactivity in Couples During a Marital Interaction Task

The ability to regulate our own physiological arousal when dealing with the emotional expression of our partner is crucial for satisfactory and stable intimate relationships. In previous physiological studies of marital interactions, researchers have found greater levels of psychophysiological arousal for members of the couple in conflictual interactions in comparison with positive interactions. Past researchers have established that intense and prolonged autonomic and neuroendocrine arousal during marital conflict can have negative consequences for mental and physical health. In this study we examined the physiological reactivity, as measured by skin conductance level, heart rate and cortisol levels, from both partners during a couple's interaction task consisting of a structured conversation about positive and negative aspects of their relationship. Participants were thirty-two heterosexual couples (N = 64) in a committed monogamous relationship with a minimum duration of one year. We found higher heart rate and cortisol levels during negative interaction condition when compared with the positive condition. Skin conductance was higher in the positive interaction condition, when compared with the negative interaction condition. In addition, we found a significant negative association between heart rate variability and autonomic arousal evoked by the interaction task. The implications of these findings for the effects of marital strain on health as well as for the design of risk-reducing interventions, namely biofeedback are discussed.

The Expression of Connexins and SOX2 Reflects the Plasticity of Glioma Stem-Like Cells

Glioblastoma (GBM) is the most malignant primary brain tumor, with an average survival rate of 15 months. GBM is highly refractory to therapy, and such unresponsiveness is due, primarily, but not exclusively, to the glioma stem-like cells (GSCs). This subpopulation express stem-like cell markers and is responsible for the heterogeneity of GBM, generating multiple differentiated cell phenotypes. However, how GBMs maintain the balance between stem and non-stem populations is still poorly understood. We investigated the GBM ability to interconvert between stem and non-stem states through the evaluation of the expression of specific stem cell markers as well as cell communication proteins. We evaluated the molecular and phenotypic characteristics of GSCs derived from differentiated GBM cell lines by comparing their stem-like cell properties and expression of connexins. We showed that non-GSCs as well as GSCs can undergo successive cycles of gain and loss of stem properties, demonstrating a bidirectional cellular plasticity model that is accompanied by changes on connexins expression. Our findings indicate that the interconversion between non-GSCs and GSCs can be modulated by extracellular factors culminating on differential expression of stem-like cell markers and cell-cell communication proteins. Ultimately, we observed that stem markers are mostly expressed on GBMs rather than on low-grade astrocytomas, suggesting that the presence of GSCs is a feature of high-grade gliomas. Together, our data demonstrate the utmost importance of the understanding of stem cell plasticity properties in a way to a step closer to new strategic approaches to potentially eliminate GSCs and, hopefully, prevent tumor recurrence.

Methylphenidate-triggered ROS generation promotes caveolae-mediated transcytosis via Rac1 signaling and c-Src-dependent caveolin-1 phosphorylation in human brain endothelial cells

Methylphenidate (MPH) is an amphetamine-like stimulant commonly prescribed for attention deficit hyperactivity disorder. Despite its widespread use, the cellular/molecular effects of MPH remain elusive. Here, we report a novel direct role of MPH on the regulation of macromolecular flux through human brain endothelial cells (ECs). MPH significantly increased caveolae-mediated transcytosis of horseradish peroxidase through ECs without affecting paracellular permeability. Using FRET-based live cell imaging, together with pharmacological inhibitors and lentiviral-mediated shRNA knockdown, we demonstrate that MPH promoted ROS generation via activation of Rac1-dependent NADPH oxidase (NOX) and c-Src activation at the plasma membrane. c-Src in turn was shown to mediate the phosphorylation of caveolin-1 (Cav1) on Tyr14 leading to enhanced caveolae formation and transendothelial transport. Accordingly, the inhibition of Cav1 phosphorylation by overexpression of a phosphodefective Cav1Y14F mutant or knocking down Cav1 expression abrogated MPH-induced transcytosis. In addition, both vitamin C and inhibition of NOX blocked MPH-triggered vesicular transport. This study, therefore, identifies Rac1/NOX/c-Src-dependent signaling in MPH-induced increase in transendothelial permeability of brain endothelial cell monolayers via caveolae-mediated transcytosis.

Facial biometry of Amazon indigenous people of the Xingu River - Perspectives on genetic and environmental contributions to variation in human facial morphology

OBJECTIVE

To evaluate facial morphology of non-mixed indigenous people living in the Xingu region. Studies on these populations report that the total genetic diversity is as high as that observed for other continental populations. On the other hand, eating habits are different between indigenous and urban population, as indigenous people still have traditional habits.

SETTING AND SAMPLE POPULATION

The sample consisted of 106 indigenous subjects, in permanent dentition stage, belonging to four groups: Arara-Laranjal (n = 35), Arara-Iriri (n = 20), Xikrin-Kaiapó (n = 24), and Assurini (n = 27).

MATERIAL AND METHODS

Standardized facial photographs were obtained, and fourteen measurements were analyzed. Intra- and intergroup homogeneities were examined by discriminant analysis, followed by anova and Kruskal-Wallis tests. Sexual dimorphism to each village was analyzed by Student's t-test or Mann-Whitney test, at p < 0.05.

RESULTS

Significant facial differences were found between male and female, indicating that sex data should not be grouped for intergroup comparison. Discriminant analysis showed a large intergroup heterogeneity, while an intragroup homogeneity was found, especially for females. It was also observed that some morphological features of the face are specific to some villages, regardless of ethnicity.

CONCLUSIONS

Facial morphological characteristics were strongly different among groups, even comparing villages from the same ethnicity. Furthermore, a low diversity within groups was observed. Our findings, supported by previous reports on genetics and eating habits in these populations, reinforce the role of the genetic determination on craniofacial morphology.

Serving the underserved: Communication activities conducted at home with children of the autism spectrum

The increase in prevalence of Autism Spectrum Disorders (ASD) demands that new strategies for delivering speech-language therapy services to them are tested and improved. Including families and familiar situations may be a way to provide more intensive stimulation. The aim of this study was to identify strategies to stimulate communication development of children with ASD that can be suggested to parents and followed-up systematically. Participants were 67 children with diagnosis within the autism spectrum that attended weekly speech-language therapy at a specialized service of a large university in São Paulo (Brazil). The study was conducted in four phases: planning of activities; four face-to-face meetings with the parents to suggest and discuss activities that should be conducted at home daily; during six weeks the parents continued to conduct the proposed activities at home, with systematic weekly follow-up by the child's therapist finally, individual the parents reported their impressions about the proposal and the outcomes regarding their child's development during individual interviews. Activities involved the main areas of disorders in ASD. They suggested that the parents used familiar situations as opportunities for games and plays involving language, cognitive and social demands. Parents reported difficulties in implementing the proposed routine of playing with their child for at least a few minutes every day. They mentioned “lack of time” and “being tired” as the main reasons for it. Nevertheless they all reported that they were more able to understand their child's needs and demands and that their child responded well to the suggestions.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Leaf Fluctuating Asymmetry and Herbivory of Tibouchina heteromalla in Restored and Natural Environments

Fluctuating asymmetry (FA) is a parameter to measure developmental stability in plants, which can be altered by disturbances, pollution, and biotic factors such as herbivory. We evaluated the effects of environmental stress and herbivory on the FA levels in individuals of Tibouchina heteromalla (Melastomataceae) that occur in natural and undergoing restoration areas in rupestrian grasslands at Serra do Cipó, Brasil. Individuals were collected and measured in seven restored and five natural areas, totalizing 240 individuals. We found that individuals in restored areas had greater leaf area, higher levels of insect herbivory and FA compared to individuals that occurred in natural areas. In both environments, the proportion of individuals with leaf damage caused by herbivory was higher than the proportion of undamaged individuals. In addition, FA was positively correlated with herbivory and total leaf area in both restored and natural areas. These results suggest that more favorable conditions in the restored areas enhanced leaf growth, resulting in higher FA.