Atrial fibrillation in acute pulmonary embolism: prognostic considerations

AIMS

Although it is accepted that atrial fibrillation (AF) may be both the contributing factor and the consequence of pulmonary embolism (PE), data on the prognostic role of AF in patients with acute venous thromboembolism are scarce. Our aim was to study whether AF had a prognostic role in patients with acute PE.

METHODS

Retrospective cohort study involving 270 patients admitted for acute PE. Collected data: past medical history, analytic/gasometric parameters, admission ECG and echocardiogram, thoracic CT angiography. Patients followed for 6 months. An analysis was performed in order to clarify whether history of AF, irrespective of its timing, helps predict intrahospital, 1-month and 6-month all-cause mortality.

RESULTS

Patients with history of AF, irrespective of its timing (n=57, 21.4%), had higher intrahospital (22.8% vs 13.1%, p=0.052, OR 2.07, 95% CI 0.98 to 4.35), 1-month (35.1% vs 16.9%, p=0.001, OR 3.16, 95% CI 1.61 to 6.21) and 6-month (45.6% vs 17.4%, p<0.001, OR 4.67, 95% CI 2.37 to 9.21) death rates. The prognostic power of AF was independent of age, NT-proBNP values, renal function and admission blood pressure and heart rate and additive to mortality prediction ability of simplified PESI (AF: p=0.021, OR 2.31, CI 95% 1.13 to 4.69; simplified PESI: p=0.002, OR 1.47, CI 95% 1.15 to 1.89). The presence of AF at admission added prognostic value to previous history of AF in terms of 1-month and 6-month all-cause mortality prediction, although it did not increase risk for intrahospital mortality.

CONCLUSIONS

The presence of AF, irrespective of its timing, may independently predict mortality in patients with acute PE. These data should be tested and validated in prospective studies using larger cohorts.

Zinc(II) phthalocyanines immobilized in mesoporous silica Al-MCM-41 and their applications in photocatalytic degradation of pesticides

In the present study the authors investigated a set of three new zinc(II) phthalocyanines (zinc(II) tetranitrophthalocyanine (ZnTNPc), zinc(II) tetra(phenyloxy)phthalocyanine (ZnTPhOPc) and the tetraiodide salt of zinc(II)tetra(N,N,N-trimethylaminoethyloxy) phthalocyaninate (ZnTTMAEOPcI)) immobilized into Al-MCM-41 prepared via ship-in-a-bottle methodology. The samples were fully characterized by diffuse reflectance-UV-vis spectroscopy (DRS-UV-vis), luminescence, thermogravimetric analysis (TG/DSC), N(2) adsorption techniques and elemental analysis. A comparative study was made on the photocatalytic performance upon irradiation within the wavelength range 320-460nm of these three systems in the degradation of pesticides fenamiphos and pentachlorophenol. ZnTNPc@Al-MCM-41 and ZnTTMAEOPcI@Al-MCM-41 were found to be the most active systems, with the best performance observed with the immobilized cationic phthalocyanine, ZnTTMAEOPcI@Al-MCM-41. This system showed high activity even after three photocatalytic cycles. LC-MS product characterization and mechanistic studies indicate that singlet oxygen ((1)O(2)), produced by excitation of these immobilized photosensitizers, is a key intermediate in the photocatalytic degradation of both pesticides.

Desempenho e ocorrência de diarreia em leitões alimentados com soro de leite

Avaliou-se influência da adição do soro de leite sobre o desempenho de suínos nas três semanas iniciais da fase creche e a ocorrência de diarréia. Trinta leitões desmamados aos 21 dias de idade com peso vivo médio de 6,00 ± 0,44 kg foram distribuídos, alojados individualmente, em delineamento inteiramente casualizado, em 3 tratamentos: adição de 0 (T1), 10 (T2) e 20 % (T3) de soro de leite a ração controle. As avaliações realizadas foram o desempenho dos animais e a ocorrência e características físicas ou escores das fezes geradas. Não se verificou diferença no ganho médio diário em peso, porém o menor (p

LR-PED rule: low risk pulmonary embolism decision rule - a new decision score for low risk pulmonary embolism

INTRODUCTION

When accurately diagnosed, non-massive Pulmonary embolism (PE) has a low mortality rate. However, some patients initially considered to be low risk show progressive deterioration. This research aims at developing a preliminary score that allows detection of low risk patients potentially eligible for outpatient treatment.

MATERIALS AND METHODS

Retrospective cohort study involving 142 asymptomatic/mildly symptomatic and hemodynamically stable patients with PE and no clinical/echocardiographic signs of right ventricular dysfunction. Collected data: risk factors, analytic/gasometric parameters, admission echocardiogram, thoracic CT angiography. Patients followed for 6months. Primary endpoint: 1-month all-cause mortality. Secondary endpoints: Intrahospital and 6-month all-cause mortality. A score designed for identification of very low risk patients eligible for outpatient treatment was developed and its prognostic accuracy compared to that of the Geneva and simplified PESI models.

RESULTS

A score for predicting 1-month mortality (Low Risk Pulmonary Embolism Decision [LR-PED] rule) was obtained using Binary Logistic Regression, including: age, atrial fibrillation at admission, previous heart failure, admission heart rate, creatinine, glycaemia, troponin I and C-reactive protein at admission. ROC curve analysis assessed its overall accuracy for predicting 1-month, intrahospital and 6-month mortality (AUC=0.756, 0.763 and 0.854, respectively). Compared to Geneva and simplified PESI, the LR-PED rule showed higher sensitivity and negative predictive value for the detection of the lowest risk patients. The net reclassification improvement index revealed significant successful upward risk reclassification by the LR-PED model of patients reaching primary or secondary outcomes.

CONCLUSIONS

LR-PED rule seems more attractive than Geneva or simplified PESI in its ability to identify patients at very low mortality risk who would be potentially eligible for outpatient treatment. Prospective validation of this score in larger cohorts is mandatory before its potential implementation.

Anodic oxidation of a biologically treated leachate on a boron-doped diamond anode

In the present study, the anodic oxidation of a leachate from an intermunicipal sanitary landfill was evaluated using a boron-doped diamond anode as a possible post-treatment to the biological one, in order to diminish the remaining bio-refractory organic matter. The influence of the dilution of the leachate sample and the applied current density on the performance of electrochemical oxidation was investigated. For the different assays performed, a comparison between the theoretical kinetic model for organic mineralization, proposed in the literature, and experimental data was done and the best correspondences were attained at lower applied current density for sample without dilution and at higher applied current density for the more diluted sample. However, the energetic most favourable treatment is attained for sample without dilution at very low current density. The DOC/COD ratio was also analysed and apparently, the mineralization of the organic matter improves with the dilution of the leachate samples.

P5-01-03: Correlation between Aromatase Expression in Metastatic and Primary Breast Cancer

Background: Estrogens are the major mitogenic factor in hormone dependent breast cancer. In postmenopausal women, estrogen production results mainly from extra-glandular conversion of androstenedione to estrone. This conversion is catalyzed by the enzyme aromatase (Aro). It is known that an higher expression and activity of the enzyme Aro is present in primary breast carcinoma compared with normal breast tissue. These data may indicate that tumors have the ability to produce their own estrogen. However, it is not known whether this process can occur at the level of metastasis. This study aims to determine the expression of aromatase in metastatic breast cancer and to analyze its correlation with expression at primary tumor and response to aromatase inhibitors (AI).

Material and Methods: We selected 41 patients with metastatic breast cancer, followed in the Department of Medical Oncology since 1995, undergoing surgery or biopsy of a metastatic lesion in the course of the disease (24 liver metastases; 10 bone metastases; 6 lung metastases; 1 lymph node metastases). For all these patients a detailed clinical chart review regarding clinical information (including treatment and tumor status) was obtained. Samples (formalin fixed and paraffin embedded) were analyzed for aromatase expression by immunohistochemistry (IHC), using the anti-aromatase monoclonal antibody # 677 (Novartis). Slides were scored considering the proportion of immunoreactive cells and intensity of the staining, and evaluating separately the epithelial and stromal component. The Fisher and log-rank test were used to determine the correlation between Aro expression in metastatic tissue and response to AI. Results: Aromatase was expressed in 51% (21/41) of the samples (13 liver metastases; 8 bone metastases). The average combined score was 130 (10 — 320). The average score was higher in the epithelial component versus the stromal component (123 vs. 17.5). There was a strong expression of Aro in bone metastases (average combined score: 176) compared with other sites.

There was no correlation between Aro expression and estrogen receptors expression. In 15 patients, it was also possible to evaluate the expression of Aro in the primary tumor. Aro was expressed in four cases (36%), with an average combined score of 52.5. The Aro expression between the primary tumor and metastasis was concordant in nine cases.

Thirty-four patients received AI to treat metastatic disease. The median time to progression (TTP) with AI in the entire population was 17.8 months. In the group of patients with Aro expression in metastasis, the median TTP in AI was 19.5 months, significantly higher than that obtained in the group without detectable Aro expression: 6.5 months (p = 0.045). The overall survival in the group with Aro expression was125 months and the 77 months in patients without Aro expression (p = 0.54).

Conclusions: Aromatase is expressed by metastatic tumor cells from breast cancer, with a positive and statistically significant correlation between its expression in the metastasis and the clinical benefit to IA. Its expression was higher in bone metastases compared with other sites of metastasis although this difference was not, in our study, statistically significant.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-01-03.

Transfer and uptake of polychlorinated dibenzo-p-dioxins and furans (PCDD/Fs) and polychlorinated biphenyls (PCBs) into meat and organs of indoor and outdoor reared pigs

This study was designed to investigate how and to what extent PCDD/Fs and PCBs are transmitted from exposure sources to porcine muscle and other tissues derived from pigs. The experimental approach involved two longitudinal studies in which indoor and outdoor pigs were reared to market readiness using typical animal husbandry practices; closely matched samples of soil, feed, bedding, meat, etc. were collected and analysed for PCDD/Fs and PCBs. The total PCDD/F + PCB WHO-TEQs in pig liver were much higher than in meat and kidney samples from the same animals and exceeded the current relevant European Union maximum limits (6 ng PCDD/F-TEQ kg⁻¹ fat). Liver samples were also characterised by much lower PCB contributions to the total TEQ than for the corresponding meat and kidney samples, and by a predominance of many of the hepta- and octa-substituted PCDD/Fs. At ages approaching market readiness, TEQ values in meat samples from outdoor pigs tended to be slightly higher than those from comparable ages in the indoor programme, possibly due to additional intake from soil. Biotransfer factors (BTFs) were derived for each of the 39 PCDD/F and PCB congeners measured. Interpretation of the findings focused particularly on trends in four selected congeners, namely: 2,3,7,8-TCDD, 2,3,4,7,8-PeCDF, PCB 153 and PCB 169. Increases in the BTF for PCB 169 in the pig-rearing programmes were noticed when the diet changed from being dominated by sow's milk to feed. Much higher transfer factors for many of the more heavily chlorinated PCDD/Fs (e.g. 2,3,4,7,8-PeCDF) were found in liver compared with meat or kidney samples from the same animals. Soil consistently accounted for at least 30% of input for many hexa- or higher chlorinated PCDD/Fs, while it rarely representing more than 10% of the total intake.

Spontaneous and induced osteoclastogenic behaviour of human peripheral blood mononuclear cells and their CD14(+) and CD14(-) cell fractions

OBJECTIVES

Osteoclasts are descended from the CD14(+) monocyte/macrophage lineage, but influence of other haematopoietic cells on osteoclastic commitment of their precursors has remained poorly understood. In this study, osteoclastogenic behaviour of peripheral blood mononuclear cells (PBMC) and their CD14(+) and CD14(-) subpopulations has been accessed, in the absence or presence of M-CSF and RANKL.

MATERIALS AND METHODS

Cell cultures were characterized for presence of actin rings and vitronectin and calcitonin receptors, TRAP activity and calcium phosphate resorbing activity, expression of osteoclast-related genes and secretion of M-CSF and RANKL.

RESULTS

In the absence of growth factors, PBMC and CD14(+) cultures had some degree of cell survival, and some spontaneous osteoclastogenesis was observed, only on cultures of the former. Supplementation with M-CSF and RANKL significantly increased osteoclastogenic behaviour of cell cultures, particularly CD14(+) cell cultures. Nevertheless, PBMC derived a higher degree of osteoclastogenesis, either as absolute values or after normalization by protein content. It was observed that unlike CD14(+) cells, PBMC were able to express M-CSF and RANKL, which increased following growth factor treatment. Also, expression of TNF-α, GM-CSF, IL-1β, IL-6 and IL-17 was higher in PBMC cultures. Finally, CD14(-) cultures exhibited limited cell survival and did not reveal any osteoclast features.

CONCLUSIONS

Results show that although osteoclastic precursors reside in the CD14(+) cell subpopulation, other populations (such as CD14(-) cells) derived from PBMC, have the ability to modulate osteoclastogenesis positively.

Antimicrobial activity and phytochemical analysis of crude extracts and essential oils from medicinal plants

We aimed to establish a phytochemical analysis of the crude extracts and performed GC-MS of the essential oils (EOs) of Eugenia uniflora L. (Myrtaceae) and Asteraceae species Baccharis dracunculifolia DC, Matricaria chamomilla L. and Vernonia polyanthes Less, as well as determining their antimicrobial activity. Establishment of the minimal inhibitory concentrations of the crude extracts and EOs against 16 Staphylococcus aureus and 16 Escherichia coli strains from human specimens was carried out using the dilution method in Mueller-Hinton agar. Some phenolic compounds with antimicrobial properties were established, and all EOs had a higher antimicrobial activity than the extracts. Matricaria chamomilla extract and E. uniflora EO were efficient against S. aureus strains, while E. uniflora and V. polyanthes extracts and V. polyanthes EO showed the best antimicrobial activity against E. coli strains. Staphylococcus aureus strains were more susceptible to the tested plant products than E. coli, but all natural products promoted antimicrobial growth inhibition.

In vitro antibacterial activity of medicinal plant extracts against Escherichia coli strains from human clinical specimens and interactions with antimicrobial drugs

The biological properties of medicinal plants have been documented worldwide for many centuries. We aimed to evaluate interactions between crude extracts from Psidium guajava, Zingiber officinale, Cymbopogon citratus, Caryophyllus aromaticus, Mikania glomerata and Allium sativum samples and antimicrobial drugs against Escherichia coli strains. The susceptibility test performed was disc diffusion, and crude extracts were diluted (%v/v) into Müller-Hinton agar (MHA) at one quarter of the minimal inhibitory concentration for 90% (MIC(90%)) of E. coli strains found previously. Synergistic interactions were observed between C. citratus and polymyxin, and A. sativum extracts and gentamicin. The crude A. sativum extract was the only one that did not show any antagonism with the antimicrobial drugs. The results thus showed the potential use of these medicinal plants against E. coli strains, although antagonism with antimicrobial drugs is a negative aspect in the combined therapy of infectious diseases caused by E. coli.

Examination Portability

Truly global radiology would exist if patients could visit any European physician without their CDs or films. It would be possible for patients to go to a hospital or a clinic in any European country and have their examinations done in a different country, analyzed and eventually compared with the examination done at that hospital. This paper analyzes two national projects that should be documented and analyzed: Scotland with a national archive with radiology images and Finland which is implementing a system that will create an online personal health record of the citizen with all health-related information. This possibility would improve quality in European radiology and create a true network of images and knowledge that can be the seed to improve efficiency by reducing costs and exposure to radiation and increasing knowledge sharing among European radiologists/neuroradiologists. We present here the idea of a network between three centers in three different countries that can be the start for a global project.

The effects of Brazilian and Bulgarian propolis in vitro against Salmonella Typhi and their synergism with antibiotics acting on the ribosome

Salmonella enterica serovar Typhi is the causative agent of typhoid fever in humans, and the use of antibiotics is essential for controlling this infection; however, the excessive use of antibiotics may select resistant strains. Propolis is a honeybee product and its antimicrobial activity has been intensively investigated. Thus, the objective of this study was to investigate a possible synergism between propolis (collected in Brazil and Bulgaria) and antibiotics acting on the ribosome (chloramphenicol, tetracycline and neomycin) against Salmonella Typhi in vitro. The synergism was investigated by using ½ and ¼ of the minimum inhibitory concentration for propolis and these antimicrobial agents, evaluating the number of viable cells according to the incubation time. Brazilian propolis showed a bacteriostatic action against S. Typhi, while Bulgarian propolis showed a bactericidal activity and a synergistic effect with the three antibiotics. Variations in the biological assays might be due to the differences in their chemical compositions. Based on the results, one may conclude that Bulgarian propolis showed an important antibacterial action, as well as a synergistic effect with antibiotics acting on the ribosome, which points out a possible therapeutic strategy evaluating the use of propolis preparations for the treatment of Salmonella Typhi infection.