In-hospital mortality of high-risk pulmonary embolism: a nationwide population-based cohort study in Portugal from 2010 to 2018

BACKGROUND

The mortality associated with high-risk pulmonary embolism (PE) is remarkably high, and reperfusion to unload right ventricle should be a priority. However, several registries report reperfusion underuse. In Portugal, epidemiological data about the incidence, rate of reperfusion and mortality of high-risk PE are not known.

METHODS

Nationwide population-based temporal trend study in the incidence and outcome of high-risk PE, who were admitted to hospitals of the National Health Service in Portugal between 2010 and 2018. High-risk PE was defined as patients with PE who developed cardiogenic shock or cardiac arrest. International Classification of Diseases (ICD), 9th and 10th revision, Clinical Modification codes, were used for data from the period between 2010 and 2016 (ICD-9-CM) and 2017-2018 (ICD-10-CM), respectively. The assessment focused on trends in the use of reperfusion treatment, which was defined by application of thrombolysis or pulmonary embolectomy. A comparison was made between the use or non-use of reperfusion therapy in order to examine trends in in-hospital mortality among high-risk PE cases.

RESULTS

From 2010 and 2018, there were 40.311 hospitalization episodes for PE in adult patients at hospitals of the National Health Service in mainland Portugal. There was a significant increase in the annual incidence of PE (41/100.000 inhabitants in 2010 to 46/100.000 in 2018; R2=0.582, p = 0.010). The average annual incidence was 45/100.000 inhabitants/year, with 2,7% of the PE episodes (1104) categorized as high-risk. The mortality rate associated with high-risk PE was high, although it has decreased over the years (74.2% in 2010 to 63.6% in 2018; R2=0.484; p = 0.022). Thrombolytic therapy was underused in high-risk PE, and its usage has not increased in recent years (17.3% in 2010 to 21.1% in 2018, R2=-0.127; p = 0.763). Surgical pulmonary embolectomy was used in 0.27% of cases, and there was no registry of catheter-directed thrombolysis. Patients with high-risk PE undergoing reperfusion therapy had lower in-hospital mortality compared to non-reperfused patients (OR=0.52; IC95% 0.38-0.70).

CONCLUSION

In Portugal, between 2010 and 2018, very few patients with PE developed high-risk forms of the disease, but the mortality rate among those patients was high. The low reperfusion rate could be associated with high in-hospital mortality and highlights the need to implement advanced therapies, as an alternative to systemic thrombolysis.

Training the Armed Forces personnel in COVID-19 contact tracing: a Portuguese case study

Background

Local contact tracing teams needed to be reinforced in preparation for a peak in Covid-19 cases. The Portuguese Armed Forces showed availability and their members initiated a formal training facilitated by the Public Health Unit (PHU) of Amadora. Health systems must be prepared to respond to all threats, as the COVID-19 pandemic showed us the need for quick task shifting and the training of non-experts’ workers.

Objectives

The aim of the project was to develop contact tracing skills by non-health professionals, in the context of the COVID-19 pandemic. The training program was held online, with a total duration of 48 hours, distributed by the topics described: introduction to health and epidemiology concepts, the national guidelines, and the information systems (13h). We privileged demonstrative and participatory training methods, followed by continuous supervision of each contact tracing survey and constant feedback (35h). Learning support materials were sent out to assist the trainees, including written and video support.

Results

More than 200 personnel - sailors, soldiers and airmen - were trained. Each Lisbon and Tagus Valley area PHU was reinforced with a team of military professionals in order to support the contact tracing process, with an increase in the number of surveys completed. We highlight as positive aspects: increased number of contact tracing surveys carried out; growth of inter-institutional partnerships; freeing up of specialized PHU resources to other important tasks. As for negative aspects we focus on the complexity in health communication, the limited time for training, and the lack of specific health knowledge of the trainees.

Conclusions

This pandemic revealed the Portuguese need for a transdisciplinary approach in the provision of care, specially at a Public Health level. Training programs like these highlight the vital role of reshaping and reorganizing the healthcare workforce answering Public Health necessities.

Key messages

• Training programs for non-health workers must be prepared to reinforce health systems when necessary. The reinforcement of contact tracing teams by the Portuguese Armed Forces was a great example.

• A transdisciplinary approach in the provision of care was essential during the COVID-19 pandemic. Specific training of non-health workers can be planned in time to respond to health threats.

Usefulness of the 6-minute walk test vs cardiopulmonary exercise test for exercise prescription in coronary artery disease patients going into a phase III cardiac rehabilitation program

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

Determining the intensity of exercise is a very important component to obtain the dose-benefits associated with exercise, while maitaining the safaty of the patient with coronary artery disease (CAD) in a cardiovascular rehabilitation (CR) programme. The cardiopulmonary exercise test (CPET) is the gols standard for exercise prescription according to the intend intensisty of aerobic workout. However, its availability is not a reality in many CR centres. The 6-minute walk test (6MWT) is a valid and widely used method because it is low-cost and simple to apply. Nevertheless, it is still unknown the corresponding intensity reached on a 6MWT compared to the one reached on a CPET in already physically active patients with CAD starting a CR phase III programme.

Purpose

To use the peak heart rate (HR) of the 6MWT as a method to prescribe the intensity of aerobic exercise in CAD patients starting a phase III CR programme and to compare it with the ventilatory threshold (VT) of the CPET.

Methods

In this retrospective study, a cohort of patients with CAD enrolled in a phase III CR programme. At the beginning of the programme, all patients performed a 6MWT and a CPET in the same week with at least 48-hour difference. The HR on the 6MWT was recorded continuously using a HR polar (H10 Polar) and on CPET using a twelve-lead ECG. Other parameters were assessed such as objective physical activity (accelerometer) and body composition.

Results

Eighty patients (87.5% males, 60.8 ± 9.4 years old) with CAD were included in this study. Patients were, on average, physically active (361 ± 182 minutes/week of moderate to vigorous physical activity) and overweight (body mass index: 27.7 ± 3.5 kg/m2). The VO2 peak reached on the CPET was 20.3 ± 5.4 ml/kg/min and the percentage of predicted maximum HR was 78.3 ± 11.4 %. The first and second VT corresponded to 75.6 ± 7.8% and 91.2 ± 4.5% of the peak HR obtained with CPET, respectively. The 6MWT HR peak was 113 ± 16 bpm (90.0 ± 13.0 HR peak CPET) and did not differ from the HR of the second VT with a mean value of 115 ± 16 bpm (91.2 ± 4.5% HR peak CPET), p>0.05. Although, the 6MWT HR peak was significantly higher than the HR oh the first VT (95 ± 14 bpm, p<0.001). In a subgroup analysis, the patients who, during the 6MWT, reached more the 90% of the HR peak CPET (n=35, 44% oof the sample) were the ones with lower functional capacity (VO2 peak: 18.4 ± 5.4 ml/kg/min vs 21.7 ± 5.0 ml/kg/min, p=0.006) and higher age (64.4 ± 8.7 years old vs 60.8 ± 9.4 years old, p=0.002).

Conclusion(s)

In the absence of a CPET, the use of a 6MWT HR peak in physically active patients with CAD starting a phase III CR programme has shown to be an efficient method to prescribe moderate to vigorous exercise intensity, corresponding to the second VT. Higher intensities on the 6MWT might be reached in active elderly patients with reduced functional capacity.

Nutrition guidelines compliance in cardiovascular disease patients attending a long-term exercise-based cardiac rehabilitation program during COVID-19 era

Funding Acknowledgements

Type of funding sources: None.

Introduction

Dietary habits influence cardiovascular disease (CVD) risk, mainly through risk factors such as lipids, blood pressure, body weight and diabetes. Therefore, a healthy diet is recommended as a cornerstone of CVD prevention in all individuals and in reducing risk of recurrent disease, yet few studies have examined diet quality in cardiac-rehabilitation patients on a long-term basis.

Purpose

To evaluate the compliance with dietary guidelines in patients who attend a long-term cardiac rehabilitation program (phase III) during COVID-19 era.

Methods

The study was developed between October 2020 and October 2021 in a phase III centre-based cardiac rehabilitation program. To evaluate dietary intake a 24hour recall questionnaire was used. Diet composition was analysed using ESHA’s Food Processor® software. Cunningham equation was used to evaluate resting energy expenditure and physical activity expenditure measured by accelerometery was added to calculate daily energetic requirements. The nutrients and cut-offs considered for the analysis were saturated fat (<10%), sodium (<2g), potassium (≥3.5g), fibre (≥30g), and alcohol (<100g/week), considering the 2021 ESC Guidelines on CVD Prevention in Clinical Practice or the World Health Organization guidelines for a healthy diet. To evaluate weight and height a digital scale SECA 799 and a stadiometer SECA 220 were used, respectively.

Results

A total of 57 patients (78.9% men) with a mean age of 63.8±8.5 were evaluated. Mean body mass index (BMI) was 28.4±3.8kg/m2, being most patients overweight or obese (61.7%). A higher caloric consumption, compared to the individual energy requirements, was found in 26.3% of patients. No statistical differences were found between mean saturated fat intake (10.1±3.6%) and the recommended intake (p=0.85). Mean sodium consumption was 3.42±1.46 grams and mean potassium intake was 3.0±1.0 grams. Sodium intake was significantly higher (p<0.001), and potassium intake significantly lower (p<0.001) than the recommendation. Fibre intake was also significantly lower than the recommendation (median intake was 21.1±12.2 grams, p<0.001). Among patients who drank alcoholic beverages (n=28), the median alcohol intake per day was 17.4±26.3 grams which was significantly higher than the limit recommended (p=0.043).

Conclusion

Our findings showed that these patients deviated from the recommendations in some key nutrients. The intake of sodium and alcohol was higher than the recommendations, and the intake of potassium and fibre were lower than the recommendations. Moreover, most patients were overweight or obese. This study highlights the need for individual nutritional counselling sessions as a reinforcement of a standard educational program, to effectively promote an adequate diet, which may reduce the risk of recurrent disease. Further research about nutritional intervention in patients undergoing on a long-term basis cardiac rehabilitation is warranted.

Cardiorespiratory fitness assessment on active patients who kept attending their phase III exercise-based cardiac rehabilitation during the COVID-19 era

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiorespiratory fitness (CRF) is a powerful predictor of all-cause mortality among individuals with coronary artery disease (CAD). A structured community-based phase III cardiac rehabilitation (CR) is very important in lifelong maintenance of phase II CRF and health gains. During the COVID-19 pandemic, CR programs had to adapt, mainly using new technologies and remote follow-up. The CRF impact in patients (Ps) who kept going their phase III program, during this troubled era is still unknown.

Purpose

Assess the variation in CRF and prognostic parameters in Ps with CAD who maintain high adherence levels in their phase III CR before and during the COVID-19 pandemic.

Methods

A cohort of Ps enrolled in a community-based phase 3 CR program, with active participation at the end of 2019, was included in this retrospective study. The inclusion criteria for this study were high levels of attendance (>80%) to the CR program before and during COVID-19 and high levels of physical activity with more than 150 mins of moderate to vigorous physical activity (MVPA). All Ps were evaluated with transthoracic echocardiography (TTE) and a cardiorespiratory exercise test (CPET) in a cycloergometer in 2019 and between october and november of 2021. All Ps had used accelerometers to measure their physical activity levels and dual-energy absorptiometry (DEXA) scan to evaluate their body composition. Between 2020 and 2021, Ps had online (in lockdown periods) and face to face exercise training sessions, 3xtimes per week, 60 mins each exercise session.

A t-test paired two sample for means was used to compare CPET variables before the beginning of the first COVID lockdown (end of 2019) and after the removal of the majority of restrictions (end of 2021).

Results

A total of 30 Ps with high levels of adherence were included (99.6% male, 65 ± 9 years old). In this cohort, the majority had history of an ACS before the referral to the CR program (73.3%) and 55.6 ± 10.4% of left ventricular ejection fraction.

There was no significant difference in body mass index (27.9 ± 3.2 kg/m2 vs 28.1 ± 3.6 kg/m2, p=0.493 but there was a significant increase in the percentage of body fat mass (30.1 ± 5.7% vs 31.0 ± 6.6%, p= 0.042). There was a maintenance on MVPA levels (352 ± 137 minutes/week vs 313 ± 194 minutes/week, p = 0.106) during this period.

When comparing the 2 CPET results, Ps achieved higher exercise loads in the 2021 test (175 ± 51W vs 185 ± 52W, p=0.005), higher VO2 peak (25.3 ± 6.9 ml/kg/min vs 21.5 ± 6.3 ml/kg/min, p =0.001) and higher percentage of predicted VO2max (78.8 ± 16.8% vs 95.27 ± 20.8%, p = 0.001).

Conclusion

In spite of all the difficulties in maintaining a phase III CR program during the COVID-19 pandemic, we observed that in physically active CAD Ps, with the aid of new technologies and remote follow-up (during the lockdown periods) and face to face exercise sessions, it is still possible to have functional gains and improvements in CRF.

Physical Activity Self-Report Is Not Reliable Among Subjects with Mild Vascular Cognitive Impairment: The AFIVASC Study

BACKGROUND

The World Health Organization (WHO) recommends a minimum of 150 minutes of moderate physical activity per week. Adherence to these recommendations is difficult to assess.

OBJECTIVE

We aimed to evaluate the validity of self-reported physical activity in mild vascular cognitive impairment (mVCI) and whether physical activity was associated with cognitive status, by using baseline data from a randomized controlled trial.

METHODS

A hundred and four subjects with mVCI were included (mean age 72 years; 51% women). Subjects underwent neurological, physical, and comprehensive neuropsychological assessments. Adherence to WHO physical activity recommendations was evaluated using both self-reported information and objective measures (accelerometry).

RESULTS

There was poor agreement (kappa = 0.106) between self-report of following WHO recommendations and actually fulfilling them according to accelerometry. Only 16.6% of participants reported following WHO recommendations and displayed compatible values according to the accelerometer. Participants whose accelerometry values confirmed adherence to WHO recommendations had better performance in a global measure of cognition, attention, and mental speed processing. In multiple regression analyses, education and accelerometry values in accordance with WHO recommendations were independently associated with the global measure of cognition, attention, and processing speed, controlling for sex, age, and depressive symptoms. Accelerometry results were not associated with memory and executive functions.

CONCLUSION

In this sample of mVCI subjects, self-reported physical activity displayed poor agreement with accelerometry values, suggesting that objective measures of physical activity are preferable. Physical activity (performed, at least, according to WHO recommendations) was associated with better cognitive performance overall.

[Digital home-based multidisciplinary cardiac rehabilitation: How to counteract physical inactivity during the COVID-19 pandemic]

Introduction and Objectives

Center-based cardiac rehabilitation (CR) programs have been forced to close due to COVID-19. Alternative delivery models to maintain access to CR programs and to avoid physical inactivity should be considered. The aim of this study was to assess physical activity (PA) levels after completing a home-based digital CR program.

Methods

A total of 116 cardiovascular disease (CVD) patients (62.6±8.9 years, 95 male) who had been attending a face-to-face CR program were recruited and assessed (baseline and at three months) on the following parameters: PA, sedentary behavior, adherence, cardiovascular and non-cardiovascular symptoms, feelings toward the pandemic, dietary habits, risk factor control, safety and adverse events. The intervention consisted of a multidisciplinary digital CR program, including regular patient assessment, and exercise, educational and psychological group sessions.

Results

Ninety-eight CVD patients successfully completed all the online assessments (15.5% drop-out rate). A favorable main effect of time was an increase in moderate to vigorous PA and a decrease in sedentary time at three months. Almost half of the participants completed at least one online exercise training session per week and attended at least one of the online educational sessions. No major adverse events were reported and only one minor event occurred.

Conclusion

During the pandemic, levels of moderate to vigorous PA improved after three months of home-based CR in CVD patients with previous experience in a face-to-face CR model. Diversified CR programs with a greater variety of content tailored to individual preferences are needed to meet the motivational and clinical requirements of CVD patients.

[Management of infectious complications associated with coronavirus infection in severe patients admitted to ICU]

Infections have become one of the main complications of patients with severe SARS-CoV-2 pneumonia admitted in ICU. Poor immune status, frequent development of organic failure requiring invasive supportive treatments, and prolonged ICU length of stay in saturated structural areas of patients are risk factors for infection development. The Working Group on Infectious Diseases and Sepsis GTEIS of the Spanish Society of Intensive Medicine and Coronary Units SEMICYUC emphasizes the importance of infection prevention measures related to health care, the detection and early treatment of major infections in the patient with SARS-CoV-2 infections. Bacterial co-infection, respiratory infections related to mechanical ventilation, catheter-related bacteremia, device-associated urinary tract infection and opportunistic infections are review in the document.

Recommendations for antibiotic selection for severe nosocomial infections

Severe infection and its evolution to sepsis are becoming more prevalent every day and are among the leading causes of critical illness and mortality. Proper management is crucial to improve prognosis. This document addresses three essential points that have a significant impact on this objective: a) early recognition of patients with sepsis criteria, b) identification of those patients who suffer from an infection and have a high risk of progressing to sepsis, and c) adequate selection and optimization of the initial antimicrobial treatment.

Management of infectious complications associated with coronavirus infection in severe patients admitted to ICU

Infections have become one of the main complications of patients with severe SARS-CoV-2 pneumonia admitted in ICU. Poor immune status, frequent development of organic failure requiring invasive supportive treatments, and prolonged ICU length of stay in saturated structural areas of patients are risk factors for infection development. The Working Group on Infectious Diseases and Sepsis GTEIS of the Spanish Society of Intensive Medicine and Coronary Units SEMICYUC emphasizes the importance of infection prevention measures related to health care, the detection and early treatment of major infections in the patient with SARS-CoV-2 infections. Bacterial co-infection, respiratory infections related to mechanical ventilation, catheter-related bacteremia, device-associated urinary tract infection and opportunistic infections are review in the document.

Body composition, lipid profile and mediterranean diet adherence in cardiovascular disease patients attending a long-term exercise-based cardiac rehabilitation program during COVID-19 pandemic

Funding Acknowledgements

Type of funding sources: None.

Introduction

 Cardiovascular disease (CVD) is recognized as a major public health issue and remains the leading cause of mortality worldwide. There is a clear association between adiposity, blood lipid profile, and adherence to the Mediterranean diet (MD) with the risk of CVD. However, the assessment of body composition parameters, dietary patterns and nutritional intervention in CVD patients undergoing a cardiovascular rehabilitation (CR) program remains insufficient. 

Purpose

 to characterize body composition, lipid profile and MD adherence in patients with CVD who were attending an exercise-based CR program during COVID-19 era. 

Methods

 The study was developed between October 2020 and January 2021 in a phase III centre-based CR program. Body composition was assessed by dual energy x-ray absorptiometry Hologic Explorer-W. Adherence to the MD was assessed by the 14-item MD questionnaire. Fasting blood sample was taken for measurement of lipid profile. 

Results

 A sample of 41 patients (mean age 64.4 ± 7.9 years, 87.8% male) was evaluated. The most prevalent CVD were coronary artery disease (89.5%) and heart failure (21.1%). The main CVD risk factors at admission in the CR program were dyslipidaemia (71.1%), hypertension (68.4%), physical inactivity (26.3%) and diabetes mellitus (21.0%). In our sample the mean body mass index was 28 ± 3.8 kg/m2, being most patients overweight (75.6%), and having a substantially increased risk of metabolic complications (85.3%) accordingly to waist-hip ratio. Body composition assessment showed that 14.6% of the patients had a body fat mass index above 90th percentile. Although only 9.8% of the patients had reduced fat free mass, 17.1% showed appendicular lean mass below the reference value. In addition, less than one third of the patients (31.7%) revealed a high adherence to the MD pattern. A sub-analysis on blood lipids (n = 26) showed that most patients had levels of LDL cholesterol (76.9%) and non-HDL cholesterol (65.4%) above the therapeutic target and 15.4% had triglycerides higher than 150 mg/dl. 

Conclusion

 Body composition, lipid profile and dietary patterns, play a major role in CVD secondary prevention. Our findings showed that a substantial number of CVD patients, in COVID-19 era, did not have optimal body composition, were above lipid profile targets, and had a low/medium adherence to the MD. Thus, this study highlights the relevance of nutrition on cardiometabolic status and demonstrates the crucial role of nutritional intervention as an integrated part of a long-term phase III CR program. Moreover, further research about nutritional intervention in patients undergoing CR is warranted.

COVID-19 era in long-term cardiac rehabilitation programs: how did physical activity and sedentary time change compared to previous years?

Funding Acknowledgements

Type of funding sources: None.

Introduction

Cardiovascular rehabilitation (CR) was one of the many areas negatively affected by the COVID-19 pandemic. A high number of cardiovascular disease (CVD) patients had their centre-based program suspended. Physical activity (PA) recommendations for CVD patients are well established and its benefits largely documented. However, few studies have objectively measured the PA of these patients throughout the years and specifically during the COVID-19 pandemic. 

Purpose

To objectively measure PA and sedentary time (ST) during COVID-19 pandemic in comparison with the previous 2 years in CVD patients who were attending a phase III centre-based CR program. 

Methods

Before COVID-19, eighty-seven CVD patients (mean age 62.9 ± 9.1, 82.8% male) were attending a face-to-face long-term CR program. Of the 87 patients, 78.2% have been on the program for at least 1 year. Every year, PA and ST were objectively assessed by accelerometery. After the CR centre-based program suspension due to COVID-19, efforts were done to create a CR home-based digital model to maintain the continuum of care and avoid losing the previous acquired benefits. After 7 months of suspension, the face-to-face CR centre was reopened and 57.5% (n = 50) patients returned. We completed the assessment of PA and ST of 37 patients (mean age 64.8 ± 8.1, 89.2% male) and compared it as follows: M1) two assessments before COVID-19; M2) last assessment before COVID-19; M3) 7 months after CR program suspension (last trimester of 2020). Patients wore an ActiGraph accelerometer for 7 consecutive days to assess daily and weekly minutes of light PA, moderate-to-vigorous PA and ST. We used repeated-measures ANOVA and Wilcoxon signed rank as a non-parametric alternative.

Results

Intention-to-treat analysis showed that in M3 patients decreased their average daily time spent in moderate-to-vigorous PA when compared with M2 (M3: 37.90 ± 3.30 min/day vs M2: 45.01 ± 3.14 min/day, p = 0.035), no changes were found between M1 and M2. Average daily time spent in light PA improved significantly from M1 to M2 (M1: 154.81 ± 7.20 min/day vs M2: 169.17 ± 6.44 min/day, p = 0.042) but did not change from M2 to M3. Despite this, in M3, 81.08% of the patients still met the recommendations for moderate-to-vigorous PA (M1: 89.19% and M2: 91.89%). No changes were found in ST.

Conclusion

Despite a significant decrease on the amount of moderate-to-vigorous PA during the COVID-19 era, most CVD patients, first in the centre-based CR program and after in the home-based CR program, were able to meet PA recommendations throughout the last years. These findings suggest that CVD patients who attend supervised long-term CR programs might be aware of the importance of reaching PA guidelines. Reducing ST by replacing it by PA of any intensity could be an important and reachable target for long-term CR programs.

Cardiovascular risk factor control: is it possible with a home-based cardiac rehabilitation program?

Funding Acknowledgements

Type of funding sources: None.

Introduction

Cardiovascular risk factors (CVRF) control, needing different strategies, through patient education, lifestyle changes and therapeutic optimization is a central core of cardiac rehabilitation. However, further studies are needed to demonstrate effectiveness of home-based Cardiac Rehabilitation (CR-HB) programs in controlling CVRF.  

Purpose

To evaluate the effectiveness of a CR-HB program in controlling cardiovascular risk factors.

Methods

Prospective cohort study including patients who were previously participating in a centre-based CR program and accepted to participate in a CR-HB program due to forced closure of the centre-based CR program for COVID-19 pandemic. The CR-HB consisted of a multidisciplinary digital CR program, including patient regular assessment, exercise, educational, and psychological and relaxation sessions. A structured online educational program for patients and family members/caregivers was provided including educational videos, and powerpoints and webinars. A real time Webinar regarding "nutritional myths and facts" was organized with the duration of 90 minutes as a substitution of the regular face-to-face regular workshop provided at our centre-based CR program. Also, self-control of blood pressure and heart rate and of glycemia in diabetics were promoted, as well as smoking cessation.

To assess the impact of the CR-HB on risk factors control, all the patients were submitted to a clinical and analytical evaluation before and after the end of this at distance program. 

Results

116 cardiovascular disease patients (62.6 ± 8.9 years, 95 males) who were attending a face-to-face CR program were included in a CR-HB program. Almost 90% (n = 103) of the participants had coronary artery disease. Regarding risk factors, obesity was the most prevalent risk factor (74.7 %) followed by hypertension (59.6%), family history (41.8%), dyslipidaemia (37.9%), diabetes (18.1%), and smoking (12.9%). 

Regarding the blood pressure control, 80% of the patients stated that almost daily they measured blood pressure at home; baseline systolic pressure decreased from 117 ± 13 to 113 ±12mmHg, p = 0.007, while there was no significant change in diastolic pressure.  

The majority (76%) of diabetic patients said they controlled blood glucose; HbA1c decreased from 6.1 ± 1.1 to 5.9 ± 0.9mg/dL (p = 0.047).

Considering the lipid profile, LDL decreased (from 75 ± 30 to 65 ± 26mg/dL, p = 0.012). The Nt-proBNP also decreased (818 ± 1332 vs 414pg/ml ± 591, p = 0.042). There were no other statistically significant differences concerning risk factors modification. 

Conclusions

Our study showed that a Home-based Cardiac Rehabilitation program can improve or maintain cardiovascular risk factors control, which has important prognostic implications and is frequently a difficult task to achieve.

Digital home-based multidisciplinary cardiac rehabilitation: the way to counteract physical inactivity during the COVID-19 pandemic?

Funding Acknowledgements

Type of funding sources: None.

Introduction

Centre-based cardiac rehabilitation (CR) programs have been forced to close due to the need for physical and social distancing imposed by COVID-19 pandemic. A major problem emerges concerning the potential harmful effects resulting from the suspension of the centre-based CR programs, leading to physical inactivity and unhealthy lifestyle routines. Therefore, the development of alternative delivery models to maintain access to CR programs and to avoid physical inactivity should be organized and tested.

Purpose

To assess the physical activity (PA) levels in a group of patients with known cardiovascular disease (CVD), after completing 3-months of a home-based multidisciplinary digital CR program, organized as an alternative method to the centre-based CR suspended program.

Methods

One hundred and sixteen patients with CVD (62.6 ± 8.9 years, 95 males) who were previously attending a face-to-face CR program were included and the following parameters were assessed at baseline and 3 months: self-reported PA and sedentary behaviour, adherence to the online CR program, cardiovascular and non-cardiovascular symptoms, feelings towards the pandemic, dietary habits, risk factor control, safety and adverse events. The intervention consisted in a multidisciplinary digital CR program, including online exercise training sessions, online educational sessions, psychological online group sessions, risk factor control, nutritional and psychological consults and patient regular assessment by cardiologist and nurse.

Results

Ninety-eight CVD patients successfully completed all the online assessments (15.5% drop-out). It was observed a significant increase from moderate-to-vigorous PA (230 ± 198 mins/week to 393 ± 378 mins/week, p < 0.001) and a decrease of the sedentary time at 3-months (6.47 ± 3.26 hours/day to 5.17 ± 3.18 hours/day, p < 0.001). Seventy percent of the patients met the PA recommendations and 41% reached more than 300 minutes per week of moderate to vigorous PA at 3 months. Almost half of the participants (46.9%) did at least more than one online exercise training session per week and attended at least one of the online educational sessions. There were no major adverse events reported and only one minor non-cardiovascular event occurred.

Conclusion

Patients with CVD, who suspended centre-based CR due to COVID-19 pandemic and started a home-based multidisciplinary digital CR program, had a significant improvement in moderate to vigorous PA after 3 months. Therefore, home-based CR programs showed to be a good option for selected clinically stable patients, who are eligible for CR and cannot attend a centre-based CR program due to COVID-19 pandemic or eventually other reasons.

Left ventricular remodeling: is there a real impact of cardiac rehabilitation?

Funding Acknowledgements

Type of funding sources: None.

Introduction

A number of randomized controlled trials have examined the effect of exercise training on left ventricle (LV) remodeling in individuals with cardiovascular disease. However, the results of these trials have been inconclusive. 

Purpose

Evaluation of the impact of a cardiac rehabilitation program (CRP) on left ventricle remodelling evaluated by echocardiogram. 

Methods

Observational single centre study including consecutive patients, undergoing structured CRP since June 2016 until February 2020. Phase II CRP included 3 months of exercise training, aerobic and strength exercise, individually prescribed, 3 times a week, 60 minutes sessions. All patients were submitted to a clinical evaluation, echocardiogram, and cardiopulmonary exercise test before and after the CRP.

Results

205 patients (62.6 ± 11 years, 83.4% men, 82.3% ischemic disease) were included in a phase II CRP. Most patients had ischemic disease (82.3%) and 23.5% of patients had left ventricular ejection fraction (LVEF) &lt;40%. Of the cardiovascular risk factors, hypertension was the most prevalent (76%), followed by dyslipidaemia (67.4%), active smoking (45.9%) and diabetes (26.9%). 

After the CRP, there was a significant improvement of LVEF (from 48.3 ± 13 to 52 ± 11.6 %, p = 0.001) and a significant reduction of LV volumes (LV end-diastolic volume, LVEDV , decreased from 140 ± 81 to 121 ± 57, p = 0.002; LV end-systolic volume , LVESV , reduced from 80 ± 75 to 64 ± 48, p = 0.004). Considering only the patients with LVEF &lt; 40% (n = 38), the improvement was even greater: LVEF increased from 30 ± 8 to 39 ± 13 (p = 0.002); LVEDV reduced from 206 ± 107 to 159 ± 81 (p = 0.001) and LVESV reduced from 142 ± 99 to 101 ± 66 (p = 0.002). 63.6%(n = 14) of these patients improved at least 10% of LVEF and only 1 of them had a cardiac resynchronization therapy device. 

Conclusions

A phase II CR program was associated with significant improvements in left ventricular reverse remodelling irrespective of baseline EF classification. Those with reduced baseline EF derived an even greater improvement, highlighting the great importance of CR in this subgroup of patients.

COVID-19 era in long-term cardiac rehabilitation programs: how was muscle strenght and lean mass affected in cardiovascular patients?

Funding Acknowledgements

Type of funding sources: None.

Introduction

Exercise prescription is one of the main components of phase III Cardiac Rehabilitation (CR) programs due to its documented prognostic benefits. It has been well established that, when added to aerobic training, resistance training (RT) leads to greater improvements in peripheral muscle strength and muscle mass in patients with cardiovascular disease (CVD). With COVID-19, most centre-based CR programs had to be suspended and CR patients had to readjust their RT program to a home-based model where weight training was more difficult to perform. How COVID-19 Era impacted lean mass and muscle strength in trained CVD patients who were attending long-term CR programs has yet to be discussed.

Purpose

To assess upper and lower limb muscle strength and lean mass in CVD patients who had their centre-based CR program suspended due to COVID-19 and compare it with previous assessments.

Methods

87 CVD patients (mean age 62.9 ± 9.1, 82.8% male), before COVID-19, were attending a phase III centre-based CR program 3x/week and were evaluated annually. After 7 months of suspension, 57.5% (n = 50) patients returned to the face-to-face CR program. Despite all constraints caused by COVID-19, body composition and muscle strength of 35 participants (mean age 64.7 ± 7.9, 88.6% male) were assessed. We compared this assessment with previous years and established three assessment time points: M1) one year before COVID-19 (2018); M2) last assessment before COVID-19 (2019); M3) the assessment 7 months after CR program suspension (last trimester of 2020). Upper limbs strength was measured using a JAMAR dynamometer, 30 second chair stand test (number of repetitions – reps) was used to measure lower limbs strength and dual energy x-ray absorptiometry was used to measure upper and lower limbs lean mass. Repeated measures ANOVA were used.

Results

Intention to treat analysis showed that upper and lower limbs lean mass did not change from M1 to M2 but decreased significantly from M2 to M3 (arms lean mass in M2: 5.68 ± 1.00kg vs M3: 5.52 ± 1.06kg, p = 0.004; legs lean mass in M2: 17.40 ± 2.46kg vs M3: 16.77 ± 2.61kg, p = 0.040). Lower limb strength also decreased significantly from M2 to M3 (M2: 23.31 ± 5.76 reps vs M3: 21.11 ± 5.31 reps, p = 0.014) after remaining stable in the year prior to COVID-19. Upper limb strength improved significantly from M1 to M2 (M1: 39.00 ± 8.64kg vs M2: 40.53 ± 8.77kg, p = 0.034) but did not change significantly from M2 to M3 (M2 vs M3: 41.29 ± 9.13kg, p = 0.517).

Conclusion

After CR centre-based suspension due to COVID-19, we observed a decrease in upper and lower limbs lean mass and lower limb strength in previously trained CVD patients. These results should emphasize the need to promote all efforts to maintain physical activity and RT through alternative effective home-based CR programs when face-to-face models are not available or possible to be implemented.

Home-based Cardiac Rehabilitation: the patients claim for new strategies but do they adhere?

Funding Acknowledgements

Type of funding sources: None.

Introduction

Cardiac rehabilitation (CR) programs are established interventions to improve cardiovascular health, despite asymmetries in referral. With covid 19 outbreak, cardiac rehabilitation home based (CR-HB) programs emerged as an alternative. However, its adherence and implementation may vary greatly with socio-demographic factors.

Purpose

To assess adherence to the various components of a CR-HB program. 

Methods

Prospective cohort study which included patients (pts) who were participating in a centre-based CR program and accepted to participate in a CR-HB after the centre-based CR program closure due to COVID-19. The CR-HB consisted in a multidisciplinary digital CR program, including: 1.patient clinical and exercise risk assessment; 2.psychological tele-appointments; 3. online exercise training sessions; 4.structured online educational program for patients and family members/caregivers;  5. follow-up questionnaires; 6. nutrition tele-appointments; 7. physician tele-appointments

Adherence to the program was assessed by

drop-out rate; number of exercise sessions in which each patient participated; number of educational sessions attended and a validated questionnaire on therapeutic adherence (composed of 7 questions with minimum punctuation of 7 and maximum of 40 points).

Results

116 cardiovascular disease (CVD) pts (62.6 ± 8.9 years, 95 males) who were attending a Centre-based CR program were included in a CR-HB program. Almost 90% (n = 103) of the participants had coronary artery disease; 13.8% pts had heart failure; the mean LVEF was 52 ± 11%. Regarding risk factors, obesity was the most common risk factor (74.7 %) followed by hypertension (59.6%), family history (41.8%), dyslipidaemia (37.9%), diabetes (18.1%), and smoking (12.9%). 

Ninety-eight pts (85.5%) successfully completed the program. Almost half (46.9%) of the participants did at least one online exercise training session per week. Among the pts who did online exercise training sessions, 58% did 2-3 times per week, 27% once per week and 15% more than 4 times per week. 

The pts participated, on average, in 1.45 ± 2.6 education sessions (rate of participation of 13,2%) and therapeutic adherence was high (39,7 ± 19; min 35-40). 

Regarding educational status of the pts, 33 pts (45,2%) had a bachelor degree. These pts tended to participate more in exercise sessions (1,7 ± 1,7 vs 1,2 ± 1,4 sessions per week) and in education sessions (2.13 vs 1.6), although this difference was not statistically significant. The therapeutic adherence did not vary with patients’ level of education. 

Conclusion

Our results showed that a high percentage of patients completed the program and almost half were weekly physically active. However, in regard to educational sessions, the degree of participation was much lower. Educational status seemed to correlate with a higher degree of participation and, in the future, patient selection might offer better results in these kinds of programs.

Home-based Cardiac Rehabilitation in Covid Era: Is it a safe option?

Funding Acknowledgements

Type of funding sources: None.

Introduction

Home-based Cardiac Rehabilitation (CR-HB) models have been shown to be effective, however, there is a large variation of protocols and minimal evidence of effectiveness in higher risk populations, in which exercise at distance might be concerning. In addition, lack of reimbursement models has discouraged the widespread adoption of CR-HB. During the coronavirus 2019 (COVID-19) pandemic, an even greater gap in CR care has emerged due to the decreased availability of on-site services.

Purpose

Evaluation of the safety of a CR-HB program during COVID-19 pandemic. 

Methods

Prospective cohort study which included patients (pts) who were participating in a centre-based CR program and accepted to participate in a CR-HB after the centre-based CR program closure due to COVID-19. The CR-HB consisted in a multidisciplinary digital CR program, including: 1.pts regular clinical and exercise risk assessment; 2.psychological tele-appointments and group sessions; 3. online exercise training sessions, which consisted of recorded videos and real time online exercise training sessions (each session recommended 3 times per week, during 60 minutes); 4.structured online educational program for pts and family members/caregivers, including educational videos and webinars; 5. follow-up fortnightly questionnaire to evaluate risk factors control and need for appointments or directing to hospital; 6. nutrition tele-appointments; 7. physician tele-appointments, scheduled according to follow-up questionnaire or at patients request (e-mail or telephone) to avoid unnecessary exposure and overload in the hospital. Minor and major adverse events such as hospitalizations due to cardiac event or other non CV reason, cardiac or noncardiac death, during or immediately after the exercise sessions, were collected.

Results

116 cardiovascular disease (CVD) pts (62.6 ± 8.9 years, 95 males) who were attending a Centre-based CR program were included in a CR-HB program. Almost 90% (n = 103) of the participants had coronary artery disease; 13.8% pts had heart failure. The mean LVEF was 52 ± 11%; 31,1% of the population had at least moderate risk. Regarding risk factors, obesity was the most common risk factor (74.7%) followed by hypertension (59.6%), family history (41.8%), dyslipidaemia (37.9%), diabetes (18.1%), and smoking (12.9%). 

98 CVD pts (85.5%) successfully completed all the online assessments. Three male participants dropped out for hospitalization due to knee surgery, pacemaker implantation and in-stent restenosis without relation to exercise sessions. No major events were registered during the exercise training sessions and only one minor adverse event, sprained ankle, was reported during the training sessions.

Conclusions

This CR-HB program, originated by the need of social distancing during  COVID-19 pandemic, revealed to be a valuable and safe strategy to reach at distance most patients previously in a Centre-based CR program.

The effects of 12-months supervised periodized training on health-related physical fitness in coronary artery disease: a randomized controlled trial

We compared the impact of a one-year periodized exercise training versus a non-periodized exercise training on health-related physical fitness (HRPF) including body composition, cardiorespiratory and muscular fitness in patients with coronary artery disease (CAD). Fifty CAD patients (60.4 ± 9.9 years) were randomized to either a periodized training group (PG) (n = 25) or a non-periodized training group (NPG) (n = 25). Both consisted of a combined training programme, performed 3 days/week for 12 months. Thirty-six CAD patients (PG: n = 18, NPG: n = 18) successfully completed the exercise regimes. In both groups, a favourable main effect for time was evident for peak VO₂, peak workload, anaerobic threshold and respiratory compensation point workloads and VO₂, whole body skeletal muscle mass and quality index at 12 months.In conclusion, a periodized model is as effective as a non-periodized model in promoting increases in HRPF outcomes following a one-year intervention. These findings indicate that health-professionals can add variation to cardiac rehabilitation workouts without compromising effectiveness.

Social and professional consequences of COVID-19 lockdown in patients with multiple sclerosis from 2 very different populations

Objective

Method

Results

Conclusions

Social and professional consequences of COVID-19 lockdown in patients with multiple sclerosis from two very different populations

The global lockdown measures implemented due to the COVID-19 pandemic have nearly always had negative consequences for patients with multiple sclerosis (MS).

OBJECTIVE

We compared the social and professional effects of confinement on patients with MS in 2 very different populations, from Spain and China.

METHODS

Questionnaires were administered to a group of patients with MS who consulted at the MS unit of Vithas hospital (DINAC Foundation) in Seville, and patients with MS attended in several provinces of China in April 2020, with the aim of analysing the differences and similarities between populations in the social and professional effects of confinement. To this end, a database was created and subsequently analysed.

RESULTS

The Chinese population includes a higher proportion of younger patients and no differences were identified regarding sex. Most of the variables studied behaved in the same way in both patient populations. Spanish patients presented a lesser impact (30.7%) on their socio-economic situation than Chinese patients (44%) (P < .05). There were no significant differences between populations in the remaining variables. Social networks were widely used in the majority of patients from both populations.

CONCLUSIONS

The social and professional consequences of the pandemic were very similar in both groups; the use of social networks and family support was also similar. Spanish patients seem to present greater economic stability, perhaps due to the social support they receive.

Kairomones from Euschistus heros egg masses and their potential use for Telenomus podisi parasitism improvement

Telenomus podisi Ashmead (Hymenoptera: Scelionidae) is the most important egg parasitoid of Euschistus heros (Fabricius) (Hemiptera: Pentatomidae), and its successful parasitism is related to their searching ability to find suitable hosts under a complex chemical environment using host-reliable cues. Thus, the objective of this study was to elucidate chemical substances on the external layer of E. heros eggs and report its potential kairomonal activity on T. podisi. We tested female wasps in olfactometer system to synthetic compounds obtained from a chemical identification of E. heros egg masses. The synthetic blend was also evaluated in parasitism tests under laboratory and semi-field conditions. We identified 31 substances from egg surface extracts, including monoterpenes, aldehydes and alkanes. Among those compounds, a synthetic solution including camphene, β-pinene, limonene and benzaldehyde-induced chemotaxic behaviour on the wasps and increased the parasitism on E. heros eggs, either in laboratory or semi-field test, suggesting its potential use to T. podisi manipulation and parasitism improvement.

Recommendations for the diagnosis and treatment of Clostridioides difficile infection: An official clinical practice guideline of the Spanish Society of Chemotherapy (SEQ), Spanish Society of Internal Medicine (SEMI) and the working group of Postoperative Infection of the Spanish Society of Anesthesia and Reanimation (SEDAR)

This document gathers the opinion of a multidisciplinary forum of experts on different aspects of the diagnosis and treatment of Clostridioides difficile infection (CDI) in Spain. It has been structured around a series of questions that the attendees considered relevant and in which a consensus opinion was reached. The main messages were as follows: CDI should be suspected in patients older than 2 years of age in the presence of diarrhea, paralytic ileus and unexplained leukocytosis, even in the absence of classical risk factors. With a few exceptions, a single stool sample is sufficient for diagnosis, which can be sent to the laboratory with or without transportation media for enteropathogenic bacteria. In the absence of diarrhoea, rectal swabs may be valid. The microbiology laboratory should include C. difficile among the pathogens routinely searched in patients with diarrhoea. Laboratory tests in different order and sequence schemes include GDH detection, presence of toxins, molecular tests and toxigenic culture. Immediate determination of sensitivity to drugs such as vancomycin, metronidazole or fidaxomycin is not required. The evolution of toxin persistence is not a suitable test for follow up. Laboratory diagnosis of CDI should be rapid and results reported and interpreted to clinicians immediately. In addition to the basic support of all diarrheic episodes, CDI treatment requires the suppression of antiperistaltic agents, proton pump inhibitors and antibiotics, where possible. Oral vancomycin and fidaxomycin are the antibacterials of choice in treatment, intravenous metronidazole being restricted for patients in whom the presence of the above drugs in the intestinal lumen cannot be assured. Fecal material transplantation is the treatment of choice for patients with multiple recurrences but uncertainties persist regarding its standardization and safety. Bezlotoxumab is a monoclonal antibody to C. difficile toxin B that should be administered to patients at high risk of recurrence. Surgery is becoming less and less necessary and prevention with vaccines is under research. Probiotics have so far not been shown to be therapeutically or preventively effective. The therapeutic strategy should be based, rather than on the number of episodes, on the severity of the episodes and on their potential to recur. Some data point to the efficacy of oral vancomycin prophylaxis in patients who reccur CDI when systemic antibiotics are required again.

Male-Produced Sex Pheromone of Tibraca limbativentris Revisited: Absolute Configurations of Zingiberenol Stereoisomers and their Influence on Chemotaxis Behavior of Conspecific Females

The rice stalk stink bug, Tibraca limbativentris, is an important rice pest in Brazil with a high invasive potential for Mexico and the USA. The sex pheromone of this species was previously identified as a combination of two stereoisomers of 1,10-bisaboladien-3-ol (zingiberenol), but the absolute configurations of these sesquiterpenes were not determined, neither were their effect(s) on T. limbativentris behavior evaluated. In this study, using two chiral columns, we compared retention times of the two natural 1,10-bisaboladien-3-ol stereoisomers from air-entrainment samples of male T. limbativentris with those of synthetic stereoisomers of 1,10-bisaboladien-3-ol. The results showed that T. limbativentris males produce (3S,6S,7R)-1,10-bisaboladien-3-ol (1) and (3R,6S,7R)-1,10-bisaboladien-3-ol (5) as their sex pheromone. Two new minor, male-specific components were also identified as cis and trans isomers of 2,10-bisaboladien-1-ol (sesquipiperitol). Y-tube olfactometer bioassays showed that the major (3S,6S,7R) isomer 1 was essential for attraction of T. limbativentris females, but the minor (3R,6S,7R) isomer 2 was not, nor did it show synergistic/antagonistic effects when added to the major isomer. The (1S,6S,7R) and (1R,6S,7R) stereoisomers of sesquipepiritol also attracted T. limbativentris females.

Impact of physical activity in vascular cognitive impairment (AFIVASC): study protocol for a randomised controlled trial

BACKGROUND

Cognitive impairment and cerebrovascular pathology are both frequent with ageing. Cognitive impairment due to vascular pathology of the brain, termed vascular cognitive impairment (VCI), is one of the most frequent causes of cognitive impairment in elderly subjects. Thus far, VCI has no specific pharmacological treatment. Recent observational studies have suggested a protective effect of physical activity in cognition, but adequate randomised controlled trials (RCT) are lacking.

METHODS

AFIVASC is a multi-centre randomised controlled trial, with a 6-month intervention treatment and an additional follow-up of 6 months, that aims to estimate the impact of 6 months of moderate intensity physical activity on cognition (the primary outcome) at 6 and 12 months in subjects with VCI. Participants are community dwellers with criteria for VCI without dementia or who have had previous stroke or transient ischaemic attack (TIA). Patients may be self-referred or referred from a medical appointment. After confirming the inclusion criteria, a run-in period of 1 month is conducted to access adherence; only after that are subjects randomly assigned (using a computerised program blinded to clinical details) to two groups (intervention group and best practice usual care group). The intervention consists of three physical activity sessions of 60 min each (two supervised and one unsupervised) per week. The primary outcome is measured by the presence or absence of decline in cognitive status. Secondary outcomes include changes in neuro-cognitive measures, quality of life, and functional and motor status. Primary and secondary outcomes are evaluated at 6 and 12 months by investigators blinded to both intervention and randomisation. A required sample size of 280 subjects was estimated. Statistical analyses will include regression analysis with repeated measures. The study was approved by the Ethics Committee for Health of Centro Hospitalar de Lisboa Norte (ref. no. 1063/13) and by the Ethics Committee for Health of Centro Hospitalar do Porto CHP (ref. no. 2016.055(049-DEFI/048-CES)).

DISCUSSION

We aim to show whether or not moderate physical activity has a beneficial impact on cognition, quality of life, motor, and functional status in people with vascular cognitive impairment, and to generate new insights on the applicability of implementing physical activity in this specific population.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03578614 July 6, 2018.

Age Influence on Sexual Behavior of the Lesser Cornstalk Borer, Elasmopalpus lignosellus (Zeller) (Lepidoptera: Pyralidae)

The objective of this work was to evaluate the reproductive behavior and response of Elasmopalpus lignosellus (Zeller) males to calling females. Frequency of mating was recorded in couples during the first 7 days of the adult stage. Calling behavior of females was observed during the first 4 days of the adult stage and responses of males, in the same age intervals, to calling females were recorded in wind tunnel bioassays. The maximum number of matings occurred when the couple was between 24 and 48 h old. The scotophase period significantly influenced mating behavior, which peaked between 6 and 8 h of darkness and the mean mating duration was 93.9 ± 4.2 min. Calling females, when evaluated in a wind tunnel, attracted significantly more males than in bioassays with clean air (control). The number of individuals in calling behavior was significantly lower for females that were between 0 to 24 h old compared to the other females evaluated, but this did not influence male response. A lower proportion of males between 48 to 72 h old responded to calling females and these responses were delayed in comparison with males of other ages (0 to 24, 24 to 48, and 72 to 96 h old). These results indicate that the age of E. lignosellus males influences the response to conspecific calling females.

The influence of volatile semiochemicals from stink bug eggs and oviposition-damaged plants on the foraging behaviour of the egg parasitoid Telenomus podisi

During host selection, physical and chemical stimuli provide important cues that modify search behaviours of natural enemies. We evaluated the influence of volatiles released by eggs and egg extracts of the stink bug Euschistus heros and by soybean plants treated with the eggs and egg extracts on Telenomus podisi foraging behaviour. Responses to volatiles were evaluated in Y-tube olfactometers after exposure to (1) one egg cluster for 24 h; (2) plants with eggs laid by the stink bug, tested at 24, 48, and 72 h after treatment; (3) plants with eggs laid artificially, tested at 24, 48, and 72 h after treatment; and (4) plants treated with acetone or hexane extracts of eggs. Telenomus podisi was attracted to volatiles emitted by one egg cluster and to acetone extracts of one egg cluster, but not to air or acetone controls. There were no responses to odours of plants treated with eggs or egg extracts. Analysis of acetone extracts of egg clusters by gas chromatography revealed the major components were saturated and unsaturated fatty acids, including hexadecanoic acid, linoleic acid, and (Z)-9-octadecenoic acid. Our results suggest that one egg cluster and the acetone extract of one egg cluster contain volatile compounds that can modify T. podisi foraging behaviour, and that the amounts of these compounds, probably together with some minor compounds, are important for host recognition by T. podisi. Also, the oviposition damage or egg extracts on the plant did not elicit indirect defences that attracted Telenomus podisi.

Influence of Two Acyclic Homoterpenes (Tetranorterpenes) on the Foraging Behavior of Anthonomus grandis Boh

Previous studies have shown that the boll weevil, Anthonomus grandis, is attracted to constitutive and conspecific herbivore-induced cotton volatiles, preferring the blend emitted by cotton at the reproductive over the vegetative stage. Moreover, this preference was paralleled by the release of the acyclic homoterpenes (tetranorterpenes) (E)-4,8-dimethyl-1,3,7-nonatriene (DMNT) and (E,E)-4,8,12-trimethyltrideca-1,3,7,11-tetraene (TMTT) in Delta Opal cotton being higher at the vegetative than at the reproductive stage. Here, we evaluated whether this difference in release of acyclic homoterpenes also occurred in other cotton varieties, and if boll weevils could recognize these compounds as indicators of a specific cotton phenological stage. Results showed that cotton genotypes CNPA TB-90, BRS-293 and Delta Opal all produced higher levels of DMNT and TMTT at the vegetative stage than at the reproductive stage and that these homoterpenes allowed for principal component analysis separation of volatiles produced by the two phenological stages. Electroantennograms confirmed boll weevil antennal responses to DMNT and TMTT. Behavioral assays, using Y-tube olfactometers, showed that adding synthetic homoterpenes to reproductive cotton volatiles (mimicking cotton at the vegetative stage in terms of homoterpene levels) resulted in reduced attraction to boll weevils compared to that to unmodified reproductive cotton. Weevils showed no preference when given a choice between plants at the vegetative stage and the vegetative stage-mimicked plant. Altogether, the results show that DMNT and TMTT are used by boll weevils to distinguish between cotton phenological stages.

Chemical Composition of Alphitobius diaperinus (Coleoptera: Tenebrionidae) Abdominal Glands and the Influence of 1,4-benzoquinones on its Behavior

This study aimed to identify and quantify the compounds present in the abdominal glands of Alphitobius diaperinus Panzer, 1797 (Coleoptera: Tenebrionidae) and to evaluate the influence of these compounds on its behavior. The extraction of volatiles present in the abdominal glands was made by dissection (10 individuals per sex) and by air entrainment (200 insects per sex), and they were analyzed by gas chromatography-flame ionization detector, gas chromatograph-mass spectrometer, and gas chromatograph-electroantennography detector (GC-EAD). The influence of these volatiles on the behavior of conspecifics was evaluated in a four-arm olfactometer. Twenty-three compounds were identified from male and female abdominal gland extracts, of which six were quinones: the 2-methyl-1,4-benzoquinone and the 2-ethyl-1,4-benzoquinone were the major components, and 1,4 benzoquinone and three hydroquinones were registered for the first time for this species. The GC-EAD analysis using the crude extracts from abdominal glands showed that male and female antennae responded to the three major benzoquinones. For the olfactometer bioassays, both genders were repelled either by the abdominal gland extracts or by synthetic solutions containing the three benzoquinones. The results suggest that the 1,4-benzoquinones play a role as a repellent to A. diaperinus.

Dual T1/T2 MRI contrast agent based on hybrid SPION@coordination polymer nanoparticles

A novel dual T₁/T₂¹H-MRI contrast agent based on the encapsulation of super-paramagnetic iron oxide nanoparticles (SPIONs) with an iron coordination polymer is proposed.

Herbivory-induced plant volatiles from Oryza sativa and their influence on chemotaxis behaviour of Tibraca limbativentris Stal. (Hemiptera: Pentatomidae) and egg parasitoids

The rice stem bug, Tibraca limbativentris Stal. (Hemiptera: Pentatomidae) is one of the most important pests of rice crops, especially irrigated crops. Plant defence strategies against these bugs may involve the emission of chemical compounds, which are released following herbivore attacks, directly or indirectly harming pest performance. The aim of this study was to evaluate the influence of constitutive and herbivory-induced volatiles from rice plants (Oryza sativa L.) on the behavioural responses of T. limbativentris adults and egg parasitoids Trissolcus basalis (Wollaston) and Telenomus podisi (Ashmead) (Hymenoptera, Platygastridae). Plant volatiles were collected from undamaged plants of the rice cultivar IRGA 424 and from plants that suffered herbivory by five males or five females of T. limbativentris. Air-entrainment extracts were analysed by GC-flame ionization detector and GC-MS, and insect responses evaluated in a 'Y' olfactometer. T. limbativentris feeding damaged on rice plants induced the release of 16 volatiles compounds in a higher amounts compared to undamaged plants The main compounds induced were (E)-2-hexenal, (E)-2-octen-1-ol, methyl salicylate and α-muurolene. Female bugs were significantly attracted to air-entrainment extracts containing volatiles from undamaged plants compared with air-entrainment extracts containing volatiles emitted from plants damaged by T. limbativentris, whereas males showed no preference. Telenomus podisi females were significantly attracted to volatiles from air-entrainment extracts of plants damaged by females, whereas T. basalis showed no preference. These results suggest that rice plants may be emitting defence compounds, which could be avoided by T. limbativentris females and also acted indirectly by attracting natural enemies.

Identification and Expression Profile of Two Putative Odorant-Binding Proteins from the Neotropical Brown Stink Bug, Euschistus heros (Fabricius) (Hemiptera: Pentatomidae)

This work presents the first identification of putative odorant-binding proteins (OBPs) from a member of the Pentatomidae, i.e. the brown stink bug Euschistus heros (Fabricius), an important pest of soybean in Brazil. Antennae from both sexes of E. heros adults (12 days old and unmated) were used to construct a cDNA library, from which two transcripts encoding putative E. heros OBPs (EherOBPs) were identified. The expression levels of EherOBP1 and EherOBP2 were found to be higher in male antennae than in female and there was difference in expression in legs, wings, and abdomens of the two sexes. The histolocalization of EherOBP1 and EherOBP2 transcripts in antennae also showed a sexual dimorphism in the chemoreception system, with different expression sites in the antennal segments between males and females, occurring predominantly at the base of the sensillum. The implications of these findings for stink bug chemoreception are discussed.

Identification of male-specific volatiles from nearctic and neotropical stink bugs (Heteroptera: Pentatomidae)

Males of the Central American stink bug species,Euschistus obscurus, produce an attractant pheromone composed of a blend of compounds characteristic of North AmericanEuschistus spp. and the South American soybean pest,E. heros. The range ofE. obscurus extends into the southern United States, the species is easy to rear, and males produce an exceptionally large quantity of pheromone (>0.5µg/day/male). These factors madeE. obscurus useful for characterizing the novel pheromone components ofE. heros without importing this pest species into the United States.Euschistus obscurus males produce methyl (2E,4Z)-decadienoate (61 %) in abundance, which is characteristic of North American species, and methyl 2,6,10-trimethyltridecanoate (27%), the main male-specific ester ofE. heros. The chirality ofEuschistus spp. methyl-branched esters, and field activity of synthetic formulations, remain to be determined.

Attractant pheromone for nearctic stink bug,Euschistus obscurus (Heteroptera: Pentatomidae): Insight into a neotropical relative

Volatiles fromEuschistus obscurus males were found to be attractive to conspecific females in bioassays. A new type of olfactometer assembled from commercially available glassware was used to bioassay aeration extracts of the Nearctic stink bug,E. obscurus. Fractionated extracts suggest that pheromonal activity is associated with late-eluting, male-specific compounds. Research onE. obscurus offered a means to indirectly study the pheromone of the Neotropical pest species,E. heros, without importing this soybean pest into the United States.

Semiochemicals from herbivory induced cotton plants enhance the foraging behavior of the cotton boll weevil, Anthonomus grandis

The boll weevil, Anthonomus grandis, has been monitored through deployment of traps baited with aggregation pheromone components. However, field studies have shown that the number of insects caught in these traps is significantly reduced during cotton squaring, suggesting that volatiles produced by plants at this phenological stage may be involved in attraction. Here, we evaluated the chemical profile of volatile organic compounds (VOCs) emitted by undamaged or damaged cotton plants at different phenological stages, under different infestation conditions, and determined the attractiveness of these VOCs to adults of A. grandis. In addition, we investigated whether or not VOCs released by cotton plants enhanced the attractiveness of the aggregation pheromone emitted by male boll weevils. Behavioral responses of A. grandis to VOCs from conspecific-damaged, heterospecific-damaged (Spodoptera frugiperda and Euschistus heros) and undamaged cotton plants, at different phenological stages, were assessed in Y-tube olfactometers. The results showed that volatiles emitted from reproductive cotton plants damaged by conspecifics were attractive to adults boll weevils, whereas volatiles induced by heterospecific herbivores were not as attractive. Additionally, addition of boll weevil-induced volatiles from reproductive cotton plants to aggregation pheromone gave increased attraction, relative to the pheromone alone. The VOC profiles of undamaged and mechanically damaged cotton plants, in both phenological stages, were not different. Chemical analysis showed that cotton plants produced qualitatively similar volatile profiles regardless of damage type, but the quantities produced differed according to the plant's phenological stage and the herbivore species. Notably, vegetative cotton plants released higher amounts of VOCs compared to reproductive plants. At both stages, the highest rate of VOC release was observed in A. grandis-damaged plants. Results show that A. grandis uses conspecific herbivore-induced volatiles in host location, and that homoterpene compounds, such as (E)-4,8-dimethylnona-1,3,7-triene and (E,E)-4,8,12-trimethyltrideca-1,3,7,11-tetraene and the monoterpene (E)-ocimene, may be involved in preference for host plants at the reproductive stage.

The death-promoting molecule tumour necrosis factor-related apoptosis inducing ligand (TRAIL) is not required for the development of peripheral lymphopenia or granuloma necrosis during infection with virulent Mycobacterium avium

Disseminated infection with virulent Mycobacterium avium in C57Bl/6 (B6) mice leads to severe lymphocyte depletion in secondary lymphoid organs. In this study, we found an up-regulation of caspase-8 activity in spleen cell extracts from M. avium 25291-infected B6 mice compared to non-infected mice. The activation of this extrinsic apoptotic pathway correlated with an increase in inter-nucleosomal DNA fragmentation in CD4(+) spleen cells, as analysed by the terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL) assay. These data suggest the involvement of death receptors in the induction of lymphocyte loss in the spleen, but previous work has excluded a role for tumour necrosis factor (TNF) receptors and Fas/CD95 in M. avium-induced lymphopenia. TNF-related apoptosis-inducing ligand (TRAIL) is expressed by different cell types of the immune system and induces apoptosis and killing of tumour cells while sparing normal cells. Here we used TRAIL(-/-) mice to determine if the absence of TRAIL prevented M. avium-induced immune pathology. We found that TRAIL-deficient mice still developed splenic lymphopenia during disseminated infection or granuloma necrosis during low-dose infections while exhibiting slightly increased susceptibility to M. avium 25291 when compared to B6 mice. However, in vivo proliferation of less virulent strains of M. avium was not influenced by TRAIL deficiency despite a decrease in interferon-γ production in infected B6.TRAIL(-/-) mice compared to B6 mice. Our results show that TRAIL does not play a significant role in either M. avium-induced pathology or protective immunity.