1
|
Trichez D, Knychala MM, Figueiredo CM, Alves SL, da Silva MA, Miletti LC, de Araujo PS, Stambuk BU. Key amino acid residues of the AGT1 permease required for maltotriose consumption and fermentation by Saccharomyces cerevisiae. J Appl Microbiol 2018; 126:580-594. [PMID: 30466168 DOI: 10.1111/jam.14161] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/22/2018] [Accepted: 11/10/2018] [Indexed: 12/24/2022]
Abstract
AIMS The AGT1 gene encodes for a general α-glucoside-H+ symporter required for efficient maltotriose fermentation by Saccharomyces cerevisiae. In the present study, we analysed the involvement of four charged amino acid residues present in this transporter that are required for maltotriose consumption and fermentation by yeast cells. METHODS AND RESULTS By using a knowledge-driven approach based on charge, conservation, location, three-dimensional (3D) structural modelling and molecular docking analysis, we identified four amino acid residues (Glu-120, Asp-123, Glu-167 and Arg-504) in the AGT1 permease that could mediate substrate binding and translocation. Mutant permeases were generated by site-directed mutagenesis of these charged residues, and expressed in a yeast strain lacking this permease (agt1∆). While mutating the Arg-504 or Glu-120 residues into alanine totally abolished (R504A mutant) or greatly reduced (E120A mutant) maltotriose consumption by yeast cells, as well as impaired the active transport of several other α-glucosides, in the case of the Asp-123 and Glu-167 amino acids, it was necessary to mutate both residues (D123G/E167A mutant) in order to impair maltotriose consumption and fermentation. CONCLUSIONS Based on the results obtained with mutant proteins, molecular docking and the localization of amino acid residues, we propose a transport mechanism for the AGT1 permease. SIGNIFICANCE AND IMPACT OF THE STUDY Our results present new insights into the structural basis for active α-glucoside-H+ symport activity by yeast transporters, providing the molecular bases for improving the catalytic properties of this type of sugar transporters.
Collapse
Affiliation(s)
- D Trichez
- Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil.,Departamento de Bioquímica, Instituto de Química, Universidade de São Paulo, São Paulo, Brazil
| | - M M Knychala
- Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - C M Figueiredo
- Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil.,Departamento de Bioquímica, Instituto de Química, Universidade de São Paulo, São Paulo, Brazil
| | - S L Alves
- Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - M A da Silva
- Departamento de Bioquímica, Instituto de Química, Universidade de São Paulo, São Paulo, Brazil
| | - L C Miletti
- Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - P S de Araujo
- Departamento de Bioquímica, Instituto de Química, Universidade de São Paulo, São Paulo, Brazil
| | - B U Stambuk
- Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| |
Collapse
|
2
|
Alves SL, Thevelein JM, Stambuk BU. Extracellular maltotriose hydrolysis by Saccharomyces cerevisiae cells lacking the AGT1 permease. Lett Appl Microbiol 2018; 67:377-383. [PMID: 29992585 DOI: 10.1111/lam.13048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/13/2018] [Accepted: 07/06/2018] [Indexed: 11/28/2022]
Abstract
In brewing, maltotriose is the least preferred sugar for uptake by Saccharomyces cerevisiae cells. Although the AGT1 permease is required for efficient maltotriose fermentation, we have described a new phenotype in some agt1Δ strains of which the cells do not grow on maltotriose during the first 3-4 days of incubation, but after that, they start to grow on the sugar aerobically. Aiming to characterize this new phenotype, we performed microarray gene expression analysis which indicated upregulation of high-affinity glucose transporters (HXT4, HXT6 and HXT7) and α-glucosidases (MAL12 and IMA5) during this delayed cellular growth. Since these results suggested that this phenotype might be due to extracellular hydrolysis of maltotriose, we attempted to detect glucose in the media during growth. When an hxt-null agt1Δ strain was grown on maltotriose, it also showed the delayed growth on this carbon source, and glucose accumulated in the medium during maltotriose consumption. Considering that the poorly characterized α-glucosidase encoded by IMA5 was among the overexpressed genes, we deleted this gene from an agt1Δ strain that showed delayed growth on maltotriose. The ima5Δ agt1Δ strain showed no maltotriose utilization even after 200 h of incubation, suggesting that IMA5 is likely responsible for the extracellular maltotriose hydrolysis. SIGNIFICANCE AND IMPACT OF THE STUDY Maltotriose is the second most abundant sugar present in brewing. However, many yeast strains have difficulties to consume maltotriose, mainly because of its low uptake rate by the yeast cells when compared to glucose and maltose uptake. The AGT1 permease is required for efficient maltotriose fermentation, but some strains deleted in this gene are still able to grow on maltotriose after an extensive lag phase. This manuscript shows that such delayed growth on maltotriose is a consequence of extracellular hydrolysis of the sugar. Our results also indicate that the IMA5-encoded α-glucosidase is likely the enzyme responsible for this phenotype.
Collapse
Affiliation(s)
- S L Alves
- Federal University of Fronteira Sul, Chapecó, Brazil.,Department of Biochemistry, Federal University of Santa Catarina, Florianópolis, Brazil.,Laboratory of Molecular Cell Biology, Institute of Botany and Microbiology, KU Leuven, Belgium
| | - J M Thevelein
- Laboratory of Molecular Cell Biology, Institute of Botany and Microbiology, KU Leuven, Belgium.,Center for Microbiology, VIB, Leuven-Heverlee, Belgium
| | - B U Stambuk
- Department of Biochemistry, Federal University of Santa Catarina, Florianópolis, Brazil
| |
Collapse
|
3
|
Zilli DMW, Lopes RG, Alves SL, Barros LM, Miletti LC, Stambuk BU. Secretion of the acid trehalase encoded by the CgATH1 gene allows trehalose fermentation by Candida glabrata. Microbiol Res 2015; 179:12-9. [PMID: 26411890 DOI: 10.1016/j.micres.2015.06.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 06/26/2015] [Accepted: 06/27/2015] [Indexed: 01/10/2023]
Abstract
The emergent pathogen Candida glabrata differs from other yeasts because it assimilates only two sugars, glucose and the disaccharide trehalose. Since rapid identification tests are based on the ability of this yeast to rapidly hydrolyze trehalose, in this work a biochemical and molecular characterization of trehalose catabolism by this yeast was performed. Our results show that C. glabrata consumes and ferments trehalose, with parameters similar to those observed during glucose fermentation. The presence of glucose in the medium during exponential growth on trehalose revealed extracellular hydrolysis of the sugar by a cell surface acid trehalase with a pH optimum of 4.4. Approximately ∼30% of the total enzymatic activity is secreted into the medium during growth on trehalose or glycerol. The secreted enzyme shows an apparent molecular mass of 275 kDa in its native form, but denaturant gel electrophoresis revealed a protein with ∼130 kDa, which due to its migration pattern and strong binding to concanavalin A, indicates that it is probably a dimeric glycoprotein. The secreted acid trehalase shows high affinity and activity for trehalose, with Km and Vmax values of 3.4 mM and 80 U (mg protein)(-1), respectively. Cloning of the CgATH1 gene (CAGLOK05137g) from de C. glabrata genome, a gene showing high homology to fungal acid trehalases, allowed trehalose fermentation after heterologous expression in Saccharomyces cerevisiae.
Collapse
Affiliation(s)
- D M W Zilli
- Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Campus Trindade, Florianópolis, SC 88040-900, Brazil
| | - R G Lopes
- Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Campus Trindade, Florianópolis, SC 88040-900, Brazil
| | - S L Alves
- Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Campus Trindade, Florianópolis, SC 88040-900, Brazil
| | - L M Barros
- Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Campus Trindade, Florianópolis, SC 88040-900, Brazil
| | - L C Miletti
- Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Campus Trindade, Florianópolis, SC 88040-900, Brazil
| | - B U Stambuk
- Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Campus Trindade, Florianópolis, SC 88040-900, Brazil.
| |
Collapse
|
4
|
Rodriguez R, da Silva ACA, Müller CA, Alves SL, Graeff-Teixeira C, Fornari F. PCR for the diagnosis of abdominal angiostrongyliasis in formalin-fixed paraffin-embedded human tissue. PLoS One 2014; 9:e93658. [PMID: 24705328 PMCID: PMC3976301 DOI: 10.1371/journal.pone.0093658] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 03/09/2014] [Indexed: 11/18/2022] Open
Abstract
To date the diagnosis of abdominal angiostrongyliasis (AA) depends on the histological identification of Angiostrongylus costaricensis (AC) in surgical specimens. However, microscopic evaluation is time consuming and often fails in identifying the parasite. We tested whether PCR might help in the diagnosis of AA by identifying parasite DNA in formalin-fixed paraffin-embedded (FFPE) tissue. We used primers based on DNA from Angiostrongilus cantonensis. Four groups of FFPE intestinal tissue were tested: (1) confirmed cases (n = 20), in which AC structures were present in the target tissue; (2) presumptive cases (n = 20), containing changes secondary to AC infection in the absence of AC structures; (3) negative controls (n = 3), consisting of normal colonic tissue; and (4) tissue affected by other parasitoses (n = 7), including strongyloidiasis, ascaridiasis, schistosomiasis, and enterobiasis. Most lesions of confirmed cases were located in small and/or large bowel (90%), as compared with presumptive cases, in which 70% of lesions were in appendix (P = 0.0002). When confronted with cases of other parasitoses, PCR showed sensitivity of 55%, specificity of 100% and positive predictive value of 100%. In presumptive cases PCR was positive in 4 (20%). All specimens from negative controls and other parasitoses were negative. In conclusion, the PCR technique showed intermediate sensitivity and optimal specificity, being clinically relevant when positive for abdominal angiostrongyliasis. It allowed a 20% gain in diagnosis of presumptive cases. PCR might help in the diagnosis of abdominal angiostrongyliasis, particularly when the pathologists are not experienced with such disease.
Collapse
Affiliation(s)
- Rubens Rodriguez
- Programa de Pós-Graduação: Ciências em Gastroenterologia e Hepatologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre-RS, Brazil
- Faculdade de Medicina, Universidade de Passo Fundo, Passo Fundo-RS, Brazil
- * E-mail:
| | - Ana Cristina Aramburú da Silva
- Laboratórios de Biologia Parasitária e Parasitologia Molecular, Pontifíca Universidade Católica do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Carla Aristonara Müller
- Laboratórios de Biologia Parasitária e Parasitologia Molecular, Pontifíca Universidade Católica do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Silvana Lunardini Alves
- Laboratórios de Biologia Parasitária e Parasitologia Molecular, Pontifíca Universidade Católica do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Carlos Graeff-Teixeira
- Laboratórios de Biologia Parasitária e Parasitologia Molecular, Pontifíca Universidade Católica do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Fernando Fornari
- Programa de Pós-Graduação: Ciências em Gastroenterologia e Hepatologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre-RS, Brazil
- Faculdade de Medicina, Universidade de Passo Fundo, Passo Fundo-RS, Brazil
| |
Collapse
|
5
|
Cousseau FEM, Alves SL, Trichez D, Stambuk BU. Characterization of maltotriose transporters from the Saccharomyces eubayanus subgenome of the hybrid Saccharomyces pastorianus lager brewing yeast strain Weihenstephan 34/70. Lett Appl Microbiol 2012; 56:21-9. [PMID: 23061413 DOI: 10.1111/lam.12011] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 09/03/2012] [Accepted: 09/30/2012] [Indexed: 11/29/2022]
Abstract
The genome from the Saccharomyces pastorianus industrial lager brewing strain Weihenstephan 34/70, a natural Saccharomyces cerevisiae/Saccharomyces eubayanus hybrid, indicated the presence of two different maltotriose transporter genes: a new gene in the S. eubayanus subgenome with 81% of homology to the AGT1 permease from S. cerevisiae, and an amplification of the S. eubayanus MTY1 maltotriose permease previously identified in S. pastorianus yeasts. To characterize these S. eubayanus transporter genes, we used a S. cerevisiae strain deleted in the AGT1 permease and introduced the desired permease gene(s) into this locus through homologous recombination. Our results indicate that both the MTY1 and AGT1 genes from the S. eubayanus subgenome encode functional maltotriose transporters that allow fermentation of this sugar by yeast cells, despite their apparent differences in the kinetics of maltotriose-H(+) symport activity. The presence of two maltotriose transporters in the S. eubayanus subgenome not only highlights the importance of sugar transport for efficient maltotriose utilization by industrial yeasts, but these new genes can be used in breeding and/or selection programs aimed at increasing yeast fitness for the efficient fermentation of brewer's wort.
Collapse
Affiliation(s)
- F E M Cousseau
- Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | | | | | | |
Collapse
|
6
|
Duval EH, Alves SL, Dunn B, Sherlock G, Stambuk BU. Microarray karyotyping of maltose-fermenting Saccharomyces yeasts with differing maltotriose utilization profiles reveals copy number variation in genes involved in maltose and maltotriose utilization. J Appl Microbiol 2009; 109:248-59. [PMID: 20070441 DOI: 10.1111/j.1365-2672.2009.04656.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS We performed an analysis of maltotriose utilization by 52 Saccharomyces yeast strains able to ferment maltose efficiently and correlated the observed phenotypes with differences in the copy number of genes possibly involved in maltotriose utilization by yeast cells. METHODS AND RESULTS The analysis of maltose and maltotriose utilization by laboratory and industrial strains of the species Saccharomyces cerevisiae and Saccharomyces pastorianus (a natural S. cerevisiae/Saccharomyces bayanus hybrid) was carried out using microscale liquid cultivation, as well as in aerobic batch cultures. All strains utilize maltose efficiently as a carbon source, but three different phenotypes were observed for maltotriose utilization: efficient growth, slow/delayed growth and no growth. Through microarray karyotyping and pulsed-field gel electrophoresis blots, we analysed the copy number and localization of several maltose-related genes in selected S. cerevisiae strains. While most strains lacked the MPH2 and MPH3 transporter genes, almost all strains analysed had the AGT1 gene and increased copy number of MALx1 permeases. CONCLUSIONS Our results showed that S. pastorianus yeast strains utilized maltotriose more efficiently than S. cerevisiae strains and highlighted the importance of the AGT1 gene for efficient maltotriose utilization by S. cerevisiae yeasts. SIGNIFICANCE AND IMPACT OF THE STUDY Our results revealed new maltotriose utilization phenotypes, contributing to a better understanding of the metabolism of this carbon source for improved fermentation by Saccharomyces yeasts.
Collapse
Affiliation(s)
- E H Duval
- Departamento de Bioquímica, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | | | | | | | | |
Collapse
|
7
|
Almeida PB, Pinheiro da Costa BE, Figueiredo AE, Conti A, Alves SL, d'Avila DO, Poli de Figueiredo CE. Erythrocyte L-arginine uptake in peritoneal dialysis patients changes over time. Adv Perit Dial 2007; 23:48-50. [PMID: 17886602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
During long-term exposure to continuous ambulatory peritoneal dialysis (PD), the characteristics of the peritoneal membrane may be altered. The substrate for nitric oxide synthesis is L-arginine, which may enter cells via the y+ and y+L transport systems. Peritoneal membrane characteristics may depend on vascular function and the L-arginine-NO pathway. Maximal capacity for L-arginine transport is higher in patients with a lower dialysis adequacy index. Our aim was to evaluate erythrocyte L-arginine uptake in PD patients at the start and end of a 3-year interval. Our longitudinal study evaluated 8 stable patients on PD who were not using NO donors and who had been free of peritonitis for at least 1 month. Uptake of L-arginine was measured in 2003 and again in 2006. Maximal transport capacity (Vmax, in micromoles per liter-cells per hour) and half-saturation constant (km, in micromoles per liter) were measured in erythrocytes using 14C as a marker and N-ethylmaleimide as inhibitor of the y+ system. For the years 2003 and 2006 respectively, mean +/- standard deviation for total L-arginine uptake Vmax was 749 +/- 182 micromol/L-cells/h and 1146 +/- 365 micromol/L-cells/h (p = 0.016, paired t-test),for y+L Vmax was 180 +/- 58 micromol/L-cells/h and 515 +/- 142 micromol/L-cells/h (p = 0. 002), and for y+ Vmax was 556 +/- 177 micromol/L-cells/h and 662 +/- 267 micromol/ L-cells/h (nonsignificant). The total y+L and y+km were not significantly different. The L-arginine maximal uptake capacity in erythrocytes increased after 3 years of PD treatment. These findings agree with the suggestion of an association between y+L activity and dialysis adequacy or uremia toxicity. Peritoneal membrane characteristics may depend on vascular function and the L-arginine-NO pathway.
Collapse
Affiliation(s)
- Priscilla B Almeida
- Programa de Pós-graduação em Medicina e Ciências da Saúde (Nefrologia), Laboratório de Nefrologia, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | | | | | | | | |
Collapse
|
8
|
Abstract
AIMS To enhance the fermentation of maltotriose by industrial Saccharomyces cerevisiae strains. METHODS AND RESULTS The capability to ferment maltotriose by an industrial yeast strain that uses this sugar aerobically was tested in shake flasks containing rich medium. While the presence of maltose in the medium did not improve maltotriose fermentation, enhanced and constitutive expression of the AGT1 permease not only increased the uptake of maltotriose, but allowed efficient maltotriose fermentation by this strain. Supplementation of the growth medium with 20 mmol magnesium l(-1) also increased maltotriose fermentation. CONCLUSIONS Over expression of the AGT1 permease and magnesium supplementation improved maltotriose fermentation by an industrial yeast strain that respired but did not ferment this sugar. SIGNIFICANCE AND IMPACT OF THE STUDY This work contributes to the elucidation of the roles of the AGT1 permease and nutrients in the fermentation of all sugars present in starch hydrolysates, a highly desirable trait for several industrial yeasts.
Collapse
Affiliation(s)
- B U Stambuk
- Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Florianópolis, Brazil.
| | | | | | | |
Collapse
|
9
|
McCall WG, Alves SL, Brooks DY, Fallacaro MD, Gray GC, Ritter D. An analysis of factors influencing nurse anesthesia educational program director turnover. 1996-1997 AANA Education Committee. AANA J 1997; 65:537-542. [PMID: 9464008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
|
10
|
Deisering LF, Alves SL. The expanding role of the clinical coordinator. AANA J 1997; 65:48-51. [PMID: 9223939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This article describes the role of the clinical coordinator in nurse anesthesia educational programs, a role which has greatly expanded as programs shift to university-based frameworks with multiple clinical sites. The role of the clinical coordinator has become vital in the success of schools of nurse anesthesia based in the university/college setting. The significance and functional responsibilities of this role need to be broadened by making the clinical coordinator a university appointed representative. The expanded role provides for university representation at each site, improves the lines of communication between the university and each site, and allows for regular visits to each clinical site. Hopefully, program directors, faculty members, and students will benefit from this innovative attempt at bridging the gap between the university and the associated clinical facilities. Regional coordinators also play a vital role in coordinating student functions between various institutions and the clinical coordinators in each of these institutions, as well as representing the university/school of nurse anesthesia interest and needs in these settings.
Collapse
Affiliation(s)
- L F Deisering
- School of Nurse Anesthesia, University of New England, Biddeford, Maine, USA
| | | |
Collapse
|
11
|
Alves SL, Deisering LF. Cardiovascular changes associated with aging: the anesthetic implications. CRNA 1996; 7:2-8. [PMID: 8680351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Successful anesthesia care of the elderly patient is highly dependent on the anesthesia care provider's knowledge of the physiological alterations on the cardiovascular system associated with aging. It is projected that by the year 2000, the elderly segment of the population will increase to 13% and by the year 2030, 52 million Americans, or 17% of the population will be older than age 65. More people than ever before are reaching old age, with the latest statistics indicating that life expectancy for a man of 45 years has increased from 70.4 to 77.3 years and from 77.0 to 82.8 years for a woman. One of the primary factors associated with the increase in longevity is the decrease in mortality from cardiovascular diseases. Since the 1960s, there has been a decline in cardiovascular mortality of about 3% per year. Recent technological advances and healthier lifestyles are among the reasons contributing to this trend. With these positive changes impacting the elderly population, anesthesia care providers must become better prepared to select and administer the appropriate agents that will ultimately influence perioperative outcome.
Collapse
|