AB0559 PATIENTS WITH EARLY-ONSET SJÖGREN’S SYNDROME

Background

The primary Sjögrens Syndrome (pSS) is an autoimmune systemic disease characterized by chronic inflammation of exocrine glands, especially lacrimal and salivary glands. The onset of pSS is usually between 50 and 60 years of age, but it may also occur in younger patients, in which case may be associated with a worse progression of the disease and a worse prognosis.

Objectives

To describe the clinical and immunological profile of patients with primary SS, aiming to investigate the clinical and laboratory characteristics of early-onset pSS patients (diagnosis before 35 years old)

Methods

The data of 58 medical records were analysed retrospectively. Based on the disease onset age, the patients were divided into two groups those with the onset age of 35 years old or younger and those with the onset age of older than 35 years old. Data normality was verified with the Shapiro-Wilk test. The comparison between patients’ profiles with the late and early diagnosis was done with Pearson’s Chi-squared test, Student’s t-test, and Mann-Whitney test. P <0.05 was considered statistically significant.

Results

55 patients were female (94,8%) and 3 were male (5,2%) and the average age on the last medical visit was 45,91±12,46 years old and the time between the diagnosis and the last appointment (follow up time) was 56,90±61,57 months. 14 patients had early-onset pSS and 44 had late-onset pSS. The mean diagnosis age in the early-onset group and the late-onset group. was 30,21±4,21 vs 50,91±9,73 years old (p<0.001) respectively and a mean follow-up time was of 41,40±50,27 vs 61,75±64,64 months respectively. There was no significant difference in demographic profile between the two studied groups, except for the age. There was no significant difference in cutaneous, joint, renal, and nervous system involvement. However there was a significantly higher frequency of xerophthalmia in the late-onset group (88.6% vs 64.3% p=0.036) and a significantly higher frequency of parotid enlargement in the early diagnosis group (42.9% vs 20.5% p=0.036) There was no significant difference in laboratory profiles between the two groups (anti-Ro, anti-La, ANA, rheumatoid factor, hypergammaglobulinemia and low complement).

Conclusion

The profile clinical of early-onset pSS patients may be different to those with later onset, with a higher prevalence of parotid enlargement. This group of patients needs to be monitored to determine the risk of a worse prognosis.

References

[1]ANQUETIL, C. et al. Is early-onset primary Sjögren’s syndrome a worse prognosis form of the disease? Rheumatology (United Kingdom), v. 58, n. 7, p. 1163–1167, 2019.

[2]YAYLA, M.E., KARAMAN, Z., TORGUTALP, M. et. al. Early onset primary Sjögren syndrome, clinical and laboratory characteristics. Clinical Rheumatology, v. 39, p. 2689-2696, 2020.

Disclosure of Interests

None declared

Strategies to reduce sodium levels in European seabass sausages

Considering the increasing demand towards "ready-to-cook" processed seafood products, recognised as being potential contributors to high sodium (Na) intake by consumers, this study aimed to assess the effect of sodium chloride (NaCl) reduction on physicochemical, microbiological and sensory properties of European seabass (Dicentrarchus labrax) sausages stored in chilling conditions during 5 weeks. Three formulations were tested in comparison with a control (100% NaCl, CTR): (i) 50% NaCl+50% ME (oleoresins microcapsules) (F1); (ii) 50% NaCl+50% KCl (F2); and (iii) only 50% NaCl (F3). The NaCl reduction mainly affected the texture and the salty taste, resulting in softer and perceived as less salty sausages after processing. However, hardness differences disappeared after 5 weeks. It seems that an antioxidant protection was obtained in sausages formulated with oleoresins microcapsules. No or low growth of psychrotrophic and mesophilic bacteria was observed (≤2.40 log CFU/g). Decreasing NaCl content and/or partially replacing it (50%) by KCl or oleoresins microcapsules seem to be suitable solutions to reduce Na (30.9-36.3%) levels, while maintaining the chilled sausages quality for 5 weeks. The partial replacement of NaCl by KCl also allows obtaining a product richer in K (997.2 mg/100 g), which ingestion may contribute for a cardiovascular protective effect.

Nutritional value and sensory properties of common carp (Cyprinus carpio L.) fillets enriched with sustainable and natural feed ingredients

Declines across global fishery stocks forced aquaculture feed manufacturers to search for new and sustainable components. Therefore, the aim of study was assessing nutritional value and sensory properties of meat of common carp (Cyprinus carpio L.) fed for 116 days with two blends. The control feed contained 5% of fishmeal and vegetable oils (rapeseed and soybean) as sole fat sources. While in the experimental diet half of the fishmeal was replaced with a blend of microalgae (Spirulina sp., Chlorella sp.), macroalgae (Laminaria digitata) and vegetable oil was replaced with salmon oil. Proximate composition, energy value, fatty acid profile of meat, nutritional characteristics of fat and protein as well as culinary properties of fillets were assessed. Fillets of carp fed experimental diet had a higher level of protein, lower level of fat and energy value. Intramuscular fat of fish fed with the experimental diet had a better parameters of quality. Protein in the meat of fish from both groups was characterized by a high quality comparing to the protein standard. Our study showed that meat of carp fed with experimental feed enriched with sustainable and natural feed ingredients can be a sensorily attractive source of nutritious ingredients in the human diet.

Effects of steaming on health-valuable nutrients from fortified farmed fish: Gilthead seabream (Sparus aurata) and common carp (Cyprinus carpio) as case studies

Fish fortification with iodine-rich macroalgae (Laminaria digitata) and Selenium-rich yeast is expected to promote nutritional added value of this crucial food item, contributing to a healthy and balanced diet for consumers. However, it is not known if steaming can affect these nutrient levels in fortified fish. The present study evaluates the effect of steaming on nutrients contents in fortified farmed gilthead seabream (Sparus aurata) and common carp (Cyprinus carpio). Fortified seabream presented enhanced I, Se and Fe contents, whereas fortified carp presented enhanced I, Se and Zn contents. Steaming resulted in increased I and Se contents in fortified seabream, and increased Fe and Zn levels in fortified carp, with higher elements true retention values (TRVs >90%). The consumption of 150 g of steamed fortified seabream contributes to a significant daily intake (DI) of I (up to 12%) and Se (up to >100%). On the other hand, steamed fortified carp contributes to 19-23% of I DI and 30%-71% of Se DI. These results demonstrate that steaming is a healthy cooking method, maintaining the enhanced nutritional quality of fortified fish. Moreover, the present fortification strategy is a promising solution to develop high-quality farmed fish products to overcome nutritional deficiencies.

Structural and molecular indices in common carp (Cyprinus carpio L.) fed n-3 PUFA enriched diet

Sustainable freshwater aquaculture has been recently gaining attention owing to the potential of nourishing the world. The study aimed to evaluate the influence of finishing diets on the activity of 21 genes involved in hepatic lipid metabolism and intestinal homeostasis, liver and intestine histology, and the level of eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids in common carp fillets. We compared two experimental diets: control diet mimicking a commercial feed (CTRL) and a test diet (CB) fortified with EPA and DHA retrieved from salmon by-products. An additional control (eCTRL) from extensively cultured carps was investigated. The study revealed that the expression of seven hepatic genes, e.g., lipoprotein lipase and fatty acid synthase, and six intestinal genes e.g., claudin-3c and γ-glutamyl transpeptidase, was influenced specifically by the experimental diets and farming type. Fish from the eCTRL group had the smallest hepatocytes and the largest nuclei compared with CTRL and CB. No pathological signs were found in intestine samples. Additionally, the levels of EPA and DHA in fillets were significantly higher in fish receiving CB compared with CTRL and eCTRL. The use of fortified diets is a promising solution to produce freshwater species with enhanced nutritional value without compromising the safety of fillets.

Green tea infusion reduces mercury bioaccessibility and dietary exposure from raw and cooked fish

Human exposure to mercury (Hg) and methylmercury (MeHg) through the ingestion of seafood raises human health-related concerns. In contrast, green tea has health benefits and its consumption potentially reduces bioaccessibility of dietary Hg. The present study aimed to assess the effect of green tea in total mercury (THg) and MeHg bioaccessibility in raw and cooked marine fish species commonly having high Hg levels. Preliminary results demonstrated that significantly higher reductions of bioaccessible THg were attained after the co-ingestion of green tea infusion (1 cup or more) in the oral and intestinal phases. Overall, the present findings clearly show that the co-ingestion of green tea along with seafood grilling strongly reduces THg and MeHg bioaccessibility in all fish species and consequently diminishes the probability of exceeding MeHg provisional tolerable weekly intakes through the consumption of these species with high Hg levels. Such results point out the need to better understand the beneficial/preventive role of green tea infusions and other food processing techniques in bioaccessibility reduction of other chemical contaminants present in food products. Such information is certainly useful to help consumers to wisely select their food, and to enable food safety authorities to integrate such information in risk assessment.

Plasma biochemistry, gene expression and liver histomorphology in common carp (Cyprinus carpio) fed with different dietary fat sources

Demand for omega-3 long chain polyunsaturated fatty acids has become global challenge for aquaculture and different components have been used to increase nutritional value of fillets. The aim of this study was to evaluate influences of feeds on zootechnical parameters, biochemical plasma parameters, expression of lipid-dependent genes, hepatocyte histomorphologies, and fatty acid profiles in common carp fillets. We compared a control diet (CTRL), mimicking a commercial feed formulation for common carp, with three diets containing blends of vegetable oils and a DHA-rich alga (Schizochytrium sp.) included at 3.125% (CB1) or 1.563% (CB2), and 2.1% salmon oil (CB3). The study revealed no differences in final body weight of fish fed CB1-3 diets in comparison with significantly lower CTRL. Concentrations of all biochemical parameters in plasma increased gradually in fish fed CB1-3 diets when compared to CTRL diet, with exception of triacylglycerol levels. Expression of hepatic fas, elovl-5a and pparα genes increased significantly in fish fed CB1 and CB2. Additionally, eicosapentaenoic (EPA) and docosahexaenoic acid (DHA) accumulation in muscle tissue was directly proportional to the amounts supplied in the diets. Our study revealed that carp fillet profiles can be manipulated for DHA and EPA-contents using enriched diets, depending on the source of fat.

Does the addition of ingredients affect mercury and cadmium bioaccessibility in seafood-based meals?

Despite the bioaccessibility of nutrients and contaminants present in individual seafood products has been thoroughly studied, information is extremely limited in what concerns complete seafood-based meals, where interactions between ingredients may occur. Hence, this study aimed to evaluate the effect of different ingredients and cooking processes in mercury (Hg) and cadmium (Cd) bioaccessibility in complete meals of tuna (Thunnus spp.) and edible crab (Cancer pagurus), respectively. The addition of ingredients/side dishes decreased Hg levels in cooked tuna meals, but increased Hg bioaccessibility (up to 31% of bioaccessible Hg in complete meals, against 13.5% in stewed tuna alone). Cd levels in edible crab meals were significantly decreased by the addition of ingredients (~36% and ~65% decrease in boiled crab and paté, respectively), but its' bioaccessibility was not significantly affected (>94% in all cases). Results showed that the weekly consumption of 2 complete tuna meals does not exceed MeHg tolerable weekly intake (TWI), whereas Cd's TWI is largely surpassed with the consumption of 50 g/week of edible crab meals. This highlights the importance of determining contaminant levels and bioaccessibility in a whole seafood-based meal context, as such approach enables a more realistic assessment of the risks that seafood can pose to consumers.

Living in a multi-stressors environment: An integrated biomarker approach to assess the ecotoxicological response of meagre (Argyrosomus regius) to venlafaxine, warming and acidification

Pharmaceuticals, such as the antidepressant venlafaxine (VFX), have been frequently detected in coastal waters and marine biota, and there is a growing body of evidence that these pollutants can be toxic to non-target marine biota, even at low concentrations. Alongside, climate change effects (e.g. warming and acidification) can also affect marine species' physiological fitness and, consequently, compromising their ability to cope with the presence of pollutants. Yet, information regarding interactive effects between pollutants and climate change-related stressors is still scarce. Within this context, the present study aims to assess the differential ecotoxicological responses (antioxidant activity, heat shock response, protein degradation, endocrine disruption and neurotoxicity) of juvenile fish (Argyrosomus regius) tissues (muscle, gills, liver and brain) exposed to VFX (via water or feed), as well as to the interactive effects of warming (ΔT °C = +5 °C) and acidification (ΔpCO₂ ~ +1000 µatm, equivalent to ΔpH = -0.4 units), using an integrated multi-biomarker response (IBR) approach. Overall, results showed that VFX toxicity was strongly influenced by the uptake pathway, as well as by warming and acidification. More significant changes (e.g. increases surpassing 100% in lipid peroxidation, LPO, heat shock response protein content, HSP70/HSC70, and total ubiquitin content, Ub,) and higher IBR index values were observed when VFX exposure occurred via water (i.e. average IBR = 19, against 17 in VFX-feed treatment). The co-exposure to climate change-related stressors either enhanced (e.g. glutathione S-transferases activity (GST) in fish muscle was further increased by warming) or attenuated the changes elicited by VFX (e.g. vitellogenin, VTG, liver content increased with VFX feed exposure acting alone, but not when co-exposed with acidification). Yet, increased stress severity was observed when the three stressors acted simultaneously, particularly in fish exposed to VFX via water (i.e. average IBR = 21). Hence, the distinct fish tissues responses elicited by the different scenarios emphasized the relevance of performing multi-stressors ecotoxicological studies, as such approach enables a better estimation of the environmental hazards posed by pollutants in a changing ocean and, consequently, the development of strategies to mitigate them.

Bioaccumulation and ecotoxicological responses of juvenile white seabream (Diplodus sargus) exposed to triclosan, warming and acidification

Triclosan (TCS) is a synthetic microbial compound widely used in the formulation of various personal care products. Its frequent detection in marine ecosystems, along with its physical and chemical properties, suggest that TCS can be highly persistent, being easily bioaccumulated by biota and, therefore, eliciting various toxicological responses. Yet, TCS's mechanisms of bioaccumulation and toxicity still deserve further research, particularly focusing on the interactive effects with climate change-related stressors (e.g. warming and acidification), as both TCS chemical behaviour and marine species metabolism/physiology can be strongly influenced by the surrounding abiotic conditions. Hence, the aim of this study was to assess TCS bioaccumulation and ecotoxicological effects (i.e. animal fitness indexes, antioxidant activity, protein chaperoning and degradation, neurotoxicity and endocrine disruption) in three tissues (i.e. brain, liver and muscle) of juvenile Diplodus sargus exposed to the interactive effects of TCS dietary exposure (15.9 μg kg^-1 dw), seawater warming (ΔTºC = +5 °C) and acidification (ΔpCO₂ ∼ +1000 μatm, equivalent to ΔpH = -0.4 units). Muscle was the primary organ of TCS bioaccumulation, and climate change stressors, particularly warming, significantly reduced TCS bioaccumulation in all fish tissues. Furthermore, the negative ecotoxicological responses elicited by TCS were significantly altered by the co-exposure to acidification and/or warming, through either the enhancement (e.g. vitellogenin content) or counteraction/inhibition (e.g. heat shock proteins HSP70/HSC70 content) of molecular biomarker responses, with the combination of TCS plus acidification resulting in more severe alterations. Thus, the distinct patterns of TCS tissue bioaccumulation and ecotoxicological responses induced by the different scenarios emphasized the need to further understand the interactive effects between pollutants and abiotic conditions, as such knowledge enables a better estimation and mitigation of the toxicological impacts of climate change in marine ecosystems.

Pharmaceuticals and endocrine disruptors in raw and cooked seafood from European market: Concentrations and human exposure levels

Pharmaceuticals (PhACs) and endocrine disrupting compounds (EDCs) are chemicals of emerging concern that can accumulate in seafood sold in markets. These compounds may represent a risk to consumers through effects on the human reproductive system, metabolic disorders, pathogenesis of breast cancer or development of microbial resistance. Measuring their levels in highly consumed seafood is important to assess the potential risks to human health. Besides, the effect of cooking on contaminant levels is relevant to investigate. Therefore, the objectives of this research were to study the presence and levels of PhACs and EDCs in commercially available seafood in the European Union market, to investigate the effect of cooking on contaminant levels, and to evaluate the dietary exposure of humans to these compounds through seafood consumption. A sampling survey of seafood from 11 European countries was undertaken. Twelve highly consumed seafood types were analysed raw and cooked with 3 analytical methods (65 samples, 195 analysis). PhACs were mostly not detectable or below quantification limits in seafood whereas EDCs were a recurrent group of contaminants quantified in the majority of the samples. Besides, cooking by steaming significantly increased their levels in seafood from 2 to 46-fold increase. Based on occurrence and levels, bisphenol A, methylparaben and triclosan were selected for performing a human exposure assessment and health risk characterisation through seafood consumption. The results indicate that the Spanish population has the highest exposure to the selected EDCs through seafood consumption, although the exposure via seafood remained below the current toxicological reference values.

Antidepressants in a changing ocean: Venlafaxine uptake and elimination in juvenile fish (Argyrosomus regius) exposed to warming and acidification conditions

The presence of antidepressants, such as venlafaxine (VFX), in marine ecosystems is increasing, thus, potentially posing ecological and human health risks. The inherent mechanisms of VFX uptake and elimination still require further understanding, particularly accounting for the impact of climate change-related stressors, such as warming and acidification. Hence, the present work aimed to investigate, for the first time, the effects of increased seawater temperature (ΔT°C = +5 °C) and pCO₂ levels (ΔpCO₂ ∼1000 μatm, equivalent to ΔpH = -0.4 units) on the uptake and elimination of VFX in biological tissues (muscle, liver, brain) and plasma of juvenile meagre (Argyrosomus regius) exposed to VFX through two different exposure pathways (via water, i.e. [VFX ] ∼20 μg L^-1, and via feed, i.e. [VFX] ∼160 μg kg^-1 dry weight, dw). Overall, results showed that VFX can be uptaken by fish through both water and diet. Fish liver exhibited the highest VFX concentration (126.7 ± 86.5 μg kg^-1 and 6786.4 ± 1176.7 μg kg^-1 via feed and water exposures, respectively), as well as the highest tissue:plasma concentration ratio, followed in this order by brain and muscle, regardless of exposure route. Both warming and acidification decreased VFX uptake in liver, although VFX uptake in brain was favoured under warming conditions. Conversely, VFX elimination in liver was impaired by both stressors, particularly when acting simultaneously. The distinct patterns of VFX uptake and elimination observed in the different scenarios calls for a better understanding of the effects of exposure route and abiotic conditions on emerging contaminants' toxicokinetics.

Differential behavioural responses to venlafaxine exposure route, warming and acidification in juvenile fish (Argyrosomus regius)

Antidepressants, such as venlafaxine (VFX), which are considered emerging environmental pollutants, are increasingly more present in the marine environment, and recent evidence suggest that they might have adverse effects on fish behaviour. Furthermore, altered environmental conditions associated to climate change (e.g. warming and acidification) can also have a determinant role on fish behaviour, fitness and survival. Yet, the underlying interactions between these environmental stressors (pharmaceuticals exposure and climate change) are still far from being fully understood. The aim of this study was to assess behavioural responses (in juvenile meagre (Argyrosomus regius) exposed to VFX via water ([VFX] ~20μgL^-1) and via dietary sources ([VFX] ~160μgkg^-1 dry weight), as well as to increased temperature (ΔT°C=+5°C) and high CO₂ levels (ΔpCO₂ ~1000μatm; equivalent to ΔpH=-0.4units). Overall, VFX bioaccumulation in fish plasma was enhanced under the combination of warming and acidification. VFX triggered fish exploration, whereas fish activity and shoal cohesion were reduced. Acidification alone decreased fish exploration and shoal cohesion, and reversed fish preference to turn leftwards compared to control conditions. Such alterations were further enhanced by VFX exposure. The combination of warming and acidification also reduced shoal cohesion and loss of lateralization, regardless of VFX exposure. The distinct behaviour observed when VFX contamination, acidification and warming acted alone or in combination highlighted the need to consider the likely interactive effects of seawater warming and acidification in future research regarding the toxicological aspects of chemical contaminants.

Integrated multi-biomarker responses of juvenile seabass to diclofenac, warming and acidification co-exposure

Pharmaceutical drugs, such as diclofenac (DCF), are frequently detected in the marine environment, and recent evidence has pointed out their toxicity to non-target marine biota. Concomitantly, altered environmental conditions associated with climate change (e.g. warming and acidification) can also affect the physiology of marine organisms. Yet, the underlying interactions between these environmental stressors (pharmaceutical exposure and climate change-related stressors) still require a deeper understanding. Comprehending the influence of abiotic variables on chemical contaminants' toxicological attributes provides a broader view of the ecological consequences of climate change. Hence, the aim of this study was to assess the ecotoxicological responses of juvenile seabass Dicenthrachus labrax under the co-exposure to DCF (from dietary sources, 500 ± 36 ng kg^-1 dw), warming (ΔTºC = +5 °C) and acidification (ΔpCO₂ ∼1000 μatm, equivalent to ΔpH = -0.4 units), using an "Integrated Biomarker Response" (IBR) approach. Fish were exposed to these three stressors, acting alone or combined, for 28 days in a full cross-factorial design, and blood, brain, liver and muscle tissues were subsequently collected in order to evaluate: i) animal/organ fitness; ii) hematological parameters and iii) molecular biomarkers. Results not only confirmed the toxicological attributes of dietary exposure to DCF in marine fish species at the tissue (e.g. lower HSI), cellular (e.g. increased ENAs and lower erythrocytes viability) and molecular levels (e.g. increased oxidative stress, protein degradation, AChE activity and VTG synthesis), but also showed that such attributes are altered by warming and acidification. Hence, while acidification and/or warming enhanced some effects of DCF exposure (e.g. by further lowering erythrocyte viability, and increasing brain GST activity and Ub synthesis in muscle), the co-exposure to these abiotic stressors also resulted in a reversion/inhibition of some molecular responses (e.g. lower CAT and SOD inhibition and VTG synthesis). IBRs evidenced that an overall higher degree of stress (i.e. high IBR index) was associated with DCF and warming co-exposure, while the effects of acidification were less evident. The distinct responses observed when DCF acted alone or the animals were co-exposed to the drug together with warming and acidification not only highlighted the relevance of considering the interactions between multiple environmental stressors in ecotoxicological studies, but also suggested that the toxicity of pharmaceuticals can be aggravated by climate change-related stressors (particularly warming), thus, posing additional biological challenges to marine fish populations.

Occurrence of cyclic imines in European commercial seafood and consumers risk assessment

Cyclic imines constitute a quite recently discovered group of marine biotoxins that act on neural receptors and that bioaccumulate in seafood. They are grouped together due to the imino group functioning as their common pharmacore, responsible for acute neurotoxicity in mice. Cyclic imines (CIs) have not been linked yet to human poisoning and are not regulated in the European Union (EU), although the European Food Safety Authority (EFSA) requires more data to perform conclusive risk assessment for consumers. Several commercial samples of bivalves including raw and processed samples from eight countries (Italy, Portugal, Slovenia, Spain, Ireland, Norway, The Netherlands and Denmark) were obtained over 2 years. Emerging cyclic imine concentrations in all the samples were analysed on a LC-3200QTRAP and LC-HRMS QExactive mass spectrometer. In shellfish, two CIs, pinnatoxin G (PnTX-G) and 13-desmethylspirolide C (SPX-1) were found at low concentrations (0.1-12µg/kg PnTX-G and 26-66µg/kg SPX-1), while gymnodimines and pteriatoxins were not detected in commercial (raw and processed) samples. In summary, SPX-1 (n: 47) and PnTX-G (n: 96) were detected in 9.4% and 4.2% of the samples, respectively, at concentrations higher than the limit of quantification (LOQ), and in 7.3% and 31.2% of the samples at concentrations lower than the LOQ (25µg/kg for SPX-1 and 3µg/kg for PnTX-G), respectively. For the detected cyclic imines, the average exposure and the 95th percentile were calculated. The results obtained indicate that it is unlikely that a potential health risk exists through the seafood diet for CIs in the EU. However, further information about CIs is necessary in order to perform a conclusive risk assessment.

Assessing the effects of seawater temperature and pH on the bioaccumulation of emerging chemical contaminants in marine bivalves

Emerging chemical contaminants [e.g. toxic metals speciation, flame retardants (FRs) and perfluorinated compounds (PFCs), among others], that have not been historically recognized as pollutants nor their toxicological hazards, are increasingly more present in the marine environment. Furthermore, the effects of environmental conditions (e.g. temperature and pH) on bioaccumulation and elimination mechanisms of these emerging contaminants in marine biota have been poorly studied until now. In this context, the aim of this study was to assess, for the first time, the effect of warmer seawater temperatures (Δ = + 4°C) and lower pH levels (Δ = - 0.4 pH units), acting alone or combined, on the bioaccumulation and elimination of emerging FRs (dechloranes 602, 603 and 604, and TBBPA), inorganic arsenic (iAs), and PFCs (PFOA and PFOS) in two estuarine bivalve species (Mytilus galloprovincialis and Ruditapes philippinarum). Overall, results showed that warming alone or combined with acidification promoted the bioaccumulation of some compounds (i.e. dechloranes 602, 604, TBBPA), but also facilitated the elimination of others (i.e. iAs, TBBPA). Similarly, lower pH also resulted in higher levels of dechloranes, as well as enhanced iAs, PFOA and PFOS elimination. Data also suggests that, when both abiotic stressors are combined, bivalves' capacity to accumulate contaminants may be time-dependent, considering significantly drastic increase observed with Dec 602 and TBBPA, during the last 10 days of exposure, when compared to reference conditions. Such changes in contaminants' bioaccumulation/elimination patterns also suggest a potential increase of human health risks of some compounds, if the climate continues changing as forecasted. Therefore, this first study pointed out the urgent need for further research on the effects of abiotic conditions on emerging contaminants kinetics, to adequately estimate the potential toxicological hazards associated to these compounds and develop recommendations/regulations for their presence in seafood, considering the prevailing environmental conditions expected in tomorrow's ocean.

Failure to activate the in-hospital emergency team: causes and outcomes

Objective

To determine the incidence of afferent limb failure of the in-hospital Medical Emergency Team, characterizing it and comparing the mortality between the population experiencing afferent limb failure and the population not experiencing afferent limb failure.

Methods

A total of 478 activations of the Medical Emergency Team of Hospital Pedro Hispano occurred from January 2013 to July 2015. A sample of 285 activations was obtained after excluding incomplete records and activations for patients with less than 6 hours of hospitalization. The sample was divided into two groups: the group experiencing afferent limb failure and the group not experiencing afferent limb failure of the Medical Emergency Team. Both populations were characterized and compared. Statistical significance was set at p ≤ 0.05.

Result

Afferent limb failure was observed in 22.1% of activations. The causal analysis revealed significant differences in Medical Emergency Team activation criteria (p = 0.003) in the group experiencing afferent limb failure, with higher rates of Medical Emergency Team activation for cardiac arrest and cardiovascular dysfunction. Regarding patient outcomes, the group experiencing afferent limb failure had higher immediate mortality rates and higher mortality rates at hospital discharge, with no significant differences. No significant differences were found for the other parameters.

Conclusion

The incidence of cardiac arrest and the mortality rate were higher in patients experiencing failure of the afferent limb of the Medical Emergency Team. This study highlights the need for health units to invest in the training of all healthcare professionals regarding the Medical Emergency Team activation criteria and emergency medical response system operations.

Exploration of the phycoremediation potential of Laminaria digitata towards diflubenzuron, lindane, copper and cadmium in a multitrophic pilot-scale experiment

The presence of contaminants in aquatic ecosystems can cause serious problems to the environment and marine organisms. This study aims to evaluate the phycoremediation capacity of macroalgae Laminaria digitata for pesticides (diflubenzuron and lindane) and toxic elements (cadmium and copper) in seawater in the presence or absence of mussels. The photosynthetic activity was monitored in the macroalgae to assess its "physiological status". The results showed that the presence of algae decreased diflubenzuron concentration in mussels by 70% after 120 h of exposure. Additionally, this macroalgae was efficient to reduce lindane, Cu and Cd in seawater; even though it not was able to reduce these contaminants in mussels. The studied pollutants did not affect the physiological status of macroalgae. This study reveals that the application of phycoremediation with macroalgae can be an useful and effective mitigation strategy to remove/decrease contaminant levels from the aquatic environment.

Ecophysiological responses of juvenile seabass (Dicentrarchus labrax) exposed to increased temperature and dietary methylmercury

The ecotoxicological effects of methylmercury (MeHg) exposure have been intensively described in literature. Yet, it is still unclear how marine biota will respond to the presence of MeHg under climate change, namely ocean warming. The present study aimed to investigate, for the first time, fish condition [Fulton's K index (K), hepatosomatic index (HIS) and brain-to-body mass ratio (BB-ratio)] and several stress-related responses in an ecologically and commercially important fish species (Dicentrachus labrax) exposed for 28days to dietary MeHg (8.0mg kg-1 dw) and temperature increase (+4°C). Results showed significant impairments on fish condition, i.e. up to 34% decrease on K, >100% increase on HIS and 44% decrease on BB-ratio, compared to control conditions. Significant changes on tissue biochemical responses were observed in fish exposed to both stressors, acting alone or combined, evidencing the relevance of assessing possible interactions between different environmental stressors in ecotoxicological studies. For instance, muscle showed to be the least affected tissue, only revealing significant alterations in GST activity of MeHg-enriched fish. On the other hand, liver exhibited a significant induction of GST (>100%) and CAT (up to 74%) in MeHg-enriched fish, regardless of temperature exposure, as well as decreased SOD activity (19%) and increased HSP70/HSC70 content (87%) in fish exposed to warming alone. Brain showed to be affected by temperature (69% of GST inhibition and >100% of increased CAT activity), MeHg (>100% of increased CAT activity, 47% of SOD inhibition and 55% of AChE inhibition), as well as by the combination of both (GST, SOD and AChE inhibition, 17%, 48% and 53%, respectively). Hence, our data provides evidences that the toxicological aspects of MeHg ca be potentiated by warmer temperatures, thus, evidencing the need for further research combining contaminants exposure and climate change effects, to better forecast ecological impacts in the ocean of tomorrow.

Toxic elements and speciation in seafood samples from different contaminated sites in Europe

The presence of cadmium (Cd), lead (Pb), mercury (THg), methylmercury (MeHg), arsenic (TAs), inorganic arsenic (iAs), cobalt (Co), copper (Cu), zinc (Zn), nickel (Ni), chromium (Cr) and iron (Fe) was investigated in seafood collected from European marine ecosystems subjected to strong anthropogenic pressure, i.e. hotspot areas. Different species (Mytilus galloprovincialis, n=50; Chamelea gallina, n=50; Liza aurata, n=25; Platichthys flesus, n=25; Laminaria digitata, n=15; and Saccharina latissima, n=15) sampled in Tagus estuary, Po delta, Ebro delta, western Scheldt, and in the vicinities of a fish farm area (Solund, Norway), between September and December 2013, were selected to assess metal contamination and potential risks to seafood consumers, as well as to determine the suitability of ecologically distinct organisms as bioindicators in environmental monitoring studies. Species exhibited different elemental profiles, likely as a result of their ecological strategies, metabolism and levels in the environment (i.e. seawater and sediments). Higher levels of Cd (0.15-0.94 mg kg(-1)), Pb (0.37-0.89 mg kg(-1)), Co (0.48-1.1 mg kg(-1)), Cu (4.8-8.4 mg kg(-1)), Zn (75-153 mg kg(-1)), Cr (1.0-4.5 mg kg(-1)) and Fe (283-930 mg kg(-1)) were detected in bivalve species, particularly in M. galloprovincialis from Ebro and Po deltas, whereas the highest content of Hg was found in P. flesus (0.86 mg kg(-1)). In fish species, most Hg was organic (MeHg; from 69 to 79%), whereas lower proportions of MeHg were encountered in bivalve species (between 20 and 43%). The highest levels of As were found in macroalgae species L. digitata and S. latissima (41 mg kg(-1) and 43 mg kg(-1), respectively), with iAs accounting almost 50% of the total As content in L. digitata but not with S. latissima nor in the remaining seafood samples. This work highlights that the selection of the most appropriate bioindicator species is a fundamental step in environmental monitoring of each contaminant, especially in coastal areas. Furthermore, data clearly shows that the current risk assessment and legislation solely based on total As or Hg data is limiting, as elemental speciation greatly varies according to seafood species, thus playing a key role in human exposure assessment via food.

Infection with Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae in solid organ transplantation

Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae is spreading globally and represents a challenge in infection control and treatment. Solid organ transplant (SOT) recipients are especially at risk for infection by multidrug-resistant bacteria, and little is known about infection with KPC-producing organisms in this setting. The aim of this study was to describe the clinical and microbiologic aspects of KPC-producing K. pneumoniae infections in SOT recipients. A KPC-2-producing K. pneumoniae outbreak was identified in a public teaching tertiary care hospital in São Paulo, Brazil, in June 2009. During the outbreak, cases of KPC-2-producing K. pneumoniae infection in SOT recipients occurred between July 2009 and February 2010; these cases were retrospectively reviewed. Overall, 12 episodes of infection with KPC-producing K. pneumoniae occurred in 2 heart, 4 liver, and 6 kidney transplant recipients with incidence rates of 16.7%, 12.9%, and 26.3% in heart, liver, and kidney transplantation, respectively. Infection occurred at a median time of 20 days after transplantation. Primary infection sites were as follows: 4 urinary tract infections, 4 bloodstream infections, 2 pneumonias, and 2 surgical site infections. All patients except one had received antibiotics in the last 30 days, mostly piperacillin-tazobactam or glycopeptides. All strains exhibited susceptibility to amikacin and gentamicin. Patients were treated with tigecycline plus polymyxin B (3 cases), polymyxin B plus carbapenem (3 cases), polymyxin B alone (3 cases), or tigecycline plus imipenem (1 case). In 2 cases, patients received only carbapenem, and death occurred before the final culture result. The overall 30-day mortality rate was 42%. In this series of KPC-producing K. pneumoniae infection in SOT recipients, the infection occurrence was high during an institutional outbreak and was potentially life threatening.

First report of investigation into an outbreak due to carbapenemase-producing Klebsiella pneumoniae in a tertiary Brazilian hospital, with extension to a patient in the community

This is the description of an investigation into an outbreak of carbapenemase-producing Klebsiella pneumoniae (KPC) that involved 22 inpatients in a public Brazilian hospital specialising in cardiac surgery, where these bacteria had never been isolated before. The dissemination of KPC also involved an external patient. This is the first description of a KPC outbreak in a Brazilian hospital.

Cryoprotective effects of antifreeze proteins delivered into zebrafish embryos

Fish embryo cryopreservation, which is useful in aquaculture or biodiversity conservation, is still far from being achieved. Structural barriers reduce the entrance of cryoprotectants into embryo compartments. Previous studies demonstrated a better ability for freezing in Arctic species which naturally express antifreeze proteins (AFPs). In this study, AFPs were delivered in early zebrafish embryos by incubation in media containing protein. Their cryoprotective effects were then analyzed. Chilling sensitivity was evaluated at 4 degrees C and -10 degrees C. Survival rates significantly increased in embryos incorporating AFPI and kept at -10 degrees C. To analyze their effects on cryopreservation, 5-somite embryos were vitrified. Incorporation of AFPI reduced the percentage of embryos that collapsed at thawing (14.2% of AFPI-treated embryos and 48.9% of controls). Cellular damage caused by vitrification was assessed after thawing by cell dissociation and further analysis of cell survival in culture (SYBR-14/IP labeling). The percentage of viable cells at thawing ranged from 25 to 50%, considered incompatible with embryo development. Cells recovered from frozen-control embryos did not survive in culture. However, the incorporation of AFPs allowed survival similar to that of cells recovered from non-frozen embryos. Blastomere cryopreservation trials incorporating AFPI in the extender also demonstrated a significant increase in viability after freezing. Our findings demonstrated that delivery of AFPs into zebrafish embryos by incubation in media containing protein at early stages is a simple and harmless method that increases cryoprotection of the cellular compartment. This beneficial effect is also noticed in blastomeres, encouraging their use in further protocols for embryo cryopreservation.

[Effect of an intensive nutritional treatment in nutritional status of head and neck cancer patients in stages III and IV]

OBJECTIVE

Malnutrition and accelerated weight loss are frequent secondary diagnosis in patients with cancer. Head and neck cancer (H & N Cancer) affects nutritional status because of the tumor type and localization. The aim of the study was to assess the effect of an intensive nutritional treatment (INT) on nutritional status of H & N cancer patients, stages III and IV and to compare that with a historical control whose nutritional treatment was conventional (CT).

METHODS

All patients were nutritionally assessed before oncological treatment started (anthropometrical, biochemical, and dietetically). A nutritional feeding plan according to their nutritional personal need was calculated. In case it was impossible to cover all the nutritional requirements orally, a feeding tube was placed. Nutritional follow up was performed each 21 days, during their oncological treatment in four occasions. The results obtained were compared with those obtained from the patients who received the CT that consisted only in nutritional counseling by the attending physician; the statistical test used was Mann Whitney U test.

RESULTS

The INT was associated with maintenance of the nutritional status along their oncological treatment. The statistical significant parameters were: weight 55 to 47 kg in the CT group vs 59 a 58 kg in the INT group (p < 0.0001), and hemoglobin: from 13 to 11 g/dl in the CT group vs 14 to 13 g/dl in the INT group (p < 0.002) as the most important ones. In the rest of the data we can observe a clear tendency of increasing the nutrition parameters in patients the INT group, while in the CT group, they showed a persistent decrease.

CONCLUSION

We concluded that patients who received the INT as part of their oncological treatment deteriorated less their nutritional status than those who received a CT.

The antifreeze protein type I (AFP I) increases seabream (Sparus aurata) embryos tolerance to low temperatures

To date, all attempts at fish embryo cryopreservation have failed. One of the main reasons for this to occur is the high chilling sensitivity reported in fish embryos thus emphasizing the need for further testing of different methods and alternative cryoprotective agents (CPAs) in order to improve our chances to succeed in this purpose. In this work we have used the antifreeze protein type I (AFP I) as a natural CPA. This protein is naturally expressed in sub-arctic fish species, and inhibits the growth of ice crystals as well as recrystallization during thawing. Embryos from Sparus aurata were microinjected with AFP I at different developmental stages, 2 cells and blastula, into the blastomere-yolk interface and into the yolk sac, respectively. Control, punctured and microinjected embryos were subjected to chilling at two different temperatures, 0 degrees C (1h) and -10 degrees C (15min) when embryos reached 5-somite stage. Embryos were subjected to -10 degrees C chilling in a 3M DMSO extender to avoid ice crystal formation in the external solution. Survival after chilling was established as the percentage of embryos that hatch. To study the AFP I distribution in the microinjected embryos, a confocal microscopy study was done. Results demonstrate that AFP I can significantly improve chilling resistance at 0 degrees C, particularly in 2-cell microinjected embryos, displaying nearly 100% hatching rates. This fact is in agreement with the confocal microscopy observations which confirmed the presence of the AFP protein in embryonic cells. These results support the hypothesis that AFP protect cellular structures by stabilizing cellular membranes.

Investigating the capacity of an activated sludge process to reduce volatile organic compounds and odor emissions

The effects of hydrogen sulfide (H2S) diffusion into activated sludge (AS) on odor and volatile organic compound (VOC) concentrations in offgas were studied over an 8-week period. Most VOCs detected in the offgas of both aeration tanks were aromatic hydrocarbons. The VOC concentrations generally decreased when H2S was introduced to the AS compared with the control, indicating a negative effect of H2S on VOC removal. Two volatile organic sulfur compounds present in the test AS offgas showed an increase followed by a decrease during H2S peak loads. Six VOCs and odor concentration increased during the introduction of an H2S peak; however no correlation was observed between H2S and odor concentration. The increase in odor concentration resulted from the increase in the concentration of six aromatic VOCs, which had their removal slowed down during a 100-ppmv H2S peak. Activated sludge diffusion provides effective H2S removal with minimal affect on odor emissions.

Comparison of different microbial bioassays to assess metal-contaminated soils

These experiments compared the sensitivity of four different types of bioassay over time after five metals were added to a wide range of soils at the maximum concentrations in the European Union Sewage Sludge Directive. Three were chronic assays (most probable number of Rhizobium leguminosarum, soil microbial C and Biolog substrate utilization). The fourth bioassay, an acute biosensor, employed a lux-marked luminescent bacterium (Escherichia coli) in the soil pore water. Five metals were added to 23 different soils as a mixture at Zn = 300, Cd = 3, Pb = 300, Cu = 135, and Ni = 75 mg/kg as nitrate salts and compared with unamended controls. Zinc and Cu were the metals most likely to be toxic at the concentrations used here. In the case of Rhizobium, the number of cells in soil was not affected after 11 d; however, by 818 d the numbers had decreased by four orders of magnitude with increasing concentrations of Zn and Cu in soil solution. Microbial biomass also was not affected after 11 d, but significantly decreased with increased Zn (p < 0.001) and Cu (p < 0.01) in soil solution after 818 d. Toxicity to the soil microbial biomass increased with time, whereas the toxicity to the biosensor remained the same. Biolog substrate utilization profiles were not responsive to the concentrations used here.

Myocardial function and energy metabolism in carnitine-deficient rats

Carnitine is essential for mitochondrial metabolism of long-chain fatty acids and thus for myocardial energy production. Accordingly, carnitine deficiency can be associated with cardiomyopathy. To better understand this disease, we determined myocardial function and energy metabolism in a rat model of carnitine deficiency. Carnitine deficiency was induced by a 3- or 6-week diet containing N-trimethyl-hydrazine-3-propionate, reducing cardiac and plasma carnitine by 70-85%. Myocardial function was investigated in isolated isovolumic heart preparations. Carnitine-deficient hearts showed left ventricular systolic dysfunction, reduced contractile reserve, and a blunted frequency-force relationship independently of the substrate used (glucose or palmitate). After glycogen depletion, palmitate could not sustain myocardial function. Histology and activities of carnitine palmitoyl transferase, citrate synthase, and cytochrome c oxidase were unaltered. Thus, as little as 3-6 weeks of systemic carnitine deficiency can lead to abnormalities in myocardial function. These abnormalities are masked by endogenous glycogen and are not accompanied by structural alterations of the myocardium or by altered activities of important mitochondrial enzymes.

Mutation of a Drosophila gamma tubulin ring complex subunit encoded by discs degenerate-4 differentially disrupts centrosomal protein localization

We have cloned the Drosophila gene discs degenerate-4 (dd4) and find that it encodes a component of the gamma-tubulin ring complex (gammaTuRC) homologous to Spc98 of budding yeast. This provides the first opportunity to study decreased function of a member of the gamma-tubulin ring complex, other than gamma-tubulin itself, in a metazoan cell. gamma-tubulin is no longer at the centrosomes but is dispersed throughout dd4 cells and yet bipolar metaphase spindles do form, although these have a dramatically decreased density of microtubules. Centrosomin (CNN) remains in broad discrete bodies but only at the focused poles of such spindles, whereas Asp (abnormal spindle protein) is always present at the presumptive minus ends of microtubules, whether or not they are focused. This is consistent with the proposed role of Asp in coordinating the nucleation of mitotic microtubule organizing centers. The centrosome associated protein CP190 is partially lost from the spindle poles in dd4 cells supporting a weak interaction with gamma-tubulin, and the displaced protein accumulates in the vicinity of chromosomes. Electron microscopy indicates not only that the poles of dd4 cells have irregular amounts of pericentriolar material, but also that they can have abnormal centrioles. In six dd4 cells subjected to serial sectioning centrioles were missing from one of the two poles. This suggests that in addition to its role in nucleating cytoplasmic and spindle microtubules, the gammaTuRC is also essential to the structure of centrioles and the separation of centrosomes.

[Determination of proliferative activity using Ki67 and expression of p53 in colorectal cancer]

BACKGROUNDS AND PURPOSE

Classically, neoplasia has been considered a disturbance in the regulation of proliferation. In the search of a prognostic discriminant, the distribution of Ki67 as a marker of cell proliferation and the expression of p53 was studied in patients with colorectal cancer, to see whether this marker correlate with clinicopathological aspects.

PATIENTS AND METHODS

Formalin-fixed paraffin-embedded tissues from 38 surgically resected adenocarcinomas of colon and rectal (5 Dukes A, 15 B and 18 C) were examined for p53 and Ki67 reactivity by immunohistochemistry (Dako). Nuclear staining of 5% of the cells was the criterion for a positive p53 reaction. For the study of Ki67 10 or more fields were chosen until 1000 nuclei per specimen were counted. The Ki67 labelling indices was determined by the number of positive nuclei/1000 cells. Correlation was done with the Dukes stage, grade of differentiation and percentual of recurrence.

RESULTS

The mean Ki67 labelling indices was 40. The p53 was positive in 79% of the patients. The mean of Ki67-Li was higher in the positive p53 patients. However we did not lymphatic find differences between Ki67 or p53 expression and sex, age, Dukes stage, grade of differentiation, neural, venous or lymphatic invasion or recurrence.

CONCLUSION

Ki67 and p53 could not be correlated to clinical and pathologic parameters in this study and was of limited use as a prognostic discriminant. The positive p53 cancers have more proliferative activity detected by a higher index of Ki67.

Ventricular fibrillation-induced intracellular Ca2+ overload causes failed electrical defibrillation and post-shock reinitiation of fibrillation

Despite high efficacy, electrical defibrillation shocks can fail or ventricular fibrillation (VF) is reinitiated after the application of the initial shock. The goal of this study was to determine whether [Ca2+]i overload, induced by VF itself, can cause failed electrical defibrillation and post-shock reinitiation of VF. For this purpose, we simultaneously measured [Ca2+]i transients (assessed by indo-1 fluorescence) and defibrillation energies (assessed by a modified implantable cardioverter defibrillator) in intact perfused rat hearts during pacing-induced sustained VF (10 min) in the absence of ischemia. We found that increasing [Ca2+]i during VF (by increasing [Ca2+]o from 3 to 6 mM) increased the defibrillation threshold (DFT) from 1.9 +/- 0.6 to 3.5 +/- 0.5 J/g (P<0.05) and also increased the total defibrillation energy (TDE) required for stabilization of sinus rhythm from 15.6 +/- 7.7 to 48.6 +/- 7.42 J/g (P<0.05). In addition, both DFT and TDE correlated linearly with [Ca2+]i (r=0.69 and 0.83, P<0.05). Furthermore, shortening the duration of VF from 10 to 1.5 min tended to limit [Ca2+]i overload and decreased TDE. Finally, all successful defibrillation shocks led to a sudden reduction of VF-induced [Ca2+]i overload (-115 +/- 3%). In contrast, failed shocks did not alter [Ca2+]i. Incomplete reduction of [Ca2+]i overload after initially successful shocks were often followed by synchronized spontaneous [Ca2+]i oscillations and subsequent reinitiation of VF. In conclusion, the present study showed for the first time that VF-induced [Ca2+]i overload can cause failed electrical defibrillation and post-shock reinitiation of VF. Because VF inevitably causes [Ca2+]i overload, this finding might be a crucial mechanism of failed defibrillation and spontaneous reinitiation of VF.

Preconditioning ischemia time determines the degree of glycogen depletion and infarct size reduction in rat hearts

The cardioprotective effect of preconditioning is associated with glycogen depletion and attenuation of intracellular acidosis during subsequent prolonged ischemia. This study determined the effects of increasing preconditioning ischemia time on myocardial glycogen depletion and on infarct size reduction. In addition, this study determined whether infarct size reduction by preconditioning correlates with glycogen depletion before prolonged ischemia. Anesthetized rats underwent a single episode of preconditioning lasting 1.25, 2.5, 5, or 10 minutes or multiple episodes cumulating in 10 (2 x 5 min) or 20 minutes (4 x 5 or 2 x 10 min) of preconditioning ischemia time, each followed by 5 minutes of reperfusion. Then both preconditioned and control rats underwent 45 minutes of ischemia induced by left coronary artery (LCA) occlusion and 120 minutes of reperfusion. After prolonged ischemia, infarct size was determined by dual staining with triphenyltetrazolium chloride and phthalocyanine blue dye. Glycogen levels were determined by an enzymatic assay in selected rats from each group before prolonged ischemia. We found that increasing preconditioning ischemia time resulted in glycogen depletion and infarct size reduction that could both be described by exponential functions. Furthermore, infarct size reduction correlated with glycogen depletion before prolonged ischemia (r = 0.98; p < 0.01). These findings suggest a role for glycogen depletion in reducing ischemic injury in the preconditioned heart.

Catalase inhibition with 3-amino-1,2,4-triazole does not abolish infarct size reduction in heat-shocked rats

BACKGROUND

Recent studies have shown that improved myocardial salvage after heat-shock pretreatment correlates with the amount of induced cardiac heat-shock protein (HSP)72. However, heat shock also induces myocardial catalase activity, potentially reducing free radical-mediated ischemic injury. The aim of the present study was to determine whether catalase inhibition with 3-amino-1,2,4-triazole (3-AT) abolishes the reduction of infarct size conferred by heat-shock treatment in rats.

METHODS AND RESULTS

Myocardial catalase activity was measured in both heat-shocked and control rats 60 minutes after either 3-AT (1000 mg/kg IV) or saline infusion. In separate experiments, heat-shocked and control rats were treated with 3-AT or saline 60 minutes before being subjected to 35 minutes of left coronary artery occlusion and 120 minutes of reperfusion. Infarct size was determined by dual perfusion with triphenyltetrazolium chloride and phthalocyanine blue dye. Heat-shock treatment significantly increased myocardial catalase compared with control animals (180.5 +/- 4.8, n = 6, versus 86.2 +/- 14.7, n = 5, units/g wet wt; P < .05). Treatment with 3-AT significantly reduced myocardial catalase activity in both heat-shocked and control animals (29.6 +/- 5.7, n = 5, and 36.4 +/- 15.3, n = 6, respectively). Heat-shock treatment significantly reduced infarct size in rats that were both treated and untreated with 3-AT compared with respective control groups (22.5 +/- 3.7%, n = 26, 28.2 +/- 4.0%, n = 22, 52.0 +/- 3.0%, n = 23, and 48.6 +/- 3.2%, n = 26, respectively; P < .0001 for both heat-shocked groups versus both control groups; infarct mass/risk area mass x 100).

CONCLUSIONS

Catalase inhibition with 3-AT does not abolish the reduction of infarct size in heat-shocked rats.

Long-term function in the remote region after myocardial infarction: importance of significant coronary stenoses in the non-infarct-related artery

BACKGROUND

Left ventricular (LV) function is the most important determinant of outcome after a myocardial infarction. Global LV function after a myocardial infarction is affected not only by wall motion in the infarct zone but also by regional function in the contralateral territory. It was hypothesised that the presence of significant stenoses in coronary arteries supplying the contralateral territory might influence the ability of this region to compensate for damaged myocardium after a myocardial infarction.

METHODS AND RESULTS

79 patients treated with thrombolysis for acute myocardial infarction had coronary and ventricular angiograms within 24 h and at a mean follow up of 12 months after myocardial infarction. Wall motion in the contralateral territory was analysed and scored by the centre line method and the change over time was correlated with the presence or absence of significant (> 70%) diameter stenoses in the non-infarct-related artery. Mean (SD) contralateral territory motion worsened, from 0.74 (1.78) to -1.55 (2.06) SD chord (p < 0.001) in 40 patients with stenoses, whereas contralateral territory motion improved from -0.02 (2.4) to 0.63 (2.21) SD chord (p < 0.05) in the 39 patients without coronary stenoses. The same pattern was present whether or not the infarct artery was patent. The global left ventricular ejection fraction at 12 months was also related to contralateral territory motion (r = 0.71, p < 0.001) and to the presence of coronary stenoses (54 (15)% in those with coronary stenoses and 62 (16)% in those without, p < 0.05).

CONCLUSION

The results demonstrate that significant stenoses in arteries supplying the non-infarct territory adversely affect global and regional left ventricular function after a transmural infarction. Non-infarct artery anatomy should be considered in intervention strategies to improve left ventricular function after acute myocardial infarction.

Heat-shock protein induction in rat hearts. A direct correlation between the amount of heat-shock protein induced and the degree of myocardial protection

BACKGROUND

Previous studies have demonstrated that heat-shock treatment results in the induction of 72-kD heat-shock protein (HSP72) and a reduction of infarct size after subsequent ischemia and reperfusion.

METHODS AND RESULTS

To test the hypothesis that the degree of protection from ischemic injury in heat-shocked rats correlates with the degree of prior HSP72 induction, rats pretreated with 40 degrees C, 41 degrees C, or 42 degrees C of whole-body hyperthermia followed by 24 hours of recovery and control rats (n = 6 in each group) were quantitatively assessed for the presence of myocardial HPS72 by optical densitometry of Western blots and a primary antibody that is specific for HSP72 and a tertiary antibody labeled with 125I. Although rats heat-shocked to 40 degrees C had no significant induction of myocardial HSP72, rats heat-shocked to 41 degrees C and 42 degrees C demonstrated progressively increased amounts of myocardial HSP72 compared with controls. Separate groups of rats heat-shocked to 40 degrees C (n = 16), 41 degrees C (n = 37), and 42 degrees C (n = 36) with 24 hours of recovery and controls (n = 26) were subjected to 35 minutes of left coronary artery occlusion and 120 minutes of reperfusion. Compared with control and 40 degrees C rats, there was progressive infarct size reduction, assessed by triphenyltetrazolium chloride staining, in rats that were heat-shocked to 41 degrees C and 42 degrees C. Furthermore, there was a direct correlation between the amount of HSP72 induced and the reduction in infarct size (r = .97, P = .037).

CONCLUSIONS

These results suggest that the improved salvage after heat-shock pretreatment may be related to the amount of HSP72 induced before prolonged ischemia and reperfusion.

Early administration of captopril and nitroglycerin in combination after acute myocardial infarction: an invasive haemodynamic study

The combination of captopril and nitroglycerin early after acute myocardial infarction (AMI) could lead to a dangerous decrease in blood pressure coronary perfusion. To evaluate the safety aspects and haemodynamic effects of this combination, we studied 36 first 'Q wave' thrombolysed anterior wall AMI patients during the 24 h following the onset of symptoms. Afterwards, thrombolysis patients received a continuous infusion of nitroglycerin and were submitted to pulmonary artery catheterization. Those patients with mean arterial pressure (MAP) > or = 70 mmHg, cardiac index > or = 2.2 l.min-1.m-2, and wedge pressure > or = 10 mmHg were included and randomized to receive 6.25 mg of captopril every 6 h on the first day and 12.5 mg qid on the second if MAP > or = 70 mmHg (group 1). A second group (group 2) received a placebo. Haemodynamic parameters were determined after 1, 6 and then every 6 h up to 48 h after basal measurements. Significant differences were observed only for the MAP and the rate-pressure product (reduction in group 1 values, P < 0.05). However, MAP was maintained within acceptable limits. Our data support the fact that the combination of captopril and nitroglycerin in the early hours of a non-complicated anterior wall AMI is safe, and could guarantee its use in large clinical trials to determine the effects on left ventricle remodelling and survival after AMI.

Diagonal earlobe crease as a marker of the presence and extent of coronary atherosclerosis

This study evaluates the association between the presence of diagonal earlobe creases (ELC) and coronary artery disease (CAD). One thousand four hundred twenty-four patients (760 men and 664 women, aged 30 to 80 years) were examined for the presence of ELC and classified into 2 groups: group I control--1,086 consecutive patients who denied symptoms of myocardial ischemia and were admitted to a general hospital for other reasons; group II CAD--338 patients with documented CAD (presence of > or = 70% coronary diameter stenosis at angiography). ELC was present in 304 patients (28%) in group I and 220 (65%) in group II (p < 0.0001). The patients were stratified in age groups to isolate the influence of age because the prevalence of ELC and CAD increased with advancing age (p < 0.0001 for both). This association remained statistically significant in all decades, except for patients aged > 70 years. To further remove the confounding effect of different age and sex distributions between the groups, a direct adjustment of the ELC prevalence was performed. When adjusted for age and sex, the prevalence of creases was still 58% higher in patients with CAD than in control subjects (p < 0.001). The presence of ELC was also related to the extent of CAD as measured by the number of major arteries narrowed (p = 0.015). The observed sensitivity of the sign for the diagnosis of CAD was 65%, the specificity 72%, the positive predictive value 42% and the negative predictive value 87%.

[The influence of lipoprotein (a) in thrombolysis with r-TPA for myocardial infarction]

PURPOSE

To evaluate the influence of lipoprotein (a) (Lp (a)) levels in thrombolysis with rt-PA for myocardial infarction (MI).

METHODS

Thirty-eight MI patients, 28 male, mean age 51 +/- 9 years, submitted to thrombolysis with rt-PA, divided in two groups according the result of the thrombolysis: A) Successful, B) Failure. Serum fibrinogen (SF) was assessed before and 90 minutes after treatment. Lp (a) levels were determined six months later. These parameters were analyzed in both groups.

RESULTS

Lp (a) levels were similar in groups A and B (p = 0.45). The SF levels were not different in the groups.

CONCLUSION

Lp (a) seems to have no influence in thrombolysis with rt-PA for MI.

[Rupture of the left sinus of Valsalva forming a subepicardial pseudoaneurysm]

A healthy 44 year-old male patient presented a calcified mass in the middle mediastinum on a chest film. During diagnostic investigation cineangiograms showed a rupture of the left sinus of Valsalva forming a large pseudoaneurysm that produced important distortion of the left coronary artery and it's main branches. The patient was submitted to surgical repair through the closure of the orifice of the ruptured left sinus of Valsalva with a bovine pericardium patch. The subepicardium was filled with organized thrombi which were removed. He was discharged from the hospital after uncomplicated postoperative course. Pathological examination of the aortic fragment did not yield the etiology of the rupture.

[Relative immunity to poliomyelitis in children from 0 to 10, after the 4th National Polio Vaccination Day with trivalent oral type Sabin vaccination, in the area of greater São Paulo, SP (Brazil), 1982]

Efetuou-se um levantamento soro-epidemiológico, abrangendo 898 crianças, para a verificação da imunidade aos poliovírus 1, 2 e 3 por meio da determinação dos títulos de anticorpos neutralizantes. De 522 crianças, ou seja, de 58,1% da população estudada, foi possível a obtenção de informações referentes à situação vacinal a partir de anotações existentes nas próprias Cadernetas de Vacinação. Neste último sub-grupo foi estudado o estado imunitário em relação ao número de doses de vacina oral tipo Sabin recebidas. Os resultados mostraram alta proporção de imunes para os três tipos de poliovírus entre as crianças estudadas, porém também revelaram a existência de lacuna imunitária nos menores de um ano, especialmente no primeiro semestre de vida. Não foram observadas diferenças importantes na proporção de imunes segundo o sorotipo considerado. Salientou-se a necessidade de um alerta constante e permanente em relação à ocorrência de possíveis surtos epidêmicos em segmentos mais vulneráveis da população, particularmente entre crianças menores de 1 ano.