Electrophysiology and 3D-imaging reveal properties of human intracardiac neurons and increased excitability with atrial fibrillation

Altered autonomic input to the heart plays a major role in atrial fibrillation (AF). Autonomic neurons termed ganglionated plexi (GP) are clustered on the heart surface to provide the last point of neural control of cardiac function. To date the properties of GP neurons in humans are unknown. Here we have addressed this knowledge gap in human GP neuron structure and physiology in patients with and without AF. Human right atrial GP neurons embedded in epicardial adipose tissue were excised during open heart surgery performed on both non-AF and AF patients and then characterised physiologically by whole cell patch clamp techniques. Structural analysis was also performed after fixation at both the single cell and at the entire GP levels via three-dimensional confocal imaging. Human GP neurons were found to exhibit unique properties and structural complexity with branched neurite outgrowth. Significant differences in excitability were revealed between AF and non-AF GP neurons as measured by lower current to induce action potential firing, a reduced occurrence of low action potential firing rates, decreased accommodation and increased synaptic density. Visualisation of entire GPs showed almost all neurons are cholinergic with a small proportion of noradrenergic and dual phenotype neurons. Phenotypic distribution differences occurred with AF including decreased cholinergic and dual phenotype neurons, and increased noradrenergic neurons. These data show both functional and structural differences occur between GP neurons from patients with and without AF, highlighting that cellular plasticity occurs in neural input to the heart that could alter autonomic influence on atrial function. KEY POINTS: The autonomic nervous system plays a critical role in regulating heart rhythm and the initiation of AF; however, the structural and functional properties of human autonomic neurons in the autonomic ganglionated plexi (GP) remain unknown. Here we perform the first whole cell patch clamp electrophysiological and large tissue confocal imaging analysis of these neurons from patients with and without AF. Our data show human GP neurons are functionally and structurally complex. Measurements of action potential kinetics show higher excitability in GP neurons from AF patients as measured by lower current to induce action potential firing, reduced low firing action potential rates, and decreased action potential accommodation. Confocal imaging shows increased synaptic density and noradrenergic phenotypes in patients with AF. Both functional and structural differences occur in GP neurons from patients with AF that could alter autonomic influence on atrial rhythm.

The effect of primary care policy changes on hospitalisation for ambulatory care sensitive conditions: notes from Brazil

OBJECTIVES

The aim of this study was to assess the effect of the Primary Health Care Reform and the impact of recent national policy changes on the trend in hospitalisation rates for Ambulatory Conditions Sensitive to Primary Care (ACSC) in the city of Rio de Janeiro, Brazil.

STUDY DESIGN

Ecological study with data from the Brazilian National Health Information System.

METHODS

This study performed an interrupted time-series analysis, comparing three different time periods related to important changes in primary care policies in Brazil: Baseline (2008-2009); Primary Health Care Reform (RCAPS) (2010-2017); and National Primary Health Care Policy (PNAB) (2018-2019). Data included total monthly admissions for ACSC and rates for 19 groups of causes for hospitalisation.

RESULTS

There was a non-significant increasing trend in ACSC hospital admissions between January 2008 and December 2009 (β = 4.01, 95% confidence interval [CI] -12.14 to 20.15). The Primary Health Care Reform (RCAPS), which commenced in January 2010, resulted in a significant reduction in ACSC hospital admission trends during this time period (β = -7.97, 95% CI -9.78 to -6.16). Change in the PNAB did not change the declining ACSC hospital admission trend but it did reduce the rate of decline. In addition, the coefficient was no longer significant (β = -1.93, 95% CI -2.46 to 0.59), suggesting that monitoring of the historical series for a long time may show a reversal of the downward trend in some months. The most consistent change in ACSC hospital admission trend occurred between baseline and the RCAPS (β slope = -0.143, P < 0.001) and the level between the RCAPS period and the new PNAB (β step = 7.00, P = 0.008). Trends and differences in the time periods vary in the different ACSC hospitalisation-cause groups.

CONCLUSION

Changes in public health policies impact ACSC hospitalisation rates, which can thus be used as an indicator for monitoring primary health care. We also recommend analysing admission rates by the individual ACSC hospitalisation-cause groups.

Current perspectives on defining and mitigating frailty in relation to critical illness

Up to half of ICU survivors, many of whom were premorbidly well, will have residual functional and/or cognitive impairment and be vulnerable to future health problems. Frailty describes vulnerability to poor resolution of homeostasis after a stressor event but it is not clear whether the vulnerability seen after ICU correlates with clinical measures of frailty. In clinical practice, the scales most commonly used in critically ill patients are based on the assessment of severity and survival. Identification and monitoring of frailty in the ICU may be an alternative or complimentary approach, particularly if it helps explain vulnerability during the recovery and rehabilitation period. The purpose of this review is to discuss the use of tools to assess frailty status in the critically ill, and consider their importance in clinical practice. Amongst these, we consider biomarkers with potential to identify patients at greater or lesser risk of developing post-ICU vulnerability.

Culinary and nutritional value of edible wild plants from northern Spain rich in phenolic compounds with potential health benefits

Wild edible plants (WEPs) have been consumed since ancient times. They are considered as non-domesticated plants that grow spontaneously in nature, particularly in forests and bushlands, where they can be found and collected to be incorporated into human nutrition. Increasingly, WEPs are gaining importance as they are potential sources of food due to their nutritional value, besides showing positive health effects and offer innovative applications in haute cuisine. As these autochthonous plants grow naturally in the environment, they are more suitable to adapt to different climatic conditions as well as biotic and abiotic factors. Therefore, a door has been opened for their possible cultivation as they seem to require fewer expenses than other commercially cultivated plants. Moreover, the consumers demand for new products of natural origin that are sustainable and ecologically labeled have also boosted WEPs' recovery and incorporation into the market. In addition, they are considered as promising sources of essential compounds needed not only in human diet including carbohydrates, proteins, and lipids but also of other minor compounds as phenols, vitamins, or carotenoids that have shown numerous beneficial bioactivities such as antioxidants, anti-inflammatory, or anti-tumor activity. The use of these plants rich in bioactive molecules could be beneficial from the health point of view as the human body is not always capable of producing enough defenses, for instance, preventing oxidative damage. In particular, the presence of phenolic compounds in these vegetal matrices is supposed to provide a prophylactic effect against further pathogenesis and disorders related to aging or oxidative stresses. Regarding all this information based on traditional knowledge and ethnobotanical data, different WEPs found in the Northwestern region of Spain were selected, namely, Mentha suaveolens, Glechoma hederacea, Prunus spinosa, Apium nodiflorum, Artemisia absinthium, Silybum marianum, Picris hieracioides, Portulaca oleracea, Crithmum maritimum, and the genus Amaranthus. However, even though tradition and popular knowledge are excellent tools for the exploitation of these plants, it is necessary to develop regulations in this aspect to assure safety and veracity of food products. This article aims to review the main aspects of their bioactive properties, their traditional use, and the possibility of their incorporation into the market as new functional foods, looking at innovative and healthy gastronomic applications.

Main bioactive phenolic compounds in marine algae and their mechanisms of action supporting potential health benefits

Given the growing tendency of consumers to choose products with natural ingredients, food industries have directed scientific research in this direction. In this regard, algae are an attractive option for the research, since they can synthesize a group of secondary metabolites, called phenolic compounds, associated with really promising properties and bioactivities. The objective of this work was to classify the major phenolic compounds, compare the effectiveness of the different extractive techniques used for their extraction, from traditional systems (like heat assisted extraction) to the most advance ones (such as ultrasound, microwave or supercritical fluid extraction); the available methods for identification and quantification; the stability of the enriched extract in phenolic compounds and the main bioactivities described for these secondary metabolites, to offer an overview of the situation to consider if it is possible and/or convenient an orientation of phenolic compounds from algae towards an industrial application.

Scientific basis for the industrialization of traditionally used plants of the Rosaceae family

Plants have been traditionally used for the treatment of different types of illness, due to biomolecules with recognised benefits. Rosaceae family is used in traditional Galician medicine. The following plants Agrimonia eupatoria, Crataegus monogyna, Filipendula ulmaria, Geum urbanum, Potentilla erecta and Rosa canina are usually found in treatments. The aim of this study is to perform an ethnobotanical review about the bioactive compounds of these plants and their different bioactivities, both studied in vitro and in vivo. The nature of the bioactive compounds is varied, highlighting the presence of different phenolic compounds, such as phenolic acids, flavonoids or tannins. Understanding the beneficial effects of the administration of the whole plant or target tissues from A. eupatoria, C. monogyna, F. ulmaria, G. urbanum, P. erecta and R. canina as well as those from their individual compounds could lead to the development of new drugs based on the use of natural ingredients.

Evaluation of reference genes for reverse transcription-quantitative PCR assays in organs of zebrafish exposed to glyphosate-based herbicide, Roundup

Roundup is a glyphosate-based herbicide (GBH) widely used in agriculture and may cause toxic effects in non-target organisms. Model organisms, as zebrafish, and analysis of gene expression by reverse transcription-quantitative PCR (RT-qPCR) could be used to better understand the Roundup toxicity. A prerequisite for RT-qPCR is the availability of appropriate reference genes; however, they have not been described for Roundup-exposed fish. The aim of this study was to evaluate the expression stability of six reference genes (rpl8, β-act, gapdh, b2m, ef1α, hprt1) and one expressed repetitive element (hatn10) in organs of males (brain, gill, testis) and females (ovary) of zebrafish exposed to Roundup WG at three concentrations (0.065, 0.65 and 6.5 mg N-(phosphonomethyl) glycine/l) for 7 days. Genes were ranked by geNorm, NormFinder, BestKeeper, Delta C t and RefFinder, and their best combinations were determined by geNorm and NormFinder programs. The two most stable ranked genes were specific to each organ: gill (β-act; rpl8); brain (rpl8; β-act); testis (ef1α; gapdh); and ovary (rpl8; hprt1). The cat transcript level was used to evaluate the effect of normalization with these reference genes. These are the first suitable reference genes described for the analysis of gene expression in organs of Roundup-exposed zebrafish, and will allow investigations of the molecular mechanisms of Roundup toxicity.

Genetic diversity of Schizolobium parahyba var. amazonicum (Huber ex. Ducke) Barneby, in a forest area in Brazil

Schizolobium parahyba var. amazonicum (Fabaceae) is an arboreal species, endemic to the Amazon Rainforest, popularly known as paricá. It is used on a commercial scale in the timber sector, pulp and paper production, reclamation projects in degraded and landscaped areas. However, there is no availability of genetically improved material selected for the environmental conditions of the State of Espírito Santo, Brazil. In this sense, the present study aimed to characterize the genetic diversity in a population of S. amazonicum, established in a forest area in the southern region of the State of Espírito Santo, using inter-simple sequence repeat (ISSR) molecular markers. DNA samples from 171 individuals were analyzed using 11 ISSR primers, which generated 79 polymorphic bands in a total of 136 fragments (58%). The polymorphic information content performed for the ISSR markers revealed a mean of 0.37, classifying them as moderately informative. The number of loci found (N = 79) was greater than that established as the optimal number (N = 69) for the analyses. High genetic diversity was found with the parameters, genetic diversity of Nei (H_E = 0.375) and Shannon index (I = 0.554). The data demonstrated in the dendrogram, based on the UPGMA cluster analysis, corroborated by the Bayesian analysis performed by the STRUCTURE program, which indicated the formation of two distinct clusters (K = 2). One of the groups was formed with the majority of the individuals (153 genotypes) and the second with the minority (18 genotypes). The results revealed high genetic diversity in the population of S. amazonicum evaluated in the present study, determining the potential of the population to be used as an orchard for seed collection and production of seedlings with confirmed genetic variability.

Cross-amplification and characterization of microsatellite markers in Alcantarea patriae Versieux & Wand

The Alcantarea patriae is a Bromeliaceae endemic to the inselbergs of the Atlantic Forest. This taxon, described in the year of 2007 by Versieux & Wanderley, presents restricted and fragmented distribution outside conservation units. Studies to evaluate the genetic structure of its populations can contribute to the conservation and management strategies for the species. In this study, 31 microsatellite markers, descriptive to six different Bromeliaceae species, were evaluated by cross-amplification tests in 20 individuals of A. patriae. The individuals were collected in the district of Vila Cruzeiro, in the municipality of Jerônimo Monteiro. Twelve markers were polymorphic and 10 monomorphic, with an amplification success rate of 71%. The displayed polymorphism information content was considered high, indicating that the selected markers are informative. The values found for the fixation index were positive and indicated the occurrence of inbreeding. The mean number of alleles was 4.66 (3-6), the mean expected and observed heterozygosities were 0.6605 and 0.4618, respectively. The detection of polymorphic markers was important for future studies of diversity and genetic structuring of natural populations and for germplasm bank creation aiming to contribute to in situ and ex situ conservations of A. patriae.

Influence of Battery Level of a Cordless LED Unit on the Properties of a Nanofilled Composite Resin

The properties of composite resins can be influenced by light activation, depending primarily on the performance of the curing unit. The aim of this study was to evaluate how different battery levels of a cordless light-emitting diode (LED) unit influence the properties of a nanofilled composite resin. First, the battery voltage and light intensity of the cordless LED unit were individually checked for all light-curing cycles. Then, composite resin discs were prepared and light-cured at different battery levels: high level (HL, 100%), medium level (ML, 50%), and low level (LL, 10%). The degree of conversion, diametral tensile strength, sorption, and solubility of the specimens were tested. Data were checked for homoscedasticity and submitted to one-way analysis of variance followed by Tukey honestly significant difference and Pearson correlation tests (p<0.05). The battery voltage and light intensity varied significantly among the groups (p<0.001). The LL group presented a lower degree of conversion than the HL and ML groups (p<0.001), which shower similar results (p=0.182). Lower diametral tensile strength was also verified for the LL group when compared with the HL and ML groups (p<0.001), which presented no difference (p=0.052). Positive correlation was observed between the light intensity and the parameters studied, with the exception of sorption and solubility (p<0.001). The ML and LL groups showed higher sorption than the HL group (p <0.001), but no difference was verified between the first two groups (p=0.535). No significant differences were found for solubility between the ML and LL groups (p=0.104), but the HL group presented lower values (p<0.001). The different battery levels of the cordless LED curing unit influenced all the properties of the nanofilled composite resin evaluated.

Study on the Hymenoptera parasitoid associated with Lepidoptera larvae in reforestation and agrosilvopastoral systems at Fazenda Canchim (Embrapa Pecuária Sudeste) São Carlos, SP, Brazil

The aim of this study was to characterize the local fauna of Hymenoptera parasitoids associated with Lepidoptera larvae in areas of reforestation and agrosilvopastoral systems at Fazenda Canchim (Embrapa Pecuária Sudeste, São Carlos, SP, Brazil). Lepidoptera larvae collected with entomological umbrella were kept in the laboratory until emergence of adults or their parasitoids. From those collected in the agrosilvopastoral system, emerged 267 specimens of hymenopteran parasitoids belonging to 16 genera: Braconidae, Agathidinae (Alabagrus), Braconinae (Bracon), Microgastrinae (Cotesia, Diolcogaster, Glyptapanteles, Pholetesor and Protapanteles), Orgilinae (Orgilus); Ichneumonidae, Campopleginae (Casinaria, Charops and Microcharops); Chalcididae, Chalcidinae (Brachymeria and Conura); Eulophidae, Entedoninae (Horismenus), Eulophinae (Elachertus and Euplectrus). From the Lepidoptera larvae collected in the reforestation, emerged 68 specimens of hymenopteran parasitoids, belonging to 8 genera: Chalcididae, Chalcidinae (Conura); Ichneumonidae, Pimplinae (Neotheronia), Campopleginae (Charops and Microcharops) and Braconidae, Microgastrinae (Apanteles, Diolcogaster, Distatrix, Glyptapanteles and Protapanteles). The results of this study suggest the occurrence of a wide variety of Hymenoptera parasitoids in the studied environments.

Biological aspects of Eriopis connexa (Germar) (Coleoptera: Coccinellidae) fed on different insect pests of maize (Zea mays L.) and sorghum [Sorghum bicolor L. (Moench.)]

Eriopis connexa (Germar) (Coleoptera: Coccinellidae) occurs in several countries of South America and its mass rearing is important for biological control programmes. This work evaluated biological aspects of E. connexa larva fed on eggs of Anagasta kuehniella (Zeller) (Lepidoptera: Pyralidae) and Spodoptera frugiperda (J. E. Smith) (Lepidoptera: Noctuidae) frozen for one day, fresh eggs of Diatraea saccharalis (Fabricius) (Lepidoptera: Pyralidae), S. frugiperda newly-hatched caterpillars, nymphs of Rhopalosiphum maidis (Fitch) and Schizaphis graminum (Rondani) (Hemiptera: Aphididae). Duration of larva, pupa and larva to adult stages differed among prey offered, whereas the prepupa stage was similar. Larva, pupa, prepupa and larva to adult viabilities were equal or major of 87.5% in all prey, except for larva fed on newly-hatched larvae of S. frugiperda. Eriopis connexa has good adaptation to different prey corroborating its polyphagous feeding habit, which evidences the potential of this natural enemy for controlling corn and sorghum pests.

Occurrence and biology of Dinocampus coccinellae (Schrank, 1802) (Hymenoptera; Braconidae: Euphorinae) parasitising different species of Coccinellidae (Coleoptera) in Neotropical region

Surveys on Coccinellidae (Coleoptera) in Sete Lagoas city, Minas Gerais state, Brazil, indicated the parasitism of adults of the species Coleomegilla maculata De Geer, 1775, Eriopis connexa (Germar, 1824) and Olla v-nigrum (Mulsant, 1866), by Dinocampus coccinellae (Schrank, 1802) (Hymenoptera; Braconidae: Euphorinae). Since then, the parasitoid have been maintained in its original hosts at the Insect Rearing Laboratory - LACRI of the Brazilian Agricultural Research Institution - Embrapa Milho e Sorgo. Besides the citation of occurrence in Brazil, this work also indicates the parasitoid preference for C. maculata (70% of parasitism), followed by O. v-nigrum (43.3% of parasitism) and E. connexa (36.7% of parasitism). Total life cycle of D. coccinellae was longer on C. maculata (32.4 ± 0.48 days), compared to O. v-nigrum (29.5 ± 0.49 days) and E. connexa (27.8 ± 0.4 days). Due to the relatively high percentage of field parasitism, D. coccinellae can reduce the efficiency of biological pest control by Coccinellidae predators especially in the case of C. maculata.

Highly palatable diet consumption increases protein oxidation in rat frontal cortex and anxiety-like behavior

Obesity is frequently associated with consumption of high amounts of sugar and/or fat. Studies have demonstrated a high prevalence of overweight and obesity associated or not with increase rates of psychiatry disorders, in particular mood and anxiety disorders. Recent works have demonstrated an association between specific genes involved in oxidative stress metabolism and anxiety-like behavior. The aim of this study was to investigate the effect of a highly palatable diet enriched with sucrose in body fat mass composition, anxiety behavior and brain oxidative status. Twenty male Wistar rats received two different diets during four months: standard chow (SC) and highly palatable (HP). Metabolic parameters, behavioral tests and oxidative stress status were evaluated. Body fat mass, insulin sensitivity and glucose tolerance were altered in the HP group (p<0.01). The same group spends less time in light compartment and had a lower risk assessment behavior (p<0.05) but no differences were observed in the open field test habituation (p>0.05). Protein degradation, DCF and TBARS levels were not different in the hippocampus between groups; however, there were higher levels of protein degration in frontal cortex of HP groups (p<0.05), although DCF and TBARS levels don't differ from the SC group (p>0.05). In conclusion, our data suggest that the consumption of HP diet leads to an obese phenotype, increases protein oxidation in frontal cortex and appears to induce anxiety-like behavior in rats.

Patient attitudes toward physician financial incentives

BACKGROUND

Despite concern about the impact of financial incentives on physician behavior, little is known about patients' attitudes toward these incentives.

OBJECTIVES

To assess patient attitudes toward physician compensation models and to explore patient characteristics associated with these attitudes.

METHODS

We mailed a survey to 2000 adult patients in a large New England health maintenance organization. We asked about their trust in their primary care physician; discomfort with compensation models of salary with withhold (salary), fee-for-service with withhold, and group capitation (capitation).

RESULTS

One thousand one hundred twenty-five (56%) of the 2000 patients who responded expressed varying levels of discomfort with the proposed compensation models: 16% for salary, 25% for fee-for-service with withhold, and 53% for capitation (P<.001). Patients who knew their primary care physician was paid through capitation did not report less trust in their primary care physician but still frequently expressed discomfort (46%) with capitation. Among all respondents, those who were younger, white, had better health, had a higher income, were more educated, and who lacked a very trusting relationship with a primary care physician were more likely to report discomfort with both capitation and fee-for-service with withhold. In multivariable analyses, discomfort with capitation was more common among white patients (odds ratio, 2.6; 95% confidence interval, 1.6-4.2), patients with incomes exceeding $20 000 (odds ratio, 3.7; 95% confidence interval, 2.3-6.1), and college-educated patients (odds ratio, 2.0; 95% confidence interval, 1.4-2.7).

CONCLUSIONS

Most patients were uncomfortable with 1 or more of the 3 common methods used to pay physicians. Discomfort was highest with capitation and was more likely among wealthier, well-educated, white patients. With capitation increasing nationally, patients' concerns should be considered in the design of compensation agreements.

Atrial natriuretic peptide and oxytocin induce natriuresis by release of cGMP

Our hypothesis is that oxytocin (OT) causes natriuresis by activation of renal NO synthase that releases NO followed by cGMP that mediates the natriuresis. To test this hypothesis, an inhibitor of NO synthase, L-nitroarginine methyl ester (NAME), was injected into male rats. Blockade of NO release by NAME had no effect on natriuresis induced by atrial natriuretic peptide (ANP). This natriuresis presumably is caused by cGMP because ANP also activates guanylyl cyclase, which synthesizes cGMP from GTP. The 18-fold increase in sodium (Na+) excretion induced by OT (1 microgram) was accompanied by an increase in urinary cGMP and preceded by 20 min a 20-fold increase in NO3- excretion. NAME almost completely inhibited OT-induced natriuresis and increased NO3- excretion; however, when the dose of OT was increased 10-fold, a dose that markedly increases plasma ANP concentrations, NAME only partly inhibited the natriuresis. We conclude that the natriuretic action of OT is caused by a dual action: generation of NO leading to increased cGMP and at higher doses release of ANP that also releases cGMP. OT-induced natriuresis is caused mainly by decreased tubular Na+ reabsorption mediated by cGMP. In contrast to ANP that releases cGMP in the renal vessels and the tubules, OT acts on its receptors on NOergic cells demonstrated in the macula densa and proximal tubules to release cGMP that closes Na+ channels. Both ANP- and OT-induced kaliuresis also appear to be mediated by cGMP. We conclude that cGMP mediates natriuresis and kaliuresis induced by both ANP and OT.