Gamma knife capsulotomy for intractable OCD: Neuroimage analysis of lesion size, location, and clinical response

Obsessive-compulsive disorder (OCD) affects 2-3% of the population. One-third of patients are poorly responsive to conventional therapies, and for a subgroup, gamma knife capsulotomy (GKC) is an option. We examined lesion characteristics in patients previously treated with GKC through well-established programs in Providence, RI (Butler Hospital/Rhode Island Hospital/Alpert Medical School of Brown University) and São Paulo, Brazil (University of São Paolo). Lesions were traced on T1 images from 26 patients who had received GKC targeting the ventral half of the anterior limb of the internal capsule (ALIC), and the masks were transformed into MNI space. Voxel-wise lesion-symptom mapping was performed to assess the influence of lesion location on Y-BOCS ratings. General linear models were built to compare the relationship between lesion size/location along different axes of the ALIC and above or below-average change in Y-BOCS ratings. Sixty-nine percent of this sample were full responders (≥35% improvement in OCD). Lesion occurrence anywhere within the targeted region was associated with clinical improvement, but modeling results demonstrated that lesions occurring posteriorly (closer to the anterior commissure) and dorsally (closer to the mid-ALIC) were associated with the greatest Y-BOCS reduction. No association was found between Y-BOCS reduction and overall lesion volume. GKC remains an effective treatment for refractory OCD. Our data suggest that continuing to target the bottom half of the ALIC in the coronal plane is likely to provide the dorsal-ventral height required to achieve optimal outcomes, as it will cover the white matter pathways relevant to change. Further analysis of individual variability will be essential for improving targeting and clinical outcomes, and potentially further reducing the lesion size necessary for beneficial outcomes.

Improvement in early antral follicle development and gene expression modulation prior to follicle aspiration in bovine cumulus-oocyte complexes by equine chorionic gonadotropin

We aimed to evaluate the morphological ovarian response to equine chorionic gonadotropin (eCG) prior to ovum pick-up (OPU) and its effects on the molecular phenotype of immature cumulus-oocyte complexes (COCs) from Nelore cow (Bos indicus) donors. To this end, 20 Nelore cows were distributed randomly into the synchronized-OPU (Sync-OPU) and synchronized plus stimulated-OPU (Sync + eCG-OPU) groups using a cross-over experimental design, as each cow was used in both treatments. On a random day of the estrus cycle (Day 0), all cows received an intravaginal implant with 1.0 g of progesterone and 2 mg IM of estradiol benzoate. On the morning of Day 3, only the Sync + eCG-OPU group received 400 IU of eCG IM. On the morning of Day 5, the P4 device was removed and OPU was conducted in both groups. Before OPU management, ultrasonography was used to identify and measure the follicles. The aspirated COCs were morphologically classified based on their cumulus cells (CC) layers and the texture of the ooplasm. The COCs classified as Grade 1, Grade 2, and Grade 3 were considered viable and used for the assessment of quality markers. Oocytes and CC were mechanically separated from pools of 25 immature COCs of the Sync-OPU and Sync + eCG-OPU groups immediately after the follicular aspiration and stored at -80 °C until RNA extraction. Relative quantification of several markers for oocyte quality was assessed by RT-qPCR. The eCG treatment increased the number of follicles sized 3.0-5.0 mm and >5.0 mm compared to that in Sync-OPU group. Moreover, the protocol with eCG improved the total number of oocytes and the number of viable oocytes, which is related to a high number of oocytes in Grade 3. Regarding the impact on transcriptional regulation in immature oocytes, the mRNA encoding BMP15, SMAD1, SMAD2, SMAD3, ACACA, and CPT1A was upregulated in Sync + eCG-OPU compared with the Sync-OPU group. Moreover, the relative mRNA abundance of CTSZ, a member of the cathepsins family functionally related to reduced oocyte competence, was lower in the Sync + eCG-OPU group than in the Sync-OPU group. In addition, CC CTSB, CTSS, and CTSK mRNA abundances were lower in the Sync + eCG-OPU group than in the Sync-OPU group. However, the relative abundance of AREG and EREG mRNA was higher in CC recovered from cows stimulated with eCG. In conclusion, the eCG approach addressing follicular stimulation in Nelore cows had a positive impact on early antral follicle development, followed by a positive morphological and molecular phenotype in bovine COCs.

First Report of HLB Causal Agent in Psyllid in State of Bahia, Brazil

The state of Bahia ranks fourth in the national rank for citrus production, and the region of Chapada Diamantina is emerging an important producer of orange for fresh fruit market. Huanglongbing (HLB) is the major phytosanitary threat to Bahia citriculture. In Brazil, the disease was first reported in 2004 in São Paulo state. The bacterium Candidatus Liberibacter asiaticus (CLas) is one of the causal agents of HLB, which is transmitted by the insect vector Diaphorina citri Kuwayama (Hemiptera: Liviidae). Bahia is a HLB-free area; therefore, it is essential to monitor its citrus-producing areas to early detect any possible introduction of the CLas. This study aimed to monitor the presence of the bacteria in the insect vector. Diaphorina citri samples were collected from 2011 to 2014 in different cities located at Chapada Diamantina region and tested by qPCR for the presence of CLas. Three samples were considered positive to bacterium, and all from psyllids collected on Murraya paniculata in the city of Seabra.

Evaluation of different air dosing strategies to enhance H2S removal in microaerobic systems treating low-strength wastewaters

This study aimed to evaluate different air dosing strategies such as microaeration flow rates and air dosing points to enhance H₂S removal in microaerobic systems treating low-strength wastewaters. Efficiency and stability of the reactors, as well as biogas quality, were assessed, and microbial community changes were evaluated using the PCR-DGGE technique. The results showed that the air dosing point affected the H₂S concentration and that air dosing at the headspace promoted the highest H₂S removal efficiency. The airflow rate also affected the process, since H₂S concentration in the biogas was higher at 0.1 mL air.min^-1 than at 0.3 mL air.min^-1. The methane concentration in the biogas was also affected by both air dosing point and flow rate, since the lowest value was observed at the highest airflow rate of the headspace dosing point, due to dilution by the N₂ influx applied to the system. The highest productivity and operational efficiency were observed at this air dosing point, with this airflow (HD_0.3), which corroborates with the operational results and the ecological parameters, since the microaeration at this stage promoted high bacterial and archaeal species richness and diversity, optimum functional organization, high COD and H₂S removal efficiencies.

Differential expression of insulin-like growth factor family members in immature cumulus-oocyte complexes from dairy cows with different genotypes

It has been evident the improvement of in vitro embryo production (IVEP) in dairy cows. Nevertheless, it is known that differences in the number and quality of oocytes between taurine and zebu females impact the efficiency and economic viability of IVEP. As the insulin-like growth factor (IGF) system is related to follicular and oocyte development, we aimed to quantify mRNA abundance of IGF system members and pregnancy-associated plasma protein-A (PAPPA) in the cumulus-oocyte complexes (COCs) of Gir, 1/2 Holstein × 1/2 Gir and Holstein cows. Four pools of 30 immature COCs from Gir, 1/2 Holstein × 1/2 Gir and Holstein cows were obtained by ovum pickup (OPU), and the oocytes and cumulus cells (CC) were mechanically separated and stored at -80°C. Total RNA was extracted from pools of 30 oocytes and their respective CC. Expression of target genes was assessed by real-time RT-PCR. In oocytes, the abundance of IGFR1 mRNA was higher (p < .05) in Gir cows compared with the other breeds. In contrast, in CC, mRNA encoding IGF2 (p < .05), IGFR2 (p < .05) and IGFBP4 (p < .01) was higher in Holstein donors compared with Gir and 1/2 Holstein × 1/2 Gir cows. Additionally, the abundance of PAPPA mRNA was higher in oocytes (p < .001) and CC (p < .01) in Gir and 1/2 Holstein × 1/2 Gir cows compared with the Holstein donors. In conclusion, the higher abundance of PAPPA mRNA in the oocytes and CC from Gir and cross-breed donors combined with the low expression of IGFBP4 in the CC suggests an enhancement of the bioavailability of IGF-free when compared with Holstein COCs.

Osteoblast, fibroblast and in vivo biological response to poly(vinylidene fluoride) based composite materials

Electroactive materials can be taken to advantage for the development of sensors and actuators as well as for novel tissue engineering strategies. Composites based on poly(vinylidene fluoride), PVDF, have been evaluated with respect to their biological response. Cell viability and proliferation were performed in vitro both with Mesenchymal Stem Cells differentiated to osteoblasts and Human Fibroblast Foreskin 1. In vivo tests were also performed using 6-week-old C57Bl/6 mice. It was concluded that zeolite and clay composites are biocompatible materials promoting cell response and not showing in vivo pro-inflammatory effects which renders both of them attractive for biological applications and tissue engineering, opening interesting perspectives to development of scaffolds from these composites. Ferrite and silver nanoparticle composites decrease osteoblast cell viability and carbon nanotubes decrease fibroblast viability. Further, carbon nanotube composites result in a significant increase in local vascularization accompanied an increase of inflammatory markers after implantation.

Effect of zeolite content in the electrical, mechanical and thermal degradation response of poly(vinylidene fluoride)/NaY zeolite composites

Polymer based composites of a-PVDF doped with different NaY zeolite (Na53Al53Si139O384) content were investigated. A good dispersion of NaY zeolite within the polymer matrix is achieved. The introduction of NaY nanoparticles enhance the storage modulus and the dielectric constant at room temperature. The dielectric constant at room temperature increases up to the value of 500 for the 32 wt% composite, at 1 kHz. The increase of the dielectric constant is mainly attributed to interfacial polarization effects. For increasing zeolite content, the nanocomposite conductivity shows two conducting regimes separted by the so called breaking voltage, which is associated to an intrazeolite charge transport. Thermogravimetric results show that the introduction of zeolites affects the thermal degradation of the polymer for low zeolite contents and also indicate the presence of water that also plays an important role in the electrical response of the materials.

Determination of the optimal rate for the microaerobic treatment of several H2S concentrations in biogas from sludge digesters

The treatment of H2S in the biogas produced during anaerobic digestion has to be carried out to ensure the efficient long-lasting use of its energetic potential. The microaerobic removal of H2S was studied to determine the treatment capacity at low and high H2S concentrations in the biogas (0.33 and 3.38% v/v) and to determine the optimal O2 rate that achieved a concentration of H2S of 150 mg/Nm3 or lower. Research was performed in pilot-plant scale digesters of sewage sludge, with 200 L of working volume, in mesophilic conditions with a hydraulic retention time of 20 d. O2 was supplied at different rates to the headspace of the digester to create the microaerobic conditions. The treatment successfully removed H2S from the biogas with efficacies of 97% for the low concentration and 99% for the highest, in both cases achieving a concentration below 150 mg/Nm3. An optimal O2 rate of 6.4 NLO2/Nm3 of biogas when treating the biogas was found with 0.33% (v/v) of H2S and 118 NLO2/ Nm3 of biogas for the 3.38% (v/v) concentration. This relation may be employed to control the H2S content in the biogas while optimising the O2 supply.

Performance evaluation of oxygen, air and nitrate for the microaerobic removal of hydrogen sulphide in biogas from sludge digestion

The removal performance of hydrogen sulphide in severely polluted biogas produced during the anaerobic digestion of sludge was studied by employing pure oxygen, air and nitrate as oxidant reactives supplied to the biodigester. Research was performed in a 200-L digester with an hydraulic retention time (HRT) of ∼20 days under mesophilic conditions. The oxygen supply (0.25 N m³/m³ feed) to the bioreactor successfully reduced the hydrogen sulphide content from 15,811 mg/N m³ to less than 400 mg/N m³. The introduction of air (1.27 N m³/m³ feed) removed more than 99% of the hydrogen sulphide content, with a final concentration of ∼55 mg/N m³. COD removal, VS reduction and methane yield were not affected under microaerobic conditions; however, methane concentration in the biogas decreased when air was employed as a result of nitrogen dilution. The nitrate addition was not effective for hydrogen sulphide removal in the biogas.

Performance and ruminal protozoa in lambs with chromium supplementation

The effects of chromium picolinate (CrPic) oral supplementation on the performance and ruminal protozoa population in sheep was investigated. Twenty-four male lambs were treated with four different levels of CrPic: placebo, 0.250, 0.375 and 0.500mg of chromium/animal/day during 84 days. The base ration was Panicum maximum cv Massai hay and concentrate. Feed intake was measured three times a week. Lambs were weighed every 2 weeks. Ruminal content was sampled five times during the trial to quantify ruminal protozoa. No difference (p>0.05) between treatments was recorded for any parameter measured: initial and final mean body weight, dry matter intake, daily gain and total body weight gain. There was a negative linear relationship between Cr supplementation and protozoa count (p=0.0013) with no additional decrease when CrPic supplemental levels were higher than 0.375mg/day. Therefore, Cr supplementation must be carried out carefully and more studies need to address stressed animals or possible toxic effects of Cr in the animal itself or to the ruminal protozoa population.

Exercise training changes IL-10/TNF-alpha ratio in the skeletal muscle of post-MI rats

Heart failure (HF) is associated with changes in the skeletal muscle (SM) which might be a consequence of the unbalanced local expression of pro- (TNF-alpha) and anti- (IL-10) inflammatory cytokines, leading to inflammation-induced myopathy, and SM wasting. This local effect of HF on SM may, on the other hand, contribute to systemic inflammation, as this tissue actively secretes cytokines. Since increasing evidence points out to an anti-inflammatory effect of exercise training, the goal of the present study was to investigate its effect in rats with HF after post-myocardial infarction (MI), with special regard to the expression of TNF-alpha and IL-10 in the soleus and extensor digitorum longus (EDL), muscles with different fiber composition. Wistar rats underwent left thoracotomy with ligation of the left coronary artery, and were randomly assigned to either a sedentary (Sham-operated and MI sedentary) or trained (Sham-operated and MI trained) group. Animals in the trained groups ran on a treadmill (0% grade at 13-20 m/min) for 60 min/day, 5 days/week, for 8-10 weeks. The training protocol was able to reverse the changes induced by MI, decreasing TNF-alpha protein (26%, P<0.05) and mRNA (58%, P<0.05) levels in the soleus, when compared with the sedentary MI group. Training also increased soleus IL-10 expression (2.6-fold, P<0.001) in post-MI HF rats. As a consequence, the IL-10/TNF-alpha ratio was increased. This "anti-inflammatory effect" was more pronounced in the soleus than in the EDL, suggesting a fiber composition dependent response.

Urban air pollution and chronic obstructive pulmonary disease-related emergency department visits

BACKGROUND

Patients with chronic obstructive pulmonary disease (COPD) can have recurrent disease exacerbations triggered by several factors, including air pollution. Visits to the emergency respiratory department can be a direct result of short-term exposure to air pollution. The aim of this study was to investigate the relationship between the daily number of COPD emergency department visits and the daily environmental air concentrations of PM(10), SO(2), NO(2), CO and O(3) in the City of São Paulo, Brazil.

METHODS

The sample data were collected between 2001 and 2003 and are categorised by gender and age. Generalised linear Poisson regression models were adopted to control for both short- and long-term seasonal changes as well as for temperature and relative humidity. The non-linear dependencies were controlled using a natural cubic spline function. Third-degree polynomial distributed lag models were adopted to estimate both lag structures and the cumulative effects of air pollutants.

RESULTS

PM(10) and SO(2) readings showed both acute and lagged effects on COPD emergency department visits. Interquartile range increases in their concentration (28.3 microg/m(3) and 7.8 microg/m(3), respectively) were associated with a cumulative 6-day increase of 19% and 16% in COPD admissions, respectively. An effect on women was observed at lag 0, and among the elderly the lag period was noted to be longer. Increases in CO concentration showed impacts in the female and elderly groups. NO(2) and O(3) presented mild effects on the elderly and in women, respectively.

CONCLUSION

These results indicate that air pollution affects health in a gender- and age-specific manner and should be considered a relevant risk factor that exacerbates COPD in urban environments.

Removing textile mill effluent recalcitrant COD and toxicity using the H2O2/UV system

The potential of the H2O2/UV process for improving quality of an industrial textile effluent before biological treatment was evaluated in the laboratory using a multivariate experimental design to determine the effects of pH, H2O2 dose and reaction time on colour, COD and toxicity removal efficiencies. Increasing reaction time (from 10 to 120 min) and H2O2 dose (from 0 to 5 mmol L(-1)) significantly improved removal efficiencies, while increasing pH (from 4 to 10) had a negative effect on colour and toxicity removals. Laboratory H2O2/UV treatment of the mill effluent under optimum conditions (pH 7, 5 mmol L(-1) H2O2, 120 min) resulted in decreases in colour (70%), COD (21%) and toxicity (67%), without lowering BOD. H2O2 was consumed within the first 30-60 min, while the effluent average oxidation state stabilized after 60 min. Decreasing reaction time to 60 min resulted in similar colour (63%) and COD (20%) removals but lower toxicity removal (44%). Spectrophotometric monitoring of the optimized reaction indicated partial destruction of residual aromatic azo dyes. H2O2 and residual peroxide and average oxidation state of the effluent Effluent biodegradability (BOD/COD) increased by 28% after the H2O2/UV treatment. Improvements observed in effluent quality are expected to enhance combined AOP-biological treatment efficiency of the mill effluent.

Hydrogen sulphide removal in the anaerobic digestion of sludge by micro-aerobic processes: pilot plant experience

H(2)S removal from biogas produced in anaerobic digestion of sludge through the introduction of oxygen under micro-aerobic conditions is studied. Research was carried out in two pilot plant reactors (working volume, 200 L each) treating sludge from WWTP with HRT of 20 days. Mixing was provided via sludge or biogas recirculation. Introduction of very low oxygen flow (0.013-0.024 L/L(reactor) d) successfully removed H(2)S content in biogas with an efficiency above 99%. Reactor performance during micro-aerobic operation in terms of biogas production, methane yield and COD removal were not affected by the amount of oxygen supplied, remaining stable and similar to the anaerobic behaviour. Sludge recirculation ( approximately 50 L/h) and biogas recirculation ( approximately 3.5 L/min) as mixing methods were found not significant in H(2)S removal from biogas while biogas recirculation reduced by 10 times dissolved sulphide concentration compared to sludge recirculation.

Effect of air pollution on diabetes and cardiovascular diseases in São Paulo, Brazil

Type 2 diabetes increases the risk of cardiovascular mortality and these patients, even without previous myocardial infarction, run the risk of fatal coronary heart disease similar to non-diabetic patients surviving myocardial infarction. There is evidence showing that particulate matter air pollution is associated with increases in cardiopulmonary morbidity and mortality. The present study was carried out to evaluate the effect of diabetes mellitus on the association of air pollution with cardiovascular emergency room visits in a tertiary referral hospital in the city of São Paulo. Using a time-series approach, and adopting generalized linear Poisson regression models, we assessed the effect of daily variations in PM10, CO, NO2, SO2, and O3 on the daily number of emergency room visits for cardiovascular diseases in diabetic and non-diabetic patients from 2001 to 2003. A semi-parametric smoother (natural spline) was adopted to control long-term trends, linear term seasonal usage and weather variables. In this period, 45,000 cardiovascular emergency room visits were registered. The observed increase in interquartile range within the 2-day moving average of 8.0 microg/m(3) SO2 was associated with 7.0% (95%CI: 4.0-11.0) and 20.0% (95%CI: 5.0-44.0) increases in cardiovascular disease emergency room visits by non-diabetic and diabetic groups, respectively. These data indicate that air pollution causes an increase of cardiovascular emergency room visits, and that diabetic patients are extremely susceptible to the adverse effects of air pollution on their health conditions.

Haemodynamic changes after spinal cord transection are anaesthetic agent dependent

1 To evaluate the effect of high spinal cord transection (SCT), between T4 and T5, on the mean arterial pressure (MAP) and heart rate in animals anaesthetized with different anaesthetic agents: ether (n = 12), 20% urethane, 1.2 g kg(-1) (n = 12), 2% tri-bromide-ethanol, 200 mg kg(-1) (n = 12); chloral hydrate and urethane, 75 and 525 mg kg(-1) respectively (n = 12). 2 In the animals anaesthetized with ether or urethane, SCT caused an immediate major drop in MAP, with hypotension and bradycardia throughout the next 10 min. In the animals anaesthetized with urethane + chloralose or tri-bromide-ethanol, SCT transiently increased MAP with subsequent hypotension and bradycardia. 3 In summary, the haemodynamic changes after complete, high SCT are anaesthetic agent dependent. Further research about the exact mechanisms responsible for these diverse autonomic changes is warranted.

Combined chemical biological treatment of bleached eucalypt kraft pulp mill effluent

Effectiveness of ozonation before and after biological treatment for removal of recalcitrant organic matter in bleached kraft pulp effluents was compared. Two industrial ECF bleached eucalypt kraft pulp effluents (E1 and E2) were pretreated with 100 mg O3/L. Raw and pretreated effluents were treated biologically in bench-scale sequencing batch reactors, under constant conditions. Following biological treatment, effluents were post-treated with 100 and 200 mg O3/L. Effluent pretreatment increased effluent biodegradability by 10% in E1 and 24% in E2. Combined O3-biological treated led to small but significant increases in COD, BOD and lignin removal over biological treatment alone, but pretreatment had no significant effect on effluent colour and carbohydrate removal. Ozone pretreatment did not affect biological activity during treatment of effluent E1 but resulted in a 38% lower specific oxygen uptake rate in effluent E2. At an equivalent dose of 100 mg/L, pre-ozonation produced better quality effluent than post-ozonation, especially with regard to COD and colour. Likewise, when an equivalent dose of 200 mg/L was applied, splitting the dose equally between pre- and post-treatments was more efficient than applying the entire dose in the post-treatment. The potential for combined chemical-biological treatment to improve effluent quality has been confirmed in this study.

The importance of Bi-Digital O-Ring Test in the treatment of multiple hepatic abscesses: a case history

The Bi-Digital O-Ring Test has been very useful in the identification of bacterial and viral infections, as well as other etiological agents, in difficult clinical cases. Case report of a patient with multiple hepatic abscesses (pylephlebitis induced hepatic abscess is the most difficult abscess to treat), in which the etiological agent was suggested through Bi-Digital O-Ring Test with excellent clinical evolution after modification of previously ineffective multi anti-microbial treatment is presented. 45 years old, female with a history of pain at right hypochondria for 15 days, with jaundice, oscillating fever and shivering. Computerized tomography showed liver with multiples nodules in the parenchyma with additional appendicitis. An appendectomy was performed with drainage of intra abdominal abscesses. Treatment with metronidazol, ceftazidim and amicacine was performed with no improvement while the general condition of the patient was deteriorating progressively in the following 3 weeks. Bi-Digital O-Ring Test was then performed to determine the etiological agent and the drug compatibility test among effective antimicrobial agents. Based on the Bi-Digital O-Ring Test, the main etiological agent was found to be Enterobacter aerogenes. Amongst the three antibiotics that were being used, only metronidazol was effective and the other 2 was cancelled its effect. Based on Bi-Digital O-Ring Test findings two new antibiotics (cefadroxil and imipenen), were added to metronidazol and additional cilantro tablets by Hayashibara, Japan was given, and Selective Drug Uptake Enhancement Method performed, with excellent clinical, laboratory testing and tomography improvement within 10 days. Bi-Digital O-Ring Test suggested the etiological agent, and effective and mutually compatible antibiotics for treating the abscesses which resulted in a good clinical evolution, characterized by relief of fever and reduction of the hepatic abscesses in a short period and followed complete disappearance of hepatic abscess.

Stunning and myocardial contractile autoregulation studied on the isolated isovolumic blood-perfused dog heart

AIM

To study, for the first time, the effects of stunning on homeometric and heterometric autoregulation.

METHODS AND RESULTS

Ischaemia (15 min)/reperfusion (30 min) was induced in the isovolumic blood-perfused dog heart preparation. Heart rate elevations (n = 9) from 60 to 200 beats min-1, in steps of 20 beats min-1, promoted the same inotropic stimulation in control (C) and stunning (S), indicating that ischaemia/reperfusion does not affect the changes in calcium kinetics elicited by the Bowditch effect. Sudden ventricular dilation (VD) (n = 10) evoked an instantaneous increase in developed pressure (Delta1DP) followed by a continuous slow performance increase (Delta2DP) in C and S. Delta1DP (C: 35 +/- 2.2 mmHg; S: 27 +/- 2.1 mmHg; P = 0.002) and Delta2DP (C: 20 +/- 1.6 mmHg; S: 14 +/- 1.3 mmHg; P = 0.002) decreased proportionally, while Delta2/Delta1DP (C: 0.57 +/- 0.13; S: 0.58 +/- 0.14) and slow response time course (T/2) were unchanged (C: 55 +/- 6.6 s; S: 57 +/- 7.7 s) after ischaemia/reperfusion. The reduction of Delta1DP can be understood as a decline of the myofilaments calcium responsiveness, the main pathophysiological effect of stunning. The reason for the weakening of Delta2DP, due to intracellular calcium gain, was not determined but it was supposed that its complete manifestation could be restricted by cyclic adenosine monophosphate (cAMP) myocardial content reduction. As reported by others, Delta2DP depends on myocardial cAMP, and it has been shown that myocardial cAMP is decreased after ischaemia/reperfusion.

CONCLUSIONS

Contractile depression due to stunning has no effect on the inotropic stimulation generated by the Bowditch phenomenon. Immediate and time-dependent enhancements of contraction evoked by sudden VD are proportionally reduced and the slow response time course is unaffected in the stunned myocardium.

Coenzyme Q10 exogenous administration attenuates cold stress cardiac injury

The influence of coenzyme Q10 (CoQ10) in cold stress test (-15 degrees C for 4 hours) cardiac functional impairment was studied in isolated isovolumic heart of control rats (C; n=12) and of placebo (P; n=11) and treated rats (CoQ10; n=10). In addition, electron microscopic evaluation of left ventricular (LV) slices (n=3 in each group) allowed us to analyze the myocardial ultrastructure. Maximal values of developed pressure (DPmax) were similarly decreased in cold stressed animals (C=129+/-3.9 mmHg; P=106+/-6.7 mmHg; CoQ10=91+/-3.9 mmHg); however, volume-induced enhancement of pressure generation (slope of DP volume relations: C=0.248+/-0.0203 mmHg / microl; P=0.2831+/-0.0187 mmHg / microl; CoQ10=0.2387 ( 0.0225 mmHg / microl; p > 0.05), and the duration of systole (C=80+/-1.6 ms; P=78+/-1.3 ms; CoQ10=80+/-2.7 ms) were not altered. Myocardial relaxation, evaluated by the relaxation constant (C=39+/-1.9 ms; P=42+/-3.4 ms; CoQ10=51+/-6.0 ms), as well as resting stress / strain relations were unaffected by cold stress. Myocardial samples showed that pretreatment with CoQ10 attenuates myofibrillar and mitochondrial lesions, and prevents mitochondrial fractional area increase (P: 53.11%>CoQ10: 38.78%=C: 33.87%; p< 0.005) indicating that the exogenous administration of CoQ10 can reduce cold stress myocardial injury.

Cantrell syndrome. Case report of an adult

Cantrell syndrome is characterized by defects that involve the diaphragm, abdominal wall, pericardium, heart, and lower region of the sternum. It is a rare entity, usually diagnosed at birth and accompanied by high mortality due to the complexity and gravity of the anomalies. In this report, we present a 32-year-old male patient, who was diagnosed in infancy but who reached adult age asymptomatic.

[Ultrastructural features of cardiac muscle fibers of albino rats during the pregnancy and puerperal cycle]

PURPOSE

In the present study we evaluated the morphology of left ventricular cardiomyocytes of albino rats during pregnancy and puerperium by means of transmission electron microscopy.

METHODS

Once pregnancy was confirmed, 77 rats were randomly divided in two groups, respectively, gestation (G) and puerperium (P). The animals of the gestation group were divided into four subgroups, according to gestational age: 1st (G-A), 7th (G-B), 14th (G-C) and 21st (G-D) days of pregnancy. The group defined as puerperium was divided into three subgroups: 7th (P-A), 14th (P-B) and 21st (P-C) days of puerperium. In the end of each established period, the animals were sacrificed and fragments of the medium third of the left ventricle were resected and routinely prepared for electron microscopy analysis.

RESULTS

The results obtained with transmission electron microscopy analysis revealed a gradative increase of the cardiomyocytes during pregnancy (increase of myofibrils, which are permeated by numerous mitochondria at the end of gestation). The blood capillary wall showed progressive thinning, with an increase of pynocytotic vesicles in endothelial cells, and intense sarcolemal folding at T-tubule level (capillary tunnels). In the puerperium group, there is a progressive regression in these alterations returning to pre-gestational level at the end of the puerperium cycle. These findings indicate the occurrence of hypertrophy of cardiomyocytes during pregnancy.

CONCLUSION

The findings indicate the occurrence of hypertrophy of cardiomyocytes during pregnancy.

[Histomorphometric study of cardiomyocytes of the left ventricle of pregnant albino rats]

PURPOSE

In the present study we evaluated, by light microscopy, and throughout morphometry, whether hypertrophy of cardiac striated muscular fibers of left ventricular occur in albino rat, during pregnancy.

METHODS

After maiting, 12 nuliparous rats were divided into four groups with three animals for each group. The female rats corresponding to each group were killed at 1st, 7th, 14th and 21st days of pregnancy.

RESULTS

Observation, on light microscopy (H.E) had at one view, did not display any alterations during pregnancy. However, the morphometry revealed that nuclei of cardiomyocytes are augmented in volume at 14th day of pregnancy and statistically significant data show the hypertrophy.

CONCLUSION

The obtained data show the existence of a dinamic and reversible process of ventricular remodelling in consequence of adaptation physiological alterations of the cardiovascular normal pregnancy.

[Development of a milk beverage based on pumpkin flakes]

Vitamin A deficiency is one of the majors public health problems in Brazilian Northeast, and among other causes may be concerned to precocious weaning. Aiming at reducing this problem, a dehydrated product based on powdered milk and pumpkin flakes was developed to act as a carotene source at weaning period. Pumpkin flakes were obtained by drum drying at a 6 atm steam pressure, 0.75 m2 contact surface and 1 rpm, and had their content of carotenoids, beta carotene, centesimal composition molds and yeast and faecal coliforms evaluated. The flakes were added to sugar and whole powdered milk according to FAO/WHO nutritional recommendation to 6-12 months old children and submitted to acceptability test by a 6 judges' panel. The results showed that the drying process had a 7% efficiency score and the flakes composition presented 4.84% moisture; 4.0% protein; 5.5% ash; 1.30% fat; 6.22% fiber; 78.14% carbohydrates; 115.08 micrograms/g total carotenois and 80.64 micrograms/g beta-carotene content. No coliforms were detected and molds and yeast content was 4.0 x 10(2) CFU/g. The powdered formulation properly diluted in water supports 45% of the RDA for children (calories, protein, carbohydrates and lipids) and 100% vitamin A and protein considering a 400 ml/day ingestion.

Anatomical and clinical aspects of the blood supply of the sinoatrial node

BACKGROUND

The recent study of the variations of the origin of the sinoatrial node and on the "arterial network of the perinodal sinusal area" in normal hearts points out the importance of this network.

PURPOSE

Report on a case of patient with syncope of ischemic etiology.

CONCLUSION

In this patient the arterial network did not protect the node from the ischemia caused by the obstruction of the artery of the sinoatrial node.

[Critical control points in the pasteurized milk processing fluxogram]

With the aim of evaluating the microbiological quality of raw and pasteurized milk and confirm the critical control points in a dairy processing industry (Recife-PE, Brazil), 84 samples of milk were collected from four points of the flow-chart considered critical (raw milk storage tank, outlet of the pasteurizer unit, pasteurized milk storage tank and packing filling machine). All samples were evaluated for the presence of mesophilic and psychotrophics microorganisms. The most probable number (MPN) of total and faecal coliforms were determined. Samples of raw and pasteurized milk (collected from the packing filling machine) were also assessed for the presence of Staphylococcus aureus. The preservation temperature of raw and pasteurized milk in the storage tanks and the MPN of total and faecal coliforms present in the water used by the industry were simultaneously evaluated. High counts of mesophilic and psychotrophics microorganisms, total and faecal coliforms and S. aureus were detect in raw milk production and processing. The pasteurization process reduced the microorganisms to acceptable numbers in the Brazilian standards, however, the statistics analysis showed that the number of microorganisms increased significantly (p < 0.01) in the pasteurized milk storage tank, representing an important point of contamination. The probable reason for this findings was the presence of coliforms in 60% samples of water which was used to clean the milk equipment and the inadequate temperatures in the storage tank. Therefore, the results of the microbiological analysis confirm that the milk maintenance temperature in the storage tanks, the pasteurization and the packaging are critical control points in the pasteurized milk processing fluxogram.

Propranolol-like action of amiodarone. An electronmicroscopic study in rats under cold stress

The cold stress leads to increased levels of catecholamines, of their precursors and metabolites, with increased oxygen consumption by the myocardium. Atrial cardiomyocytes of amiodarone-treated rats, previously stressed by cold, showed a marked decrease of the morphological alterations observed in the animals submitted to cold stress without amiodarone protection. Such results indicate, at the subcellular level, that amiodarone could improve cardiac function by a propranolol-like action when there is heart failure, a condition in which there is a high level of catecholamine.

Rhabdomyolysis due to hyperosmolarity leading to acute renal failure

Authors present the case of a 37-year-old man admitted to the emergency room of Universidade Federal de São Paulo-Escola Paulista de Medicina, with hyperosmolar coma, following progressive muscle discomfort and loss of renal function, with further need of dialysis therapy. Initial laboratory evaluation showed marked hyperglycemia, hypernatremia, hyperosmolarity, and high levels of creatinine. In the evolution he presented an elevation of creatino-phosphokinase levels in parallel with increasing levels of urea and creatinine. Urinalyses showed progressive increase in proteinuria and hematuria. A muscle biopsy was performed and confirmed the presence of muscular necrosis. The purpose of this paper is to emphasize hyperosmolarity as a newly described cause of rhabdomyolysis. The authors point out its multifactorial physiopathology and also stress the relatively common occurrence of acute renal failure (ARF) following an episode of rhabdomyolysis, and the poor prognosis that this complication represents.

[Clinical and surgical importance of anatomosurgical segments and subsegments of the organs of the human body]

OBJECTIVE

To emphasize the ubiquity of the anatomicosurgical segments and subsegments and to underscore their clinical and surgical importance, based upon recent advances in morphology, physiology, pathology, internal medicine and surgery.

PURPOSE

To update basic knowledge of the structure and its application in modern medicine and surgery, for more conservative approach to treat diseases of organs in most systems of the body.

METHOD

Comparative study of the anatomico-surgical segments and subsegments already described.

RESULTS

The data show that the concept of anatomicrosurgical segmentation is applicable to practically all organs.

CONCLUSION

The segmentation of the structures of the body from the anatomical and surgical standpoints is another general principle of construction of the human body and of other mammals as well as in vertebrates. Such a new approach to evaluate the vascular and ductal components of each organ opens broader horizons to the treatment of diseases.

[Critical analysis of the clinical and surgical importance of the variations in the origin of the sinoatrial node artery of the human heart]

There are several clinical controversies derived from the discrepancy on the description and relations of the coronary arteries in human hearts of either sex and in different races. OBJECTIVE--To study the clinical and surgical importance of the variations of the origin of the artery of the sinoatrial node in hearts of human individuals. MATERIAL AND METHOD--Normal hearts of cadavers of 100 individuals (31 females and 69 males), belonging to 24 Caucasians (whites) and 36 non-Caucasians (Negroes and Mulattoes), whose age varied ranged from 7 to 80 years, were studied. The coronary arteries were injected with gelatin mixed to a radiopaque substance (Cylatrast) and a red or blue pigment. RESULTS AND CONCLUSIONS--1) The artery of the sinoatrial node was originated more frequently from the right coronary artery (58%) than from the left. 2) When originated from the left coronary artery the artery of the sinoatrial node was more frequently a branch of the circumflex artery (30%) than from the trunk of the artery (12%). 3) No sexual or racial factor influenced the anatomical variations. 4) The most frequent arteries originating the artery of the sinoatrial node were the right anterior medial atrial artery and the left anterior medial atrial artery. 5) No cases of blood supply to the sinoatrial node were found originating neither from other arteries than the coronary arteries nor from both coronary arteries. 6) The distribution of the coronary arteries allows to understand the possible ischemic etiology of the sinusal node syndrome and permits to the surgeon a safe approach to cardiac disease.

Variations of the origin of the artery of the sinoatrial node in normal human hearts

The artery of the sino-atrial node was studied in 100 normal human hearts after injection of each coronary artery with coloured gelatine containing a radiopaque substance. The hearts belonged to 69 males and 31 females, being 64 Caucasians and 36 non-Caucasians (Negroes and Mulattoes) whose age ranged from 7 to 80 years. Since the individuals had committed suicide or were victims of accidents, their hearts, after pathologists' evaluation, were considered normal. The sinoatrial node of the normal human heart is supplied by the right coronary artery more frequently (58% +/- 4.9% of the cases) than by the left (42% +/- 4.9). The right anterior medial atrial artery, originating from the right coronary at the level of the medial third of the right anterior quadrant of the atrial dome, is most frequently (50% +/- 5) responsible for the blood supply of the sinoatrial node. Among the branches of the left coronary artery, the left anterior medial atrial artery, originating at the level of the medial third of the left. anterior quadrant of the atrial cupola, was the most frequent blood supplier (25% +/- 4.3) of the sinoatrial node. The origin of the artery of the sinoatrial node from the proximal portion or trunk of the left coronary artery was less frequent (12% +/- 3.2) than the origin from the circumflex artery (30% +/- 4.5). Neither sex nor race influenced the variations of the origin of the sino-atrial node.

Anatomical terms of Yanomani Indians translated into Portuguese and English

The authors translated into Portuguese and English the basic anatomical terminology used by the Yanomani indians. The knowledge of the names of organs and other parts of the human body and of a few having a clinical meaning should help those interested in the study of and in interaction with the Yanomanis.

The relationship between the papillary muscles and the anatomicosurgical segments of the left ventricle of the human heart

The relationship between the blood supply of the papillary muscles of the left ventricle of 90 adult human Caucasian hearts and the arteries of the cardiac anatomicosurgical segments was studied after arterial injection of Vinyl acetate and partial or total corrosion. The anterior papillary muscle belongs in most cases to the I SV segment whereas the posterior muscle belongs to the III DV segment, the former pertaining to the left coronary a. and the latter to the right a.

Subcellular alterations of cardiac fibers in rats subjected to hypothyroidism

Subcellular changes of the atrial cardiomyocytes of rats submitted to hypothyroidism caused by administration of 1 mg/100 g of body weight of propylthiouracil showed a) swollen mitochondria and lysis of their cristae; b) myofibrils with marked heterogeneity of patterns, some exhibiting rupture and loss of continuity of their myofilaments; c) lesser concentration of atrial granules in the perinuclear area; d) abundant granular interstitial tissue and collagen separating the myofibrils.

Action of propranolol on the atrial cardiomyocytes of rats submitted to cold stress

Subcellular changes of the atrial cardiomyocytes of rats caused by cold showed a) altered mitochondria with edema and lysis of crests; b) myofibrils with marked heterogeneity of patterns and ruptures, c) myofilaments disarrangement, partial necrosis and disintegration of filaments, d) lesser concentration of atrial granules in the perinuclear area. Atrial muscle fibers of propranolol-treated rats previously stressed by cold showed a marked decrease of the morphological alterations observed in the animals submitted to cold stress without propranolol protection.

Systolic and diastolic time intervals in the critically ill patient

OBJECTIVE

The waveform of the first derivative of thoracic electrical bioimpedance was used to calculate systolic time intervals of the cardiac cycle, preejection period/left ventricular ejection time ratio, and diastolic time intervals, isovolumic relaxation period/filling time ratio.

DESIGN

Prospective clinical study. Waveforms were examined from 913 normal and abnormal tracings from a thoracic electrical bioimpedance monitor. This monitor was coupled to a two-channel strip-chart recorder that identified preejection period/LV ejection time and isovolumic relaxation period/filling time in 86% of the tracings.

SETTING

Two university-affiliated hospitals and one community hospital.

PATIENTS

We assessed 100 subjects (ranging in age from 17 to 93 yrs) under various conditions.

MEASUREMENTS AND MAIN RESULTS

Data from 15 normal subjects were used as a reference series to define normative values. Preejection period/left ventricular ejection time ratio was 0.35 +/- 0.1 (SD) and was consistent with data from systolic time intervals derived from simultaneous study of the ECG recording, carotid artery tracing, and phonocardiography. The diastolic time ratio (isovolumic relaxation period/filling time) was 0.4 +/- 0.2, in agreement with normal values derived by echocardiography and angiography. In a subgroup of 17 critically ill patients, a correlative study of simultaneously measured thoracic electrical bioimpedance, nuclear stethoscope, and radionuclide ventriculography was conducted. Systolic functions were compared by the ejection fraction derived by preejection period/left ventricular ejection time ratio displayed on the thoracic electrical bioimpedance monitor and by the radionuclide technique, and were found to be 57 +/- 13.8% and 58 +/- 8.6%, respectively (r2 = .49; y = 4.06x + 0.94; p less than .02; n = 17). Increased diastolic time ratios with normal or near-normal systolic time intervals were documented in nine (53%) of 17 critically ill patients with low systolic index.

CONCLUSION

Both systolic and diastolic time intervals can be investigated noninvasively at the bedside by the thoracic electrical bioimpedance technique to provide a better understanding of left heart function.