Bartonella and Coxiella infective endocarditis in Brazil: molecular evidence from excised valves from a cardiac surgery referral center in Rio de Janeiro, Brazil, 1998 to 2009

SummaryPCR was used to detect Coxiella burnetii and Bartonella spp in heart valves obtained during the period 1998–2009 from patients operated on for blood culture-negative endocarditis in a cardiac surgery hospital in Brazil. Of the 51 valves tested, 10 were PCR-positive; two were positive for Bartonella and one for C. burnetii

Bipolar versus unipolar energy in the surgical ablation of atrial fibrillation in patients with mitral valve surgery

Objective: To evaluate the presence of sinus rhythm or atrial fibrillation (AF) in patients who had mitral valve surgery with concomitant surgical ablation of AF, by unipolar or bipolar radiofrequency. Methods: Adults patients who had mitral valve replacement or mitral valvuloplasty with concomitant surgical ablation of AF, either by unipolar or bipolar radiofrequency, were consecutively included between the 2008 and 2012. Surgery was done by conventional median sternotomy. Results: A total of 99 patients were included; 20 (20.2%) had surgical ablation by unipolar energy and 79 (79.8%) by bipolar energy. There were 76 (76.8%) women, and mean age± SD was 51 ±11 years.  The median duration of AF before surgery was 41 months. Type of AF was paroxysmal in 21 (21%), persistent in 11 (11%), and long-standing persistent in 67 (67%). Mean left atrium size in the preoperative period was 5.54 ± 0.82 cm. Mean left ventricular ejection fraction was 58±12.4%. Types of mitral valve surgery were valvuloplasty (n=10), mechanical valve replacement in 30, and bioprosthesis replacement in 59. Concomitant tricuspid annuloplasty was performed in 39 patients. Thirty- day mortality was 8/99 (8%). Mean follow-up time was 1274 days (3.49 years). Survival was 92%. After 4 years no patient who had had unipolar ablation was in sinus rhythm, whilst 67% of those who had bipolar energy ablation were in sinus rhythm (p<0.001). Conclusion: The use of bipolar energy is superior to unipolar energy in the surgical ablation of atrial fibrillation in patients submitted to mitral valve surgery

Angiotensin II Facilitates Breast Cancer Cell Migration and Metastasis

Breast cancer metastasis is a leading cause of death by malignancy in women worldwide. Efforts are being made to further characterize the rate-limiting steps of cancer metastasis, i.e. extravasation of circulating tumor cells and colonization of secondary organs. In this study, we investigated whether angiotensin II, a major vasoactive peptide both produced locally and released in the bloodstream, may trigger activating signals that contribute to cancer cell extravasation and metastasis. We used an experimental in vivo model of cancer metastasis in which bioluminescent breast tumor cells (D3H2LN) were injected intra-cardiacally into nude mice in order to recapitulate the late and essential steps of metastatic dissemination. Real-time intravital imaging studies revealed that angiotensin II accelerates the formation of metastatic foci at secondary sites. Pre-treatment of cancer cells with the peptide increases the number of mice with metastases, as well as the number and size of metastases per mouse. In vitro, angiotensin II contributes to each sequential step of cancer metastasis by promoting cancer cell adhesion to endothelial cells, trans-endothelial migration and tumor cell migration across extracellular matrix. At the molecular level, a total of 102 genes differentially expressed following angiotensin II pre-treatment were identified by comparative DNA microarray. Angiotensin II regulates two groups of connected genes related to its precursor angiotensinogen. Among those, up-regulated MMP2/MMP9 and ICAM1 stand at the crossroad of a network of genes involved in cell adhesion, migration and invasion. Our data suggest that targeting angiotensin II production or action may represent a valuable therapeutic option to prevent metastatic progression of invasive breast tumors

Invading Basement Membrane Matrix Is Sufficient for MDA-MB-231 Breast Cancer Cells to Develop a Stable In Vivo Metastatic Phenotype

1 - ArticleIntroduction: The poor efficacy of various anti-cancer treatments against metastatic cells has focused attention on the role of tumor microenvironment in cancer progression. To understand the contribution of the extracellular matrix (ECM) environment to this phenomenon, we isolated ECM surrogate invading cell populations from MDA-MB-231 breast cancer cells and studied their genotype and malignant phenotype. Methods: We isolated invasive subpopulations (INV) from non invasive populations (REF) using a 2D-Matrigel assay, a surrogate of basal membrane passage. INV and REF populations were investigated by microarray assay and for their capacities to adhere, invade and transmigrate in vitro, and to form metastases in nude mice. Results: REF and INV subpopulations were stable in culture and present different transcriptome profiles. INV cells were characterized by reduced expression of cell adhesion and cell-cell junction genes (44% of down regulated genes) and by a gain in expression of anti-apoptotic and pro-angiogenic gene sets. In line with this observation, in vitro INV cells showed reduced adhesion and increased motility through endothelial monolayers and fibronectin. When injected into the circulation, INV cells induced metastases formation, and reduced injected mice survival by up to 80% as compared to REF cells. In nude mice, INV xenografts grew rapidly inducing vessel formation and displaying resistance to apoptosis. Conclusion: Our findings reveal that the in vitro ECM microenvironment per se was sufficient to select for tumor cells with a stable metastatic phenotype in vivo characterized by loss of adhesion molecules expression and induction of proangiogenic and survival factors

Nirs detection of moldy core in apples

Proceedings of the International Conference “Environmentally friendly and safe technologies for quality of fruit and vegetables”, held in Universidade do Algarve, Faro, Portugal, on January 14-16, 2009. This Conference was a join activity with COST Action 924.Moldy core of apples is undetectable until the fruit is cut or bitten into, it can therefore pose serious problems to both producer and consumer. Removal of diseased fruits prior to storage would be most desirable. The objective of this study was to evaluate the ability of VIS-NIR mini-spectrometers to detect moldy core in apples, on line. An apparatus which is qualified for online NIRS (near infrared spectrometry) measurements was developed based on off-the-shelf mini-spectrometers. ‘Top Red’ apples, were collected from several orchards before and during the commercial harvest, and were stored at 0°C pending the tests. The data were analyzed by chemometric procedures, specifically, by partial least squares regression (PLSR), and were classified by means of canonical discriminant analysis. The canonical variables were represented by the latent variables of the PLS models, which were based on the spectra. The accuracy of the classification results was high when the moldy fraction threshold was set at 5%; in such a case the mold covers only the seed carpals of the fruit, where it might remain without really damaging the fruit. Improvements should aim to reduce errors in classifying low-level damage, and also in misclassifying some healthy fruits. The rate of testing (1 s per fruit) is acceptable for quality control purposes, but should be accelerated for future packing-line implementation

Streptococcus bovis endocarditis: analysis of cases between 2005 and 2014

Background: Streptococcus bovis is a classical etiology of endocarditis and is associated with colonic lesions. No series of cases from Brazil has been described. Objectives: To describe aspects of S. bovis endocarditis. Methods: This is a case series of patients admitted to a cardiac surgery referral center, during the years 2005-2014. Clinical, laboratory, echochardiographic, colonoscopic, treatment, surgical and outcome variables were studied. Results: Nine patients with S. bovis endocarditis were included; all cases ful&#64257;lled the modi&#64257;ed Duke criteria. Incidence was 8/220 (4%) in years 2006-2014. There were seven male and two female patients; mean age was 56.7 years, standard deviation 13.4. All patients had native aortic valve involvement. Presentation was subacute in 7/9 (71%). Fever was present in 7/9 (77.7%), embolic lesions to solid organs occurred in three, and perivalvular abscess in two patients. All echocardiograms showed moderate to severe valvular regurgitation and vegetations. Microcytic anemia was seen in 7/7 patients. Colonoscopy showed abnormal &#64257;ndings in 7/9 (77.7%). Surgery was indicated for 6/9 patients due to acute aortic regurgitation and left ventricular failure. All patients were discharged home. Conclusions: S. bovis most frequently affected the aortic valve of male patients. Colon disease was frequent. Surgery was indicated frequently due to hemodynamic compromise

Prevalence and Prediction of Obstructive Coronary Artery Disease in Patients Undergoing Primary Heart Valve Surgery

Abstract Background: The prevalence of coronary artery disease (CAD) in valvular patients is similar to that of the general population, with the usual association with traditional risk factors. Nevertheless, the search for obstructive CAD is more aggressive in the preoperative period of patients with valvular heart disease, resulting in the indication of invasive coronary angiography (ICA) to almost all adult patients, because it is believed that coronary artery bypass surgery should be associated with valve replacement. Objectives: To evaluate the prevalence of obstructive CAD and factors associated with it in adult candidates for primary heart valve surgery between 2001 and 2014 at the National Institute of Cardiology (INC) and, thus, derive and validate a predictive obstructive CAD score. Methods: Cross-sectional study evaluating 2898 patients with indication for heart surgery of any etiology. Of those, 712 patients, who had valvular heart disease and underwent ICA in the 12 months prior to surgery, were included. The P value < 0.05 was adopted as statistical significance. Results: The prevalence of obstructive CAD was 20%. A predictive model of obstructive CAD was created from multivariate logistic regression, using the variables age, chest pain, family history of CAD, systemic arterial hypertension, diabetes mellitus, dyslipidemia, smoking, and male gender. The model showed excellent correlation and calibration (R² = 0.98), as well as excellent accuracy (ROC of 0.848; 95%CI: 0.817-0.879) and validation (ROC of 0.877; 95%CI: 0.830 - 0.923) in different valve populations. Conclusions: Obstructive CAD can be estimated from clinical data of adult candidates for valve repair surgery, using a simple, accurate and validated score, easy to apply in clinical practice, which may contribute to changes in the preoperative strategy of acquired heart valve surgery in patients with a lower probability of obstructive disease

Valor preditivo da angina em detectar doença coronariana em pacientes com estenose aórtica grave a partir da quinta década de vida Predictive value of angina to detect coronary artery disease in patients with severe aortic stenosis aged 50 years or older

OBJETIVO: O objetivo deste estudo é verificar o valor de previsão da angina de peito no diagnóstico da DAC em pacientes portadores de EA, a partir da quinta década de vida. MÉTODOS: A população estudada foi constituída por 186 pacientes consecutivos com EA e idade e" 50 anos, referidos para cirurgia de troca valvar aórtica entre junho de 1989 e setembro de 2004. Cinecoronariografia de rotina foi realizada em todos os pacientes. Cento e um eram homens (54,3%) e 85, mulheres (45,7%), com idade de 66&plusmn;8 anos. Angina estava presente em 124 pacientes (66,7%). O gradiente máximo transvalvar aórtico foi de 89,4&plusmn;27,6 mmHg e a área valvar aórtica de 0,59&plusmn;0,17 cm2. Calculamos a sensibilidade, a especificidade, o valor de previsão positivo e negativo e a razão de verossimilhança positiva da angina na predição da presença de DAC. RESULTADOS: DAC estava presente em 93 pacientes (50%). Dos 124 pacientes com angina, 68 (54,8%) apresentavam DAC; enquanto dos 62 sem angina, 25 apresentavam DAC (40,3%). Portanto, a sensibilidade da angina para DAC foi de 73,1%, a especificidade de 39,7%, valor preditivo positivo de 54,8%, valor preditivo negativo de 59,6% e razão de verossimilhança positiva de 1,6. CONCLUSÃO: A angina de peito não é bom preditor da presença de DAC em pacientes com EA a partir da quinta década de vida.<br>OBJECTIVE: The objective of this study is to evaluate the value of angina pectoris as a predictor of CAD (coronary artery disease) in patients with AS (aortic stenosis) during and beyond the 5th decade of life. METHODS: The study population consisted of 186 consecutive patients with AS and e" 50 years of age, referred for surgical aortic valve replacement (AVR) between June 1989 and September 2004. Routine coronary angiography was performed for all patients. One hundred and one patients were males (54.3%) and 85 were females (45.7%), and the mean age was 66&plusmn;8 years. One hundred and twenty-four patients (66.7%) had angina. The maximum transvalve gradient was 89.4&plusmn;27.6 mmHg, and the aortic valve area measured 0.59&plusmn;0.17 cm2. We calculated the sensitivity, specificity, positive and negative predictive values, as well as the likelihood ratio of a positive test result for angina in predicting the presence of CAD. RESULTS: Ninety-three patients (50%) had CAD. Of the 124 patients with angina, 68 (54.8%) had CAD, whereas of the 62 patients without angina, 25 had CAD (40.3%) (p=0.087). Therefore, the diagnostic sensitivity of angina to detect CAD was 73.1%, specificity was 39.7%, positive predictive value was 54.8%, negative predictive value was 59.6%, and the likelihood ratio of a positive test result was 1.6. CONCLUSION: Angina pectoris is not a good predictor of CAD in patients with AS who are more than 50 years of age

ENDOCARDITE INFECCIOSA DE VÁLVULA AÓRTICA DE IMPLANTE PERCUTÂNEO E ENTEROCOCCUS FAECALIS: COINCIDÊNCIA?

A Endocardite Infecciosa (E.I.) é uma séria complicação do implante Transcatéter de Valva Aórtica (TAVI). A incidência pós TAVI é similar à pós troca valvar cirúrgica. Há expectativa que o número de TAVI cresça nos próximos anos. A EI de TAVI possui maior incidência nos primeiros meses após procedimento, e seu manejo é complicado pelo alto risco cirúrgico dos pacientes. Caso 1: mulher, 71 anos, hipertensa, diabética, coronariopata, com Doença Renal Crônica (DRC) em Tratamento Conservador (TCon), submetida a TAVI por estenose aórtica grave há 10 meses. Dá entrada em emergência com hemiparesia esquerda. Ao exame força grau 3 em dimídio esquerdo e discreta alteração da sensibilidade. Tomografia Computadorizada (TC) de crânio sem alterações agudas. Leucocitose de 19.900 mL, PCR-T: 26,8 mg/mL. Coletadas hemoculturas, com crescimento de Enterococcus faecalis. Iniciado ceftriaxone e ampicilina. Ecocardiograma transesofágico (ECOTE) demonstrou prótese aórtica de implante percutâneo normofuncionante, sem imagens aditivas. TC de abdome: áreas sugestivas de isquemia em baço e artéria mesentérica superior com falha de enchimento sugerindo infarto da gordura mesentérica. Ressonância Magnética de crânio mostrou injúria vascular isquêmica recente. PET-CT com FDG após 2 semanas de antibióticos foi normal. Colonoscopia sem alterações. Paciente sem possibilidade cirúrgica, sendo realizados 42 dias de antibiótico, com boa evolução clínica. Caso 2: homem, 84 anos, hipertenso, diabético, ex-tabagista, portador de DRC em TCon, coronariopata, submetido a TAVI há 3 meses. Procura emergência após febre e astenia há 1 semana. Coletadas hemoculturas, realizadas TCs de crânio e abdome sem alterações agudas, além de ECOTE. Este demonstrou prótese aórtica tipo TAVI com regurgitação periprotética moderada, sem imagens aditivas. Hemoculturas colhidas. Prescrito ampicilina e gentamicina. Identificação de E. faecalis, resistente à gentamicina, substituída por ceftriaxona. Cintilografia com leucócitos marcados demonstrou captação no sítio da TAVI. Sem condições cirúrgicas, tratado com 42 dias de ceftriaxona e ampicilina com boa evolução. Descrevemos dois casos de EI em TAVI, ambas em pacientes idosos com comorbidades e com alto risco cirúrgico, que foram tratadas conservadoramente com sucesso. E. faecalis foi o agente isolado em ambos os casos, cuja porta de entrada foi provavelmente o acesso femoral para a TAVI. É fundamental rever a profilaxia antimicrobiana e antissepsia para a TAVI

Asymptomatic and symptomatic embolic events in infective endocarditis: associated factors and clinical impact

Submitted by Janaína Nascimento ([email protected]) on 2019-01-28T10:52:47Z No. of bitstreams: 1 ve_Monteiro_Thaíssa_etal_INI_2017.pdf: 612961 bytes, checksum: 65617226ceb7d4b094abe81e56efd491 (MD5)Approved for entry into archive by Janaína Nascimento ([email protected]) on 2019-01-28T11:11:13Z (GMT) No. of bitstreams: 1 ve_Monteiro_Thaíssa_etal_INI_2017.pdf: 612961 bytes, checksum: 65617226ceb7d4b094abe81e56efd491 (MD5)Made available in DSpace on 2019-01-28T11:11:13Z (GMT). No. of bitstreams: 1 ve_Monteiro_Thaíssa_etal_INI_2017.pdf: 612961 bytes, checksum: 65617226ceb7d4b094abe81e56efd491 (MD5) Previous issue date: 2017Instituto Nacional de Cardiologia. Departamento de doenças da válvula cardíaca. Rio de Janeiro, RJ, Brasil.Instituto Nacional de Cardiologia. Departamento de Bioestatística. Rio de Janeiro, RJ, Brasil.Instituto Nacional de Cardiologia. Departamento de doenças da válvula cardíaca. Rio de Janeiro, RJ, Brasil.Instituto Nacional de Cardiologia. Unidade de Controle de Infecções. Rio de Janeiro, RJ, Brasil.Instituto Nacional de Cardiologia. Departamento de doenças da válvula cardíaca. Rio de Janeiro, RJ, Brasil.Instituto Nacional de Cardiologia. Departamento de doenças da válvula cardíaca. Rio de Janeiro, RJ, Brasil / Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil / Universidade do Grande Rio. Rio de Janeiro, RJ, Brasil.Embolic complications of infective endocarditis are common. The impact of asymptomatic embolism is uncertain