The role of interleukin 17-mediated immune response in Chagas disease:High level is correlated with better left ventricular function

Interleukin 17A (IL-17A) has been associated with protective rather than pathogenic response in Chagas disease (ChD). However, it is not established whether or not IL-17A-mediated immune response is correlated with patient's left ventricular (LV) function in ChD. To address this question we have gathered cardiac functional parameters from ChD patients and analysed the possible relationship between their plasma IL-17A levels and LV function. Plasma IL-17A levels were measured by BD Cytometric Bead Array (CBA) in 240 patients with positive specific serology for Trypanosoma cruzi (T. cruzi) grouped as indeterminate (IND) and Chagas cardiomyopathy (CARD) forms. The levels of IL-17A in ChD patients were compared with 32 healthy individuals, mean age of 39 years, 50% male, that were also included as a control group (non-infected [NI]). The overall mean age of ChD patients was 46 years and 52% were male. The IND group included 95 asymptomatic patients, with ages ranging from 27 to 69 years (mean of 43 years), and 42.1% of them were male. The CARD group included 145 patients, which 58.6% were male, with ages ranging from 23 to 67 years (mean of 49). The IND group presented substantially higher levels of IL-17A, median of 26.16 (3.66-48.33) as compared to both the CARD group, median of 13.89 (3.87-34.54) (P <0.0001), and the NI group, median of 10.78 (6.23-22.26) (P <0.0001). The data analysis demonstrated that the IND group comprises a significantly greater proportion (P <0.001) of high IL-17A producers (52.6%, 50 of 95 subjects) than do the other groups. A significant direct correlation was verified between IL-17A levels and cardiac function expressed by LV ejection fraction (LVEF), LV diastolic diameter (LVDd), and body surface area (BSA)-indexed LVDd as well as ratio of the early diastolic transmitral flow velocity to early diastolic mitral annular velocity (E/e') in both groups. We demonstrated that plasma IL-17A levels has an accurate sensitivity and specificity to predict heart failure in serology-positive patients and might be a useful parameter to distinguish patients with or without cardiac impairment. This study indicates a consistent relationship between high expression of IL-17A and better LV in human chronic ChD. Our data raise the possibility that IL-17A plays an important immunomodulatory role in the chronic phase of ChD and might be involved in protection against myocardial damage

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Clinical, eletrocardiographic, and echocardiographic characteristics of the study population.

<p>Clinical, eletrocardiographic, and echocardiographic characteristics of the study population.</p

Receiver operating characteristics curve of sensitivity of heart failure prediction against specificity.

<p>A risk score was calculated on the basis of the plasma IL-17A levels in the IND and CARD groups by logistic regression, and the proportion of all cases that score greater than any given cutoff (sensitivity) against the proportion of the IND patients that would also exceed the same cutoff (specificity) was plotted. The slope of the tangent line at a cutpoint indicates the likelihood ratio for that value of the test and the diagonal line represents random prediction.</p

Correlation analysis between plasma IL-17A levels and echocardiographic parameters of left ventricular function in Chagas disease patients.

<p>Correlation analysis was performed between plasma IL-17A levels and variables of LV function (LVEF, LVDd, LVDd/BSA, and E/e’ ratio) in the ChD patients as a whole. The analysis was performed using the Spearman correlation coefficient, and results were considered significant when <i>P</i>-value <0.05. Significant differences are indicated in each graph together with the r value.</p

Correlation analysis between plasma IL-17A levels and echocardiographic parameters of left ventricular function according to the form of Chagas disease.

<p>Correlation analysis was performed between plasma IL-17A levels and parameters of LV function (LVEF, LVDd, LVDd/BSA, and E/e’ ratio) in the IND (n = 95, A, B, C, and D, respectively) and CARD (n = 145, E, F, G, and H, respectively) groups. The analysis was performed using the Spearman correlation coefficient, and results were considered significant when <i>P</i>-value <0.05. Significant differences are indicated in each graph together with the r value.</p

Analyses of plasma IL-17A levels in the study groups.

<p>Representative scatter plot graph of plasma IL-17A used to establish the cutoff to define low, intermediate, and high cytokine producers. Low IL-17A producers were defined by values of lower than the first tertile. Intermediate IL-17A producers were defined by values equal to or lower than the second tertile, while high IL-17A producers were defined by values higher than or equal to the second tertile [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0172833#pone.0172833.ref018" target="_blank">18</a>]. The results were expressed by pg/mL. Results were considered significant with a <i>P</i>-value <0.05.</p

Resumos concluídos - Neurociências

Resumos concluídos -  Neurociência