Preditores de anormalidades do sistema de conduçao cardíaco e necessidade de marcapasso definitivo após implante por cateter de bioprótese valvar aórtica (Transcatheter Aortic Valve Implantation - TAVI)

O implante por cateter de bioprótese valvar aórtica (do inglês Transcatheter Aortic Valve Implantation - TAVI) vem ganhando espaço e configura-se como opçao terapêutica para pacientes com estenose aórtica grave sintomática e risco cirúrgico elevado ou proibitivo. Apesar da menor manipulaçao e da menor agressividade comparativamente à abordagem cirúrgica tradicional, a incidência de bloqueio atrioventricular avançado é expressiva e resulta em aproximadamente 30% de implantes de marcapasso cardíaco definitivo. A identificaçao de fatores clínicos, eletrocardiográficos, anatômicos e relacionados ao tipo de prótese ou à técnica de liberaçao do dispositivo é fundamental para o desenvolvimento de novas técnicas e materiais, visando a reduzir a taxa de bloqueio atrioventricular avançado após o procedimento de TAVI. Os preditores mais relevantes analisados foram: bloqueio de ramo direito prévio, tipo de prótese (autoexpansível vs. balao expansível), profundidade do implante sobre a via de saída do ventrículo esquerdo, expansao excessiva da prótese, bloqueio atrioventricular total intraprocedimento, bloqueio atrioventricular de 1º grau ao eletrocardiograma de base e sexo masculino

Preditores de anormalidades do sistema de conduçao cardíaco e necessidade de marcapasso definitivo após implante por cateter de bioprótese valvar aórtica (Transcatheter Aortic Valve Implantation - TAVI)

O implante por cateter de bioprótese valvar aórtica (do inglês Transcatheter Aortic Valve Implantation - TAVI) vem ganhando espaço e configura-se como opçao terapêutica para pacientes com estenose aórtica grave sintomática e risco cirúrgico elevado ou proibitivo. Apesar da menor manipulaçao e da menor agressividade comparativamente à abordagem cirúrgica tradicional, a incidência de bloqueio atrioventricular avançado é expressiva e resulta em aproximadamente 30% de implantes de marcapasso cardíaco definitivo. A identificaçao de fatores clínicos, eletrocardiográficos, anatômicos e relacionados ao tipo de prótese ou à técnica de liberaçao do dispositivo é fundamental para o desenvolvimento de novas técnicas e materiais, visando a reduzir a taxa de bloqueio atrioventricular avançado após o procedimento de TAVI. Os preditores mais relevantes analisados foram: bloqueio de ramo direito prévio, tipo de prótese (autoexpansível vs. balao expansível), profundidade do implante sobre a via de saída do ventrículo esquerdo, expansao excessiva da prótese, bloqueio atrioventricular total intraprocedimento, bloqueio atrioventricular de 1º grau ao eletrocardiograma de base e sexo masculino

Expression analysis and in silico characterization of intronic long noncoding RNAs in renal cell carcinoma: emerging functional associations

Abstract Background Intronic and intergenic long noncoding RNAs (lncRNAs) are emerging gene expression regulators. The molecular pathogenesis of renal cell carcinoma (RCC) is still poorly understood, and in particular, limited studies are available for intronic lncRNAs expressed in RCC Methods Microarray experiments were performed with custom-designed arrays enriched with probes for lncRNAs mapping to intronic genomic regions. Samples from 18 primary RCC tumors and 11 nontumor adjacent matched tissues were analyzed. Meta-analyses were performed with microarray expression data from three additional human tissues (normal liver, prostate tumor and kidney nontumor samples), and with large-scale public data for epigenetic regulatory marks and for evolutionarily conserved sequences. Results A signature of 29 intronic lncRNAs differentially expressed between RCC and nontumor samples was obtained (false discovery rate (FDR) <5%). A signature of 26 intronic lncRNAs significantly correlated with the RCC five-year patient survival outcome was identified (FDR <5%, p-value ≤0.01). We identified 4303 intronic antisense lncRNAs expressed in RCC, of which 22% were significantly (p <0.05) cis correlated with the expression of the mRNA in the same locus across RCC and three other human tissues. Gene Ontology (GO) analysis of those loci pointed to 'regulation of biological processes’ as the main enriched category. A module map analysis of the protein-coding genes significantly (p <0.05) trans correlated with the 20% most abundant lncRNAs, identified 51 enriched GO terms (p <0.05). We determined that 60% of the expressed lncRNAs are evolutionarily conserved. At the genomic loci containing the intronic RCC-expressed lncRNAs, a strong association (p <0.001) was found between their transcription start sites and genomic marks such as CpG islands, RNA Pol II binding and histones methylation and acetylation. Conclusion Intronic antisense lncRNAs are widely expressed in RCC tumors. Some of them are significantly altered in RCC in comparison with nontumor samples. The majority of these lncRNAs is evolutionarily conserved and possibly modulated by epigenetic modifications. Our data suggest that these RCC lncRNAs may contribute to the complex network of regulatory RNAs playing a role in renal cell malignant transformation.We would like to thank Helder I Nakaya and Tarik A El-Jundi for help with the 44 k microarray experiments and, together with Rodrigo Louro, for helpful discussions. This work was supported by grants from Fundação de Amparo a Pesquisa do Estado de São Paulo (FAPESP) and from Instituto Nacional de Ciência e Tecnologia em Oncogenômica to SVA and EMR, and by fellowships from FAPESP to AAF, ACT, SAVA and VMC. SVA and EMR received research fellowship awards from Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq), Brazil

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure &lt;= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Purification of rabbit sarcoplamic reticulum Ca2+-ATPase expressed in yeast

Este estudo descreve um novo método para a produção da Ca2+-ATPase do retículo sarcoplasmático de coelho em levedura utilizando um vetor de expressão regulado por choque térmico. Após solubilização das membranas de levedura com lisofosfatidilcolina, a introdução de um \"tag\" de 6 histidinas na extremidade amino-terminal da Ca2+-ATPase permitiu a sua purificação por cromatografia de afinidade utilizando uma resina carregada com níquel. Utilizando essa estratégia, foi possível obter frações enriquecidas em até 75% de Ca2+-ATPase recombinante, algo não descrito ainda na literatura. A 6xHis Ca2+-ATPase solubilizada em LPC e purificada em coluna de níquel se mantém estável desde que seja introduzido DOPC juntamente com o detergente nas etapas de lavagem e eluição. Nessas condições, a enzima purificada possui elevada atividade ATPásica cálcio-dependente (1.5-2.0 &#181;mol/mg proteína.min) durante vários minutos de reação. A titulação da atividade ATPásica em função do cálcio livre demonstrou que a 6xHis Ca2+-ATPase purificada possui alta afinidade para o íon (K0.5= 0.15 &#181;lM) e manteve uma forte cooperatividade na ativação por cálcio (nH = 2.07). A quantidade e o grau de pureza obtidos são suficientes para permitir a caracterização bioquímica e espectroscópica de mutantes pontuais da Ca2+-ATPase já construídos e expressos em levedura. A conversão da energia presente em ligações químicas em gradiente eletroquímico é um tema central da bioenergética. Espera-se que o estudo dos mutantes pontuais de triptofano da Ca2+-ATPase gerados nesse trabalho contribua para uma melhor compreensão do mecanismo de acoplamento entre a hidrólise de ATP e o transporte vetorial de íons nesse modêlo de estudo de proteínas de transporte.We describe in this work a new method for the production of SERCA-l Ca2+-ATPase in yeast using a heat-shock regulated expression vector. Following solubilization of yeast membranes with lysophospholipids, the presence of an hexahistidine tag introduced at the Nterminal end of the Ca2+-ATPase allowed its purification by metal chelating affinity chromatography using a nickel-NTA resin. Using this procedure highly enriched ftactions (75% oftotal protein in the ftaction) of yeast-expressed rabbit Ca2+-ATPase were obtained. Detergent-solubilized 6xHis-Ca2+-ATPase retained highly active (1.5 - 2 &#181;mol/mg protein .min) calcium-dependent, vanadate inhibitable ATPase activity as determined by 32P-&#947;-ATP hydrolysis. Titration of ATPase activity as a function of ftee calcium revealed high Ca2+ affinity (K0.5 =~ 0.15 &#181;M) and the persistence of a strong cooperative pattem of calcium activation (Hill number of 2.07). The yield and purity of 6xHis Ca2+-ATPase fractions produced with this method allows the biochemical and spectroscopic characterization of Ca2+-ATPase mutants produced in the course of this work. Conversion of the energy present in chemical bonds to electrochemical gradient is a central theme of bioenergetics. It is hoped that the study of the Ca2+-ATPase tryptophan mutants generated in this work will contribute to a better understanding of the coupling mechanism between ATP hydrolysis and the vectorial transport of ions across membranes that occur in this model system

Purification of rabbit sarcoplamic reticulum Ca2+-ATPase expressed in yeast

Este estudo descreve um novo método para a produção da Ca2+-ATPase do retículo sarcoplasmático de coelho em levedura utilizando um vetor de expressão regulado por choque térmico. Após solubilização das membranas de levedura com lisofosfatidilcolina, a introdução de um \"tag\" de 6 histidinas na extremidade amino-terminal da Ca2+-ATPase permitiu a sua purificação por cromatografia de afinidade utilizando uma resina carregada com níquel. Utilizando essa estratégia, foi possível obter frações enriquecidas em até 75% de Ca2+-ATPase recombinante, algo não descrito ainda na literatura. A 6xHis Ca2+-ATPase solubilizada em LPC e purificada em coluna de níquel se mantém estável desde que seja introduzido DOPC juntamente com o detergente nas etapas de lavagem e eluição. Nessas condições, a enzima purificada possui elevada atividade ATPásica cálcio-dependente (1.5-2.0 &#181;mol/mg proteína.min) durante vários minutos de reação. A titulação da atividade ATPásica em função do cálcio livre demonstrou que a 6xHis Ca2+-ATPase purificada possui alta afinidade para o íon (K0.5= 0.15 &#181;lM) e manteve uma forte cooperatividade na ativação por cálcio (nH = 2.07). A quantidade e o grau de pureza obtidos são suficientes para permitir a caracterização bioquímica e espectroscópica de mutantes pontuais da Ca2+-ATPase já construídos e expressos em levedura. A conversão da energia presente em ligações químicas em gradiente eletroquímico é um tema central da bioenergética. Espera-se que o estudo dos mutantes pontuais de triptofano da Ca2+-ATPase gerados nesse trabalho contribua para uma melhor compreensão do mecanismo de acoplamento entre a hidrólise de ATP e o transporte vetorial de íons nesse modêlo de estudo de proteínas de transporte.We describe in this work a new method for the production of SERCA-l Ca2+-ATPase in yeast using a heat-shock regulated expression vector. Following solubilization of yeast membranes with lysophospholipids, the presence of an hexahistidine tag introduced at the Nterminal end of the Ca2+-ATPase allowed its purification by metal chelating affinity chromatography using a nickel-NTA resin. Using this procedure highly enriched ftactions (75% oftotal protein in the ftaction) of yeast-expressed rabbit Ca2+-ATPase were obtained. Detergent-solubilized 6xHis-Ca2+-ATPase retained highly active (1.5 - 2 &#181;mol/mg protein .min) calcium-dependent, vanadate inhibitable ATPase activity as determined by 32P-&#947;-ATP hydrolysis. Titration of ATPase activity as a function of ftee calcium revealed high Ca2+ affinity (K0.5 =~ 0.15 &#181;M) and the persistence of a strong cooperative pattem of calcium activation (Hill number of 2.07). The yield and purity of 6xHis Ca2+-ATPase fractions produced with this method allows the biochemical and spectroscopic characterization of Ca2+-ATPase mutants produced in the course of this work. Conversion of the energy present in chemical bonds to electrochemical gradient is a central theme of bioenergetics. It is hoped that the study of the Ca2+-ATPase tryptophan mutants generated in this work will contribute to a better understanding of the coupling mechanism between ATP hydrolysis and the vectorial transport of ions across membranes that occur in this model system

NEOTROPICAL XENARTHRANS: a data set of occurrence of xenarthran species in the Neotropics

Xenarthrans—anteaters, sloths, and armadillos—have essential functions for ecosystem maintenance, such as insect control and nutrient cycling, playing key roles as ecosystem engineers. Because of habitat loss and fragmentation, hunting pressure, and conflicts with domestic dogs, these species have been threatened locally, regionally, or even across their full distribution ranges. The Neotropics harbor 21 species of armadillos, 10 anteaters, and 6 sloths. Our data set includes the families Chlamyphoridae (13), Dasypodidae (7), Myrmecophagidae (3), Bradypodidae (4), and Megalonychidae (2). We have no occurrence data on Dasypus pilosus (Dasypodidae). Regarding Cyclopedidae, until recently, only one species was recognized, but new genetic studies have revealed that the group is represented by seven species. In this data paper, we compiled a total of 42,528 records of 31 species, represented by occurrence and quantitative data, totaling 24,847 unique georeferenced records. The geographic range is from the southern United States, Mexico, and Caribbean countries at the northern portion of the Neotropics, to the austral distribution in Argentina, Paraguay, Chile, and Uruguay. Regarding anteaters, Myrmecophaga tridactyla has the most records (n = 5,941), and Cyclopes sp. have the fewest (n = 240). The armadillo species with the most data is Dasypus novemcinctus (n = 11,588), and the fewest data are recorded for Calyptophractus retusus (n = 33). With regard to sloth species, Bradypus variegatus has the most records (n = 962), and Bradypus pygmaeus has the fewest (n = 12). Our main objective with Neotropical Xenarthrans is to make occurrence and quantitative data available to facilitate more ecological research, particularly if we integrate the xenarthran data with other data sets of Neotropical Series that will become available very soon (i.e., Neotropical Carnivores, Neotropical Invasive Mammals, and Neotropical Hunters and Dogs). Therefore, studies on trophic cascades, hunting pressure, habitat loss, fragmentation effects, species invasion, and climate change effects will be possible with the Neotropical Xenarthrans data set. Please cite this data paper when using its data in publications. We also request that researchers and teachers inform us of how they are using these data

Neotropical freshwater fisheries : A dataset of occurrence and abundance of freshwater fishes in the Neotropics

The Neotropical region hosts 4225 freshwater fish species, ranking first among the world's most diverse regions for freshwater fishes. Our NEOTROPICAL FRESHWATER FISHES data set is the first to produce a large-scale Neotropical freshwater fish inventory, covering the entire Neotropical region from Mexico and the Caribbean in the north to the southern limits in Argentina, Paraguay, Chile, and Uruguay. We compiled 185,787 distribution records, with unique georeferenced coordinates, for the 4225 species, represented by occurrence and abundance data. The number of species for the most numerous orders are as follows: Characiformes (1289), Siluriformes (1384), Cichliformes (354), Cyprinodontiformes (245), and Gymnotiformes (135). The most recorded species was the characid Astyanax fasciatus (4696 records). We registered 116,802 distribution records for native species, compared to 1802 distribution records for nonnative species. The main aim of the NEOTROPICAL FRESHWATER FISHES data set was to make these occurrence and abundance data accessible for international researchers to develop ecological and macroecological studies, from local to regional scales, with focal fish species, families, or orders. We anticipate that the NEOTROPICAL FRESHWATER FISHES data set will be valuable for studies on a wide range of ecological processes, such as trophic cascades, fishery pressure, the effects of habitat loss and fragmentation, and the impacts of species invasion and climate change. There are no copyright restrictions on the data, and please cite this data paper when using the data in publications

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.13Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt