Prognostic Value of the Leuko-Glycaemic Index in the Postoperative Period of Coronary Artery Bypass Grafting

Abstract Introduction: High leuko-glycaemic index (LGI) (> 2000) has been associated with poor prognosis in many critical care settings. However, there is no evidence of LGI's prognostic value in the postoperative period of coronary artery bypass grafting (CABG). This study aims to analyze the prognostic value of LGI in the postoperative period of CABG. Methods: Single-center retrospective analysis of prospectively collected data was performed. Consecutive adult patients undergoing CABG between 2007 and 2019 were included. Blood glucose levels and white blood cells count were evaluated in the immediate postoperative period. LGI was calculated by multiplying both values and dividing them by 1,000 and analyzed in quartiles. Receiver operating characteristic curve was used to determine the best cutoff value. The primary combined endpoint was in-hospital mortality, low cardiac output (LCO), or acute kidney injury (AKI). Secondary endpoints included in-hospital death, AKI, atrial fibrillation, and LCO. Results: The study evaluated 3,813 patients undergoing CABG (88.5% male, 89.8% off-pump surgery, aged 64.6 years [standard deviation 9.6]). The median of LGI was 2,035. Presence of primary endpoint significantly increased per LGI quartile (9.2%, 9.7%, 11.8%, and 15%; P<0.001). High LGI was associated with increased occurrence of in-hospital mortality, LCO, AKI, and atrial fibrillation. The best prognostic cutoff value for primary endpoint was 2,000. In a multivariate logistic regression model, high LGI was independently associated with in-hospital death, LCO, or AKI. Conclusion: High LGI was an independent predictor of in-hospital mortality, LCO, or AKI in postoperative period of CABG. It was also associated with higher in-hospital death.

Cirugía de preservación valvular como alternativa en enfermedad de la raíz aórtica / Aortic Valve Sparing Surgery as Alternative in Aortic Root Disease

RESUMEN Introducción: Desde 1968, la enfermedad aneurismática de la raíz aórtica ha sido tratada mediante el remplazo con tubo valvulado. En las últimas décadas la cirugía de preservación valvular surgió y evolucionó como una opción al remplazo protésico. Objetivo: Reportar la experiencia institucional en la técnica de preservación valvular y sus resultados a largo plazo. Material y métodos: Revisión de 116 casos consecutivos con criterios de reparabilidad, intervenidos entre 2005 y 2019. Previo ecocardiograma transesofágico (ETE) y angiotomografía (AngioTC), se procedió quirúrgicamente acorde a la clasificación anatomofuncional, con la combinación de técnicas. Se realizó control intraoperatorio y conversión a remplazo según el criterio del cirujano interviniente. Se reportan las variables intraoperatorias, la morbimortalidad intrahospitalaria y la mortalidad, la libertad de insuficiencia valvular significativa y la reoperación en el seguimiento clínico y ecocardiográfico. Resultados: La edad media era 56 ± 15,6 años, varones 73%, 59% asintomáticos, intervenidos por diámetro aórtico (52 ± 11,7 mm) o progresión de valvulopatía. En el posprocedimiento, 4% de los casos resultó con insuficiencia leve o nula y 2 conversiones (1,7%); mortalidad hospitalaria 0,9%. A 10 años de seguimiento, sobrevida actuarial del 88% y libertad de insuficiencia significativa (moderada/grave) 79%. Se reintervinieron 5 casos, a un intervalo promedio de 9,1 años, libertad de reoperación de 90% a 10 años. No se registraron eventos tromboembólicos ni hemorrágicos mayores. Conclusión: las técnicas de preservación valvular aórtica, en contexto de enfermedad de la raíz, resultan una opción factible, segura y estable en el tiempo.

ABSTRACT Background: Since 1968, ascending aorta replacement with a valved conduit has been the standard practice for aortic root aneurysm. By the end of the 20th century, aortic valve sparing operation emerged and evolved as an alternative to aortic valve replacement. Objective: The aim of this study was to report our experience with aortic valve sparing technique and its long -term outcomes. Methods: A total of 116 consecutive cases with criteria of repairability operated on between 2005 and 2019 were analyzed. Preopera- tive transesophageal echocardiography (TEE) and computed tomography angiography (CTA) were used in combination to determine the aortic phenotype based on a previous anatomical and functional classification. Perioperative control was performed and conver- sion to aortic valve replacement was left to the discretion of the attending surgeon. Intraoperative variables, in-hospital morbidity and mortality, freedom from significant aortic regurgitation (AR) and reoperation in the clinical and echocardiographic follow-up were reported. Results: Mean age was 56±15.6 years and 73% were men; 59% were asymptomatic, and the reason for the intervention was the aortic diameter (52±11.7 mm) or progression of AR. After the procedure, 4% of the cases presented mild or trivial AR and 2 patients required conversion to aortic valve replacement (1.7%). In hospital mortality was 0.9%. Actuarial survival was 88% at 10 years, and 79% were free from significant (moderate/severe) AR. Five cases underwent reoperation after a mean interval of 9.1 years and free- dom from reoperation at 10 years was 90%. There were no major thromboembolic or bleeding events. Conclusion: Aortic valve sparing technique in the setting of aortic root disease is a feasible and safe option, and stable over time.

Aneurisma de aorta ascendente: ¿cuál es el riesgo de reemplazar la raíz? / Ascending Aorta Aneurysm: What is the Risk of Replacing the Aortic Root?

RESUMEN Introducción: El riesgo-beneficio del reemplazo de los senos de Valsalva con el consiguiente reimplante coronario frente a la alternativa de mantenerlos, cuando hay dilataciones moderadas de la raíz, es un tópico que se debe definir. Objetivo: Analizar la morbimortalidad posoperatoria y a largo plazo en pacientes sometidos a reemplazo de la raíz aórtica comparados con aquellos en los que se han respetado los senos de Valsalva. Material y métodos: Entre 2002 y 2016, a 426 pacientes se les realizó reemplazo de aorta ascendente. Tras excluir de esa población las cirugías de urgencia, las aortopatías genéticas (excepto bicúspide), las reoperaciones y las cirugías del arco, se conformó una población de 259 pacientes. En 99 de ellos (38,2%) se reemplazó la aorta ascendente conservando la raíz; estos pacientes fueron comparados con los 160 (61,8%) pacientes restantes, en quienes se reemplazaron los senos de Valsalva. Resultados: El grupo en el que se preservó la raíz fue más añoso, con más mujeres, con un Euroscore mayor, con mayor incidencia de válvula bicúspide y enfermedad coronaria. El tiempo de circulación extracorpórea fue mayor en el grupo en el que se reemplazó la raíz. La mortalidad hospitalaria no fue diferente (1% para la conservación de raíz vs. 3,1% para el reemplazo de los senos de Valsalva (p = 0,272). En el análisis multivariado, el tiempo de circulación extracorpórea fue predictor de mortalidad posoperatoria. La sobrevida a 8 años no mostró diferencias significativas entre grupos. En el seguimiento, ningún paciente requirió reoperación debido a complicaciones de la aorta. En el análisis multivariado, la edad y la presencia de enfermedad valvular mitral fueron predictores de mortalidad alejada. Conclusión: El reemplazo de la aorta ascendente, ya sea reemplazando la raíz o respetando los senos de Valsalva, es una cirugía segura, con baja morbimortalidad hospitalaria. A largo plazo, la preservación de los senos de Valsalva no se asocia con más eventos ni con mayor mortalidad.

ABSTRACT Background: In mildly dilated aortic root, the cost-benefit of replacing of the sinuses of Valsalva with reimplantation of the coronary arteries or preserving them is still a matter of debate. Objective: The goal of this study was to analyze the postoperative and long-term morbidity and mortality of patients undergo-ing aortic root replacement versus aortic root surgery with sinuses of Valsalva preservation. Methods: Between 2002 and 2016, 426 patients underwent replacement of the ascending aorta. After excluding patients under-going urgent procedures, genetic aortic diseases (except for bicuspid aortic valve), reoperations and surgery of the aortic arch, the cohort was made up of 259 patients. In 99 of them (38.2%) the ascending aorta was replaced, preserving the aortic root; these patients were compared with the remaining 160 (61.8%) patients who underwent replacement of the sinuses of Valsalva. Results: Patients undergoing preservation of the aortic root were older, had higher percentage of female sex, higher EuroSCORE and with greater incidence of bicuspid aortic valve and coronary artery disease. Cardiopulmonary bypass time was longer in the group undergoing aortic root replacement. There were no significant differences in in-hospital mortality between both groups (1% in the group with preservation of the aortic root vs. 3.1% for replacement of the sinuses of Valsalva, p=0.272). Multivariate analysis showed that cardiopulmonary bypass was a predictor of in-hospital mortality. Survival at 8 years was similar in both groups. There were no new operations due to complications in the aorta during follow-up. At multivariate analysis, age and mitral valve disease were identified as predictors of long-term mortality. Conclusion: Replacement of the ascending aorta, either replacing the aortic root or preserving the sinuses of Valsalva, is a safe procedure, with low in-hospital mortality. Preservation of the sinuses of Valsalva is not associated with greater rate of events or mortality at the long-term.

Inter-laboratory ring trial to evaluate real-time reverse transcription polymerase chain reaction methods used for detection of infectious pancreatic necrosis virus in Chile

Background: Infectious Pancreatic Necrosis Virus (IPNV) is the etiological agent of a highly contagious disease that affects salmonids. In Chile, the second worldwide salmon producer, IPNV causes great economic loss and is one of the most frequently detected pathogens. Due to its high level of persistence and the lack of information about the efficiency of its diagnostic techniques, the National Reference Laboratory (NRL) for IPNV in Chile performed the first inter-laboratory ring trial, to evaluate the sensitivity, specificity and repeatability of the qRT-PCR detection methods used in the country. Results: Results showed 100% in sensitivity and specificity in most of the laboratories. Only three of the twelve participant laboratories presented problems in sensitivity and one in specificity. Problems in specificity (false positives) were most likely caused by cross contamination of the samples, while errors in sensitivity (false negatives) were due to detection problems of the least concentrated viral sample. Regarding repeatability, many of the laboratories presented great dispersion of the results (Ct values) for replicate samples over the three days of the trial. Moreover, large differences in the Ct values for each sample were detected among all the laboratories. Conclusions: Overall, the ring trial showed high values of sensitivity and specificity, with some problems of repeatability and inter-laboratory variability. This last issue needs to be addressed in order to allow harmonized diagnostic of IPNV within the country. We recommend the use of the NRL methods as validated and reliable qRT-PCR protocols for the detection of IPNV.

Relationship between apoptosis and the BH2 domain sequence of the VP5 peptide of infectious pancreatic necrosis virus / Relación entre apoptosis y secuencia del dominio BH2 del peptido VP5 del virus de la necrosis pancreatica infecciosa

Objective. To determine whether the level of apoptosis induced by infectious pancreatic necrosis virus (IPNV) is related to the amino acid sequence of the BH2 domain of the VP5 protein and the level of infectivity. Materials and methods. Three IPNV strains were used, the VP2 protein gene was amplified for genotyping and the VP5 sequence was also obtained. The infectivity of the strains was calculated using the viral titer obtained at 12, 24, 36 and 45 hpi in CHSE-214 cells. The percentage of apoptosis in infected cells was visualized by TUNEL assay and immunohistochemistry (caspase 3 detection). Results. The V70/06 and V33/98 strains corresponded to genotype Sp, while V112/06 to VR-299; the amino acid analysis of the V70/06 strain allows its classification as middle virulent strain and V33/98 and V112/06 strains as low virulent ones; infection with the V112/06 strain produced a lower viral titer (p<0.05). The VP5 gene of the 3 strains showed four homologous domains to Bcl-2, however, the BH2 domain was truncated in V70/06 and V33/98 (12 kDa), being complete (15kDa) in V112/06, which also showed the Trp155 residue, equivalent to Trp188 considered as a critical factor for the function of Bcl-2. The average apoptosis was below 12%, showing no differences between strains (p>0.05). Conclusions. The results showed that the differences in the BH2 sequence of the VP5 protein, infectivity and the VP2 sequence are not associated with the modulation of apoptosis.

Objetivo. Determinar si el nivel de apoptosis inducido por cepas del virus de la necrosis pancreática infecciosa (IPNV) tiene relación con la secuencia aminoacídica del dominio BH2 de la proteína VP5 y el nivel de infectividad. Materiales y métodos. Se utilizaron tres cepas de IPNV; el gen de la proteína VP2 fue amplificado para genotipificación y se obtuvo la secuencia de VP5. La infectividad de las cepas se calculó mediante el título viral obtenido a 12, 24, 36 y 45 hpi en células CHSE-214. Los porcentajes de apoptosis en células infectadas se visualizaron mediante ensayo TUNEL e inmuno-histoquímica (detección de caspasa 3). Resultados. Las cepas V70/06 y V33/98 correspondieron a genotipo Sp, mientras que V112/06 a VR-299; el análisis aminoacídico relacionó a V70/06 como cepa de mediana virulencia y a V33/98 y V112/06 de baja virulencia; la infección con V112/06 produjo menor título viral (p<0.05). El gen VP5 de las 3 cepas presentó los cuatro dominios homólogos a Bcl-2; sin embargo, el dominio BH2 fue truncado en V70/06 y V33/98 (12 kDa); siendo completo (15kDa) en V112/06, que además, presentó el residuo Trp155, equivalente a Trp188 considerado factor crítico para la función de Bcl-2. El promedio de apoptosis fue inferior a 12%, no se observaron diferencias entre cepas (p>0.05). Conclusiones. Los resultados mostraron que las diferencias en la secuencia de BH2 de la proteína VP5, la infectividad y en la secuencia de la proteína VP2 no están asociadas con la modulación de apoptosis.

Infectious pancreatic necrosis virus (IPNV) enumeration through epifluorescence microscopy: technical aspects

A method for counting Infectious pancreatic necrosis virus (IPNV) through epifluorescence microscopy was analyzed in detail. Image processing and statistic considerations are included. The particle size of viruses was compared in different experimental conditions such as the staining of the virus with SYBR-Green I or with antibodies for specific fluorescence labeling of viral proteins. The type of surface used as mounting support was assayed as well. The results indicated that the most suitable method involves the mounting of the viral-containing suspension on a membrane filter followed by the staining with a monoclonal antibody specific for a viral protein combined with a FITC (fluorescein isothiocyanate)-conjugated secondary antibody.

Restauraciones clase V sin microfiltración: estudio "in vitro" / Class V restorations without microleakage: an in vitro study

Se estudió la influencia de la contracción de polimerización de la resina compuesta sobre la capacidad de sellado de restauraciones mixtas de clase V. Se prepararon cavidades en bucal y lingual de 21 molares extraídos y se restauraron con Silux-Plus, Scotchbond 2 y Vitrebond. Siete grupos de seis cavidades cada uno fueron preparados. Un grupo fue restaurado sólo con ionómero de vidrio, cuatro grupos recibieron tratamientos diferentes de la superficie del cemento ionomérico. En un grupo la cavidad fue preparada con algunas modificaciones de diseño y finalmente un grupo fue sometido a ciclaje térmico entre 5 y 55 grados. Luego, los dientes fueron sumergidos en una solución de fucsina básica al 2 por ciento por 24 horas, lavados y seccionados para observar el grado de penetración del colorante. Los resultados demostraron que las restauraciones realizadas sólo con Vitrebond no fueron capaces de prevenir la filtración severa en ningún margen. Las restauraciones mixtas fueron superiores en ambos márgenes. La microfiltración en las restauraciones mixtas fue menor en los márgenes de esmalte que de dentina. Los tratamientos realizados sobre la superficie del ionómero, la modificación del diseño cavitario y el ciclaje térmico no modificaron la intensidad de la filtración