Reperfusion Strategies in Acute Myocardial Infarction: State of the Art

Abstract ST elevation myocardial infarction (STEMI) is a highly prevalent condition worldwide. Reperfusion therapy is strongly associated with the prognosis of STEMI and must be performed with a high standard of quality and without delay. A systematic review of different reperfusion strategies for STEMI was conducted, including randomized controlled trials that included major cardiovascular events (MACE), and systematic reviews in the last 5 years through the PRISMA ( Preferred Reporting Items for Systematic Reviews and Meta-Analysis) methodology. The research was done in the PubMed and Cochrane Central Register of Controlled Trials databases, in addition to a few manual searches. After the exclusion criteria were applied, 90 articles were selected for this review. Despite the reestablishment of IRA patency in PCI for STEMI, microvascular lesions occur in a significant proportion of these patients, which can compromise ventricular function and clinical course. Several therapeutic strategies - intracoronary administration of nicorandil, nitrates, melatonin, antioxidant drugs (quercetin, glutathione), anti-inflammatory substances (tocilizumab [an inhibitor of interleukin 6], inclacumab, P-selectin inhibitor), immunosuppressants (cyclosporine), erythropoietin and ischemic pre- and post-conditioning and stem cell therapy - have been tested to reduce reperfusion injury, ventricular remodeling and serious cardiovascular events, with heterogeneous results: These therapies need confirmation in larger studies to be implemented in clinical practice

Electrical stunning in South American catfish (Rhamdia quelen) using direct current waveform: welfare and meat quality / Insensibilização elétrica em Jundiá (Rhamdia quelen) usando corrente direta: bem-estar e qualidade da carne

ABSTRACT: In Brazil, humane slaughter regulation is in use since 2000; however it is not applied to fish. This paper studied parameters for electrical stunning using direct current waveform in South American catfish (Rhamdia quelen) and its subsequent effects on muscular pH and rigor mortis. Seventy fish were allocated into two groups. In group 125, fish were stunned using 125 Volts (V), 30 Hz, duty cycle of 90% and 1.3 Amp (A) applied for 30 s; in group 400, fish were stunned with 400 V, 30 Hz, duty cycle of 27%, 0.9 A, for 30 s. Unconsciousness time was determined through behavioural assessment. After slaughter, ten fish from each group were refrigerated for both measurements muscular pH and rigor mortis index (RMI) at 0, 3, 6, 24, 72 and 120 h. In 125, 14.4% (5/35) of fish were not effectively stunned, in contrast with 400 in which 100% of fish (35/35) were effectively stunned. The unconsciousness duration was higher in 400 group (87.7±16.1 s) in contrast with group 125 (66.6 ± 16.1 s). Until 6 h post mortem ninety percent of fish reached maximum rigor mortis (RMI=100%).

RESUMO: No Brasil, a normativa de abate humanitário está em vigência desde 2000, no entanto tal norma não contempla peixes. O objetivo deste trabalho foi estudar os parâmetros para insensibilização elétrica em Jundiá (Rhamdia quelen) e seus efeitos sobre o pH muscular e o rigor mortis. Setenta peixes foram alocados em dois grupos. No grupo 125, os peixes foram insensibilizados usando 125 Volts (V), 30 Hz, duty cycle of 90% e 1.3 Amp (A) durante 30 s; no grupo 400, os peixes foram insensibilizados com 400 V, 30 Hz, duty cycle of 27%, 0.9 A, durante 30 s. O tempo de inconsciência foi determinado por avaliação comportamental. Após o abate, 10 peixes de cada grupo foram refrigerados para mensurações de pH muscular e o índice rigor mortis (RMI) às 0, 3, 6, 24, 72 e 120 h. No grupo 125, 14.4% (5/35) dos peixes não foram efetivamente insensibilizados, em contraste com o grupo 400, em que 100% dos peixes (35/35) foram efetivamente insensibilizados. A duração da inconsciência foi significativamente maior no tratamento 400, igual a 87.7 ± 16.1 s em relação aos 66.6 ± 16.1 s no 125. Noventa por cento dos peixes atingiram o máximo rigor mortis (RMI=100%) dentro das 6 h pós-abate. A insensibilização elétrica em Jundiá parece ser possível usando parâmetros do grupo 400, devido à duração de inconsciência maior que 60 s.

Abate halal com e sem insensibilização em ovinos: implicações sobre o bem-estar animal e a eficiência da sangria / [Halal slaughter with and without stunning in sheep: implications on animal welfare and bleeding efficiency]

O objetivo deste estudo foi avaliar as implicações sobre o bem-estar animal e a eficiência da sangria no abate halal com e sem insensibilização em ovinos. Foram avaliados 102 ovinos, em abate comercial, separados randomicamente pelo peso em dois grupos: com insensibilização (CI) e sem insensibilização (SI). Verificou-se que os animais sem insensibilização apresentaram sinais de endireitamento e vocalização após 20 segundos da degola. Houve diferença significativa para hemácias (P<0,01), hemoglobina (P<0,01), leucócitos totais (P<0,001), bem como para os biomarcadores de estresse, como CK (P<0,01) e lactato (P<0,001). Apesar de não apresentarem diferença estatística significativa, o LDH e o cortisol ficaram acima dos valores basais em ambos os grupos. Não foram observadas alterações séricas para glicose e AST. Houve diferença estatística significativa para eficiência da sangria (P<0,01). Os resultados demonstraram que houve estresse no abate halal com e sem insensibilização e melhor eficiência da sangria em animais não insensibilizados.(AU)

The objective of this study was to evaluate the implications on animal welfare and the sangria efficiency in halal slaugther with and without stunning in sheep. 102 sheep were appraised in a commercial slaugthter, divided randomly for the weight in two groups: with stunning (CI) and without stunning (SI). It was verified that the animals without stunning presented straighten signs and vocalization after 20 seconds of decapitation. There was significant difference for erythrocytes (P<0.05), hemoglobin (P<0.01), leucocytes (P<0.01), stress of biomarkers CK (P<0.01) and lactate (P<0.01). Alterations in serum were not observed for glucose and AST. There was significant statistical difference for bleeding efficiency (P<0.01). The results demonstrated that there was stress in the halal slaugther with and without stunning and better bleeding efficiency in animals with traditional religious slaughter without stunning.(AU)

Anesthesia management for a patient undergoing pulmonary endarterctomy without cardiopulmonary bypass

Abstract Pulmonary endarterectomy is a curative procedure for chronic thromboembolic Pulmonary Hypertension. As usual, cardiopulmonary bypass circuit is required. However, there are several complications attributed to extracorporeal circulation. Hemodilution, systemic inflammatory response syndrome and leukocyte sequestration are circulation related complications. The severe forms include Acute Respiratory Distress Syndrome, Acute Lung Injury, myocardial stunning, dysfunction of the right ventricle, coagulopathy, postoperative stroke or renal dysfunction. In this case report, we aimed to give information about perioperative anesthesia and surgical management of pulmonary endarterectomy which was successfully managed without Cardiopulmonary Bypass.

Myocardial viability: from PARR-2 to IMAGE HF - current evidence and future directions / Viabilidade miocárdica: de PARR-2 a IMAGE HF - evidências atuais e futuras direções

Ischemic heart failure is a growing disease with high morbidity and mortality. Several studies suggest the benefit of viability imaging to assist revascularization decision, but there is controversy. Multiple imaging modalities can be used to accurately define hibernating myocardium; however, the best approach remains uncertain. This review will highlight current evidence and future directions of viability imaging assessment

Reperfusing the myocardium - a damocles Sword

Return of blood flow after periodic ischemia is often accompanied by myocardial injury, commonly known as lethal reperfusion injury (RI). Experimental studies have shown that 50% of muscle die of ischemia and another 50% die because of reperfusion. It is characterized by myocardial, vascular, or electrophysiological dysfunction that is induced by the restoration of blood flow to previously ischemic tissue. This phenomenon reduces the efficiency of the present modalities used to combat the ischemic myocardium. Moreover, despite an improved understanding of the pathophysiology of this process and encouraging preclinical trials of multiple agents, most of the clinical trials to prevent RI have been disappointing and leaves us at ground zero to explore newer approaches.

Practical Implications of Myocardial Viability Studies / Implicações Práticas da Pesquisa de Viabilidade Miocárdica

Abstract Many non-invasive methods, such as imaging tests, have been developed aiming to add a contribution to existing studies in estimating patients' prognosis after myocardial injury. This prognosis is proportional to myocardial viability, which is evaluated in coronary artery disease and left ventricular dysfunction patients only. While myocardial viability represents the likelihood of a dysfunctional muscle (resulting from decreased oxygen supply for coronary artery obstruction), hibernation represents post-interventional functional recovery itself. This article proposes a review of pathophysiological basis of viability, diagnostic methods, prognosis and future perspectives of myocardial viability. An electronic bibliographic search for articles was performed in PubMed, Lilacs, Cochrane and Scielo databases, according to pre-established criteria. The studies showed the ability of many imaging techniques in detecting viable tissues in dysfunctional areas of left ventricle resulting from coronary artery injuries. These techniques can identify patients who may benefit from myocardial revascularization and indicate the most appropriate treatment.

Resumo Diversos métodos não invasivos, como novos exames de imagem, vem sendo aprimorados, a fim de somar esforços com os atuais em estimar o prognóstico de pacientes pós-injúria miocárdica. Este prognóstico é proporcional à viabilidade miocárdica, a qual tem sua avaliação reservada para pacientes portadores de doença arterial coronariana e insuficiência ventricular esquerda. Enquanto a viabilidade miocárdica se mostra como a capacidade de recuperação funcional do músculo com disfunção por redução de oxigênio fornecido por artérias coronárias obstruídas, a hibernação consiste na própria recuperação funcional após intervenções. Este artigo propõe uma revisão sobre as bases fisiopatológicas do processo de viabilidade, métodos diagnósticos disponíveis, prognóstico e perspectivas para o futuro acerca dessa condição. Realizou-se pesquisa de busca bibliográfica informatizada em bases eletrônicas de dados, como PubMed, Lilacs, Cochrane e Scielo, onde foram selecionados os estudos de acordo com critérios pré-determinados. Os estudos demonstram a capacidade de várias técnicas de imagem de identificar tecido viável em regiões disfuncionais do ventrículo esquerdo em decorrência de lesões em artérias coronárias. Estas técnicas podem identificar pacientes com potencial benefício da revascularização miocárdica e orientar o tratamento mais adequado.

New thoughts in mechanism research of acupuncture for myocardial stunning from κ-opioid receptor signaling pathway / 中国针灸

By reviewing the literature regarding the development mechanism of myocardial stunning, effects of acupuncture on myocardial ischemic injury, and correlation between acupuncture and κ-opioid receptor, it was suggested that acupuncture was highly likely to act on κ-opioid receptor in myocardial cells, and directly treated myocardial malfunction induced by myocardial stunning through κ-opioid receptor and its signaling pathway. In addition, acupuncture could inhabit the signaling pathway of adrenoceptor β1, one of the main functional receptors, to indirectly improve myocardial ischemic injury. From κ-opioid receptor signaling pathway, the action mechanism of acupuncture for prevention and treatment of myocardial stunning was discussed in this paper, hoping to provide new ideas for possible mechanism of acupuncture for myocardial ischemic injury.

Reconsideration of the role of viable myocardium in revascularization / 中华核医学与分子影像杂志

Recent studies on the role of viable myocardium in revascularization are hot spots.The definition of viable myocardium,multimodality imaging in the assessment of myocardial viability,Meta analyses related to the value of viable myocardium in revascularization,prospective randomized trials,and factors affecting the prognosis of patients after revascularization are reviewed in this article.

COMPARACIÓN DE DOS TIPOS DE SACRIFICIO Y DIFERENTES TIEMPOS DE MADURACIÓN SOBRE VARIABLES FÍSICO-QUÍMICAS Y MICROBIOLÓGICAS DE LA CARNE DE CUY (Cavia porcellus) / COMPARISON OF TWO TYPES OF SACRIFICE AND DIFFERENT RIPENING TIMES ON PHYSICO-CHEMICAL AND MICROBIOLOGICAL VARIABLES OF GUINEA PIG (Cavia porcellus) MEAT

El objetivo fue determinar el comportamiento de las variables fisicoquímicas y microbiologías durante la maduración de la carne de cuy (Cavia porcellus), utilizando dos métodos de insensibilización (desnucamiento y electronarcosis). La investigación se realizó en los laboratorios de la Universidad de Nariño y se utilizaron 24 animales: 12 para cada método. Los animales ayunaron 12 h antes del sacrificio y las canales se maduraron en refrigeración (2 a 4°C) durante 24 h. Se determinaron las variables pH, acidez, temperatura, capacidad de retención de agua (CRA), conductibilidad eléctrica (CE) y pérdida de agua en refrigeración cada 4 h. Se evaluaron los parámetros microbiológicos coliformes totales y fecales a las 0, 16 y 24 h, además de Listeria sp. y la presencia de antibióticos (sulfamidas) al inicio de la maduración. Para detectar diferencia entre métodos de insensibilización para las variables fisicoquímicas se utilizó un diseño de medidas repetidas en el tiempo; para las demás variables se utilizó estadística descriptiva. Los resultados mostraron que el mejor tiempo de maduración fue a las 16 horas, con un pH promedio de 5,42, acidez de 0,272 % y CRA de 12,73. Además, las variables microbiológicas estuvieron por debajo de la norma vigente garantizando la inocuidad de la carne evaluada. No se observó diferencia estadísticas entre métodos de insensibilización y los resultados de antibióticos fueron negativos. Se concluye que el tiempo adecuado de maduración para la carne de cuy fue de 16 horas sin diferencias en el método de insensibilización.

The objective was to determine the behavior of the physicochemical and microbiological during ripening of meat of guinea pig (Cavia porcellus) variables, using two methods of desensitization (whiplash and electric stun). The research was conducted in the laboratories of the University of Narino and 24 animals were used: 12 for each method. 12h fast animals before slaughter and channels matured under refrigeration (2-4°C) for 24 h. the variables pH, acidity, temperature, water retention capacity (WRC), electrical conductivity (EC) and cooling water loss every 4 hours were determined. Total coliforms and fecal parameters were evaluated at 0, 16 and 24 h, plus Listeria sp. and presence of antibiotics (sulfonamides) at the start of ripening. To detect difference between desensitization methods for physicochemical variables repeated measures design was used in time; whereas for the other variables descriptive statistics were used. The results showed that the best time to maturity was at 16 hours, with an average pH of 5.42, 0.272% acidity and CRA of 12.73. Further, microbiological variables were below the current standard guaranteeing the safety of meat assessed. No statistical difference was observed between desensitization methods and results were negative antibiotics. It is concluded that the proper ripening time for guinea pig meat was 16 hours without differences in the method of desensitization.

Atrial Strain and Strain Rate: A Novel Method for the Evaluation of Atrial Stunning / Strain Atrial e Strain Rate: Novo Método para Avaliar Atordoamento Atrial

Abstract Background: Atrial fibrillation (AF) is the most common arrhythmia seen in adults. Atrial stunning is defined as the temporary mechanical dysfunction of the atrial appendage developing after AF has returned to sinus rhythm (SR). Objectives: We aimed to evaluate atrial contractile functions by strain and strain rate in patients with AF, following pharmacological and electrical cardioversion and to compare it with conventional methods. Methods: This study included 41 patients with persistent AF and 35 age-matched control cases with SR. All the AF patients included in the study had transthoracic and transesophageal echocardiography performed before and after. Septum (SEPsSR), left atrium (LAsSR) and right atrium peak systolic strain rate (RAsSR) were defined as the maximum negative value during atrial contraction and septum (SEPε), left atrium (LAε) and right atrium peak systolic strain (RAε) was defined as the percentage of change. Parameters of two groups were compared. Results: In the AF group, 1st hour and 24th hour LAε, RAε, SEPε, LAsSR, RAsSR, SEPsSR found to be significantly lower than in the control group (LAε: 2.61%±0.13, 3.06%±0.19 vs 6.45%±0.27, p<0.0001; RAε: 4.03%±0.38, 4.50%±0.47 vs 10.12%±0.64, p<0.0001; SEPε: 3.0%±0.22, 3.19%±0.15 vs 6.23%±0.49, p<0.0001; LAsSR: 0.61±0.04s-1, 0.75±0.04s- 1 vs 1.35±0.04s-1, p<0.0001; RAsSR: 1.13±0.06s-1, 1.23±0.07s-1 vs 2.10±0.08s- 1, p<0.0001; SEPsSR: 0.76±0.04s- 1, 0.78±0.04s- 1 vs 1.42±0.06 s- 1, p<0.0001). Conclusion: Atrial strain and strain rate parameters are superior to conventional echocardiographic parameters for the evaluation of atrial stunning in AF cases where SR has been achieved.

Resumo Fundamento: A fibrilação atrial (FA) é a arritmia mais comum em adultos. Define-se atordoamento atrial como a disfunção mecânica temporária do apêndice atrial que se desenvolve depois de reversão da FA ao ritmo sinusal (RS). Objetivos: Avaliar as funções atriais contráteis através de strain atrial e strain rate em pacientes com FA, após cardioversão farmacológica e elétrica, assim como compará-los com os métodos convencionais. Métodos: Este estudo incluiu 41 pacientes com FA persistente e 35 controles com RS e pareados por idade. Todos os pacientes com FA incluídos neste estudo foram submetidos a ecocardiografia transtorácica e transesofágica antes e após. Strain rates de pico sistólico do septo (SEPsSR), do átrio esquerdo (LAsSR) e do átrio direito (RAsSR) foram definidas como o máximo valor negativo durante contração atrial. Strains de pico sistólico do septo (SEPε), do átrio esquerdo (LAε) e do átrio direito (RAε) foram definidas como porcentagem de mudança. Resultados: No grupo com FA, os parâmetros LAε, RAε, SEPε, LAsSR, RAsSR e SEPsSR da 1a hora e da 24a hora foram significativamente mais baixos que no grupo controle (LAε: 2,61%±0,13; 3,06%±0,19 vs 6,45%±0,27; p<0,0001; RAε: 4,03%±0,38; 4,50%±0,47 vs 10,12%±0,64; p<0,0001; SEPε: 3,0%±0,22; 3,19%±0,15 vs 6,23%±0,49; p<0,0001; LAsSR: 0,61±0,04s-1; 0,75±0,04s-1 vs 1,35±0,04s-1; p<0,0001; RAsSR: 1,13±0,06s-1; 1,23±0,07s-1 vs 2,10±0,08s-1; p<0,0001; SEPsSR: 0,76±0,04s-1; 0,78±0,04s-1 vs 1,42±0,06 s-1; p<0,0001). Conclusão: Os parâmetros strain atrial e strain rate são superiores aos parâmetros ecocardiográficos convencionais para avaliar atordoamento atrial em pacientes com FA que reverteram ao RS.

Effect of electrical and controlled atmosphere stunning methods on broiler chicken behavior at slaughter, blood stress indicators and meat traits / Efeito da eletronarcose e do método de insensibilização por atmosfera controlada no comportamento das aves ao abate, nos indicadores sanguíneos de estresse e nas características da carne

Brazil is the world's largest exporter and third largest producer of chicken meat. To maintain competitiveness, the productive sector must always be alert to consumer demands, and concern about animal welfare is a growing tendency. Aspects involving animal welfare are especially critical in the slaughter of broiler chickens. This study evaluated the stunning of chickens in a CO2- enriched atmosphere chamber to reduce bird stress, comparing with electrical water bath stunning, the most usual desensitization method used in chicken slaughter. The reaction of birds when exposed to a high CO2 concentration (30%) and to a 10% initial CO2 level, gradually elevated to 30% was compared. The effect of mixing argon with CO2 was also evaluated, always aiming to reduce the discomfort of birds. In all the gas stunning parameters evaluated, evident discomfort reactions before stunning were observed in about two thirds of the birds, but the blood levels of corticosterone and glucose, used as stress indicators, indicated that gas increased the birds' welfare. Gas exposure time required to stun the birds and time to regain consciousness after exiting the gas chamber presented a wide variation. Controlled atmosphere stunning method facilitated bird handling during slaughter, but more studies will be necessary to develop this technological alternative and make it viable for industrial use.(AU)

O Brasil é o maior exportador e terceiro maior produtor mundial de carne de frango. A fim de manter a competitividade, o setor produtivo deve estar sempre alerta às exigências dos consumidores e a preocupação com o bem-estar animal é uma tendência crescente. Aspectos envolvendo bem-estar animal são particularmente críticos no abate de frangos de corte. Este estudo avaliou a insensibilização de frangos em uma câmara com atmosfera enriquecida deCO2para reduzir o estresse das aves, em comparação com a insensibilização elétrica em cuba d'água, o método de atordoamento mais usual no abate de frangos. Foi comparada a reação das aves quando expostas a uma alta concentração de CO2 (30%) ou a uma concentração inicial de 10% de CO2, elevada gradualmente até 30%. O efeito da mistura de argônio com CO2 também foi avaliado, sempre visando a redução das reações de desconforto das aves. Cerca de dois terços das aves apresentaram reações evidentes de desconforto antes do atordoamento, em todos os parâmetros de insensibilização gasosa utilizados, porém, as concentrações sanguíneas de corticosterona e glicose, usados como indicadores de estresse, indicaram que a insensibilização com CO2 promoveu o bem-estar das aves. O tempo de exposição ao CO2 necessário para o atordoamento das aves e o tempo de recuperação da consciência após a saída da câmara de gás apresentou ampla variação. A insensibilização por atmosfera controlada de CO2 facilitou o manejo das aves durante o abate, mas serão necessários mais estudos para desenvolver essa alternativa tecnológica, de forma a torná-la viável para aplicação industrial.(AU)

Improvement of cardiac function after cardiopulmonary resuscitation by using isosorbide ;mononitrate in porcine models / 中华急诊医学杂志

Objective To determine the protective effect of isosorbidemononitrate (IM) on myocardial injury after restoration of spontaneous circulation (ROSC)in swine models of cardiac arrest induced by ventricular fibrillation.Methods The experiment was carried out in Animal Lab of Beijing Chao-Yang Hospital,Capital Medical University.Ventricular fibrillation was induced and untreated for 8 min in twenty WhuZhiShan piglets.CPR was performed until ROSC occurred.The animals were randomized (random number)into two groups:IMgroup (n =10)and control group (n =10).IM [2 μg/(kg· min)]or the equivalent volume in saline was administered respectively for 6 h after ROSC.Hemodynamics and post-resuscitation cardiac function were monitored until 24 h after ROSC. Echocardiography and transmission electron microscopy were useed at 72 h after ROSC.Results There was no significant difference in survival rate between the two groups.No significant differences in mean arterial pressures (mmHg)at ROSC 6 h (88.5 ±5.6 vs.87.8 ±6.0,P =0.790)and ROSC 24 h (89.3 ±3.8 vs.86.9 ± 5.0,P =0.245)between the two groups were found.Cardiac outputs (L/min)were significantly increased at ROSC 6 h (2.40 ±0.17 vs.1.60 ±0.14,P <0.01)and ROSC 24 h (2.49 ±0.17 vs.2.09 ±0.21,P<0.01);and ejection fraction at ROSC 72 h (0.67 ±0.08 vs.0.56 ±0.09,P =0.044)was improved too,and significant differences were found between the two groups.The ultra-structural myocardial injury was ameliorated in the MI group at 72 h after CPR observed by using electron microscopy.Conclusions IM can ameliorate post-resuscitation cardiac dysfunction in porcine models of cardiac arrest induced by ventricular fibrillation.

Papel de la tiorredoxina-1 en el atontamiento cardíaco en ratones transgénicos / Role of Thioredoxin-1 on Myocardial Stunning in Transgenic Mice

Introducción: La disfunción ventricular posisquémica (miocardio atontado) involucra un aumento del estrés oxidativo. En este sentido, la célula cuenta con mecanismos de defensa, como la tiorredoxina-1, un antioxidante que protege al miocardio de la lesión por isquemia/reperfusión, reduciendo el tamaño del infarto. Objetivo: Evaluar el comportamiento de la función ventricular sistólica y diastólica, particularmente estudiando la rigidez miocárdica y la relajación isovolúmica en el miocardio atontado en diferentes ratones transgénicos. Material y métodos: Se utilizaron corazones de ratones que sobreexpresan tiorredoxina-1 y de ratones transgénicos que sobreexpresan tiorredoxina-1 mutada en su sitio activo (dominante negativo), comparados con los de ratones no transgénicos, los cuales fueron sometidos a 15 minutos de isquemia global y 30 minutos de reperfusión utilizando la técnica de Langendorff. Se evaluó la función ventricular sistólica y diastólica y se calculó el t63 y el t93 como índice de relajación isovolúmica. Resultados: Las mediciones a los 30 minutos de reperfusión mostraron una mejoría significativa del estado contráctil en los ratones tiorredoxina-1 (57,4 ± 4,9 mm Hg; p ≤ 0,05 vs. no transgénicos) y también en la rigidez (11,8 ± 2,9 mm Hg; p ≤ 0,05 vs. no transgénicos). Por otra parte, en los ratones dominantes negativos se observó un aumento de la rigidez (37,7 ± 5,5 mm Hg; p ≤ 0,05 vs. no transgénicos) y un enlentecimiento de la relajación a los 30 minutos de la reperfusión (78,2 ± 9,8 mseg; p ≤ 0,05 vs. no transgénicos). Conclusión: Este trabajo evidencia el rol protector de la tiorredoxina-1 en el miocardio atontado y su importancia fisiopatológica en ratones que sobreexpresan este antioxidante.

Background: Postischemic ventricular dysfunction (myocardial stunning) involves increased oxidative stress. In this sense, the cell has defense mechanisms, as thioredoxin-1, an antioxidant that protects the myocardium from ischemia/reperfusion injury, reducing infarct size. Objective: The aim of this study was to evaluate systolic and diastolic ventricular function, specifically analyzing myocardial stiffness and isovolumic relaxation, during myocardial stunning in different transgenic mice. Methods: Hearts from mice overexpressing thioredoxin-1 and transgenic mice overexpressing thioredoxin-1 with gene mutation in its active site (dominant negative) were compared with hearts from non-transgenic mice after 15-minute global ischemia and 30-minute reperfusion using the Langendorff technique. Systolic and diastolic ventricular function was evaluated and t63 and t93 were calculated as ventricular relaxation index. Results: At 30-minute reperfusion, thioredoxin-1 mice showed a significantly improved contractile state (57.4±4.9 mmHg; p≤0.05 vs. non-transgenic mice) and stiffness (11.8±2.9 mmHg; p≤0.05 vs. non-transgenic mice). Conversely, at the same reperfusion time, dominant negative mice exhibited increased stiffness (37.7±5.5 mmHg; p≤0.05 vs. non-transgenic mice) and slower relaxation (78.2±9.8 ms; p≤0.05 vs. non-transgenic mice). Conclusion: This study reveals the protective role of thioredoxin-1 on myocardial stunning and its pathophysiological importance in mice overexpressing this antioxidant.

Influência do manejo pré-abate de bovinos na indústria sobre os parâmetros de bem-estar animal e impactos no ph 24 horas post mortem / Influence of handling pre-slaughter cattle industry on the parameters of animal welfare and impacts on ph 24 hours post mortem

Avaliou-se o manejo pré-abate de 320 fêmeas bovinas, divididas em oito lotes de 40 animais, de acordo com a procedência, hígidas e azebuadas com idade entre 2 a 4 anos, provenientes de oito propriedades do Triângulo Mineiro­MG, as quais foram abatidas em um matadouro frigorífico localizado nessa mesma região. Relacionaram-se nesse manejo, parâmetros de bem-estar animal e seus efeitos no atordoamento, sangria e pH 24 horas. Analisou-se a condução dos animais no matadouro frigorífico, desde os currais até o boxe de atordoamento, insensibilização dos bovinos e monitoramento do tempo até a sangria, a eficiência do atordoamento e a mensuração do pH das carcaças após 24 horas do abate. Ao considerar cada lote de 40 animais, os escorregões e as quedas variaram de 0 (0%) a 2 (5%), e vocalizações de 0 (0%) a 10 (25%), contabilizadas durante a condução dos bovinos. O menor valor do uso do bastão elétrico por lote de 40 animais foi de 23 (57,5%) e o maior de 40 (100%), o que reflete a falta de um manejo adequado nesta fase. Os bovinos avaliados após o atordoamento e adequadamente insensibilizados estiveram entre 31 a 40 animais (77,5% a 100%) por lote. A insensibilização com um disparo oscilou de 29 a 36 animais (72,5% a 90%), com exceção de um lote, cujo atordoamento não foi eficiente por defeito no equipamento no dia de avaliação e todos os animais receberam mais de um disparo. O intervalo entre o atordoamento e a sangria não variou (P> 0,05), mantendo-se dentro de um minuto. O tempo de sangria variou entre lotes (P<0,05), porém dentro do tempo mínimo preconizado (3 minutos), exceto um lote que obteve menor tempo (2,54 minutos). Os valores médios de pH 24 horas post mortem em um lote ficou dentro do ideal que é de até 5,8; seis lotes ficaram entre 5,81 a 5,99, considerados intermediários em relação ao pH ideal. Em um lote, os valores médios para as carcaças dos bovinos estiveram acima de 6,0; avaliada como parâmetro indesejável. O manejo pré-abate no matadouro frigorífico influencia nos parâmetros de bem-estar animal, pois irregularidade de manutenção de equipamentos e instalações, mão de obra não qualificada e supervisão ineficiente provocam falhas nos processos de atordoamento, sangria e pH 24 horas, com perda da qualidade da carne.

It was evaluated the pre-slaughter handling of 320 healthy and crossbred (zebu) cows, divided into eight groups of 40 animals, according to their origin, aged 2-4 years, coming from eight properties of Triângulo Mineiro - Minas Gerais, which were slaughtered in a slaughterhouse placed at the same region. It was related, in this handling, parameters of animal welfare and its effects on the stunning, bleeding and 24 hours pH. It was analyzed the leading of the animals in the slaughterhouse, from the pens until the stunning cabinet, the stunning of the cattle and the control of the time until the bleeding, the efficiency of the stunning and the measurement of pH of carcasses after 24 hours of slaughter. Considering each group of 40 animals, the slips and the falls varied from 0 (0%) to 2 (5%), and vocalizations from 0 (0%) to 10 (25%), numbered during the leading of the cattle. The smallest amount of the use of the electric stick per group of 40 animals was 23 (57.5%) and the biggest one was 40 (100%), which reflects the lack of an appropriate handling at this stage. The evaluated cattle, after stunning and properly numb, were among 31 to 40 animals (77.5% to 100%) per group. The stunning with one shot ranged from 29 to 36 animals (72.5% to 90%), except for one group, whose stunning was not efficient for defect in the equipment at the evaluation day and all the animals received more than one shot. The interval between stunning and bleeding did not vary (P>0.05) keeping within one minute. The bleeding time varied among groups (P<0.05), but within the recommended minimum time (3 minutes), except for one group that got less time (2.54 minutes). The averages amounts of 24 hours pH post mortem in one group kept in the recommended which is until 5,8; six groups kept among 5,81 a 5,99, considered intermediates in relation to the recommended pH. In one group, the average amounts to the carcasses of the cattle were more than 6,0; evaluated as undesired parameter, with marks the (5.81 to 5.99), one group had medium marks above 6.0. The pre-slaughter handling in the slaughterhouse influences the parameters of animal welfare, because irregular maintenance of equipment and facilities, unqualified workmanship and inefficient supervision cause failures in the processes of stunning, bleeding and 24 hours pH, with loss of meat quality.

Is thyroid stunning clinically relevant? A retrospective analysis of 208 patients / O atordoamento da tireoide é clinicamente relevante? Análise retrospectiva de 208 pacientes

Objective : Current guidelines have advised against the performance of 131I-iodide diagnostic whole body scintigraphy (dxWBS) to minimize the occurrence of stunning, and to guarantee the efficiency of radioiodine therapy (RIT). The aim of the study was to evaluate the impact of stunning on the efficacy of RIT and disease outcome.Subjects and methods : This retrospective analysis included 208 patients with differentiated thyroid cancer managed according to a same protocol and followed up for 12-159 months (mean 30 ± 69 months). Patients received RIT in doses ranging from 3,700 to 11,100 MBq (100 mCi to 300 mCi). Post-RIT-whole body scintigraphy images were performed 10 days after RIT in all patients. In addition, images were also performed 24-48 hours after therapy in 22 patients. Outcome was classified as no evidence of disease (NED), stable disease (SD) and progressive disease (PD).Results : Thyroid stunning occurred in 40 patients (19.2%), including 26 patients with NED and 14 patients with SD. A multivariate analysis showed no association between disease outcome and the occurrence of stunning (p = 0.3476).Conclusion : The efficacy of RIT and disease outcome do not seem to be related to thyroid stunning. Arq Bras Endocrinol Metab. 2014;58(3):292-300.

Objetivo : As diretrizes atuais alertam contra a execução da cintigrafia de corpo inteiro com iodo-131 (dxWBS) para minimizar a ocorrência de atordoamento e garantir a eficiência do tratamento com radioiodo (RIT). O objetivo deste estudo foi avaliar o impacto do atordoamento sobre a eficácia do RIT e desfechos da doença.Sujeitos e métodos : Esta análise retrospectiva incluiu 208 pacientes com câncer diferenciado de tireoide submetidos ao mesmo protocolo e acompanhados por 12-159 semanas (média de 30 ± 69 meses). Os pacientes receberam RIT com doses variando de 3.700 a 11.100 MBq (100 mCi a 300 mCi). As imagens da cintigrafia após a RIT foram feitas 10 dias depois da RIT em todos os pacientes. Além disso, as imagens foram também obtidas após 24-48h em 22 pacientes. O desfecho foi classificado como nenhuma evidência de doença (NED), doença estável (SD) e doença progressiva (PD).Resultados : O atordoamento da tireoide ocorreu em 40 pacientes (19,2%), incluindo 26 pacientes com NED e 14 pacientes com SD. A análise multivariada não mostrou associação entre o desfecho da doença e a ocorrência de atordoamento (p = 0,3476).Conclusão : A eficácia da RIT e o desfecho da doença não parecem estar relacionados com o atordoamento da tireoide. Arq Bras Endocrinol Metab. 2014;58(3):292-300.

The Value of Assessing Myocardial Deformation at Recovery after Dobutamine Stress Echocardiography

BACKGROUND: The purpose of this study was to evaluate whether performing an assessment of myocardial deformation using speckle tracking imaging during the recovery period after dobutamine stress echocardiography (DSE) allows detection of significant coronary artery disease (CAD) in patients with chest discomfort. METHODS: DSE and coronary angiography were performed in 44 patients with chest discomfort. The mean global longitudinal peak systolic strain (GLS) was measured at rest, at low stress (dobutamine infusion rate of 10 microg/kg/min) and at recovery (5 min after cessation of dobutamine infusion) of DSE using automated function imaging with apical views. Fractional flow reserve (FFR) was also performed in patients with intermediate coronary stenosis. CAD was defined as having a > or = 70% diameter stenosis on coronary angiography or as having a FFR < 0.8. Patients were divided two groups based on the absence or presence of CAD [CAD (-) group vs. CAD (+) group]. RESULTS: There were no significant differences in the clinical characteristics and results of conventional echocardiography between the two groups. GLS at recovery was lower in the CAD (+) group than in the CAD (-) group (-18.0 +/- 3.4% vs. -21.0 +/- 1.9%, p = 0.003). The optimal cutoff of GLS at recovery for detection of CAD was -19% (sensitivity of 70.6%, specificity of 83.3%). CONCLUSION: Assessment of GLS at recovery of DSE is a reliable and objective method for detection of CAD. This finding may suggest that systolic myocardial stunning remains even after recovery of wall motion abnormalities in patients with CAD.