Relationship between Mitral Regurgitation and Transcatheter Aortic Valve Implantation: a Multi-Institutional Follow-up Study. / A Relação entre Regurgitação Mitral e Implante Transcateter de Válvula Aórtica: um Estudo de Acompanhamento Multi-Institucional.

BACKGROUND: Mitral regurgitation (MR) is prevalent in patients undergoing transcatheter aortic valve implantation (TAVI). There are some controversies about the prognostic impact of MR in survival of TAVI patients. OBJECTIVE: To examine the relationship between TAVI and MR in a patient population from the Brazilian TAVI Registry. METHODS: Seven hundred and ninety-five patients from the Brazilian TAVI Registry were divided at baseline, discharge, and follow-up according to their MR grade as follows: absent/mild (AMMR) or moderate/severe (MSMR). They were subsequently regrouped according to their immediate and late changes in MR severity after TAVI as follows: no change, improved, or worsened MR. Predictors and prognostic impact on baseline as well as changes in MR severity were analyzed. Statistical significance was set at p < 0.05. RESULTS: Baseline MSMR was present in 19.3% of patients and was a predictor of increased late mortality. Immediately after TAVI, 47.4 % of cases improved to AMMR, predicted by a higher Society of Thoracic Surgeons score and a higher grade of baseline aortic regurgitation. Upon follow-up, 9.2% of cases of AMMR worsened to MSMR, whereas 36.8% of cases of MSMR improved to AMMR. Lower baseline left ventricular ejection fraction (LVEF) and improvement in LVEF at follow-up were predictors of MR improvement. Progressive worsening of MR upon follow-up was an independent predictor of higher late mortality after TAVI (p = 0.005). CONCLUSIONS: Baseline MSMR predicts late mortality after TAVI. Lower LVEF and improved LVEF at follow-up predict MR improvement after TAVI. Progressive worsening of MR severity at follow-up is an independent predictor of late mortality, which is a rare finding in the literature.

FUNDAMENTO: A regurgitação mitral (RM) é prevalente em pacientes submetidos a implante transcateter de válvula aórtica (TAVI). Há algumas controvérsias sobre o impacto prognóstico da RM na sobrevida de pacientes submetidos a TAVI. OBJETIVO: Examinar a relação entre TAVI e RM em uma população de pacientes do Registro Brasileiro de TAVI. MÉTODOS: Setecentos e noventa e cinco pacientes do Registro Brasileiro de TAVI foram divididos na linha de base, alta e acompanhamento de acordo com o grau da RM da maneira seguinte: ausente/leve (RMAL) ou moderado/grave (RMMG). Eles foram subsequentemente reagrupados de acordo com as mudanças imediatas e tardias na gravidade da RM após TAVI da maneira seguinte: RM sem mudança, melhora ou piora. Foram analisados os preditores e o impacto prognóstico na linha de base, bem como as mudanças na gravidade da RM. A significância estatística foi estabelecida em p < 0,05. RESULTADOS: RMMG basal estava presente em 19,3% dos pacientes e foi um preditor de aumento da mortalidade tardia. Imediatamente após o TAVI, 47,4% dos casos melhoraram para RMAL, previsto por uma pontuação mais alta da Society of Thoracic Surgeons e um grau mais alto de regurgitação aórtica basal. No acompanhamento, 9,2% dos casos de RMAL pioraram para RMMG, enquanto 36,8% dos casos de RMMG melhoraram para RMAL. Fração de ejeção do ventrículo esquerdo (FEVE) mais baixa na linha de base e melhora na FEVE durante o acompanhamento foram preditores de melhora da RM. Piora progressiva da RM no acompanhamento foi um preditor independente de maior mortalidade tardia após TAVI (p = 0,005). CONCLUSÕES: A RMMG na linha de base é um preditor de mortalidade tardia após TAVI. FEVE mais baixa e melhora na FEVE durante o acompanhamento são preditores de melhora da RM após TAVI. A pior progressiva da gravidade da RM durante o acompanhamento é um preditor independente de mortalidade tardia; isto é um achado raro na literatura.

A Relação entre Regurgitação Mitral e Implante Transcateter de Válvula Aórtica: um Estudo de Acompanhamento Multi-Institucional / Relationship between Mitral Regurgitation and Transcatheter Aortic Valve Implantation: a Multi-Institutional Follow-up Study

Resumo Fundamento A regurgitação mitral (RM) é prevalente em pacientes submetidos a implante transcateter de válvula aórtica (TAVI). Há algumas controvérsias sobre o impacto prognóstico da RM na sobrevida de pacientes submetidos a TAVI. Objetivo Examinar a relação entre TAVI e RM em uma população de pacientes do Registro Brasileiro de TAVI. Métodos Setecentos e noventa e cinco pacientes do Registro Brasileiro de TAVI foram divididos na linha de base, alta e acompanhamento de acordo com o grau da RM da maneira seguinte: ausente/leve (RMAL) ou moderado/grave (RMMG). Eles foram subsequentemente reagrupados de acordo com as mudanças imediatas e tardias na gravidade da RM após TAVI da maneira seguinte: RM sem mudança, melhora ou piora. Foram analisados os preditores e o impacto prognóstico na linha de base, bem como as mudanças na gravidade da RM. A significância estatística foi estabelecida em p < 0,05. Resultados RMMG basal estava presente em 19,3% dos pacientes e foi um preditor de aumento da mortalidade tardia. Imediatamente após o TAVI, 47,4% dos casos melhoraram para RMAL, previsto por uma pontuação mais alta da Society of Thoracic Surgeons e um grau mais alto de regurgitação aórtica basal. No acompanhamento, 9,2% dos casos de RMAL pioraram para RMMG, enquanto 36,8% dos casos de RMMG melhoraram para RMAL. Fração de ejeção do ventrículo esquerdo (FEVE) mais baixa na linha de base e melhora na FEVE durante o acompanhamento foram preditores de melhora da RM. Piora progressiva da RM no acompanhamento foi um preditor independente de maior mortalidade tardia após TAVI (p = 0,005). Conclusões A RMMG na linha de base é um preditor de mortalidade tardia após TAVI. FEVE mais baixa e melhora na FEVE durante o acompanhamento são preditores de melhora da RM após TAVI. A pior progressiva da gravidade da RM durante o acompanhamento é um preditor independente de mortalidade tardia; isto é um achado raro na literatura.

Abstract Background Mitral regurgitation (MR) is prevalent in patients undergoing transcatheter aortic valve implantation (TAVI). There are some controversies about the prognostic impact of MR in survival of TAVI patients. Objective To examine the relationship between TAVI and MR in a patient population from the Brazilian TAVI Registry. Methods Seven hundred and ninety-five patients from the Brazilian TAVI Registry were divided at baseline, discharge, and follow-up according to their MR grade as follows: absent/mild (AMMR) or moderate/severe (MSMR). They were subsequently regrouped according to their immediate and late changes in MR severity after TAVI as follows: no change, improved, or worsened MR. Predictors and prognostic impact on baseline as well as changes in MR severity were analyzed. Statistical significance was set at p < 0.05. Results Baseline MSMR was present in 19.3% of patients and was a predictor of increased late mortality. Immediately after TAVI, 47.4 % of cases improved to AMMR, predicted by a higher Society of Thoracic Surgeons score and a higher grade of baseline aortic regurgitation. Upon follow-up, 9.2% of cases of AMMR worsened to MSMR, whereas 36.8% of cases of MSMR improved to AMMR. Lower baseline left ventricular ejection fraction (LVEF) and improvement in LVEF at follow-up were predictors of MR improvement. Progressive worsening of MR upon follow-up was an independent predictor of higher late mortality after TAVI (p = 0.005). Conclusions Baseline MSMR predicts late mortality after TAVI. Lower LVEF and improved LVEF at follow-up predict MR improvement after TAVI. Progressive worsening of MR severity at follow-up is an independent predictor of late mortality, which is a rare finding in the literature.

Impact of green tea epigallocatechin-3-gallate on HIF1-α and mTORC2 expression in obese women: anti-cancer and anti-obesity effects?

INTRODUCTION: Introduction: epigallocatechin-3-gallate (EGCG) is the most abundant catechin contained in green tea (Camellia sinensis) and has been associated with anti-obesity and anti-cancer effects, but the exact molecular mechanisms remain elusive. In this context, this study was designed to improve the understanding of the EGCG anti-obesity and anti-cancer action. Objectives: this study was designed to examine the effects of EGCG on the expression of genes involved in obesity and cancer pathways in the peripheral blood mononuclear cells of obese women. Material and methods: this longitudinal interventional study enrolled eleven women with severe obesity that were submitted to eight weeks of green tea (decaffeinated green tea capsules with 450.7 mg of EGCG, two capsules/day) supplementation (intervention group) and ten eutrophic women as a control group. Weight (kg), body mass index (BMI, kg/m2), fat mass (kg) and gene expression (qPCR method) were assessed before and after supplementation. HIF1-alpha (HIF1-α), phosphoinositide-3-kinase regulatory subunit 1 (PIK3R1) and rapamycin-insensitive companion of mTOR (RICTOR) were selected as potential targets. Results: after supplementation, body weight (114.9 ± 14.3 versus 115 ± 13.8 kg), body mass index (44.1 ± 3.7 versus 44.1 ± 3.9 kg/m2) and fat mass (47.6 ± 3.3 versus 47.3 ± 3.4 kg) did not change. EGCG upregulated the RICTOR and HIF1-α expression, however, did not modify PI3K expression. Conclusion: this study demonstrated that EGCG has a potential role to obesity and cancer related to obesity control and can be used not only for the purpose of weight loss, but also for the improvement of obesity-related comorbidities.

INTRODUCCIÓN: Introducción: la obesidad se asocia con altos niveles de estrés oxidativo (EO) e inflamación. Existe mucha evidencia de que algunos polifenoles, como el té verde, tienen un impacto positivo en el estado del sistema operativo y consecutivamente en la inflamación. Objetivos: los propósitos de este estudio fueron: a) acceso a biomarcadores de EO en mujeres obesas y de peso normal; y b) evaluar si la suplementación con té verde tiene impacto en los biomarcadores de citoquinas inflamatorias y de EO de mujeres obesas. Métodos: evaluamos mujeres obesas (índice de masa corporal - IMC ≥ 40 kg/m²) y peso normal (IMC entre 18,5 y 24,9 kg/m²). Se utilizaron muestras de sangre para acceder al malondialdehído (MDA), la capacidad antioxidante equivalente de Trolox (TEAC) y las citoquinas inflamatorias. Elegimos al azar pacientes obesos (18 individuos) y luego les dimos suplementos de té verde durante 8 semanas. El análisis estadístico incluyó las pruebas de Shapiro-Wilk, Wilcoxon, t pareadas e independientes, p < 0,05 se consideraron significativas. Resultados: se reclutaron 42 mujeres obesas (IMC: 48,2 ± 9,3 kg/m2) y 21 de peso normal (IMC: 22,5 ± 2 kg/m2) con una edad promedio de 36,2 ± 9,1 años. Los niveles séricos de MDA fueron más altos en las personas obesas (2,52 ± 0,31 µmol/L) que en las mujeres eutróficas (2,13 ± 0,26 µmol/L; p = 0.000). Por otro lado, se observaron valores de TEAC más bajos en obesos (0,75 ± 0,06 mM) que en el grupo eutrófico (0,78 ± 0,04 mM; p = 0,009). Después de la intervención del té verde, la MDA disminuyó 4,7% y el TEAC aumentó 10%. Los niveles séricos de interleucina-6 (IL-6) disminuyeron 12,7% después del tratamiento (p = 0,03). Conclusiones: el grupo obeso tenía menor capacidad antioxidante que el eutrófico. La suplementación con té verde mejoró TEAC y MDA y redujo los niveles séricos de IL-6 en mujeres obesas.

RNA sequencing differential gene expression analysis of isolated perfused bovine udders experimentally inoculated with Streptococcus agalactiae.

The aim of this study was to elucidate the differential gene expression in the RNA sequencing transcriptome of isolated perfused udders collected from 4 slaughtered Holstein × Zebu crossbred dairy cows experimentally inoculated with Streptococcus agalactiae. We studied 3 different statistical tools (edgeR, baySeq, and Cuffdiff 2). In summary, 2 quarters of each udder were experimentally inoculated with Strep. agalactiae and the other 2 were used as a control. Mammary tissue biopsies were collected at times 0 and 3 h after infection. The total RNA was extracted and sequenced on an Illumina HiSeq 2000 (Illumina Inc., San Diego, CA). Transcripts were assembled from the reads aligned to the bovine UMD 3.1 reference genome, and the statistical analyses were performed using the previously mentioned tools (edgeR, baySeq, and Cuffdiff 2). Finally, the identified genes were submitted to pathway enrichment analysis. A total of 1,756, 1,161, and 3,389 genes with differential gene expression were identified when using edgeR, baySeq, and Cuffdiff 2, respectively. A total of 122 genes were identified by the overlapping of the 3 methods; however, only the platelet activation presented a significantly enriched pathway. From the results, we suggest the FCER1G, GNAI2, ORAI1, and VASP genes shared among the 3 methods in this pathway for posterior biological validation.

Prevalence and identification of Salmonella spp. in water buffaloes from São Paulo State, Brazil / Prevalência e identificação de Salmonella spp. em búfalos do Estado de São Paulo, Brasil

O objetivo do estudo foi investigar a prevalência de Salmonella spp. em amostras de fezes de búfalos do estado de São Paulo, Brasil, e identificar os sorotipos isolados. Foram examinadas 116 amostras de suabes retais de búfalos das raças Jafarabadi e Murrah, coletadas em triplicata, em seis propriedades rurais localizadas nas regiões Central, Centro-Oeste e Nordeste do estado de São Paulo, Brasil. Para avaliar a presença de Salmonella spp., foram utilizados três diferentes caldos de enriquecimento (caldo selenito cistina, caldo tetrationado Muller-Kauffmann e caldo Rappaport-Vassiliadis) e dois diferentes meios de cultura (ágar verde brilhante modificado e ágar XLT4). Das 116 amostras de suabes retais examinadas, oito amostras (6,90%; 8/116) foram positivas para Salmonella spp., incluindo quatro sorotipos: S. Panama (50%; 4/8), S. Agona (25%; 2/8) , S. Newport (12,5%; 1/8) e S. Saintpaul (12,5%; 1/8), todos isolados de búfalos sem sinais clínicos de salmonelose, indicando a importância dos animais assintomáticos como fonte de infecção para outros animais e seres humanos. Das seis propriedades rurais avaliadas, apenas em duas fazendas (33,3%; 2/6) não foi detectada Salmonella spp. O uso de mais de um caldo de enriquecimento seletivo e de mais de um meio de cultura é indicado para o isolamento de Salmonella.(AU)

Alemtuzumab as graft-versus-host disease (GVHD) prophylaxis strategy in a developing country: lower rate of acute GVHD, increased risk of cytomegalovirus reactivation.

Acute graft-versus-host disease (aGVHD) and cytomegalovirus reactivation are important complications after allogeneic stem cell transplantation (alloHSCT). Here, we evaluated the impact of treatment with alemtuzumab on the occurrence of aGVHD, cytomegalovirus reactivation and survival after alloHSCT. This was a prospective cohort study conducted at the allo-HSCT unit of Hospital das Clínicas, Universidade Federal de Minas Gerais, Brazil, from January 2009 to December 2011. Fifty-seven patients who underwent alloHSCT were included. Forty-five (79%) patients had a malignant disease. Alemtuzumab was administered before the conditioning regimen at a dose of 1 mg/kg in children and 30 mg/day for 2 days in adults or children weighing more than 40 kg (a total dose of 60 mg) with a non-malignant disease or patients with a malignant disease and high-risk for GVHD mortality. Alemtuzumab was used in 23 (40%) patients, of whom 17 received a reduced-intensity conditioning. Eleven patients presented aGVHD (grade 2-4) and only 1 of them received alemtuzumab. Cumulative incidence of aGVHD (grade 2-4) at day 100 after transplantation (D+100) was 4 for patients receiving alemtuzumab and 29% for patients not receiving alemtuzumab. Cumulative incidence of cytomegalovirus reactivation for patients receiving or not alemtuzumab was 62 and 38%, respectively. Sixteen patients died in the first 100 days after alloHSCT, most of them due to bacterial sepsis. Only 2 patients died of aGVHD until D+100. Overall survival was 50% without any impact of alemtuzumab. Alemtuzumab effectively controlled aGVHD but increased the risk of cytomegalovirus reactivation without improving survival.

Parameter estimates for reproductive and carcass traits in Nelore beef cattle.

The aim of this study was to estimate genetic parameters for scrotal circumference at 365 (SC365) and 450 (SC450) days of age, age at first calving (AFC), ribeye area (REA), backfat (BF) thickness, and rump fat (RF) thickness, in order to provide information on potential traits for Nelore cattle breeding program. Genetic parameters were estimated using the Average Information Restricted Maximum Likelihood method in single- and multitrait analyses. Four different animal models were tested for SC365, SC450, REA, BF, and RF in single-trait analyses. For SC365 and SC450, the maternal genetic effect was statistically significant (P < 0.01) and was included for multitrait analyses. The direct heritability estimates for SC365, SC450, AFC, REA, BF, and RF were equal to 0.31, 0.38, 0.24, 0.32, 0.16, and 0.19, respectively. Maternal heritability for SC365 and SC450 was equal to 0.06 and 0.08, respectively. The highest genetic correlations were found among the scrotal circumferences. Testing for the inclusion of maternal effects in genetic parameters estimation for scrotal circumference should be evaluated in the Nelore breeding program, mostly for correctly ranking the animal's estimated breeding values. Similar heritability estimates were observed for scrotal circumference, as well as favorable genetic correlations of this trait with AFC and carcass traits. Thus, scrotal circumference measured at 365 days of age could be a target trait for consideration in the Nelore selection index in order to improve most of the traits herein analyzed.

Estimates of genetic parameters and genetic trends for reproductive traits and weaning weight in Tabapuã cattle.

The Tabapuã breed is a beef cattle Brazilian breed known for its sexual precocity and desirable characteristics for tropical conditions. However, this is a newly formed breed and few studies have been conducted regarding genetic parameters and genetic trends for its reproductive traits. The objective of the present study was to estimate the genetic parameters, genetic trends, and relative selection efficiency for weaning weight adjusted to 210 d of age (W210), age at first calving (AFC), average calving interval (ACI), first calving interval (CI1), and accumulated productivity (ACP) among Tabapuã beef cattle. Pedigree data on 15,241 Tabapuã animals born between 1958 and 2011 and phenotype records from 7,340 cows born between 1970 and 2011 were supplied by the National Association of Breeders and Researchers (Associação Nacional de Criadores e Pesquisadores). Analysis through the least squares method assisted in defining the fixed effects that were considered within the models. The estimates for the genetic parameters were obtained through the REML, using a multitrait animal model. The likelihood ratio test applied for W210 was significant ( < 0.05) for the inclusion of maternal additive genetic and permanent environmental effects in the model. Genetic trends were calculated through linear regression of the EBV of the animals, according to the year of birth. The heritability estimates obtained ranged from 0.04 ± 0.03 for CI1 to 0.25 ± 0.05 for W210. The genetic correlations ranged from 0.004 ± 0.19 for W210-AFC and 0.93 ± 0.12 for ACI-CI1. The genetic trend was significant ( < 0.05) and favorable for CI1 and the maternal genetic effect of W210 and was significant ( < 0.05) and unfavorable for AFC, ACI, and ACP. The ACP could be used in the selection index to assist the breeding goal of improved productive and reproductive performance. The genetic trends indicated small and unfavorable genetic changes for AFC, ACI, and ACP in light of the recent implementation of a genetic breeding program for this breed.

Examination portability.

Truly global radiology would exist if patients could visit any European physician without their CDs or films. It would be possible for patients to go to a hospital or a clinic in any European country and have their examinations done in a different country, analyzed and eventually compared with the examination done at that hospital. This paper analyzes two national projects that should be documented and analyzed: Scotland with a national archive with radiology images and Finland which is implementing a system that will create an online personal health record of the citizen with all health-related information. This possibility would improve quality in European radiology and create a true network of images and knowledge that can be the seed to improve efficiency by reducing costs and exposure to radiation and increasing knowledge sharing among Europeanradiologists/neuroradiologists. We present here the idea of a network between three centers in three different countries that can be the start for a global project.

Controlling Bacillus cereus adherence to stainless steel with different cleaning and sanitizing procedures used in dairy plants / Controle do processo de adesão de Bacillus cereus ao aço inoxidável após diferentes procedimentos de limpeza e sanitização usados na indústria de laticínios

Bacillus cereus adherence to stainless steel used to milk contact surfaces was observed, depending on the cleaning and sanitizing procedures applied and the physicochemical properties of the surfaces. Numbers of surviving B. cereus after hygiene procedures were affected by temperature, the concentrations of both alkaline and acid washes, and the pH of the chlorine solution. The adhesion of B. cereus to the stainless steel was not thermodynamically favorable, and the adherence of this microorganism occurred in lower number, in accordance to the thermodynamic aspect of adhesion.

Foi observada a adesão de Bacillus cereus em superfície de aço inoxidável em contato com o leite, segundo o procedimento de limpeza, a sanitização e as propriedades físico-químicas da superfície. O número de B. cereus viáveis, após os procedimentos de higienização, foi afetado pela temperatura, pela concentração das soluções alcalinas e ácidas e pelo pH da solução clorada. A adesão de B. cereus em aço inoxidável não foi termodinamicamente favorável, e ocorreu pouca adesão desse microrganismo, de acordo com os aspectos termodinâmicos da adesão.

Estudo ecocardiográfico evolutivo das alterações anátomo-funcionais do coração em obesos submetidos à cirurgia bariátrica / Evolutive echocardiographic study of the structural and functional heart alterations in obese individuals after bariatric surgery

OBJETIVO: Avaliar com a Dopplerecocardiografia a reversibilidade das alterações estruturais e funcionais do coração em obesos submetidos à cirurgia bariátrica. MÉTODOS: Foram estudados 23 obesos (19 mulheres: 82,6 por cento) com idade média de 37,9 anos. Tinham obesidade classe III ou classe II com co-morbidades. Realizaram avaliação clínica e ecocardiográfica no pré-operatório, 6 meses e 3 anos após a cirurgia. RESULTADOS: Antes da operação o peso era de 128,7 ± 25,8 kg e a pressão arterial (PA) 142,2 ± 16,2/92,2 ± 10,4 mmHg. No pós-operatório houve redução do peso aos 6 meses (97,6 ± 18,3 Kg) e aos 3 anos (83,6 ± 13,5 Kg), e da PA aos 6 meses (128,5 ± 16,1/80,7 ± 9,9 mmHg) com resultado mantido em 3 anos. Ao ecocardiograma, antes da cirurgia havia hipertrofia da parede posterior do ventrículo esquerdo (VE) e septo interventricular, com dimensão diastólica do VE normal e padrão geométrico predominante de remodelamento concêntrico (74 por cento). Após 6 meses, diminuíram as espessuras do septo e da parede posterior, e aumentou a dimensão diastólica do VE. Em 3 anos o padrão geométrico predominante era o normal (69 por cento), com redução da massa de VE e do índice de massa do VE/altura² . Observou-se também melhora da função diastólica de VE, com aumento da relação E/A em 6 meses, mantendo-se em 3 anos e diminuição do tempo de relaxamento isovolumétrico do VE em 6 meses e em 3 anos. Houve melhora do índice de Desempenho Miocárdico em 6 meses, mantendo-se em 3 anos, em 13 pacientes estudados retrospectivamente. Notou-se aumento do tempo de ejeção em 6 meses, mantendo-se em 3 anos, e discreto aumento da fração de ejeção em 3 anos, sugerindo melhora da função sistólica de VE. CONCLUSÃO: A redução de peso obtida através da cirurgia para obesidade promove modificações estruturais e funcionais benéficas ao coração.

OBJECTIVE: To evaluate with Doppler echocardiography the reversibility of structural and hemodynamic changes in obeses after bariatric surgery. METHODS: Twenty-three patients (19 women = 82.6 percent) were studied. Mean age was 37.9 years. All subjects had Class III or Class II obesity with comorbidity and were submitted to bariatric surgery. Clinical and echocardiographic evaluation were performed preoperatively, in 6 months and 3 years after surgery. RESULTS: Preoperatively, the mean weight and blood pressure (BP) were respectively 128.7± 25.8 kg and 142.2 ± 16.2 / 92.2 ± 10.4 mmHg. Postoperatively, they showed important body weight reduction in 6 months (97.6 ± 18.3 kg) and 3 years (83.6 ± 13.5 kg), and BP reduction in 6 months (128.5 ± 16.1/80.7 ± 9.9 mmHg) that remain stable in 3rd year. On echocardiogram, preoperatively, there was hypertrophy of the septum and posterior wall associated with normal diastolic dimension; the predominant LV geometric pattern was concentric remodeling (74 percent). At six months, thinning of the ventricular septum and LV posterior wall, and increase in LV diastolic dimension were demonstrated. At 3rd year, the predominant LV pattern was normal (69 percent), with reduction of LV mass and LV mass/height² index. We noticed improved diastolic function, with an increased E/A ratio and a decreased LV isovolumic relaxation time. The Myocardial Performance Index was obtained retrospectively in 13 patients and improved in 6 months. There was an increase of the ejection time in 6 months and an elevation of the ejection fraction in 3rd year, suggesting improvement of the LV systolic function. CONCLUSION: The weight loss obtained with bariatric surgery promotes both structural and functional myocardial changes that improve cardiac performance.

Evolutive echocardiographic study of the structural and functional heart alterations in obese individuals after bariatric surgery.

OBJECTIVE: To evaluate with Doppler echocardiography the reversibility of structural and hemodynamic changes in obeses after bariatric surgery. METHODS: Twenty-three patients (19 women = 82.6%) were studied. Mean age was 37.9 years. All subjects had Class III or Class II obesity with comorbidity and were submitted to bariatric surgery. Clinical and echocardiographic evaluation were performed preoperatively, in 6 months and 3 years after surgery. RESULTS: Preoperatively, the mean weight and blood pressure (BP) were respectively 128.7 +/- 25.8 kg and 142.2 +/- 16.2 / 92.2 +/- 10.4 mmHg. Postoperatively, they showed important body weight reduction in 6 months (97.6 +/- 18.3 kg) and 3 years (83.6 +/- 13.5 kg), and BP reduction in 6 months (128.5 +/- 16.1/80.7 +/- 9.9 mmHg) that remain stable in 3rd year. On echocardiogram, preoperatively, there was hypertrophy of the septum and posterior wall associated with normal diastolic dimension; the predominant LV geometric pattern was concentric remodeling (74%). At six months, thinning of the ventricular septum and LV posterior wall, and increase in LV diastolic dimension were demonstrated. At 3rd year, the predominant LV pattern was normal (69%), with reduction of LV mass and LV mass/height2 index. We noticed improved diastolic function, with an increased E/A ratio and a decreased LV isovolumic relaxation time. The Myocardial Performance Index was obtained retrospectively in 13 patients and improved in 6 months. There was an increase of the ejection time in 6 months and an elevation of the ejection fraction in 3rd year, suggesting improvement of the LV systolic function. CONCLUSION: The weight loss obtained with bariatric surgery promotes both structural and functional myocardial changes that improve cardiac performance.

ISDN based teleradiology and image analysis with the software system KAMEDIN.

This contribution describes the software system KAMEDIN (Kooperatives Arbeiten und MEdizinische Diagnostik auf Innovativen Netzen) that is designed as an ISDN based computer supported cooperative work (CSCW) tool for usage in medical diagnostics. Medical image data from various sources (for example CT and MR) can be interchanged and analyzed in bilateral teleconferences via ISDN. During a cooperative session, user interactions for image processing etc., are synchronized and performed on both workstations, Features like telepointing, remote control, and audio connection enhance communication quality. With ISDN as a transmission line, widespread availability and low communication costs are achieved. Further, automatic tissue labeling in intracranial MR data can be invoked. For this purpose, artificial neural network classifiers such as multilayer perceptron and Kohenen feature map are integrated. Classification results can be viewed as 3D-reconstructions.