Preditores de degeneração hemodinâmica protética após implante de prótese aórtica transcateter / Predictors of prosthetic hemodynamic degeneration after transcatheter aortic prosthesis implantation

INTRODUÇÃO: O implante valvar aórtico percutâneo (TAVI - transcatheter aortic valve implantation) se estabeleceu como tratamento para pacientes com estenose aórtica severa sintomática de alto ou proibitivo risco cirúrgico. Estudos recentes demonstraram não-inferioridade ou superioridade para TAVI em relação à cirurgia em pacientes de risco intermediário. A degeneração hemodinâmica e consequente disfunção protética em pacientes submetidos a TAVI passa a ser uma preocupação evolutiva, pelo que sua durabilidade tem sido questionada. Com isso, o objetivo do trabalho é escrever a evolução do perfil hemodinâmico e durabilidade da bioprótese nos pacientes submetidos a TAVI na experiência de dois centros nacionais. MÉTODOS: Pesquisa observacional, longitudinal, com coleta de dados prospectiva de pacientes com diagnóstico de estenose grave sintomática submetidos à TAVI. O acompanhamento foi feito de julho de 2009 até julho de 2016 em dois centros nacionais. Usamos as definições estandardizadas para deterioração estrutural (SVD ­ structural valve deterioration) e falência de prótese (BVF ­ bioprosthetic valve failure) publicadas pelo consenso da European Association of Percutaneous Cardiovascular Interventions (EAPCI), European Society of Cardiology (ESC) e European Association for Cardio-Thoracic Surgery (EACTS), publicadas em 2017 no European Heart Journal. Foram incluídos para análise de degeneração hemodinâmica da prótese os pacientes com avaliação ecocardiográfica no pós procedimento e com pelo menos uma avaliação de seguimento em pelo menos seis meses após o implante. RESULTADOS: Obtivemos dados de 339 pacientes, com média de idade de 81,6 anos, sendo 45,86% (n=156) homens e 54,14% (n=183) mulheres. A mortalidade por todas as causas até o último seguimento foi de 20,1% (n=68). A média do Euroscore foi de 7,5+6,01 e o STS de 6,56+5,96. Pacientes tratados com prótese balão expansível foram 38% (n=130), enquanto 62% (n=208) com auto expansível. Após seguimento médio de 42 meses, foi observado 28 (8,25%) pacientes com SVD e 2 (0,6%) pacientes apresentaram BVF. O gradiente sistólico médio no baseline foi de 20,06+ 8,49mmHg e a área valvar de 1,9+ 0,3mmHg, e mantiveram-se com comportamento estável no seguimento. CONCLUSÕES: O seguimento após TAVI mostrou favorável performance hemodinâmica e boa durabilidade da bioprótese em nossa experiência de dois centros nacionais. (AU)

Biogeographical origin and timing of the founder ichthyosis TGM1 c.1187G > A mutation in an isolated Ecuadorian population.

An unusually high frequency of the lamellar ichthyosis TGM1 mutation, c.1187G > A, has been observed in the Ecuadorian province of Manabí. Recently, the same mutation has been detected in a Galician patient (Northwest of Spain). By analyzing patterns of genetic variation around this mutation in Ecuadorian patients and population matched controls, we were able to estimate the age of c.1187G > A and the time to their most recent common ancestor (TMRCA) of c.1187G > A Ecuadorian carriers. While the estimated mutation age is 41 generations ago (~1,025 years ago [ya]), the TMRCA of Ecuadorian c.1187G > A carrier haplotypes dates to just 17 generations (~425 ya). Probabilistic-based inferences of local ancestry allowed us to infer a most likely European origin of a few (16% to 30%) Ecuadorian haplotypes carrying this mutation. In addition, inferences on demographic historical changes based on c.1187G > A Ecuadorian carrier haplotypes estimated an exponential population growth starting ~20 generations, compatible with a recent founder effect occurring in Manabí. Two main hypotheses can be considered for the origin of c.1187G > A: (i) the mutation could have arisen in Spain >1,000 ya (being Galicia the possible homeland) and then carried to Ecuador by Spaniards in colonial times ~400 ya, and (ii) two independent mutational events originated this mutation in Ecuador and Galicia. The geographic and cultural characteristics of Manabí could have favored a founder effect that explains the high prevalence of TGM1 c.1187G > A in this region.

The geographic mosaic of Ecuadorian Y-chromosome ancestry.

Ecuadorians originated from a complex mixture of Native American indigenous people with Europeans and Africans. We analyzed Y-chromosome STRs (Y-STRs) in a sample of 415 Ecuadorians (145 using the AmpFlSTR® Yfiler™ system [Life Technologies, USA] and 270 using the PowerPlex®Y23 system [Promega Corp., USA]; hereafter Yfiler and PPY23, respectively) representing three main ecological continental regions of the country, namely Amazon rainforest, Andes, and Pacific coast. Diversity values are high in the three regions, and the PPY23 exhibits higher discrimination power than the Yfiler set. While summary statistics, AMOVA, and RST distances show low to moderate levels of population stratification, inferred ancestry derived from Y-STRs reveal clear patterns of geographic variation. The major ancestry in Ecuadorian males is European (61%), followed by an important Native American component (34%); whereas the African ancestry (5%) is mainly concentrated in the Northwest corner of the country. We conclude that classical procedures for measuring population stratification do not have the desirable sensitivity. Statistical inference of ancestry from Y-STRS is a satisfactory alternative for revealing patterns of spatial variation that would pass unnoticed when using popular statistical summary indices.

Hybrid sequential treatment of aromatic hydrocarbon-polluted effluents using non-ionic surfactants as solubilizers and extractants.

A treatment train combining a biological and a physical approach was investigated for the first time in order to remediate polycyclic aromatic hydrocarbons (PAHs)-polluted effluents. Given the hydrophobic nature of these contaminants, the presence of non-ionic surfactants is compulsory to allow their bioavailability. The presence of these surfactants also entails an advantage in order to ease contaminant removal by the formation of aqueous two-phase systems (ATPS). The segregation ability of environmentally benign salts such as potassium tartrate, citrate, and oxalate was discussed for extracting phenanthrene (PHE), pyrene (PYR), and benzo[a]anthracene (BaA). The biological remediation efficiency reached circa 60% for PHE and PYR, and more than 80% for BaA. The coupling of ATPS subsequent stage by using potassium citrate allowed increasing the total PAH remediation yields higher than 97% of PAH removal. The viability of the proposed solution was investigated at industrial scale by using the software tool SuperPro Designer.

Novel physico-biological treatment for the remediation of textile dyes-containing industrial effluents.

In this work, a novel remediation strategy consisting of a sequential biological and physical process is proposed to remove dyes from a textile polluted effluent. The decolorization ability of Anoxybacillus flavithermus in an aqueous effluent containing two representative textile finishing dyes (Reactive Black 5 and Acid Black 48, as di-azo and antraquinone class, respectively) was proved. The decolorization efficiency for a mixture of both dyes reached almost 60% in less than 12h, which points out the suitability of the selected microorganism. In a sequential stage, an aqueous biphasic system consisting of non-ionic surfactants and a potassium-based organic salt, acting as the salting out agent, was investigated. The phase segregation potential of the selected salts was evaluated in the light of different thermodynamic models, and remediation levels higher than 99% were reached.

Approaching chlorpyrifos bioelimination at bench scale bioreactor.

Chlorpyrifos (CP) is one of the most commonly applied insecticides for control of pests and insects. The inappropriate use of this kind of chemicals has caused heavy contamination of many terrestrial and aquatic ecosystems thus representing a great environmental and health risk. The main purpose of this work is to investigate novel microbial agents (Pseudomonas stutzeri and the previously obtained consortium LB2) with the ability to degrade CP from polluted effluents. This goal was achieved by operating at different lab scales (flask and bioreactor) and operation modes (batch and fed-batch). Very low degradation and biomass levels were detected in cultures performed with the consortium LB2. In contrast, near complete CP degradation was reached by P. stutzeri at the optimal conditions in less than 1 month, showing a depletion rate of 0.054 h(-1). The scale-up at bench scale stirred tank bioreactor allowed improving the specific degradation rate in ten folds and total CP degradation was obtained after 2 days. Moreover, biomass and biodegradation profiles were modelled to reach a better characterization of the bioremediation process.

Viability of phenanthrene biodegradation by an isolated bacterial consortium: optimization and scale-up.

In the present work, biodegradation of phenanthrene by a bacterial consortium (LB2), isolated from lab-polluted soils has been investigated. The 16S rRNA gene-based molecular analysis revealed that the bacterial consortium LB2 consisted of two strains showing a very high homology with Staphylococcus warneri and Bacillus pumilus. The optimization of phenanthrene degradation by the consortium LB2, using a central composite face-centered design was carried out taking into account three important parameters such as temperature, pH, and phenanthrene concentration. Near complete phenanthrene degradation was reached by consortium LB2 at the optimal conditions (pH of 7.5 and 37.5 °C) in less than 48 h. Moreover, the efficiency of phenanthrene biodegradation was assessed by using logistic and Luedeking and Piret-type models. Finally, the process was implemented at bench-scale bioreactor and the main degradation routes were identified based on GC-MS data.

Efficient PAHs biodegradation by a bacterial consortium at flask and bioreactor scale.

In this work, the biodegradation of three polycyclic aromatic hydrocarbons (PAHs) such as Phenanthrene (PHE), Pyrene (PYR) and Benzo[a]anthracene (BaA) has been investigated. A bacterial consortium consisting of two strains was used for the first time based on preliminary promising biodegradation data. They were tentatively identified as Staphylococcus warneri and Bacillus pumilus. Degradation values higher than 85% were obtained for each single PAH when operating at flask scale, whereas minimum levels of 90% of PAHs removal were obtained after just 3 days of cultivation at bioreactor scale. The operation in cometabolic conditions led to maximum levels about 75% and 100% at flask and bioreactor scale, respectively. All the experimental data were analyzed in the light of logistic and Luedeking and Piret type models, with the purpose to better characterize the biodegradation process by S. warneri and B. pumilus. Finally, the metabolic pathway followed to degrade each PAH was ascertained.

Assessment of a process to degrade metal working fluids using Pseudomonas stutzeri CECT 930 and indigenous microbial consortia.

The development of a novel biological process to treat metal working fluids (MWFs)-containing effluents at bioreactor scale was pursued in this work. The bacteria Pseudomonas stutzeri CECT 930 was investigated for the first time as an alternative agent for MWF degradation. An adequate medium design and mixing and aeration system, as well as an appropriate microorganism proved to be crucial for reaching high levels of degradation by P. stutzeri and by an indigenous consortium (about 70% and 50% of reduction in total petroleum hydrocarbon content in less than 2 wk, respectively). Additionally, as there is no information in literature trying to kinetically characterize an MWF-polluted effluent degradation process, all the experimental data were fitted to logistic and Luedeking and Piret models, that allowed to elucidate the growth-associated character of the biodegradation process.

Technoeconomic assessment of phenanthrene degradation by Pseudomonas stutzeri CECT 930 in a batch bioreactor.

Polycyclic aromatic hydrocarbons (PAHs) are among the most persistent pollutants that accumulate in natural environment mainly as a result of anthropogenic activities. Therefore, the improvement of the available bank of microbial resources and information is crucial to the proper management of PAHs-polluted sites and effluents. In this work, Pseudomonas stutzeri CECT 930 was selected for aerobically degrading an aqueous effluent containing phenanthrene (PHE). Maximum PHE degradation of 90% was obtained both at flask and stirred tank bioreactor scale. All the experimental data were fitted to logistic and Luedeking and Piret models, and licensed to quantitatively ascertain a stronger dependence on the biomass of the metabolites triggering the bioremediation process. In addition, PHE degradation via protocatechuate pathway was elucidated through GC-MS data. Finally, based on the promising results of biodegradation, a preliminary economic evaluation of this process at industrial scale was approached by means of simulation data obtained with SuperPro Designer.

Decolorization of dye Reactive Black 5 by newly isolated thermophilic microorganisms from geothermal sites in Galicia (Spain).

In this study, thermophilic microbial strains from thermal spots in northwestern Spain displaying excellent decolorization capability were isolated. The research work tackled: (i) the ability of consortia to degrade a model di-azo dye Reactive Black at different pHs in flask cultures, obtaining that just neutral pHs licensed degradation levels near to 70%, (ii) the isolation of tree of the bacteria, which rendered possible reaching high levels of decolorization (80%) after just 24 h in aerobic conditions, and which were identified through 16S rRNA sequencing to possess high homology (99%) with Anoxybacillus pushchinoensis, Anoxybacillus kamchatkensis and Anoxybacillus flavithermus, and (iii) the cultivation of the isolates in a bench-scale bioreactor, which led to a decolorization rate two-fold higher than that obtained in flask cultures. Therefore, this work makes up the first time that a decolorization process of an azo dye by thermophilic microorganisms in aerobic conditions is investigated.

Suicidio con fosfuro de aluminio: presentación de un caso / Suicide by ingestion of aluminum phosphide: a case report

Se describe el primer caso publicado en Cuba de envenenamiento letal por ingestión intencional de fosfuro de aluminio, un pesticida usado contra los roedores e insectos. Se revisan los principales efectos tóxicos. Entre ellos, destaca la hipoglicemia, manifestación infrecuentemente descrita y los cambios en el electrocardiograma sugerentes de infarto subendocardico (AU)

This is the first Cuban report of a suicide carried out by lethal intake of aluminum phosphide, a pesticide used to control rodents and insects. We review the main toxic effects, placing emphasis on hypoglycemia, which is seldom mentioned, and electrocardiographic abnormalities suggestive of subendocardial infarction (AU)