Chronic Cadmium Exposure and Genetic Polymorphisms of MMP-2 and MMP-9 in a Population Exposed to Steel Slag in the State of Rio de Janeiro, Brazil: A Cross-Sectional Study.

Genetic polymorphisms in the matrix metalloproteinases (MMPs) family genes may be associated with cadmium (Cd) levels and its adverse effects. This study investigated the impact of MMP-2 and MMP-9 polymorphisms on Cd levels in 238 residents of a condominium in Rio de Janeiro, Brazil, built over an industrial steel slag waste. Polymorphisms were genotyped using TaqMan validated assays, and the Cd levels were measured in blood (BCd) and urine (UCd) samples by atomic absorption spectrometry. Associations were evaluated by linear correlation coefficients and multiple logistic regression, using odds ratios (OR) and 95% confidence intervals (CI). Mean age was 50 ± 15 years; 58% were female, 69% non-smokers. Mean concentrations for BCd and UCd were 0.70 ± 0.2 µg L-1 and 0.56 ± 0.55 µg L-1, respectively. Smoking status was associated with BCd ≥ 0.70 µg L-1 (OR = 2.9; 95% CI = 1.6-5.9). MMP-9 rs17576 A > G was associated with BCd ≥ 0.70 µg L-1 (OR = 2.11; 95% CI = 1.10-4.05) and UCd ≥ 0.56 µg L-1 (OR = 3.38; 95% CI = 1.82-7.65). Knowing possible individual predisposing factors is essential to understand Cd toxicity, and to improve the monitoring of high-risk populations.

Predictors of mortality among patients with acute leukemias admitted to an intensive care unit specialized in patients with hematological disease at a Brazilian hospital

Abstract Introduction Hematologists deal every day with high mortality rates of acute leukemia patients. Many times these patients need Intensive Care Unit (ICU) support and some general ICU teams believe that these patients have a much greater chance of dying than patients with other pathologies. In Brazil, data related to mortality rates and ICUs for acute leukemia patients are scarce. Methods Therefore, to assess mortality predictors in patients with acute leukemia admitted to a specialized hematological ICU, we evaluated demographics, supportive care, hospitalization time, disease status, admitting diagnosis, neutropenia, number of transfusions and Acute Physiology and Chronic Health Evaluation (APACHE)/Sepsis Related Organ Failure Assessment (SOFA) scores as possible factors associated with mortality. Data were extracted from the first admission records of 110 patients with acute leukemia admitted to the Hemocentro de Pernambuco (Hemope) ICU between 2006 and 2009. Results In this retrospective cohort study, 72/110 of the patients were men, and 64/110 were from the metropolitan area of Recife. The patients' age median was 43.5 years (±17.9); 67.3% had acute myeloid leukemia (AML) and 32.7% had acute lymphoid leukemia. The main admitting diagnosis in the ICU was sepsis (66.7%). The mean APACHE II score was 18.3. Of the total, 65 (59%) died, and the mortality rate was independently related to longer hospitalization (p < 0.001), the increase in the APACHE II score (p < 0.038) and having received hemodialysis (p < 0.006). Neutropenia, receiving multiple transfusions and using any kind of mechanical ventilation or vasoactive drug on admission were not relevant to mortality. Factors associated with higher mortality rates were: longer hospitalization, increase in the APACHE II score, and use of hemodialysis. Conclusion With these data, to prevent organ lesions before admission to the ICU, a better strategy might be to reduce mortality for leukemia patients.

Predictors of mortality among patients with acute leukemias admitted to an intensive care unit specialized in patients with hematological disease at a Brazilian hospital.

INTRODUCTION: Hematologists deal every day with high mortality rates of acute leukemia patients. Many times these patients need Intensive Care Unit (ICU) support and some general ICU teams believe that these patients have a much greater chance of dying than patients with other pathologies. In Brazil, data related to mortality rates and ICUs for acute leukemia patients are scarce. METHODS: Therefore, to assess mortality predictors in patients with acute leukemia admitted to a specialized hematological ICU, we evaluated demographics, supportive care, hospitalization time, disease status, admitting diagnosis, neutropenia, number of transfusions and Acute Physiology and Chronic Health Evaluation (APACHE)/Sepsis Related Organ Failure Assessment (SOFA) scores as possible factors associated with mortality. Data were extracted from the first admission records of 110 patients with acute leukemia admitted to the Hemocentro de Pernambuco (Hemope) ICU between 2006 and 2009. RESULTS: In this retrospective cohort study, 72/110 of the patients were men, and 64/110 were from the metropolitan area of Recife. The patients' age median was 43.5 years (±17.9); 67.3% had acute myeloid leukemia (AML) and 32.7% had acute lymphoid leukemia. The main admitting diagnosis in the ICU was sepsis (66.7%). The mean APACHE II score was 18.3. Of the total, 65 (59%) died, and the mortality rate was independently related to longer hospitalization (p<0.001), the increase in the APACHE II score (p<0.038) and having received hemodialysis (p<0.006). Neutropenia, receiving multiple transfusions and using any kind of mechanical ventilation or vasoactive drug on admission were not relevant to mortality. Factors associated with higher mortality rates were: longer hospitalization, increase in the APACHE II score, and use of hemodialysis. CONCLUSION: With these data, to prevent organ lesions before admission to the ICU, a better strategy might be to reduce mortality for leukemia patients.

Coupling physiological analysis with proteomic profile to understand the photosynthetic responses of young Euterpe oleracea palms to drought.

This study examined whether drought sensitivity in açaí (Euterpe oleracea Mart.) is associated with reductions in photosynthesis and increasing oxidative stress in response to down-regulation of proteins related to photosynthetic reactions, photorespiration, and antioxidant system. Well-watered (Control) and drought-stressed plants were compared when leaf water potential in stressed plants reached around - 1.5 and - 3.0 MPa, representing moderate and severe drought. Drought caused 84 and 96% decreases in net photosynthetic rate (Pn) and stomatal conductance. Stress-mediated changes in maximum quantum efficiency of photosystem II (PSII) photochemistry were unobserved, but drought decreased photochemical quenching, actual quantum yield of PSII electron transport, and apparent electron transport rate (ETR). Moderate and severe drought induced, respectively, decreases and increases in non-photochemical quenching (NPQ) and 74 and 273% increases in ETR/Pn. Moderate drought down-regulated PSII protein D2, chlorophyll a-b binding protein 8, photosystem I reaction center subunit N, sedoheptulose-1,7-bisphosphatase, and transketolase; while severe drought down-regulated LHC II proteins, ferredoxin-NADP reductase, ATP synthase subunits ε and ß, and carbonic anhydrase isoform X2. The glutamate-glyoxylate aminotransferase 2 and glycine dehydrogenase were down-regulated upon moderate drought, while catalase 2 and glycine cleavage system H protein 3 were up-regulated. Severe drought up-regulated glycolate oxidase, glycine cleavage system H protein 3, and aminomethyl transferase, but most of photorespiration-related proteins were only found in control plants. Down-regulation of chaperones and antioxidant enzymes and increased lipid peroxidation in stressed plants were observed upon both stress severities. Therefore, the decreases in Pn and failure in preventing oxidative damages through adjustments in NPQ and photorespiration- and antioxidant-related proteins accounted for drought sensitivity in açaí.

Identification of Patients with Myocardial Infarction. Vectorcardiographic and Electrocardiographic Analysis.

BACKGROUND: The largest morbidity and mortality group worldwide continues to be that suffering Myocardial Infarction (MI). The use of vectorcardiography (VCG) and electrocardiography (ECG) has improved the diagnosis and characterization of this cardiac condition. OBJECTIVES: Herein, we applied a novel ECG-VCG combination technique to identifying 95 patients with MI and to differentiating them from 52 healthy reference subjects. Subsequently, and with a similar method, the location of the infarcted area permitted patient classification. METHODS: We analyzed five depolarization and four repolarization indexes, say: a) volume; b) planar area; c) QRS loop perimeter; d) QRS vector difference; e - g) Area under the QRS complex, ST segment and T-wave in the (X, Y, Z) leads; h) ST-T Vector Magnitude Difference; i) T-wave Vector Magnitude Difference; and j) the spatial angle between the QRS complex and the T-wave. For classification, patients were divided into two groups according to the infarcted area, that is, anterior or inferior sectors (MI-ant and MI-inf, respectively). RESULTS: Our results indicate that several ECG and VCG parameters show significant differences (p-value<0.05) between Healthy and MI subjects, and between MI-ant and MI-inf. Moreover, combining five parameters, it was possible to classify the MI and healthy subjects with a sensitivity = 95.8%, a specificity = 94.2%, and an accuracy = 95.2%, after applying a linear discriminant classifier method. Similarly, combining eight indexes, we could separate out the MI patients in MI-ant vs MI-inf with a sensitivity = 89.8%, 84.8%, respectively, and an accuracy = 89.8%. CONCLUSIONS: The new multivariable MI patient identification and localization technique, based on ECG and VCG combination indexes, offered excellent performance to differentiating populations with MI from healthy subjects. Furthermore, this technique might be applicable to estimating the infarcted area localization. In addition, the proposed method would be an alternative diagnostic technique in the emergency room.

Novel technique for ST-T interval characterization in patients with acute myocardial ischemia.

BACKGROUND: The novel signal processing techniques have allowed and improved the use of vectorcardiography (VCG) to diagnose and characterize myocardial ischemia. Herein, we studied vectorcardiographic dynamic changes of ventricular repolarization in 80 patients before (control) and during Percutaneous Transluminal Coronary Angioplasty (PTCA). METHODS: We propose four vectorcardiographic ST-T parameters, i.e., (a) ST Vector Magnitude Area (aSTVM); (b) T-wave Vector Magnitude Area (aTVM); (c) ST-T Vector Magnitude Difference (ST-TVD), and (d) T-wave Vector Magnitude Difference (TVD). For comparison, the conventional ST-Change Vector Magnitude (STCVM) and Spatial Ventricular Gradient (SVG) were also calculated. RESULTS: Our results indicate that several vectorcardiographic parameters show significant differences (p-value<0.05) before starting and during PTCA. Statistical minute-by-minute PTCA comparison against the control situation showed that ischemic monitoring reached a sensitivity=90.5% and a specificity=92.6% at the 5th minute of the PTCA, when aSTVM and ST-TVD were used as classifiers. CONCLUSIONS: We conclude that the sensitivity and specificity for acute ischemia monitoring could be increased with the use of only two vectorcardiographic parameters. Hence, the proposed technique based on vectorcardiography could be used in addition to the conventional ST-T analysis for better monitoring of ischemic patients.

Acute myocardial ischemia monitoring before and during angioplasty by a novel vectorcardiographic parameter set.

BACKGROUND: This work evaluates the vectorcardiographic dynamic changes in ischemic patients before and during Percutaneous Transluminal Coronary Angioplasty (PTCA). METHODS: Four QRS-loop parameters were computed in 51 ischemic and 52 healthy subjects with the objective of assessing the vectorcardiographic differences between both groups: maximum vector magnitude (QRS(mVM)), planar area (QRS(PA)), maximum distance between centroid and loop (QRS(mDCL)) and perimeter (QRS(P)).The conventional ST-change vector magnitude (STC(VM)), QRS-vector difference (QRS(VD)) and spatial ventricular gradient (SVG) were also calculated. RESULTS: Statistical minute-by-minute PTCA comparison against a healthy population showed that ischemic patients monitoring is greatly enhanced when all the QRS-loop parameters, in combination with the standard STC(VM), QRS(VD) and SVG indexes, are used in the classification. Sensitivity and Specificity, in turn, reached rather high values, 95.4% and 95.2%, respectively. CONCLUSIONS: These new vectorcardiographic set of complementary QRS-loop parameters, when combined with the classics STC(VM), QRS(VD) and SVG indexes, increase sensitivity and specificity for acute ischemia monitoring.

Sleep apnea detection based on spectral analysis of three ECG - derived respiratory signals.

An apnea detection method based on spectral analysis was used to assess the performance of three ECG derived respiratory (EDR) signals. They were obtained on R wave area (EDR1), heart rate variability (EDR2) and R peak amplitude (EDR3) of ECG record in 8 patients with sleep apnea syndrome. The mean, central, peak and first quartile frequencies were computed from the spectrum every 1 min for each EDR. For each frequency parameter a threshold-based decision was carried out on every 1 min segment of the three EDR, classifying it as 'apnea' when its frequency value was below a determined threshold or as 'not apnea' in other cases. Results indicated that EDR1, based on R wave area has better performance in detecting apnea episodes with values of specificity (Sp) and sensitivity (Se) near 90%; EDR2 showed similar Sp but lower Se (78%); whereas EDR3 based on R peak amplitude did not detect appropriately the apneas episodes reaching Sp and Se values near 60%.

Performance evaluation of three methods for respiratory signal estimation from the electrocardiogram.

A comparative study of three methods for estimating respiratory signal through electrocardiogram (ECG) was carried out. The three methods analyzed were based on R wave area, R peak amplitude and heart rate variability (HRV). For each method, cross-correlation coefficient and spectral coherence in a range of frequencies up to 0.5 Hz were computed between the ECG derived respiratory signals (EDR) and the three real respiratory signals: oronasal, and two inductance plethysmographies recordings (chest and abdominal). Results indicate that EDR methods based on R wave area and HRV are better correlated and show a wider spectral coherence with real respiratory signals than the other EDR method based on R peak amplitude.