Atresia congênita do tronco da coronária esquerda em adulto jovem: rasa e potencialmente fatal anomalia coronária / Congenital atresia of the left main coronary artery in a young adult: a rare and potentially fatal coronary anomaly

Relato do caso de paciente do sexo masculino, 35 anos de idade, com atresia congênita do tronco da artéria coronária esquerda, afecção extremamente rara e com poucos casos descritos na literatura. Nessa afecção, o óstio da coronária esquerda está ausente, o tronco da coronária esquerda termina em fundo cego e o fluxo sanguíneo se dá da coronária direita para a esquerda por pequenas artérias colaterais e retrogradamente. O diagnóstico diferencial envolve outras malformações congênitas (artéria coronária direita única e origem anômala da artéria coronária esquerda do tronco da artéria pulmonar) e doença aterosclerótica adquirida do tronco da coronária esquerda.

We report the case of a 35-year-old male patient with congenital atresia of the left main coronary artery, a raredisease with few cases reported in the literature. In this anomaly, the left coronary ostium is absent, the proximalleft main trunk ends blindly and blood flow is retrograde from the right to the left coronary artery by small collateralarteries. Differential diagnosis includes other congenital malformations (single right coronary artery and anomalousorigin of the left coronary artery from the pulmonary artery) and acquired atherosclerotic disease of the left main coronary artery.

Accumulation of functional recombinant human coagulation factor IX in transgenic soybean seeds.

The seed-based production of recombinant proteins is an efficient strategy to achieve the accumulation, correct folding, and increased stability of these recombinant proteins. Among potential plant molecular farming systems, soybean [Glycine max (L.) Merrill] is a viable option for the production of recombinant proteins due to its high protein content, known regulatory sequences, efficient gene transfer protocols, and a scalable production system under greenhouse conditions. We report here the expression and stable accumulation of human coagulation factor IX (hFIX) in transgenic soybean seeds. A biolistic process was utilised to co-introduce a plasmid carrying the hFIX gene under the transcriptional control of the α' subunit of a ß-conglycinin seed-specific promoter and an α-Coixin signal peptide in soybean embryonic axes from mature seeds. The 56-kDa hFIX protein was expressed in the transgenic seeds at levels of up to 0.23% (0.8 g kg(-1) seed) of the total soluble seed protein as determined by an enzyme-linked immunosorbent assay (ELISA) and western blot. Ultrastructural immunocytochemistry assays indicated that the recombinant hFIX in seed cotyledonary cells was efficiently directed to protein storage vacuoles. Mass spectrometry characterisation confirmed the presence of the hFIX recombinant protein sequence. Protein extracts from transgenic seeds showed a blood-clotting activity of up to 1.4% of normal plasma. Our results demonstrate the correct processing and stable accumulation of functional hFIX in soybean seeds stored for 6 years under room temperature conditions (22 ± 2°C).

Influência dos stents farmacológicos na seleção de pacientes diabéticos tratados por meio de intervenção coronária percutânea / Influence of drug-eluting stents in the selection of diabetic pacients treated by percutaneous coronary intervention

Introdução: Os diabéticos representam um desafio para as intervenções coronárias percutâneas (ICP) em decorrência das elevadas taxas de reestenose, limitando a utilização desse procedimento em situações com grande perspectiva de recidiva, restringindo o emprego da técnica e predispondo à revascularização incompleta. Os stents farmacológicos contribuíram para a atenuação expressiva dessas limitações, podendo ter causado mudanças nas características dos casos tratados contemporaneamente. Assim, nosso objetivo foi comparar o perfil dos diabéticos tratados por ICP em dois momentos distintos desta década. Método: Estudo de coorte envolvendo 2.530 pacientes diabéticos revascularizados de forma consecutiva, divididos em dois grupos: grupo A, 1.309 pacientes revascularizados no período de 2006 a 2008; e grupo B, 1.221 pacientes tratados entre 2003 e 2005. Excluíram-se apenas os pacientes em que foram utilizados stents farmacológicos não disponíveis para uso comercial...

Background: Diabetic patients represent a challenge for percutaneous coronary interventions (PCI) due to the highrestenosis rates, which limit the use of the procedure in cases prone to recurrences, predisposing patients to incomplete revascularization. Drug-eluting stents (DES) have contributed for a significant improvement of these limitations and may have caused changes in the characteristics of patients treated contemporaneously. Thus, our objective was to compare the profile of diabetic patients treated intwo different periods of this decade. Method: This was a consecutive cohort study including 2,530 diabetic patientswho were divided into two groups: group A, 1,309 patients revascularized from 2006 to 2008; and group B, 1,221patients treated from 2003 to 2005. Only patients using DES not commercially available were excluded. Results: DES were more frequently used in group A (23% vs. 9%; P < 0.0001), which has a higher prevalence of insulin requiring patients (14% vs. 10%; P = 0.0001), chronic renal failure (20% vs. 10.1%; P < 0.0001), B2/C lesions(68% vs. 63%; P = 0.003), total occlusions (17% vs. 10%; P < 0.0001), stent diameter < 2.5 mm (26% vs. 22%; P = 0.01) and stent length > 24 mm (31% vs. 22%; P < 0.0001).Multivessel interventions (12% vs. 6%; P < 0.001) and complete revascularization (65% vs. 59%; P = 0.002) also prevailed in group A. Clinical hospital results were not different between groups. Conclusion: The greater availability of DES has led to significant changes in the profile ofdiabetic patients treated currently, expanding the indications for more complex patients and providing a more complete myocardial revascularization.

Dor Torácica na sala de emergência / Chest Pain in the Emergency Departments

A dor torácica é reponsável por um grande volume de atendimento em serviços de emergência, sendo sua apresentação clínica muitas vezes inespecífica, gerando dúvida no médico assistente, podendo resultar em diagnósticos errôneos, manejo clínico inadequado e ônus desnecessário. As uidades de dor torácica facilitam o diagnóstico diferencial discernindo pacientes graves, que necessitam de intervenções precoces, daqueles que podem receber alta hospitalar com posterior acompanhamento ambulatorial. O uso de uma estratégia diagnóstica sistematizada permit um melhor manuseio dos pacientes com dor torácica, com conseuqnete melhora no prognóstico dos pacientes tratados, além da redução dos custos decorrentes e admissões e exames desnecessários...

Expression of functional recombinant human factor IX in milk of mice.

Human factor IX is synthesized in the liver and secreted in the blood, where it participates in a group of reactions involving coagulation factors and proteins that permit sanguinary coagulation. In this work two lines of transgenic mice were developed to express the FIX gene in the mammalian glands under control of milk beta-casein promoter. The founding females secreted the FIX in their milk (3% total soluble protein). The stable integration of transgene was confirmed by southern blot analysis. The presence of the FIX recombinant protein in the milk of transgenic females was confirmed by western blot and the clotting activity was revealed in blood-clotting assays. The coagulation activity in human blood treated with recombinant FIX increased while the time of coagulation decreased. Our results confirm the production of a large amount of recombinant biologically active FIX in the mammary gland of transgenic mice.