Coronary Sinus Phlebography in Cardiac Resynchronization Therapy Patients: Identifying and Solving Demanding Cases.

Cardiac resynchronization therapy (CRT) improves symptoms and reduces morbidity and mortality in select heart failure patients but remains challenging to deploy widely because of difficult or unsuccessful coronary sinus (CS) access in up to 10% to 15% of patients. This report describes the radiological and anatomical aspects for improving CS catheterization and left ventricular (LV) lead positioning, focusing on the radioscopic and anatomical aspects, based on phlebography, to identify demanding cases in patients with dilated cardiomyopathy referred for CRT implantation. Anatomical and radiological aspects were explored in the anteroposterior, 30° left anterior oblique, and 30° right anterior oblique (RAO) views. In total, 117 phlebographies were performed in 39 consecutive procedures (one reintervention). Access to the CS was successful 37 times (94.9%). The most difficult cases were complicated by issues related to the altered spatial orientation of the CS ostium toward the tricuspid annular plane (TAP), which was best perceived in the 30° RAO projection and occurred in 37% of patients. One of two catheterization failures that occurred was caused by anomalous coronary venous drainage into the left atrium. Final LV lead positioning was successful in 36 (92.3%) of 39 procedures. More severe heart failure and worse LV ejection fraction did not translate into greater difficulty in LV lead implantation. As such, understanding anatomical and radiological relationships is the key to successful LV lead positioning. RAO projection can be particularly useful in the assessment of demanding CRT implant cases, especially when the CS ostium pointed to the TAP.

Development and evaluation of a new recombinant protein vaccine (YidR) against Klebsiella pneumoniae infection.

Vaccination is a promising approach to prevent Klebsiella infection; however, the high heterogeneity of strains is a limiting factor. The best antigenic target for an anti-Klebsiella vaccine should be expressed by all or most of strains. We previously found YidR protein to be highly conserved among K. pneumoniae strains independently of antigen serotype. Therefore, in the present study, we developed a recombinant YidR protein vaccine and evaluated its protective efficacy against lethal challenge with K. pneumoniae in a mouse model. The yidR gene was cloned in Escherichia coli for recombinant expression. The lethal dose (LD100) of K. pneumoniae was determined and lethal challenge was carried out after immunization with recombinant purified YidR. After immunization, the concentration of total serum IgG was significantly higher in YidR-immunized mice than in non-immunized mice, indicating strong induction of antibodies. Mice were challenged with LD100 of K. pneumoniae, and significantly lower murine sepsis and higher body weight were observed in YidR-immunized mice compared to unvaccinated controls. Moreover, ∼90% of YidR-immunized mice survived beyond 10 days of observation, whereas none of the control mice survived past 48 h. The protective effect of YidR recombinant protein vaccine was demonstrated and YidR may be a promising vaccine candidate to prevent klebsiellosis.

ANTHELMINTIC EFFECTS OF DRIED GROUND BANANA PLANT LEAVES (MUSA SPP.) FED TO SHEEP ARTIFICIALLY INFECTED WITH HAEMONCHUS CONTORTUS AND TRICHOSTRONGYLUS COLUBRIFORMIS.

BACKGROUND: Helminths is a endoparasites that cause the major losses for profitable sheep production in Brazil. The increased development of resistant strains of endoparasites have enforced the search for sustainable alternatives. The aim of this paper was to provide information about endoparasites control with banana leaves in infected sheep as alternative control strategies and see its viability. MATERIALS AND METHODS: In this study, we performed two trials to investigate the anthelmintic properties of banana leaves on endoparasites in sheep. In Trial 1, twelve sheep were artificially infected with Trichostrongylus colubriformis; in Trial 2, eleven sheep were artificially infected with Haemonchus contortus. Clinical examinations, packed cell volume, total protein, faecal egg counts (FECs) and egg hatchability tests (EHTs) were performed. At the end of the trials, the sheep were humanely slaughtered, and total worm counts were performed. RESULTS: In Trial 1 and 2, no significant FEC decreases were note but significant diference in EHTs were observed. Total worm counts, clinical and haematological parameters did not reveal significant changes between the treatment and control groups. These results suggest that feeding dried ground banana plant leaves to sheep may reduce the viability of Trichostrongylus colubriformis eggs, and this anthelmintic activity is potentially exploitable as part of an integrated parasite management programme. CONCLUSION: However, further investigation is needed to establish the optimal dosage, develop a convenient delivery form and confirm the economic feasibility of using banana plantation byproducts as feed for ruminant species. Abbreviations: Coproculture test (CT)., Faecal egg count (FEC)., Egg hatchability test (EHT).