Initial Upper Paleolithic bone technology and personal ornaments at Bacho Kiro Cave (Bulgaria).

The expansion of Homo sapiens and our interaction with local environments, including the replacement or absorption of local populations, is a key component in understanding the evolution of our species. Of special interest are artifacts made from hard animal tissues from layers at Bacho Kiro Cave (Bulgaria) that have been attributed to the Initial Upper Paleolithic. The Initial Upper Paleolithic is characterized by Levallois-like blade technologies that can co-occur with bone tools and ornaments and likely represents the dispersal of H. sapiens into several regions throughout Eurasia starting by 45 ka or possibly earlier. Osseous artifacts from the Initial Upper Paleolithic are important components of this record and have the potential to contribute to our understanding of group interactions and population movements. Here, we present a zooarchaeological, technological, and functional analysis of the diverse and sizable osseous artifact collection from Bacho Kiro Cave. Animal raw material sources are consistent with taxa found within the faunal assemblage including cervids, large bovids, and cave bears. A variety of bone tool morphologies, both formal and informal, indicate a diverse technological approach for conducting various on-site activities, many of which were focused on the processing of animal skins, likely for cold weather clothing. Technological flexibility is also evident in the manufacture of personal ornaments, which were made primarily from carnivore teeth, especially cave bear, though herbivore teeth and small beads are also represented. The osseous artifacts from Bacho Kiro Cave provide a series of insights into the bone technology and indirectly on the social aspects of these humans in southeast Europe, and when placed within the broader Initial Upper Paleolithic context, both regional and shared behaviors are evidently indicating widespread innovation and complexity. This is especially significant given the location and chronology of the site in the context of H. sapiens dispersals.

Combining DNA metabarcoding and ecological networks to inform conservation biocontrol by small vertebrate predators.

In multifunctional landscapes, diverse communities of flying vertebrate predators provide vital services of insect pest control. In such landscapes, conservation biocontrol should benefit service-providing species to enhance the flow, stability and resilience of pest control services supporting the production of food and fiber. However, this would require identifying key service providers, which may be challenging when multiple predators interact with multiple pests. Here we provide a framework to identify the functional role of individual species to pest control in multifunctional landscapes. First, we used DNA metabarcoding to provide detailed data on pest species predation by diverse predator communities. Then, these data were fed into an extensive network analysis, in which information relevant for conservation biocontrol is gained from parameters describing network structure (e.g., modularity) and species roles in such network (e.g., centrality, specialization). We applied our framework to a Mediterranean landscape, where 19 bat species were found to feed on 132 insect pest species. Metabarcoding data revealed potentially important bats that consumed insect pest species in high frequency and/or diversity. Network analysis showed a modular structure, indicating sets of bat species that are required to regulate specific sets of insect pests. A few generalist bats had particularly important roles, either at network or module levels. Extinction simulations highlighted six bats, including species of conservation concern, which were sufficient to ensure that over three-quarters of the pest species had at least one bat predator. Combining DNA metabarcoding and ecological network analysis provides a valuable framework to identify individual species within diverse predator communities that might have a disproportionate contribution to pest control services in multifunctional landscapes. These species can be regarded as candidate targets for conservation biocontrol, although additional information is needed to evaluate their actual effectiveness in pest regulation.

Quinolone-Hydroxyquinoline Tautomerism in Quinolone 3-Esters. Preserving the 4-Oxoquinoline Structure To Retain Antimalarial Activity.

Recent publications report in vitro activity of quinolone 3-esters against the bc1 protein complex of Plasmodium falciparum and the parasite. Docking studies performed in silico at the yeast Qo site established a key role for the 4-oxo and N-H groups in drug-target interactions. Thus, the possibility of 4-oxoquinoline/4-hydroxyquinoline tautomerism may impact in pharmacologic profiles and should be investigated. We describe the synthesis, structure, photochemistry, and activity against multidrug-resistant P. falciparum strain Dd2 of ethyl 4-oxo-7-methylquinoline-3-carboxylate (7Me-OQE) and ethyl 4-hydroxy-5-methylquinoline-3-carboxylate (5Me-HQE), obtained from diethyl 2-[((3-methylphenyl)amino)methylene]malonate. Theoretically (B3LYP/6-311++G(d,p)), 5Me-HQE and 7Me-OQE show clear preference for the hydroxyquinoline form. The difference between the lowest energy hydroxyquinoline and quinolone forms is 27 and 38 kJ mol(-1), for 5Me-HQE and 7Me-OQE, respectively. Calculations of aromaticity indexes show that in 5Me-HQE both rings are aromatic, while in the corresponding oxo tautomers the nitrogen-containing ring is essentially non-aromatic. The structure of monomeric 5Me-HQE was studied using matrix isolation coupled to FTIR spectroscopy. No traces of 4-oxoquinoline tautomers were found in the experimental IR spectra, revealing that the species present in the crystal, 5Me-HQE·HCl, was lost HCl upon sublimation but did not tautomerize. Continuous broadband irradiation (λ > 220 nm; 130 min) of the matrix led to only partial photodecomposition of 5Me-HQE (ca. 1/3).

Changing with the times: Seasonal environmental gradients unveil dynamic bat assemblages and vulnerability.

Uncovering the temporal and spatial dynamics of biological communities in response to biotic and abiotic drivers is essential to predict the effects of environmental change on biodiversity. Similarly, estimating species vulnerability in the face of such dynamics is crucial for implementing effective conservation actions. We explored how bat diversity changes over the year across an altitudinal gradient and identified the environmental drivers that shape bat communities. By analysing species' marginality within the biophysical niche space, we evaluated bats' vulnerability to foreseeable environmental changes. Our results suggest that altitude, the proportion of forest cover and shrub cover are the main drivers shaping bat communities year-round. Additionally, while some bat species are restricted to a single ecological assemblage (or ecological preferences group), others show greater plasticity throughout the year. Importantly, we found that although bats associated with highland habitats and forests could be particularly vulnerable to environmental changes (in particular Myotis mystacinus), this vulnerability correlates poorly with their national conservation status. We suggest that species' ecological plasticity is critical for the resilience of biological communities exposed to environmental changes and should be considered when planning tailored conservation strategies.

Validation of a lithium-ion commercial battery pack model using experimental data for stationary energy management application.

Background: A cost-effective solution for the design of distributed energy storage systems implies the development of battery performance models yielding a suitable representation of its dynamic behaviour under realistic operation conditions. Methods: In this work, a lithium-ion battery (LIB) is tested to be further modelled and integrated into an existing energy management control system. This specific LIB (5.0 kW /9.8 kWh) is integrated with a commercial inverter and solar photovoltaic (PV) system (3.3 kWp) as part of a microgrid that is also encompassing other energy storage technologies at the University of Évora, Pole of INIESC - National Research Infrastructure for Solar Energy Concentration. A testing protocol fully characterizes the battery and the inverter efficiency to describe their performance better. Then, a battery model is built upon both the existent LIB description and experimental fitting regression. The model allows obtaining the voltage curve, the internal resistance (i.e., to describe instantaneous voltage drop/rise and transients), and the state of charge (SOC) and/or energy capacity based on the current input. The developed model is validated through the comparison with the experimental results. Results: The model approach presented a higher voltage RMSE (root mean square error) of 5.51 V and an MRE (maximum relative error) of 5.68 % in the discharge state. Regarding SOC, the MRE obtained was approximately 6.82 %. In the charge state, the highest RMSE voltage was 5.27 V, with an MRE of 6.74 %. Concerning SOC, the MRE obtained was approximately 6.53 %.  Conclusions: The developed model is validated through the comparison with experimental results. Based on computational effort, simplicity of use and the associated model error, the approach is validated to the regular conditions of the commercial battery pack to be incorporated in the next research step, following a bottom-up modelling approach for an increasingly more complex smart grid.

Counteracting forces of introgressive hybridization and interspecific competition shape the morphological traits of cryptic Iberian Eptesicus bats.

Cryptic species that coexist in sympatry are likely to simultaneously experience strong competition and hybridization. The first phenomenon would lead to character displacement, whereas the second can potentially promote morphological similarity through adaptive introgression. The main goal of this work was to investigate the effect of introgressive hybridization on the morphology of cryptic Iberian Eptesicus bats when facing counteracting evolutionary forces from interspecific competition. We found substantial overlap both in dentition and in wing morphology traits, though mainly in individuals in sympatry. The presence of hybrids contributes to a fifth of this overlap, with hybrids showing traits with intermediate morphometry. Thus, introgressive hybridization may contribute to species adaptation to trophic and ecological space responding directly to the macro-habitats characteristics of the sympatric zone and to local prey availability. On the other hand, fur shade tended to be browner and brighter in hybrids than parental species. Colour differences could result from partitioning of resources as an adaptation to environmental factors such as roost and microhabitats. We argue that a balance between adaptive introgression and niche partitioning shapes species interactions with the environment through affecting morphological traits under selection.

A case of behavioral changes in a castrated male cat due to a functional adrenocortical adenoma producing testosterone and androstenedione.

CASE SUMMARY: This case report describes a 9-year-old neutered male cat with a functional adrenal tumor showing aggression toward other cats in the household, excessive meowing and urine spraying. The diagnosis was made based on the clinical signs, an enlarged right adrenal gland on ultrasound, penile spines and elevated sex hormones on an adrenocorticotropic hormone stimulation test. The cat was submitted to celiotomy and adrenalectomy. Histopathological examination confirmed the adrenocortical adenoma. Three months after surgery the penile spines disappeared and urine spraying, as well as excessive meowing, had greatly decreased; however, aggressive behavior took much longer to stop and required behavior therapy. RELEVANCE AND NOVEL INFORMATION: Functional adrenal tumors producing only sex hormones and behavioral changes are uncommon. The cat reported herein started showing behavioral changes before spines appeared on the penis, and structural alterations in the adrenal gland at the abdominal ultrasonography were detected. Considering all the possible implications resulting from severe behavior problems such as cat-cat aggression, from a permanent separation of the cats to relinquishment, a detailed investigation of underlying medical mechanisms in these animals is crucial from the start. Examinations may need to be repeated later in the course.

Hidden in our pockets: building of a DNA barcode library unveils the first record of Myotis alcathoe for Portugal.

BACKGROUND: The advent and boom of DNA barcoding technologies have provided a powerful tool for the fields of ecology and systematics. Here, we present the InBIO Barcoding Initiative Database: Portuguese Bats (Chiroptera) dataset containing DNA sequences of 63 specimens representing the 25 bat species currently known for continental Portugal. For that, we sequenced tissues samples obtained in a vast array of projects spanning the last two decades. NEW INFORMATION: We added four new Barcoding Index Numbers (BINs) to existing Chiroptera barcodes on BOLD, two belonging to Myotis escalerai, one to Plecotus auritus and the other to Rhinolophus hipposideros. Surprisingly, one of the samples initially identified in the field as Myotis mystacinus turned out to be Myotis alcathoe, which represents the first record of this species for Portugal. The presence of Nyctalus noctula in Portugal was also genetically confirmed for the first time. This case study shows the power and value of DNA barcoding initiatives to unravel new data that may be hidden on biological collections.

Rational Design, Synthesis, and Biological Evaluation of Heterocyclic Quinolones Targeting the Respiratory Chain of Mycobacterium tuberculosis.

A high-throughput screen (HTS) was undertaken against the respiratory chain dehydrogenase component, NADH:menaquinone oxidoreductase (Ndh) of Mycobacterium tuberculosis (Mtb). The 11000 compounds were selected for the HTS based on the known phenothiazine Ndh inhibitors, trifluoperazine and thioridazine. Combined HTS (11000 compounds) and in-house screening of a limited number of quinolones (50 compounds) identified ∼100 hits and four distinct chemotypes, the most promising of which contained the quinolone core. Subsequent Mtb screening of the complete in-house quinolone library (350 compounds) identified a further ∼90 hits across three quinolone subtemplates. Quinolones containing the amine-based side chain were selected as the pharmacophore for further modification, resulting in metabolically stable quinolones effective against multi drug resistant (MDR) Mtb. The lead compound, 42a (MTC420), displays acceptable antituberculosis activity (Mtb IC50 = 525 nM, Mtb Wayne IC50 = 76 nM, and MDR Mtb patient isolates IC50 = 140 nM) and favorable pharmacokinetic and toxicological profiles.

Direct communication between the left circumflex and the right coronary arteries: a very rare coronary anomaly circulation.

Coronary artery anomalies (CAA) are congenital changes in their origin, course, and/or structure. Intercoronary communication (ICC) is a very rare subset with uni- or bidirectional blood flow between two or more coronary arteries. We present the case of a 58-year-old man with an acute coronary syndrome whose coronary angiography incidentally showed a surprising and very rare communication between the right coronary and left circumflex arteries.

Exercise training attenuates blood pressure elevation and adverse remodeling in the aorta of spontaneously hypertensive rats.

OBJECTIVE: To observe the extracellular matrix modifications and quantify the structural alterations of the aortic wall in spontaneously hypertensive rats (SHR) submitted to an aerobic physical activity (PA) protocol. MATERIAL AND METHODS: Three groups of five rats each were studied: sedentary normotensive Wistar rats (SED-Wistar) and SHR (divided in SHR that underwent a 1 h/day 5 days/week PA for 20 weeks (EX-SHR) and those that were restricted to cage-bound activity (SED-SHR). RESULTS: BP was lower in EX-SHRs and SED-Wistar rats (-35%) than in SED-SHRs. This difference became significant from the 3rd week of PA. The wall thickness was smaller in the EX-SHR and SED-Wistar (-45%) than in the SED-SHR (p<0.0001). In EX-SHR group, oxytalan and elaunin fibers were more pronounced than in the other groups, while SED-SHR and SED-Wistar rats showed an equivalent appearance of aortic elaunin fibers. EX-SHR and SED-Wistar rats showed more than 65% greater smooth muscle nuclei numerical density per unit area than SED-SHRs while SED-SHRs showed more than 45% smaller surface density of lamellae than both EX-SHR and SED-Wistar rats. However, no quantitative differences were found in the aortic wall comparing EX-SHR and SED-Wistar rats. CONCLUSION: PA might alter the aortic wall remodeling to adapt the artery to a hyperkinetic blood flow resulting in alterations of the extracellular matrix modulation and vascular resistance.

[Intracoronary inflammatory markers after percutaneous coronary interventions]. / Marcadores inflamatórios intracoronarianos após intervenções coronarianas percutâneas.

OBJECTIVE: To analyze intracoronary release of inflammatory markers (IM) after percutaneous coronary interventions (PCI) and compare their concentrations concerning the type of PCI used (rotablator vs. balloon angioplasty). METHODS: Twenty-two patients with average age of 60 +/- 11.9 years old, 12 of male sex, with stable coronary disease, submitted to elective treatment of a single coronary lesion, using rotablator (N = 11) or balloon pre-dilatation (N = 11) for stent implant were randomized. Samples were collected at aorta root and coronary sinus, immediately before and 15 minutes after intervention. All dosages were made before stent implant, and the cytokines TNF-a, IL-6 and IL-1 and the soluble adhesion molecules ICAM-1, E-selectin and P-selectin were analyzed by using ELISA method. RESULTS: TNF-a and IL-6 concentrations increased after PCI, respectively from 9.5 +/- 1.5 pg/ml to 9.9 +/- 1.8 pg/ml (p = 0.017) and from 6.0 +/- 2.4 pg/ml to 6.9 +/- 3.0 pg/ml (p < 0.001). There was no significant changes in IL-1, ICAM-1 and P-selectin, and a decrease in E-selectin concentrations after the procedures (52.0 +/- 17.5 ng/ml to 49.3 +/- 18.7 ng/ml; p = 0.009) was observed. There were no significant differences between IM concentrations after PCI, concerning the type of procedure used. CONCLUSION: At the early period, post-percutaneous coronary interventions, an increase of intracoronary concentrations of TNF-a and IL-6, and absence of significant difference between concentrations of inflammatory markers released in coronary flow through rotablator and balloon angioplasty were observed.

Luminal recovery from six to twelve months after implantation of "thicker strut" coronary stents.

A group of 50 patients with 51 de novo lesions treated with thicker strut stents (strut thickness >100 microm) was angiographically evaluated at baseline, after stenting, and at 6 and 12 months. Minimal luminal diameter (MLD) significantly increased from 6 to 12 months (6 months: 1.72 +/- 0.50 mm vs 12 months: 1.81 +/- 0.47 mm; p <0.01). The binary restenosis (diameter stenosis >50%) rate was 17% at 6 months and 11% at 12 months (p = NS). At multivariate analysis, lumen loss at 6 months (p = 0.018) and deployment pressure (p = 0.041) independently predicted the changes in MLD between 6 and 12 months.

Evaluation of plaque composition by intravascular ultrasound "virtual histology": the impact of dense calcium on the measurement of necrotic tissue.

AIMS: We aimed to evaluate if the co-localisation of calcium and necrosis in intravascular ultrasound virtual histology (IVUS-VH) is due to artefact, and whether this effect can be mathematically estimated. METHODS AND RESULTS: We hypothesised that, in case calcium induces an artefactual coding of necrosis, any addition in calcium content would generate an artificial increment in the necrotic tissue. Stent struts were used to simulate the "added calcium". The change in the amount and in the spatial localisation of necrotic tissue was evaluated before and after stenting (n=17 coronary lesions) by means of a especially developed imaging software. The area of "calcium" increased from a median of 0.04 mm2 at baseline to 0.76 mm2 after stenting (p<0.01). In parallel the median necrotic content increased from 0.19 mm2 to 0.59 mm2 (p<0.01). The "added" calcium strongly predicted a proportional increase in necrosis-coded tissue in the areas surrounding the calcium-like spots (model R2=0.70; p<0.001). CONCLUSIONS: Artificial addition of calcium-like elements to the atherosclerotic plaque led to an increase in necrotic tissue in virtual histology that is probably artefactual. The overestimation of necrotic tissue by calcium strictly followed a linear pattern, indicating that it may be amenable to mathematical correction.

Prognostic heterogeneity among patients with chronic stable coronary disease: determinants of long-term mortality after treatment with percutaneous intervention.

AIMS: To evaluate the risk and predictors of death in a large population of patients with stable coronary disease treated with percutaneous intervention. METHODS AND RESULTS: The study population comprised 1,276 patients with chronic angina or silent ischaemia who underwent elective coronary angioplasty. Baseline and in-hospital mortality data were prospectively collected for all patients during the index hospitalisation. Post-discharge outcome was assessed at out-patient clinic, by review of the patients' records, or direct phone contact. Deaths were classified as cardiac and non-cardiac. Age, peripheral arterial disease, congestive heart failure with NYHA class >or= III, triple-vessel disease, and procedural success (i.e. angiographic success for all lesions in the absence of peri-procedural infarction) remained as multivariate independent predictors of death. For the entire population 4-year cumulative all-cause and cardiac mortality were respectively 5.4% and 4.1%. Four-year mortality for patients without any multivariate predictor was 2.4%, while for patients with two or more predictors the death rate was 16.3% after four years. CONCLUSIONS: Patients with stable coronary disease undergoing percutaneous treatment have an overall low mortality rate after four years. Nevertheless, stable patients comprise a heterogeneous population in terms of risk profile, ranging from patients at very low risk of late death to individuals with a poor long-term prognosis.

Tendências da Utilização da Via de Acesso Transradial em Mais de Uma Década: A Experiência do InCor / Trends in the Use of the Transradial Approach in More Than a Decade: The InCor's Experience

Introdução: A utilização da via radial para a realização de cateterismo cardíaco diagnóstico e intervenção coronária percutânea varia entre os diversos centros de hemodinâmica. Descrevemos as tendências do uso dessa via de acesso ao longo dos últimos 14 anos num serviço terciário. Métodos: Foram identificados procedimentos coronarianos consecutivos realizados de 1999 a 2013, em um único centro, em pacientes com idade ≥ 35 anos. Dados como idade, sexo, fonte provedora de recursos (Sistema de Saúde Público ou Saúde Suplementar/Privado) e complexidade do procedimento (diagnóstico ou terapêutico) foram retrospectivamente analisados. Resultados: Foram incluídos 103.253 procedimentos, dos quais o Sistema Único de Saúde (SUS) foi o provedor de recursos em 77% dos casos. A média de idades dos pacientes foi 62,2 ± 11,3 e 58,8% eram do sexo masculino. A via radial foi utilizada em 6.402 (6,2%) dos procedimentos, apresentando ascensão significativa ao longo do tempo, mais evidente quando analisada comparativamente nos seis períodos de experiência do serviço: 0,2%, 0,6%, 3,1%, 2,1%, 6,9% e 24,4%, respectivamente (p < 0,01). Porcentuais ainda maiores do uso da via radial foram encontrados, restringindo-se aos procedimentos realizados pelo SUS e quando apenas os cateterismos cardíacos diagnósticos foram contabilizados. Houve também mudança no perfil da via de acesso, ainda que de menor monta, no setor de Saúde Suplementar/Privado. Conclusões: Demonstramos a progressiva modificação do perfil de utilização das vias de acesso para a realização de cateterismo cardíaco diagnóstico e intervenção coronária percutânea de um centro de grande porte ao longo do tempo. Esses dados são condizentes...

Background: The use of the radial approach for diagnostic cardiac catheterization and percutaneous coronary interventions varies among different interventional cardiology centers in the world. We describe the trends in the use of this approach over the past 14 years at a tertiary hospital. Methods: Consecutive coronary procedures performed from 1999 to 2013 at a single center, in patients aged ≥ 35 years were identified. Age, gender, resource provider (Public or Private Healthcare System) and the complexity of the procedure (diagnostic or therapeutic) were retrospectively analyzed. Results: 103,253 procedures were included. The Brazilian Public Healthcare Service (SUS - Sistema Único de Saúde) was the resource provider in 77% of the cases. Mean age of patients was 62.2 ± 11.3 years and 58% were male. The radial approach was used in 6,402 (6.2%) procedures, showing a significant rise over time, which was more evident when analyzed comparatively for the six timepoints of service experience: 0.2%; 0.6%; 3.1%; 2.1%; 6.9%, and 24.4% respectively (p < 0.01). Even larger percentages of radial approach were observed when only the procedures performed by the SUS and diagnostic cardiac catheterizations were taken into account. There were also changes in the profile of vascular access, even though smaller, in the Private Healthcare System. Conclusions: We demonstrated progressive changes in the profile of the use of access routes for diagnostic cardiac catheterization and percutaneous coronary interventions at a large center over time. These data are consistent with the global trend and are significantly robust, especially when the last sextile is analyzed...

Dissecção Espontânea de Artéria Coronária: Abordagem Terapêutica e Desfechos de Uma Série Consecutiva de Casos / Spontaneous Coronary Artery Dissection: Therapeutic Approach and Outcomes of a Consecutive Series of Cases

Introdução: A dissecção espontânea de artéria coronária é causa rara de síndrome coronariana aguda e, em mais de 70% das vezes, o diagnóstico é feito por meio de necrópsia. O tratamento ideal ainda é incerto, sendo a intervenção coronária percutânea, a cirurgia de revascularização miocárdica e o tratamento clínico as opções terapêuticas. O objetivo deste trabalho foi avaliar as características clínicas, o tratamento e a evolução de uma série de casos de dissecção espontânea de artéria coronária. Métodos: Estudo retrospectivo, unicêntrico, baseado em análise de banco de dados de um serviço de alta complexidade em cardiologia. Resultados: Identificamos 25 pacientes com dissecção espontânea de artéria coronária, dos quais 56% eram do sexo feminino, com idade de 48,8 ± 10 anos. Apenas 24% não apresentaram fator de risco para aterosclerose e, em 92% dos casos, o quadro clínico foi de síndrome coronária aguda. A artéria descendente anterior foi o vaso mais acometido (48%) e houve apenas um caso envolvendo múltiplos vasos. A estratégia conservadora foi realizada em 56%, a intervenção coronária percutânea em 40% e a revascularização miocárdica em 4%. A taxa livre de eventos hospitalares e tardios foi de 92 e 84,2%, respectivamente. Conclusões: A dissecção espontânea de artéria coronária foi predominante em mulheres jovens, com pelo menos um fator de risco para doença arterial coronariana. A escolha de diferentes estratégias terapêuticas confirma a natureza ainda controversa da abordagem ideal da dissecção espontânea de artéria coronária. Acreditamos que o tratamento ideal ainda seja o individualizado.

Background: Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome and diagnosis is made by necropsy in more than 70% of the cases. Optimal treatment is still uncertain, and the treatment options are percutaneous coronary intervention, coronary artery bypass surgery and medical therapy. The objective of this study was to evaluate the clinical characteristics, treatment modalities and outcome of a series of cases with spontaneous coronary artery dissection. Methods: Retrospective, single-center study, based on the analysis of the database at a high-complexity cardiology service. Results: We identified 25 patients with spontaneous coronary artery dissection, 56% were female, with a mean age of 48.8 ± 10 years. Only 24% had no risk factor for atherosclerosis and in 92% of the cases, the clinical presentation was of acute coronary syndrome. The left anterior descending artery was the most commonly affected vessel (48,1%) and there was only one case involving multiple vessels. The conservative approach was used in 56%, percutaneous coronary intervention in 40% and coronary artery bypass grafting in 4%. The in-hospital and late event-free survival was 92% and 84.2%, respectively. Conclusions: Spontaneous coronary artery dissection predominated in young women, with at least one risk factor for coronary artery disease. The choice of different therapeutic strategies confirms the still controversial nature of the optimal approach for spontaneous coronary artery dissection. We believe that individualized therapy is still the optimal modality.

Remoção Precoce do Introdutor Arterial Após Intervenção Coronária Percutânea por Via Femoral: Estudo de Segurança e Eficácia / Early Removal of the Arterial Sheath After Percutaneous Coronary Intervention Using the Femoral Approach: Safety and Efficacy Study

Introdução: Avaliamos a segurança e eficácia do uso de protamina, guiada pelo tempo de coagulação ativado, para a remoção imediata do introdutor arterial femoral em pacientes submetidos à intervenção coronária percutânea com heparina não fracionada, com o objetivo de propor um algoritmo para a prática clínica. Métodos: Estudo prospectivo, com pacientes consecutivos, com angina estável ou com síndrome coronariana aguda de baixo ou moderado risco. Comparamos os pacientes com a retirada precoce do introdutor arterial àqueles nos quais o introdutor foi retirado de acordo com o protocolo convencional. A decisão pela remoção precoce ou convencional do introdutor foi deixada a critério do operador. Resultados: O grupo de remoção precoce (n = 149) apresentou menor tempo de manuseio do sítio de punção que o grupo de remoção convencional (58,3 ± 21,4 minutos vs. 355 ± 62,9 minutos; p < 0,01), principalmente devido à redução do tempo até a retirada do introdutor (42,3 ± 21,1 minutos vs. 338,6 ± 61,5 minutos; p < 0,01), sem impacto sobre a duração da compressão femoral (16,0 ± 3,6 minutos vs. 16,4 ± 5,1 minutos; p = 0,49). Não houve trombose hospitalar de stent e nem diferença significativa na incidência de eventos vasculares ou hemorrágicos. A incidência de outras hemorragias, que levaram à hospitalização prolongada, foi menor no grupo de remoção precoce (1,3% vs. 5,1%; p = 0,05). Conclusões: O uso seletivo de uma abordagem, para a remoção imediata do introdutor femoral guiada pelo tempo de coagulação ativado e a administração de protamina, é seguro e eficaz em pacientes submetidos à intervenção coronária...

Introduction: We evaluated the safety and efficacy of protamine administration, guided by activated clotting time, for the immediate femoral arterial sheath removal in patients undergoing percutaneous coronary intervention with unfractionated heparin in order to propose an algorithm for clinical practice. Methods: Prospective study with consecutive patients with stable angina or low-to-moderate risk acute coronary syndrome. We compared patients with an early removal of the arterial sheath to those whose sheath removal was based on a standard protocol. Results: The early removal group (n = 149) had lower access manipulation time than the conventional group (58.3 ± 21.4 minutes vs. 355.0 ± 62.9 minutes; p < 0.01), mainly due to a reduced time to sheath removal (42.3 ± 21.1 minutes vs. 338.6 ± 61.5 minutes; p < 0.01), with no impact on the duration of femoral compression (16.0 ± 3.6 minutes vs. 16.4 ± 5.1 minutes; p = 0.49). There was no stent thrombosis during hospitalization and no significant differences in the incidence of major vascular or bleeding events. The incidence of other bleeding events leading to a prolonged in-hospital length of stay was lower in the early removal group (1.3% vs. 5.1%; p = 0.05). Conclusions: The selective use of an approach for immediate femoral sheath removal, based on activated clotting time guidance and protamine administration, is a safe and effective option in patients undergoing percutaneous coronary intervention by femoral access...

Angiographic segment size in patients referred for coronary intervention is influenced by constitutional, anatomical, and clinical features.

BACKGROUND: Factors influencing the size of target vessels of patients referred for coronary intervention are poorly defined. We aimed to investigate in a large series of patients undergoing percutaneous intervention the relation of constitutional, anatomical, and clinical features with the reference diameter of coronary vessels treated with stenting. METHODS: A total of 4,850 de novo coronary lesions, non-ostial and non-bifurcational, located in native vessels were analyzed. The following pre-specified characteristics were analyzed to reflect the relation between constitutional, anatomical, and clinical features on reference vessel diameter: age, gender, height, weight, proximal location, vessel, diabetes, hypertension, multivessel disease, and clinical presentation. RESULTS: The average reference diameter was 2.66+/-0.50 mm. All pre-specified markers had a significant relation with the vessel reference diameter at univariate analysis, except by hypertension which showed a strong tendency. However, at multivariate analysis, only diabetes, proximal location, multivessel disease, clinical presentation, vessel, weight, and height were identified as independent predictors of reference vessel diameter. CONCLUSION: Reference diameter of coronary vessels at the site of lesions treated by stenting is significantly influenced by a variety of characteristics. We hypothesize that the treated segment size of patients undergoing stenting ultimately reflects the conjoint effect of several different factors, including constitutional, anatomical, and clinical features.