RESUMO
BACKGROUND: During the first pandemic of COVID-19, early empirical antibiotic use rates for pneumonia varied widely. The benefit remains hypothetical. METHODS: We assessed the benefit of empirical antibiotic use at admission in patients hospitalized with COVID-19 pneumonia. We enrolled all adults admitted from 1 March to 30 April 2020 with symptoms for ≤14â days, a positive nasopharyngeal PCR or a highly suggestive CT scan. The primary outcome was mortality at Day 28. The secondary outcomes were transfer to the ICU, mechanical ventilation and length of hospital stay. To handle confounding-by-indication bias, we used a propensity score analysis, expressing the outcomes in the original and overlap weighted populations. RESULTS: Among 616 analysed patients, 402 (65%) received antibiotics. At Day 28, 102 patients (17%) had died, 90 (15%) had been transferred to the ICU and 24 (4%) had required mechanical ventilation. Mortality in patients who received antibiotics was higher before but not after weighting (OR 2.7, 95% CI 1.5-5.0, Pâ<â0.001 and OR 1.4, 95% CI 0.8-2.5, Pâ=â0.28, respectively. Antibiotic use had no benefit on: transfer to ICU before and after weighting (OR 1.3, 95% CI 0.8-2.3, Pâ=â0.30 and OR 1.1, 95% CI 0.6-1.9, Pâ=â0.78, respectively); mechanical ventilation before and after weighting (OR 0.5, 95% CI 0.2-1.1, Pâ=â0.079 and OR 0.75, 95% CI 0.3-2.0, Pâ=â0.55, respectively); and length of hospital stay before and after weighting (mean difference -0.02â±â0.5â days, Pâ=â0.97 and mean difference 0.54â±â0.75â days, Pâ=â0.48, respectively). CONCLUSIONS: We did not find any benefit of antibiotic use in patients hospitalized with COVID-19 pneumonia.
RESUMO
Pompe disease (PD) is a neuromuscular disorder caused by acid α-glucosidase (GAA) deficiency. Reduced GAA activity leads to pathological glycogen accumulation in cardiac and skeletal muscles responsible for severe heart impairment, respiratory defects, and muscle weakness. Enzyme replacement therapy with recombinant human GAA (rhGAA) is the standard-of-care treatment for PD, however, its efficacy is limited due to poor uptake in muscle and the development of an immune response. Multiple clinical trials are ongoing in PD with adeno-associated virus (AAV) vectors based on liver- and muscle-targeting. Current gene therapy approaches are limited by liver proliferation, poor muscle targeting, and the potential immune response to the hGAA transgene. To generate a treatment tailored to infantile-onset PD, we took advantage of a novel AAV capsid able to increase skeletal muscle targeting compared to AAV9 while reducing liver overload. When combined with a liver-muscle tandem promoter (LiMP), and despite the extensive liver-detargeting, this vector had a limited immune response to the hGAA transgene. This combination of capsid and promoter with improved muscle expression and specificity allowed for glycogen clearance in cardiac and skeletal muscles of Gaa-/- adult mice. In neonate Gaa-/- , complete rescue of glycogen content and muscle strength was observed 6 months after AAV vector injection. Our work highlights the importance of residual liver expression to control the immune response toward a potentially immunogenic transgene expressed in muscle. In conclusion, the demonstration of the efficacy of a muscle-specific AAV capsid-promoter combination for the full rescue of PD manifestation in both neonate and adult Gaa-/- provides a potential therapeutic avenue for the infantile-onset form of this devastating disease.
Assuntos
Dependovirus , Doença de Depósito de Glicogênio Tipo II , Camundongos , Humanos , Animais , Recém-Nascido , Dependovirus/genética , Dependovirus/metabolismo , Vetores Genéticos/genética , Camundongos Knockout , Doença de Depósito de Glicogênio Tipo II/genética , Doença de Depósito de Glicogênio Tipo II/terapia , Doença de Depósito de Glicogênio Tipo II/patologia , alfa-Glucosidases/genética , alfa-Glucosidases/uso terapêutico , Fígado/metabolismo , Músculo Esquelético/patologia , Glicogênio/metabolismo , Terapia Genética , FenótipoRESUMO
OBJECTIVES: The aim of the study was to assess whether the timing of combination antiretroviral therapy (cART) initiation, the choice of cART and virological response differ in migrants versus European natives in the north and east of Paris area, after dissemination of French recommendations for universal treatment. METHODS: Antiretroviral therapy-naïve HIV-1-infected adults with at least two follow-up visits at one of 15 participating centres between 1 January 2014 and 31 March 2015 were included in the study. Factors associated with cART initiation before 31 March 2015, with protease inhibitor (PI)-containing cART among individuals initiating cART, and with 1-year virological success after cART initiation were assessed using multivariable logistic regression models. Sex, age, region of origin [Western Europe, sub-Saharan Africa (SSA) or other], HIV transmission group, baseline AIDS status, CD4 cell count and plasma viral load (VL), and hepatitis B and/or C virus infection were considered in the analyses. RESULTS: Among 912 individuals, only 584 (64%) started cART during the study period. After adjustment, migrants from SSA were half as likely to initiate cART and to have a subsequent virological response compared with individuals from Western Europe [adjusted odds ratio (aOR) 0.54; 95% confidence interval (CI) 0.36-0.82; and aOR 0.52; 95% CI 0.28-0.98, respectively]. PI-containing cART was more frequently prescribed in migrants from SSA, in people with lower CD4 cell counts and in people with higher VL. CONCLUSIONS: Even in the context of universal cART recommendations and of free access to care, migrants from SSA still have delayed access to cART and a lower virological response. Efforts are still necessary to provide immediate cART to all people living with HIV.
Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Inibidores da Protease de HIV/uso terapêutico , Adulto , Antirretrovirais/farmacologia , Contagem de Linfócito CD4 , Feminino , França/etnologia , Infecções por HIV/etnologia , Infecções por HIV/imunologia , Inibidores da Protease de HIV/farmacologia , HIV-1/efeitos dos fármacos , HIV-1/genética , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Migrantes/estatística & dados numéricos , Resultado do Tratamento , Carga Viral , Adulto JovemRESUMO
OBJECTIVES: HIV-infected individuals are at increased risk of incident fractures. Evaluation of trabecular bone micro-architecture is an important tool to assess bone strength, but its use has not yet been reported in middle-aged HIV-infected male individuals. The aim of the study was to compare bone micro-architecture between HIV-infected and HIV-uninfected men. METHODS: In this cross-sectional study, 53 HIV-infected male individuals with a mean (± standard deviation) age of 49 ± 9 years who had been receiving antiretroviral therapy including tenofovir disoproxil fumarate (DF) for at least 60 months were compared with 50 HIV-uninfected male controls, matched for age and ethnic origin. We studied the volumetric bone density and micro-architecture of the radius and tibia using high-resolution peripheral quantitative computed tomography (HR-p QCT). RESULTS: Volumetric trabecular bone density was 17% lower in the tibia (P < 10(-4) ) and 16% lower in the radius (P < 10(-3) ) in HIV-infected patients compared with controls. By contrast, the cortical bone density was normal at both sites. The tibial trabecular micro-architecture differed markedly between patients and controls: bone volume/total volume (BV/TV) and trabecular number were each 13% lower (P < 10(-4) for both). Trabecular separation and inhomogeneity of the network were 18% and 24% higher in HIV-infected patients than in controls, respectively. The radial BV/TV and trabecular thickness were each 13% lower (P < 10(-3) and 10(-2) , respectively). Cortical thickness was not different between the two groups. CONCLUSIONS: The findings of lower volumetric trabecular bone density and disrupted trabecular micro-architectural parameters in middle-aged male HIV-infected treated patients help to explain bone frailty in these patients.
Assuntos
Antirretrovirais/uso terapêutico , Doenças Ósseas/patologia , Osso Esponjoso/patologia , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Adulto , Densidade Óssea , Doenças Ósseas/diagnóstico por imagem , Estudos Transversais , Humanos , Masculino , Pessoa de Meia-Idade , Rádio (Anatomia)/patologia , Tenofovir/uso terapêutico , Tíbia/patologia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Controlling prekallikrein activation by C1 inhibitor (C1Inh) represents the most essential mechanism for angioedema patient protection. C1Inh function in the plasma is usually measured based on the residual activity of the C1s protease not involved in the pathological process. We have hereby proposed an alternative enzymatic measurement of C1Inh function based on contact-phase activation and correlation with angioedema diagnostic requirements. METHODS: The contact phase was reconstituted using the purified components, with C1Inh standard or plasma sample. The kinetics of the amidase activity were monitored using Pro-Phe-Arg-pNA, independently of alpha2-macroglobulin. We prevented any interference from a possible high plasma kininogenase activity by preincubating the samples with protease inhibitor. Receiver operating characteristics (ROC) were used to calculate the assay's diagnostic performance. RESULTS: The calibration curve was built using C1Inh standard (threshold limit 0.10 × 10(-3) U, i.e., 0.2 pmol), and C1Inh function was quantified in the sample, with a reference interval established based on healthy individuals (n = 281; men: 0.61-1.10 U/ml, median: 0.85 U/ml; women: 0.42-1.08 U/ml, median: 0.74 U/ml). The median values of female donors were lower than those of the others due to estrogen, yet C1Inh function remained within the reference interval. The ROC curve calculation provided the following optimum diagnostic cutoff values: women 0.36 U/ml (area under curve [AUC]: 0.99; sensitivity: 93.48%; specificity: 99.37%); and men 0.61 U/ml (AUC: 1; sensitivity: 100.0%; specificity: 100.0%). CONCLUSION: The performance outcome provided features suitable for angioedema diagnostic or follow-up. Established by means of the kinin formation process, this assay should be preferred over the method based on a C1s protease target.
Assuntos
Proteínas Inativadoras do Complemento 1/metabolismo , Peptídeo Hidrolases/metabolismo , Angioedemas Hereditários/diagnóstico , Angioedemas Hereditários/imunologia , Angioedemas Hereditários/metabolismo , Bioensaio/métodos , Bioensaio/normas , Estrogênios/metabolismo , Fator XIIa/metabolismo , Feminino , Humanos , Cininogênios/metabolismo , Masculino , Pré-Calicreína/metabolismo , Ligação Proteica , Curva ROC , Valores de Referência , Reprodutibilidade dos Testes , alfa-Macroglobulinas/metabolismoRESUMO
OBJECTIVES: Previous studies in HIV-infected populations have yielded conflicting results on the effect of antiretroviral therapy (ART) on cognition. Our objective was to investigate the effect of several years of ART with stable central nervous system penetration effectiveness (CPE) score on neuropsychological performance in HIV-infected individuals. METHODS: We analysed a clinical cohort of HIV-infected patients who initiated ART between June 2003 and December 2006 and maintained stable CPE scores. Patients were evaluated with a short neuropsychological battery. Using linear regression, we examined the relationship between results of cognitive tests and CPE scores in all patients. RESULTS: Patients were divided into three similarly sized groups (CPE ≤ 1, CPE between 1.5 and 2.5, and CPE ≥ 2.5). We found that ART with high CPE scores was associated with poorer executive performances in HIV-1-infected patients. CONCLUSION: These results suggest that cognitive performance in treated HIV-infected patients could be influenced by ART.
Assuntos
Fármacos Anti-HIV/efeitos adversos , Sistema Nervoso Central/efeitos dos fármacos , Cognição/efeitos dos fármacos , Disfunção Cognitiva/induzido quimicamente , Soropositividade para HIV/tratamento farmacológico , Adulto , Fármacos Anti-HIV/farmacologia , Contagem de Linfócito CD4 , Sistema Nervoso Central/fisiopatologia , Disfunção Cognitiva/fisiopatologia , Escolaridade , Feminino , França , Soropositividade para HIV/complicações , Soropositividade para HIV/fisiopatologia , Humanos , Modelos Lineares , Masculino , Testes Neuropsicológicos , Fatores de TempoRESUMO
Data were collected in the course of a divergent selection experiment for residual feed intake (RFI) of Large White growing pigs. This data set was used to estimate (i) heritability for RFI and genetic correlations of RFI with growth and carcass traits within the three sexes (male, castrate and female) and (ii) genetic correlations between sexes for these traits. Individual feed intake of animals raised in collective pens was measured by single-place electronic feeders on 1121 males (candidates for selection), 508 females and 535 castrates (sibs of candidates). Variance components were estimated using the REML methodology applied to a multitrait animal model. Estimates of heritability for RFI were 0.16 ± 0.04, 0.16 ± 0.08 and 0.23 ± 0.10 for males, females and castrates, respectively. Estimates of genetic correlations between sexes for homologous traits were not significantly different from 1 (0.88 to 0.99 for RFI, 0.79 to 0.99 for growth traits and 0.65 to 0.99 for carcass composition traits). The relatively low genetic correlations between castrates and males or females for backfat thickness (0.65 and 0.69, respectively) suggest the presence of genotype by sex interactions for this trait.
Assuntos
Carne , Sus scrofa/crescimento & desenvolvimento , Sus scrofa/genética , Tecido Adiposo/crescimento & desenvolvimento , Animais , Ingestão de Alimentos , Feminino , Masculino , Orquiectomia , Aumento de PesoRESUMO
OBJECTIVE: The WHO recommends same-day sputum smear microscopy for the diagnosis of smear-positive tuberculosis (TB) in countries with high TB burden for earlier diagnosis and treatment, a cornerstone to prevent air-borne transmission. We aimed to compare the conventional strategy (sputum collection on three consecutive days) and the same-day strategy (hour h, h+1, h+2) in France, a country with low TB burden. PATIENTS AND METHODS: Over a six-month period, all adult individuals presenting with presumptive smear-positive TB were eligible for the study, registered in https://clinicaltrials.gov/ ID (NCT02961569). Sputum specimens were collected three times the first day, then once on the second day and once on the third day. The concordance between the two strategies regarding smears and cultures were assessed. RESULTS: Of the 131 eligible individuals, 34 were given a TB treatment. Smears from hour h, h+1, h+2, day two and three were negative in 19 of these 34 patients. Positive smears were obtained in 15, 14, 15, 14, and 14 patients at hour h, h+1, h+2, on day two and three, respectively. Concordance regarding smear or culture was good, with Kappa 0.69 and 0.64, respectively. CONCLUSION: The same-day strategy seems to be a good alternative to the conventional strategy.
Assuntos
Mycobacterium tuberculosis/isolamento & purificação , Escarro/microbiologia , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Precoce , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Adulto JovemRESUMO
BACKGROUND: We describe a homosexual man who strongly controlled HIV-1 for ten years despite lack of protective genetic background. METHODS: HIV-1 DNA was measured in blood and other tissues. Cell susceptibility was evaluated with various strains. HIV-1-specific (CD4 and CD8 activation markers and immune check points) and NK cells responses were assessed; KIRs haplotypes and HLA alleles were determined. FINDINGS: Two HIV-1 RNA copies/mL of plasma were detected in 2009, using an ultra-sensitive assay. HIV-DNA was detected at 1.1 and 2 copies/106 PBMCs in 2009 and 2015 respectively, at 1.2 copies/106 cells in rectal cells in 2011. WBs showed weak reactivity with antibodies to gp160, p55 and p25 from 2007 to 2014, remaining incomplete in 2017. CD4 T cells were susceptible to various strains including HIVKON, a primary isolate of his own CRF02_AG variant. CD8 T cells showed a strong poly-functional response against HIV-Gag, producing mainly IFN-γ; a robust capacity of antibody-dependant cell cytotoxicity (ADCC) was observed in NK cells. Case patient was group B KIR haplotype. Neutralizing antibodies were not detected. CD4 and CD8 blood T cells showed normal proportions without increased activation markers. Phylogenetic analyses identified the same CRF02_AG variant in his partner. The patient and his partner were heterozygous for the CCR5ΔD32 deletion and shared HLA-B*07, C*07 non-protective alleles. INTERPRETATION: This thorough description of the natural history of an individual controlling HIV-1 in various compartments for ten years despite lack of protective alleles, and of his partner, may have implications for strategies to cure HIV-1 infection.
Assuntos
Patrimônio Genético , Homossexualidade Masculina/genética , Parceiros Sexuais , Adulto , Infecções por HIV/genética , Infecções por HIV/imunologia , Infecções por HIV/virologia , HIV-1/fisiologia , Humanos , Masculino , Filogenia , Linfócitos T/imunologiaRESUMO
PURPOSE: The distinction between tuberculosis (TB), a worldwide infectious granulomatosis requiring specific antibiotic therapy, and sarcoidosis, a rare granulomatous disease that may require corticosteroids is not straightforward and may result in diagnostic and therapeutic delay. METHODS: We prospectively and consecutively evaluated the presence of epithelioid granulomas in minor salivary gland biopsy of 65 consecutive patients with TB. RESULTS: In our study, 10.8 % of our TB patients had epithelioid granulomas without caseous necrosis identified in their minor salivary gland biopsy, regardless of the location of TB, HIV status and whether or not the sputum examination was positive for tuberculous bacilli. CONCLUSION: The presence of epithelioid granulomas in minor salivary gland biopsy may not be helpful to the clinician to rule out TB in a patient with suspected sarcoidosis.
Assuntos
Granuloma/patologia , Doenças das Glândulas Salivares/patologia , Sarcoidose/patologia , Tuberculose/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Diagnóstico Diferencial , Feminino , Granuloma/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Doenças das Glândulas Salivares/epidemiologia , Glândulas Salivares Menores/patologia , Sarcoidose/diagnóstico , Tuberculose/epidemiologia , Adulto JovemRESUMO
OBJECTIVES: This study was carried out to determine the effect of the once-daily calcium channel blocking agent amlodipine (half-life 35 to 50 h) on the circadian pattern of myocardial ischemia in patients with chronic stable angina. BACKGROUND: Myocardial ischemia during normal daily life, both symptomatic and asymptomatic, has been associated with increased risk of cardiovascular morbidity and mortality, and the circadian pattern parallels that for myocardial infarction and sudden death. METHODS: The Circadian Anti-Ischemia Program in Europe (CAPE) was a large, 10-week international (63 sites), double-blind, parallel study. After a 2-week, single-blind placebo phase, during which stable doses of antianginal treatment were maintained (beta-adrenergic blocking agents in 65% of patients), patients with chronic stable angina with at least three attacks of angina per week, with at least four ischemic episodes or > or = 20 min of ST segment depression in 48 h of Holter monitoring, were randomized to receive treatment with either 5 mg/day of amlodipine or placebo (2:1 randomization). The dose was increased to 10 mg/day after 4 weeks. During week 7 of treatment, 48-h ambulatory ECG monitoring was repeated. RESULTS: Three hundred fifteen of 1,160 patients screened were eligible, and 250 had complete evaluable data. Compared with placebo, amlodipine significantly reduced both the frequency of ST segment depression episodes (60% for amlodipine vs. 44% for placebo, p = 0.025) and total integrated ST ischemic area (62% mm-min vs. 50% mm-min, p = 0.042). Amlodipine reduced ischemia over the 24 h with the intrinsic circadian pattern maintained. In addition, diary data showed a significant reduction in angina (70% for amlodipine vs. 44% for placebo, p = 0.0001) and in nitroglycerin consumption (67% vs. 22%, respectively, p = 0.0006). Amlodipine and placebo demonstrated similar safety profiles (adverse events 17.3% for amlodipine and 13.3% for placebo; discontinuation rates due to adverse events were 2% vs. 4.4%, respectively). CONCLUSIONS: Once-daily amlodipine, when added to background treatment, significantly reduced both symptomatic and asymptomatic ischemic events over 24 h in patients with chronic stable angina.
Assuntos
Anlodipino/uso terapêutico , Ritmo Circadiano , Isquemia Miocárdica/prevenção & controle , Adulto , Idoso , Anlodipino/administração & dosagem , Anlodipino/efeitos adversos , Método Duplo-Cego , Esquema de Medicação , Quimioterapia Combinada , Eletrocardiografia Ambulatorial/efeitos dos fármacos , Europa (Continente) , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/fisiopatologia , Nitroglicerina/uso terapêuticoRESUMO
Improvement of feed efficiency in pigs has been achieved essentially by increasing lean growth rate, which resulted in lower feed intake (FI). The objective was to evaluate the impact of strategies for improving feed efficiency on the dynamics of FI and growth in growing pigs to revisit nutrient recommendations and strategies for feed efficiency improvement. In 2010, three BWs, at 35±2, 63±9 and 107±7 kg, and daily FI during this period were recorded in three French test stations on 379 Large White and 327 French Landrace from maternal pig populations and 215 Large White from a sire population. Individual growth and FI model parameters were obtained with the InraPorc® software and individual nutrient requirements were computed. The model parameters were explored according to feed efficiency as measured by residual feed intake (RFI) or feed conversion ratio (FCR). Animals were separated in groups of better feed efficiency (RFI- or FCR-), medium feed efficiency and poor feed efficiency. Second, genetic relationships between feed efficiency and model parameters were estimated. Despite similar average daily gains (ADG) during the test for all RFI groups, RFI- pigs had a lower initial growth rate and a higher final growth rate compared with other pigs. The same initial growth rate was found for all FCR groups, but FCR- pigs had significantly higher final growth rates than other pigs, resulting in significantly different ADG. Dynamic of FI also differed between RFI or FCR groups. The calculated digestible lysine requirements, expressed in g/MJ net energy (NE), showed the same trends for RFI or FCR groups: the average requirements for the 25% most efficient animals were 13% higher than that of the 25% least efficient animals during the whole test, reaching 0.90 to 0.95 g/MJ NE at the beginning of the test, which is slightly greater than usual feed recommendations for growing pigs. Model parameters were moderately heritable (0.30±0.13 to 0.56±0.13), except for the precocity of growth (0.06±0.08). The parameter representing the quantity of feed at 50 kg BW showed a relatively high genetic correlation with RFI (0.49±0.14), and average protein deposition between 35 and 110 kg had the highest correlation with FCR (-0.76±0.08). Thus, growth and FI dynamics may be envisaged as breeding tools to improve feed efficiency. Furthermore, improvement of feed efficiency should be envisaged jointly with new feeding strategies.
Assuntos
Aminoácidos/metabolismo , Ração Animal/análise , Ingestão de Alimentos , Suínos/fisiologia , Ciências da Nutrição Animal , Fenômenos Fisiológicos da Nutrição Animal , Animais , Cruzamento , Ingestão de Alimentos/genética , Masculino , Fenótipo , Suínos/genética , Suínos/crescimento & desenvolvimento , Aumento de PesoRESUMO
The comparison of the anti-ischemic activity of trimetazidine and propranolol was evaluated by multiple end points (clinical, exercise test, and ambulatory electrocardiogram [ECG] monitoring criteria) in 149 male patients with effort angina who received either trimetazidine 20 mg tid or propranolol 40 mg tid during a period of 3 months. The distribution of the standardized differences between the two treatments for each variable was obtained by a permutation method. The medians (estimation of the actual difference between the two treatments) and the 5, 25, 75 and 95% quantiles were represented on the same diagram for all end points. The pattern of the standardized distribution of the differences showed a similar activity of both drugs on symptoms and nitrates consumption, on exercise tolerance and increase in ischemic threshold at exercise, and on ischemia recorded at ambulatory ECG monitoring. Conversely, only propranolol decreased heart rate and rate pressure product at rest as well as at exercise, underlining the difference in the mode of action of the two drugs. This descriptive technique is an attractive method to evaluate the differences between drugs considering multiple criteria favouring the estimation of these differences together with their variability.
Assuntos
Angina Pectoris/tratamento farmacológico , Propranolol/uso terapêutico , Trimetazidina/uso terapêutico , Vasodilatadores/uso terapêutico , Angina Pectoris/fisiopatologia , Interpretação Estatística de Dados , Método Duplo-Cego , Eletrocardiografia Ambulatorial , Tolerância ao Exercício , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Despite high patency rates, primary angioplasty for myocardial infarction does not necessarily result in optimal myocardial reperfusion and limitation of infarct size. Experimentally, trimetazidine limits infarct size, decreases platelet aggregation, and reduces leukocyte influx into the infarct zone. To assess trimetazidine as adjunctive therapy to primary angioplasty for acute myocardial infarction a prospective, double-blind, placebo-controlled pilot trial was performed. METHODS: 94 patients with acute myocardial infarction were randomized to receive trimetazidine (40 mg bolus followed by 60 mg/day intravenously for 48 h) (n=44) or placebo (n=50), starting before recanalization of the infarct vessel by primary angioplasty. Patients underwent continuous ST-segment monitoring to assess return of ST-segment deviation to baseline and presence of ST-segment exacerbation at the time of vessel recanalization. Infarct size was measured enzymatically from serial myoglobin measurements. Left ventricular angiography was performed before treatment and repeated at day 14. RESULTS: Blinded ST segment analysis showed that despite higher initial ST deviation from baseline in the trimetazidine group (355 (32) vs. 278 (29) microV, P=0.07), there was an earlier and more marked return towards baseline within the first 6 h than in the placebo group (P=0.014) (change: 245 (30) vs. 156 (31) microV respectively, P=0.044). There was a trend towards less frequent exacerbation of ST deviation at the time of recanalization in the trimetazidine group (23.3 vs. 42.2%, P=0.11). There was no difference in left ventricular wall motion at day 14, or in enzymatic infarct size. There was no side effect from treatment. Clinical outcomes were similar between groups. CONCLUSION: Trimetazidine was safe and led to earlier resolution of ST-segment elevation in patients treated by primary angioplasty for acute myocardial infarction.
Assuntos
Angioplastia Coronária com Balão , Infarto do Miocárdio/tratamento farmacológico , Infarto do Miocárdio/terapia , Trimetazidina/uso terapêutico , Vasodilatadores/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimioterapia Adjuvante , Angiografia Coronária , Método Duplo-Cego , Feminino , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Trimetazidina/administração & dosagem , Vasodilatadores/administração & dosagemRESUMO
Growth process of animals is regulated by a multitude of physiological pathways among which components of the somatotropic axis play a key role. A number of severe, simply inherited growth disturbances have been identified in humans, laboratory and farm animals. These disorders are controlled by defective alleles at major loci referring to hormones or hormone receptors, e.g. growth hormone receptor for the recessive sex-linked dwarfism (dw) in chickens and the recessive autosomal Laron-type dwarfism in man, and growth hormone releasing hormone receptor for the recessive "little" mutation (lit) in mice. Apart from these particular cases, growth rate is a quantitative polygenic trait which has a moderate heritability (close to 0.30) and is influenced by prenatal and postnatal maternal effects. Increase in the average coefficient of inbreeding in a population is also known to result in lower growth rate. Divergent selection experiments have shown that upward or downward selection on growth is effective, sometimes with asymmetrical responses, but patterns of changes in underlying physiological traits appear to differ among experiments.
Assuntos
Nanismo/veterinária , Transtornos do Crescimento/veterinária , Alelos , Animais , Galinhas , Nanismo/genética , Impressão Genômica/genética , Transtornos do Crescimento/genética , Hormônio do Crescimento/deficiência , Humanos , Endogamia , Camundongos , Camundongos Knockout , Mutação , Característica Quantitativa Herdável , Seleção Genética , SuínosRESUMO
The outbreak of bovine spongiform encephalopathy (BSE) and the discovery of the central role played by meat-and-bone meal (MBM) as the vehicle of infection resulted, from the late 1980s onwards, in the implementation of new regulations on the incorporation of animal proteins, and then of most fats of animal origin, into diets fed to ruminants and other farmed animals. The BSE-related feed ban, which has gradually been reinforced over time, has led to the investigation of cost-effective routes for adequately replacing MBM and tallow by new sources of dietary proteins, minerals and lipids in the formulation of manufactured concentrates. As far as the technical fulfilment of the nutritive requirements of growing and lactating ruminants is concerned, efficient alternative solutions, based principally on recourse to food materials from vegetals already exist or hopefully will soon be available in most of the situations prevailing in Europe. However, related aspects, such as animal feed-processing, availability and traceability of certain food materials, quality of animal products, environmental constraints or disposal of animal waste from the meat industry give cause for concern. The expected consequences of the BSE-related feeding regulations on the organisational and economic framework of animal and crop production sectors throughout Europe and at world level must also be evaluated.
Assuntos
Ração Animal/normas , Proteínas Alimentares/normas , Encefalopatia Espongiforme Bovina/prevenção & controle , Legislação sobre Alimentos , Ruminantes , Ração Animal/efeitos adversos , Animais , Bovinos , Gorduras na Dieta/normas , Surtos de Doenças/prevenção & controle , Surtos de Doenças/veterinária , Encefalopatia Espongiforme Bovina/epidemiologia , Encefalopatia Espongiforme Bovina/etiologia , Europa (Continente)/epidemiologia , HumanosRESUMO
A total of 383 barrows and gilts from a French Large White experimental herd were slaughtered at 100 kg BW. Samples of longissimus muscle were taken to categorize myofibers according to their contractile (I, IIA, and IIB) and metabolic (oxidative and nonoxidative) properties. Myofiber percentages, cross-sectional areas (CSA), and relative areas were measured. Growth rate, carcass composition, muscle chemical composition, metabolic enzyme activities, and meat quality traits were also measured to estimate phenotypic and genetic correlations between these traits and myofiber characteristics. Genetic parameters were estimated using a REML procedure applied to an individual animal model. Heritabilities of fiber traits were moderate to high (h2 = .20 to .59). Highest heritabilities were found for type I fiber percentage (h2 = .46 +/- .11), type IIBw fiber percentage (h2 = .58 +/- .11), and type I fiber cross-sectional area (h2 = .59 +/- .10). For a given fiber type, the relative area was phenotypically and genetically more closely related to the percentage than to the CSA. Phenotypic correlations between fiber type composition and other traits were low. Genetically, growth rate, carcass leanness, and loin eye area were positively related to fiber CSA. Intramuscular fat content was not related to fiber type composition (r(g) = -.05 to .06), whereas it was positively related to fiber CSA (r(g) = .68). Type IIBw fiber percentage was related to pH at 30 min (r(g) = -.46), pH at 24 h (r(g) = -.62), glycolytic potential (r(g) = .31), and lightness of color (r(g) = .55) of longissimus muscle.
Assuntos
Composição Corporal/genética , Carne/normas , Desenvolvimento Muscular , Fibras Musculares Esqueléticas/fisiologia , Músculo Esquelético/crescimento & desenvolvimento , Músculo Esquelético/fisiologia , Suínos/genética , Alelos , Animais , Composição Corporal/fisiologia , Citrato (si)-Sintase/análise , Feminino , Genótipo , Histocitoquímica , L-Lactato Desidrogenase/análise , Masculino , Fibras Musculares Esqueléticas/química , Fibras Musculares Esqueléticas/enzimologia , Músculo Esquelético/química , Fenótipo , Caracteres Sexuais , Suínos/crescimento & desenvolvimento , Suínos/fisiologiaRESUMO
The objective of this study was to investigate the effects of the halothane (HAL) genotype, slaughter weight (SW), and the HAL x SW interaction on compositional and textural traits of raw and cooked pork. Pigs were bred to exhibit one of the three HAL genotypes (NN, Nn, and nn) with otherwise equivalent genomes. The nn halothane reactors are known to typically produce PSE pork, whereas NN pigs do not typically produce PSE pork. Pietrain x Large White gilts and boars, all with verified Nn genotype (by DNA test), were mated to obtain F2 littermates of the three HAL genotypes. These pigs were slaughtered at either 101 +/- 3 ("light") or 127 +/- 3 ("heavy") kg BW and were evaluated for longissimus muscle traits. The pH at .5 h after death (pH1) was 6.35, 6.13, and 5.68 in NN, Nn, and nn pigs, respectively. Sarcomere length was greater in nn than in NN and Nn pigs (1.94 vs 1.83 and 1.85 microm, respectively). Mechanical resistance was higher in nn than in NN pigs for both raw and cooked meat. Meat from nn pigs was judged by a trained panel to be less rough, more cohesive, harder, more fibrous, less granular, more elastic, and less easy to swallow than meat from NN pigs. For most traits under study, the heterozygotes were intermediate between the homozygotes but closer to NN than to nn pigs. Muscle from heavy pigs had longer sarcomeres and less moisture than muscle from light pigs. The n allele of the HAL gene unfavorably affects pork texture, and this effect is maintained throughout the range of 101 to 127 kg BW.
Assuntos
Anestésicos Inalatórios , Peso Corporal/genética , Halotano , Carne , Suínos/anatomia & histologia , Suínos/genética , Anestésicos Inalatórios/efeitos adversos , Animais , Feminino , Tecnologia de Alimentos , Genótipo , Halotano/efeitos adversos , Masculino , Hipertermia Maligna/genética , Carne/classificaçãoRESUMO
An experiment was conducted to evaluate the effects of the RN genotype on skeletal muscle characteristics in pigs sharing otherwise the same polygenic background. Animals were genotyped for RN on the basis of RTN (Rendement Technologique Napole) records using segregation analysis methods. Samples of longissimus (L) and semispinalis capitis (S) muscles were taken from 39 rn+/rn+, 38 RN-/rn+ and 37 RN-/RN- pigs slaughtered at 108 +/- 8.6 kg live weight. Activities of lactate dehydrogenase (LDH), citrate synthase (CS), and beta-hydroxy-acyl-coenzyme A dehydrogenase (HAD) were measured on both muscles to assess glycolytic, oxidative, and lipid beta-oxidation capacities, respectively. Histological examinations and chemical analyses were performed on L muscle. The energetic metabolism of the white L muscle was more oxidative in RN-/RN- than in rn+/rn+ pigs, as shown by increased CS and HAD activities (P < .001), decreased LDH activity (P < .001), larger cross-sectional area of IIA (P < .05) and IIB-red (P < .05) fibers, higher relative area of IIA fibers ( P < .05), and lower relative area of IIB-white fibers (P < .001). No significant difference was found between heterozygous and homozygous carriers of the RN- allele, except for CS activity, which was lower in RN-/rn+ than in RN-/RN- pigs. In L muscle, the RN- allele led to a large increase in glycolytic potential (+3.5 phenotypic SD between homozygotes) and lightness (+.7 SD), and a decrease in ultimate pH, dry matter, and protein contents (-1.7 to -2 phenotypic SD for these three traits), with an almost completely dominant effect. No differences were found between genotypes for intramuscular fat and hydroxyproline contents. In the red S muscle, the presence of RN- had no influence on enzyme activities. These results indicate that the RN genotype greatly influences compositional and histochemical traits and metabolic enzyme activities in a muscle type-dependent manner, with a completely or incompletely dominant effect of the RN- allele.
Assuntos
Fibras Musculares Esqueléticas/ultraestrutura , Músculo Esquelético/anatomia & histologia , Suínos/anatomia & histologia , Suínos/genética , Alelos , Animais , Genótipo , Carne , Fibras Musculares Esqueléticas/química , Fibras Musculares Esqueléticas/enzimologia , Músculo Esquelético/química , Músculo Esquelético/enzimologiaRESUMO
Current applications of quantitative genetics for genetic improvement of farm animals rely on sophisticated statistical procedures applied to failly simple genetic models and have been effective in producing large cumulative genetic changes in many traits. Recent advances in molecular genetics provide a potential for renewed methods in animal breeding. The two main possible fields of application of recombinant DNA methologies, i.e. marker-assisted breeding and gene transfer, are reviewed. Use of genetic markers as an aid to present breeding practice appears to be rather promising, but research effort remains to be done before implementation of marker-assisted breeding schemes on a significant scale. It is not, at this stage, obvious that transgenesis will be an important way of improving meat-producing animals, at least in the near future.