RESUMEN
Peroxisomes are organelles with vital functions in metabolism and their dysfunction is associated with human diseases. To fulfill their multiple roles, peroxisomes import nuclear-encoded matrix proteins, most carrying a peroxisomal targeting signal (PTS) 1. The receptor Pex5p recruits PTS1-proteins for import into peroxisomes; whether and how this process is posttranslationally regulated is unknown. Here, we identify 22 phosphorylation sites of Pex5p. Yeast cells expressing phospho-mimicking Pex5p-S507/523D (Pex5p2D) show decreased import of GFP with a PTS1. We show that the binding affinity between a PTS1-protein and Pex5p2D is reduced. An in vivo analysis of the effect of the phospho-mimicking mutant on PTS1-proteins revealed that import of most, but not all, cargos is affected. The physiological effect of the phosphomimetic mutations correlates with the binding affinity of the corresponding extended PTS1-sequences. Thus, we report a novel Pex5p phosphorylation-dependent mechanism for regulating PTS1-protein import into peroxisomes. In a broader view, this suggests that posttranslational modifications can function in fine-tuning the peroxisomal protein composition and, thus, cellular metabolism.
Asunto(s)
Peroxisomas , Receptores Citoplasmáticos y Nucleares , Humanos , Fosforilación , Peroxisomas/metabolismo , Receptor de la Señal 1 de Direccionamiento al Peroxisoma/metabolismo , Receptores Citoplasmáticos y Nucleares/metabolismo , Proteínas Portadoras/metabolismo , Saccharomyces cerevisiae/metabolismo , Transporte de ProteínasRESUMEN
AIMS: Left atrial appendage occlusion (LAAO) may be considered for patients with non-valvular atrial fibrillation (NVAF) and a relative/formal contraindication to anticoagulation. This study aimed to summarize the impact of aging on LAAO outcomes at short and long-term follow-up. METHODS AND RESULTS: We compared subjects aged <70, ≥70 and <80, and ≥80 years old in the prospective, multicentre Amplatzer™ Amulet™ Occluder Observational Study (Abbott, Plymouth, MN, USA). Serious adverse events (SAEs) were reported from implant through a 2-year post-LAAO visit and adjudicated by an independent clinical events committee. Overall, 1088 subjects were prospectively enrolled. There were 265 subjects (24.4%) <70 years old, 491 subjects (45.1%) ≥70 and <80 years old, and 332 subjects (30.5%) ≥80 years old, with the majority (≥80%) being contraindicated to anticoagulation. As expected, CHA2DS2-VASc and HAS-BLED Scores increased with age. Implant success was high (≥98.5%) across all groups, and the proportion of subjects with a procedure- or device-related SAE was similar between groups. At follow-up, the observed ischaemic stroke rate was not significantly different between groups, and corresponding risk reductions were 62, 56, and 85% when compared with predicted rates for subjects <70, ≥70 and <80, and ≥80 years old, respectively. Major bleeding and mortality rates increased with age, while the incidence of device-related thrombus tended to increase with age. CONCLUSIONS: Despite the increased risk for ischaemic stroke with increasing age in AF patients, LAAO reduced the risk for ischaemic stroke compared with the predicted rate across all age groups without differences in procedural SAEs.
Asunto(s)
Apéndice Atrial , Fibrilación Atrial , Isquemia Encefálica , Dispositivo Oclusor Septal , Accidente Cerebrovascular , Anciano , Anciano de 80 o más Años , Apéndice Atrial/diagnóstico por imagen , Apéndice Atrial/cirugía , Fibrilación Atrial/diagnóstico , Humanos , Estudios Prospectivos , Dispositivo Oclusor Septal/efectos adversos , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/prevención & control , Resultado del TratamientoRESUMEN
The current view on peroxisomes has changed dramatically from being human cell oddities to vital organelles that host several key metabolic pathways. To fulfil over 50 different enzymatic functions, human peroxisomes host either unique peroxisomal proteins or dual-localized proteins. The identification and characterization of the complete peroxisomal proteome in humans is important for diagnosis and treatment of patients with peroxisomal disorders as well as for uncovering novel peroxisomal functions and regulatory modules. Hence, here we compiled a comprehensive list of mammalian peroxisomal and peroxisome-associated proteins by curating results of several quantitative and non-quantitative proteomic studies together with entries in the UniProtKB and Compartments knowledge channel databases. Our analysis gives a holistic view on the mammalian peroxisomal proteome and brings to light potential new peroxisomal and peroxisome-associated proteins. We believe that this dataset, represents a valuable surrogate map of the human peroxisomal proteome.
Asunto(s)
Peroxisomas/metabolismo , Proteoma/análisis , Proteoma/metabolismo , Proteómica , Animales , Humanos , Redes y Vías Metabólicas , Trastorno Peroxisomal/metabolismoRESUMEN
PURPOSE: Shoulder dislocation is often associated with intense pain, and requires urgent pain therapy and reduction. Interscalene block, general anesthesia, or intravenous analgesia alone are applied procedures that facilitate shoulder reduction by the surgeon and ease patients' pain. This study was conducted to compare procedure times, patient satisfaction, side-effects, and clinical outcome of these clinical procedures. METHODS: Retrospective chart analysis was performed for all patients treated at the Emergency Department of a primary care hospital. In addition, standardized telephone interviews were conducted. Subjective clinical outcome and patient satisfaction (SF-36, Quick-DASH, ZUF-8) were measured with the standardized questionnaires. RESULTS: The shortest overall procedure time [67.5 min (48.8-93.5 min), P = 0.003] was found in patients with interscalene block. The advantage of general anesthesia was the shortest anesthesia induction time [10 min (7.8-10 min), P < 0.0001]; reduction time [6 min (4.3-6 min), P = 0.039]; and time to discharge [90 min (67.5-123.8 min), P = 0.0001] were significantly prolonged in comparison to interscalene block [5 min (1-5 min) and 45 min (2-67.5 min)]. The longest reduction time [11 min (10-13.5 min), P = 0.0008] was seen in patients in the intravenous analgesia group. Overall, patient satisfaction was greater in patients with regional as compared to general anesthesia [measured by ZUF-8: 12 (9-15) vs. 17 (12-24), P = 0.03]. Subjective clinical outcome (SF-36, DASH) was comparable among the three groups. There was one immediately identified esophageal intubation in the general anesthesia group. CONCLUSIONS: Out-patient shoulder reduction can be accomplished no matter whether general anesthesia, regional anesthesia, or intravenous analgesia alone was administered. Clinical outcome as measured by SF-36 and DASH was comparable among the three groups, but the shortest overall procedure time and greater patient satisfaction were found in patients with interscalene block.
Asunto(s)
Analgesia/métodos , Anestesia General/métodos , Anestésicos Locales/administración & dosificación , Hombro/cirugía , Adulto , Anciano , Bloqueo del Plexo Braquial/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pacientes Ambulatorios , Manejo del Dolor , Dimensión del Dolor , Dolor Postoperatorio/tratamiento farmacológico , Satisfacción del Paciente , Estudios RetrospectivosRESUMEN
The peroxisomal matrix protein import is facilitated by cycling import receptors that shuttle between the cytosol and the peroxisomal membrane. The import receptor Pex5p mediates the import of proteins harboring a peroxisomal targeting signal of type I (PTS1). Purified recombinant Pex5p forms a dimeric complex with the PTS1-protein Pcs60p in vitro with a KD of 0.19 µm. To analyze the structural basis for receptor-cargo recognition, the PTS1 and adjacent amino acids of Pcs60p were systematically scanned for Pex5p binding by an in vitro site-directed photo-cross-linking approach. The cross-linked binding regions of the receptor were subsequently identified by high resolution mass spectrometry. Most cross-links were found with TPR6, TPR7, as well as the 7C-loop of Pex5p. Surface plasmon resonance analysis revealed a bivalent interaction mode for Pex5p and Pcs60p. Interestingly, Pcs60p lacking its C-terminal tripeptide sequence was efficiently cross-linked to the same regions of Pex5p. The KD value of the interaction of truncated Pcs60p and Pex5p was in the range of 7.7 µm. Isothermal titration calorimetry and surface plasmon resonance measurements revealed a monovalent binding mode for the interaction of Pex5p and Pcs60p lacking the PTS1. Our data indicate that Pcs60p contains a second contact site for its receptor Pex5p, beyond the C-terminal tripeptide. The physiological relevance of the ancillary binding region was supported by in vivo import studies. The bivalent binding mode might be explained by a two-step concept as follows: first, cargo recognition and initial tethering by the PTS1-receptor Pex5p; second, lock-in of receptor and cargo.
Asunto(s)
Regulación Fúngica de la Expresión Génica , Ligasas/química , Proteínas de la Membrana/química , Proteínas de Transporte de Membrana/química , Proteínas Recombinantes de Fusión/química , Proteínas de Saccharomyces cerevisiae/química , Saccharomyces cerevisiae/genética , Secuencia de Aminoácidos , Secuencia de Bases , Sitios de Unión , Cinética , Ligasas/genética , Ligasas/metabolismo , Proteínas de la Membrana/genética , Proteínas de la Membrana/metabolismo , Proteínas de Transporte de Membrana/genética , Proteínas de Transporte de Membrana/metabolismo , Datos de Secuencia Molecular , Receptor de la Señal 1 de Direccionamiento al Peroxisoma , Peroxisomas/metabolismo , Fosforilación , Plásmidos/química , Plásmidos/metabolismo , Unión Proteica , Multimerización de Proteína , Estructura Secundaria de Proteína , Estructura Terciaria de Proteína , Transporte de Proteínas , Proteínas Recombinantes de Fusión/genética , Proteínas Recombinantes de Fusión/metabolismo , Saccharomyces cerevisiae/metabolismo , Proteínas de Saccharomyces cerevisiae/genética , Proteínas de Saccharomyces cerevisiae/metabolismo , Transducción de Señal , Termodinámica , TransfecciónRESUMEN
AIMS: Elevated left ventricular (LV) pacing thresholds or phrenic nerve stimulation (PNS) might be possible reasons for absence of continuous and effective biventricular stimulation. This study investigated the benefit and clinical efficacy of the ability to choose one out of three different LV pacing vectors for the management of suboptimal LV pacing thresholds and PNS. METHODS AND RESULTS: This prospective, observational multicentre study enrolled 132 patients (Pts) implanted with a cardiac resynchronization therapy defibrillator, that offers three LV pacing vectors: (i) Bipolar; (ii) LVtip â RVcoil; (iii) LVring â RVcoil (RV = right ventricular). Left ventricular pacing thresholds and PNS thresholds were obtained in sitting and left lateral body position for all programmable LV pacing vectors at hospital discharge and follow up (FU). In 97%, a bipolar transvenous LV lead was successfully implanted. In 87% of Pts at least one acceptable pacing vector could be identified that provides good pacing threshold (≤ 2.5 V at 5 ms) and acceptable margin to PNS (≥ 2:1). This is an increase of 18% compared with conventional bipolar systems (74%) with two LV vectors and of 25% compared with unipolar systems (70%). The LVtip â RVcoil vector provided the best LV pacing thresholds, but the highest rate of PNS. CONCLUSIONS: The programmability of LV pacing vectors is a powerful feature to avoid PNS and obtain acceptable LV pacing thresholds. In order to retain reprogramming options for LV vectors during FU, LV pacing leads with at least two electrodes should be chosen whenever possible.
Asunto(s)
Terapia de Resincronización Cardíaca/efectos adversos , Terapia de Resincronización Cardíaca/métodos , Desfibriladores Implantables/efectos adversos , Insuficiencia Cardíaca/terapia , Nervio Frénico/fisiopatología , Disfunción Ventricular Izquierda/terapia , Anciano , Electrodos Implantados/efectos adversos , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Disfunción Ventricular Izquierda/fisiopatologíaRESUMEN
BACKGROUND: Nonagenarians constitute a fast-growing and high-risk segment of the population, with scarce data on specific outcomes for percutaneous left atrial appendage occlusion (LAAO). The aim of the present paper was to assess the outcomes of nonagenarian patients undergoing LAAO from the prospective global Amplatzer Amulet observational study. Overall, 1088 subjects were prospectively included in the study. Among them, 9 (1%) were nonagenarians. Amulet device implant success was achieved in all patients and the only major procedural adverse event was a pseudoaneurysm. During the 2-year follow-up after LAAO, no ischemic strokes or transient ischemic attacks were reported. Further studies will be necessary to confirm the favorable LAAO outcomes in this growing segment of the atrial fibrillation population.
Asunto(s)
Apéndice Atrial , Fibrilación Atrial , Dispositivo Oclusor Septal , Accidente Cerebrovascular , Anciano de 80 o más Años , Apéndice Atrial/diagnóstico por imagen , Apéndice Atrial/cirugía , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/cirugía , Humanos , Nonagenarios , Estudios Prospectivos , Dispositivo Oclusor Septal/efectos adversos , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/prevención & control , Resultado del TratamientoRESUMEN
AIMS: To evaluate factors influencing the length of stay in patients undergoing percutaneous left atrial appendage occlusion (LAAO). METHODS AND RESULTS: Patient characteristics, procedural data and the occurrence of serious adverse events were analyzed from the AmplatzerTM AmuletTM Occluder Observational Study. Patients were divided into three groups: same day (S, 0day, n = 60, 5.6%) early (E, 1day, n = 526, 48.9%), regular (R, 2-3days, n = 338, 31.4%) and late (L, ≥4days, n = 152, 14.1%) discharge and followed up for 60 days. Procedure and device related SAE during the in-hospital stay (S: 0.0% vs. E: 1.0% vs. R: 2.1% vs. L: 23%, p<0.0001) were a major trigger for a prolonged in-hospital stay. Of the 37 subjects in the late discharge group with an SAE prior to discharge, cardiac or bleeding complications were the most common underlying conditions, occurring in 26 subjects. Multinomial logistic analysis only identified HAS-BLED score as an independent influencing factor (p = 0.04) for a late discharge. After 60 days, mortality tended to be greatest in the late discharge group (S: 0.0% vs. E: 1.0% vs. R: 1.2% vs. L: 3.3%, p = 0.1066). CONCLUSION: Over half of the subjects receiving an Amplatzer Amulet occluder were discharged within 1 day of the implant procedure. Serious adverse events were a major trigger for a late discharge after LAAO. Increased HAS-BLED score was associated with a prolonged in-hospital stay.
Asunto(s)
Apéndice Atrial/fisiopatología , Fibrilación Atrial/terapia , Hemorragia/terapia , Accidente Cerebrovascular Isquémico/terapia , Dispositivo Oclusor Septal , Anciano , Fibrilación Atrial/fisiopatología , Cateterismo Cardíaco/métodos , Femenino , Factores de Riesgo de Enfermedad Cardiaca , Hemorragia/complicaciones , Hemorragia/fisiopatología , Humanos , Accidente Cerebrovascular Isquémico/complicaciones , Accidente Cerebrovascular Isquémico/fisiopatología , Tiempo de Internación , Masculino , Resultado del TratamientoRESUMEN
BACKGROUND: Percutaneous LAAO represents an alternative for stroke prevention in patients not tolerating anticoagulation. While women are at higher risk of complications during percutaneous coronary or valvular interventions, the impact of gender on LAAO outcomes is not well characterized. The current study assessed potential gender-related differences in procedural and long-term outcomes following left atrial appendage occlusion (LAAO). METHODS: 1088 AF patients were enrolled in the prospective, multicenter, Amplatzer™ Amulet™ Observational Study and followed for 2 years with scheduled adverse event assessments. The prespecified primary outcome was ischemic stroke, systemic embolism or cardiovascular (CV) death at 2 years. We also compared the rate of procedural success, device-related thrombus (DRT) and major bleeding between genders. RESULTS: 702 men and 386 women underwent LAAO. Implant successwas high, and similar between men and women (98.9 vs 99.5%, p = 0.58). Similarly, no difference was observed in the primary outcome (12.0 vs 12.5%, p = 0.82). Compared to the CHA2DS2-VASc predicted rate, we observed a numerically greater absolute risk reduction of ischemic stroke in women (from 7.6 to 2.1%/year) than men (from 6.2 to 2.2%/year). DRT through 2 years was similar between groups (1.6%, p = 0.96). We found no significant gender difference in terms of periprocedural or long-term (7.1 vs 7.6%/year) major bleeding. CONCLUSIONS: In this large group of patients undergoing LAAO using the Amplatzer™ Amulet™ device we found no significant gender difference in terms of procedural or long-term clinical outcomes. Similarly to oral anticoagulation, device-based LAA occlusion renders AF-related stroke risk similar in women and men. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT02447081.https://clinicaltrials.gov/ct2/show/NCT02447081.
RESUMEN
BACKGROUND: Major bleeding (MB) events are independent predictors of mortality after cardiac interventional procedures. The clinical relevance of MB following left atrial appendage occlusion (LAAO) remains unclear. AIMS: This study aimed to investigate the incidence and clinical impact of MB after LAAO in a real-world population at high risk for bleeding and contraindicated to anticoagulation. METHODS: The two-year results of the Amplatzer Amulet Observational Post-Market Study were analysed. An independent committee adjudicated MBs according to the Bleeding Academic Research Consortium scale. Cox proportional hazards regression identified variables associated with MB events and mortality. RESULTS: The MB rate was 7.2%/year, with a rate of 10.1%/year during year one, decreasing to 4.0%/year over year two. The most common bleeding location was gastrointestinal, accounting for 48% of MBs. Pre-LAAO MB was associated with an increased risk for post-LAAO MB (HR 2.34, 95% CI: 1.37-3.99). The occurrence of post-LAAO MB was associated with increased mortality (37.3% vs 12.7%; p<0.0001), driven mainly by events occurring beyond the periprocedural period. The annualised rate of ischaemic stroke or TIA was similar in patients with and without MB (2.3% vs 3.3%; p=0.446). MB post LAAO was a strong independent predictor of mortality (HR 3.07, 95% CI: 2.15-4.40). CONCLUSIONS: In real-world patients at high bleeding risk, MB following LAAO was not uncommon and associated with a significant increase in mortality, without increasing the risk of stroke. ClinicalTrials.gov Identifier: NCT02447081. https://clinicaltrials.gov/ct2/show/NCT02447081.
Asunto(s)
Apéndice Atrial , Fibrilación Atrial , Isquemia Encefálica , Dispositivo Oclusor Septal , Accidente Cerebrovascular , Apéndice Atrial/diagnóstico por imagen , Apéndice Atrial/cirugía , Fibrilación Atrial/epidemiología , Cateterismo Cardíaco/efectos adversos , Hemorragia/epidemiología , Humanos , Incidencia , Dispositivo Oclusor Septal/efectos adversos , Accidente Cerebrovascular/epidemiología , Resultado del TratamientoRESUMEN
OBJECTIVE: To evaluate the safety and efficacy of percutaneous left atrial appendage occlusion (LAAO) using conscious sedation (CS). BACKGROUND: Several percutaneous structural heart disease interventions are safely and efficiently performed using CS instead of general anaesthesia (GA). This concept has not been evaluated in a large multicenter cohort of patients undergoing LAAO. METHODS: Patients from the prospective, global Amplatzer Amulet Occluder Observational Study were divided into two groups (GA vs CS). Baseline information, periprocedural and postprocedural efficacy and complications, as well as outcomes through 7 days post implant were compared. RESULTS: Patients undergoing transesophageal-guided implants were categorised by GA (n=607, 64%) or CS (n=342, 36%) usage. Mean age was 75 years in both groups. LAAO technical success was achieved in 99% of both groups. The procedure duration (GA: 35±22 min vs CS: 27±19 min, p<0.001), total amount of contrast medium (GA: 105±81 mL vs CS: 86±66 mL, p<0.001) and fluoroscopic time (GA: 13±9 min vs CS: 12±13 min, p<0.001) were less in CS cases. Procedure-related or device-related serious adverse events during the first 7 days were numerically higher in the CS group (GA: 4.9% vs CS: 7.6%, p=0.114). Peridevice residual flow was absent or ≤5 mm 1-3 months after the procedure in 99.7% of the GA and in 100% of the CS group (p=1.000). CONCLUSIONS: In a large global study, LAAO with the Amplatzer Amulet occluder is safe and feasible using CS. Procedure duration and total amount of contrast were less with CS than GA cases. TRIAL REGISTRATION NUMBER: NCT02447081; Results.
Asunto(s)
Apéndice Atrial , Fibrilación Atrial , Accidente Cerebrovascular , Anciano , Anestesia General , Apéndice Atrial/diagnóstico por imagen , Apéndice Atrial/cirugía , Fibrilación Atrial/terapia , Cateterismo Cardíaco/efectos adversos , Sedación Consciente , Humanos , Estudios Prospectivos , Resultado del TratamientoRESUMEN
OBJECTIVES: The aim of this study was to evaluate the impact of CHA2DS2-VASc and HAS-BLED scores on ischemic and bleeding events of patients enrolled in the Amplatzer Amulet Observational Study. BACKGROUND: Baseline CHA2DS2-VASc and HAS-BLED scores have been validated in atrial fibrillation patients to guide about anticoagulation but not in patients treated by left atrial appendage occlusion (LAAO). METHODS: Subjects were stratified according to CHA2DS2-VASc and HAS-BLED scores. Clinical outcomes were collected through 2 years and adjudicated by an independent committee. RESULTS: Subjects were considered at low (n = 156), moderate (n = 715), and high (n = 215) risk for ischemic stroke, corresponding to CHA2DS2-VASc scores of <3, 3 to 5, and ≥6, respectively. The annual rates of ischemic stroke were 1.1%, 2.0%, and 3.5%, respectively. When compared with the predicted rate, LAAO reduced the risk of ischemic stroke by 56%, 69%, and 68%. Device-related thrombus occurred in 0.7%, 1.5%, and 3.0% of subjects at low, moderate, and high risk for ischemic stroke, respectively. The HAS-BLED score was ≤3 in 629 subjects and >3 in 456 subjects, respectively. Non-peri-procedural major bleeding was reduced by 11% and 9% compared with predicted rates in the low and high bleeding risk groups, respectively. CONCLUSIONS: LAAO with the Amplatzer Amulet reduced the risk of ischemic stroke compared with the predicted rate, with a greater magnitude among patients at high thromboembolic risk without increasing the bleeding risk. (Amplatzer™Amulet™ Post-Market Study [Amulet™PMS]; NCT02447081).
Asunto(s)
Hemorragia , Apéndice Atrial , Fibrilación Atrial , Humanos , Dispositivo Oclusor Septal , Accidente Cerebrovascular , Resultado del TratamientoRESUMEN
Treacher Collins syndrome (TCS, OMIM 154500) is a well-defined mandibulofacial dysostosis characterized by symmetric facial anomalies consisting of malar hypoplasia, coloboma of the lower eyelid, dysplastic ears, micrognathia, cleft palate and deafness. Other mandibulofacial dysostoses (MDs) such as Toriello (OMIM 301950), Bauru (OMIM 604830), Hedera-Toriello-Petty (OMIM 608257), and Guion-Almeida (OMIM 610536) syndromes are less well characterized and much rarer. Here we describe three unrelated patients showing clinical features overlapping with TCS, but who in addition have developmental delay, microcephaly and a distinct facial gestalt. Because of the distinct ear anomalies and the hearing loss a HOXA2 mutation was taken into account. CHARGE syndrome was discussed because of ear anomalies, choanal atresia, and developmental delay in our patients. But mutational analyses including sequencing of the TCOF1, the HOXA2, and the CHD7 genes, deletion screening of the TCOF1 gene as well as genomewide array analyses revealed normal results. We suggest that these three patients have a new type of mandibulofacial dysostosis. As all three cases are sporadic and both sexes are affected the pattern of inheritance might be autosomal dominant or autosomal recessive. Identification of additional patients will allow to further delineate the phenotype, to assign the inheritance pattern and to identify the molecular basis.
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Atresia de las Coanas/diagnóstico , Discapacidades del Desarrollo/diagnóstico , Disostosis Mandibulofacial/diagnóstico , Microcefalia/diagnóstico , Atresia de las Coanas/genética , Análisis Mutacional de ADN , Discapacidades del Desarrollo/genética , Femenino , Estudio de Asociación del Genoma Completo , Humanos , Lactante , Masculino , Disostosis Mandibulofacial/genética , Microcefalia/genética , SíndromeRESUMEN
BACKGROUND: Bipolar low polarization electrodes are recommended for a regular AutoCapture (St. Jude Medical, Inc., Sylmar, CA, USA) function in order to effectively detect the evoked response (ER) signal. The objective of this national multicenter registry was to evaluate the electrical performance and the AutoCapture characteristics of the bipolar ventricular pacing lead IsoFlex S, model 1636T or 1646T (St. Jude Medical), in combination with single- and dual-chamber pacemakers. METHODS: Ventricular pacing and sensing thresholds, lead impedance, ER amplitude, and polarization signals were measured at discharge and routine follow-up visits after 1, 3, 6, 9, and 12 months. AutoCapture activation was recommended based on the results of the ER sensitivity test. RESULTS: Of the 252 patients initially included, 109 (43%) have completed the follow-up. The mean ventricular pacing threshold was 0.43 +/- 0.19 V at discharge and 0.68 +/- 0.32 V at 12 months postimplant. The values for the ventricular sensing threshold were between 9.51 +/- 4.12 and 9.99 +/- 4.09 mV at discharge and at the 12-month follow-up. The unipolar lead impedance decreased from 533 +/- 94 to 476 +/- 73 ohms during the follow-up. The mean ER amplitude was 16.47 +/- 6.70 mV at discharge and 17.42 +/- 7.43 mV after 12 months, and the corresponding mean polarization signals were 0.59 +/- 1.00 and 0.74 +/- 1.24 mV, respectively. AutoCapture activation was recommended in at least 95% of the patients investigated over the 12-month follow-up. CONCLUSION: The bipolar ventricular pacing lead IsoFlex S 1636/1646T shows a good electrical performance and is mostly compatible with the AutoCapture algorithm.
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Electrocardiografía/instrumentación , Electrodos Implantados/estadística & datos numéricos , Análisis de Falla de Equipo/estadística & datos numéricos , Marcapaso Artificial/estadística & datos numéricos , Sistema de Registros , Terapia Asistida por Computador/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Diseño de Equipo , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVES: This study sought to report the incidence, characteristics, and clinical impact of device-related thrombus (DRT) following left atrial appendage occlusion (LAAO) with the AMPLATZER Amulet device (Abbott, Plymouth, Minnesota). BACKGROUND: DRT is a potential serious complication of LAAO, but the incidence and clinical impact of DRTs in a real-world setting are not well characterized. METHODS: A total of 1,088 patients were enrolled in a multicenter prospective study and followed for 1 year. All events were adjudicated by an independent committee, including the presence of DRT. Patients with DRT were reviewed for suboptimal device implantation and characterization of DRT formation. Multiple Cox regression was performed to identify predictors of DRT formation. RESULTS: Device implantation was successful in 1,078 (99%) patients, with 1-year follow-up completed in 96.3% of patients. A total of 18 DRTs occurred in 17 patients (1.7%/year), as a second DRT developed following complete resolution of an initial DRT in 1 patient. The left upper pulmonary vein ridge was not covered by the Amulet disc in 82% of DRT patients, indicating suboptimal implantation, with most thrombus developing in the untrabeculated area of the LAA ostium between the pulmonary vein ridge and the upper edge of the disc. Three (18%) DRT patients had an ischemic stroke, all within 3 months of DRT diagnosis. Patients with a DRT were at a greater risk for ischemic stroke or transient ischemic attack compared with non-DRT patients (hazard ratio: 5.27; 95% confidence interval: 1.58 to 17.55; p = 0.007). Larger LAA orifice width was a predictor of DRT formation (hazard ratio: 1.09; 95% confidence interval: 1.00 to 1.19; p = 0.04). CONCLUSIONS: Following LAAO with the AMPLATZER Amulet device, DRT was observed infrequently. Although the presence of DRT was associated with an increased rate of ischemic stroke or transient ischemic attack as compared with patients without DRT, the large majority of DRT patients (82%) did not experience any ischemic neurologic events.
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Apéndice Atrial/fisiopatología , Fibrilación Atrial/terapia , Cateterismo Cardíaco/efectos adversos , Cateterismo Cardíaco/instrumentación , Trombosis/epidemiología , Anciano , Anciano de 80 o más Años , Apéndice Atrial/diagnóstico por imagen , Fibrilación Atrial/diagnóstico por imagen , Fibrilación Atrial/epidemiología , Fibrilación Atrial/fisiopatología , Isquemia Encefálica/epidemiología , Femenino , Humanos , Incidencia , Ataque Isquémico Transitorio/epidemiología , Masculino , Supervivencia sin Progresión , Estudios Prospectivos , Diseño de Prótesis , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/epidemiología , Trombosis/diagnóstico por imagen , Factores de TiempoRESUMEN
Oculo-auriculo-vertebral spectrum (MIM 164210) is a term suggested by Gorlin to summarize the different phenotypic expressions of a continuum that has been known as hemifacial microsomia, Goldenhar syndrome, or first and second branchial arch anomalies. The different terms indicate the extremely variable clinical findings, including especially defects of aural, oral and mandibular development. Additionally, cardiac, renal, skeletal and other anomalies occur. The majority of oculo-auriculo-vertebral spectrum cases are sporadic; nevertheless, several families have been reported with proof of both autosomal dominant and autosomal recessive inheritance. We describe a family with transmission of oculo-auriculo-vertebral spectrum from a mother to her two daughters indicating an autosomal dominant mode of inheritance. Our literature review reveals that patients with autosomal dominant inheritance of oculo-auriculo-vertebral spectrum are more often bilaterally affected than patients with sporadic occurrence of oculo-auriculo-vertebral spectrum. In addition, hearing loss, absent or narrow external auditory canal, anomalies of the mouth and epibulbar dermoids seem to occur less frequently in patients with autosomal dominant oculo-auriculo-vertebral spectrum compared with sporadic oculo-auriculo-vertebral spectrum.
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Conducto Auditivo Externo/anomalías , Anomalías del Ojo/genética , Genes Dominantes , Síndrome de Goldenhar/genética , Anomalías de la Boca/genética , Adulto , Anciano , Niño , Preescolar , Conducto Auditivo Externo/patología , Familia , Femenino , Síndrome de Goldenhar/patología , Humanos , Masculino , Anomalías de la Boca/patología , LinajeRESUMEN
Reversible protein phosphorylation is a frequently occurring posttranslational modification mediated by protein kinases and phosphatases that plays an essential role in the regulation of a large number of cellular processes. Evidence is accumulating that protein phosphorylation is also an important mechanism governing processes associated with peroxisome biology. For an improved and detailed understanding of these processes and their regulation it is therefore crucial to study phosphorylation of peroxisome-associated proteins and to determine the phosphorylated amino acid(s). To place peroxisome-related processes into a larger, cellular context, it is further required to identify the kinases and phosphatases catalyzing phosphorylation and dephosphorylation events in peroxisomal proteins. We here provide a strategy for the targeted analysis of peroxisomal phosphoproteins of Saccharomyces cerevisiae combining affinity purification of epitope-tagged peroxisomal proteins with Phos-tag SDS-PAGE and high-resolution mass spectrometry (MS) for the identification and precise localization of in vivo phosphosites. Furthermore, we describe a protocol for an MS-based in vitro kinase assay using recombinant peroxisomal proteins and a selected kinase facilitating the site-resolved analysis of kinase-substrate relationships.
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Peroxisomas/metabolismo , Proteínas/metabolismo , Proteómica , Cromatografía Liquida , Espectrometría de Masas , Fosfoproteínas/metabolismo , Fosforilación , Proteínas Quinasas/metabolismo , Proteínas/aislamiento & purificación , Proteolisis , Proteómica/métodos , Proteínas Recombinantes/metabolismo , Saccharomyces cerevisiae/metabolismo , Proteínas de Saccharomyces cerevisiae/metabolismoRESUMEN
BACKGROUND: Noninvasive ventilation (NIV) is increasingly used in intensive care medicine, but only little information is available how different NIV interfaces affect the performance of a ventilatory system. Therefore, we compared delay times, pressure time products (PTPs), and wasted efforts during inspiration among patients receiving invasive ventilation and NIV with a helmet (NIV-h) or a face mask (NIV-fm). METHODS: Using an in vitro lung model capable of simulating spontaneous breathing, gas flow and airway pressure were measured with varying positive end-expiratory pressure and pressure support (PS) levels. Wasted efforts were determined while lung compliance, respiratory rate (RR), continuous positive airway pressure (CPAP), and PS levels were changed. RESULTS: Delay times were more than twice as long with a helmet compared to NIV-fm or invasive ventilation (p < 0.001), but decreased during NIV-h with increasing CPAP (p < 0.001) and PS levels (p < 0.001). During the initial inspiratory phase, PTP was smaller with NIV-h compared to NIV-fm or invasive ventilation, but not so when a complete inspiration with PS was evaluated. Wasted efforts occurred earlier during NIV-h and were aggravated with rising PS, RR, and compliance. CONCLUSIONS: Although delay times are prolonged during NIV-h, PTP is initially smaller compared to NIV-fm and invasive ventilation, indicating less work of breathing due to the high volume the patient can access. Increasing the CPAP or PS level decreases delay times in NIV-h and should therefore be considered whenever possible. Wasted inspiratory efforts occurred at higher RRs and should carefully be monitored during NIV.
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Dispositivos de Protección de la Cabeza , Máscaras , Respiración con Presión Positiva/instrumentación , Mecánica Respiratoria/fisiología , Sistema Respiratorio/fisiopatología , Humanos , Rendimiento Pulmonar/fisiología , Modelos Biológicos , Respiración con Presión Positiva/métodos , Trabajo Respiratorio/fisiologíaRESUMEN
ABSTRACT Fusarium fungi, including F. culmorum, cause seedling blight, foot rot, and head blight diseases of cereals, resulting in yield loss. In a screen for potential disease control organisms and agents, Pseudomonas fluorescens strains MKB 100 and MKB 249, P. frederiksbergensis strain 202, Pseudomonas sp. strain MKB 158, and chitosan all significantly reduced the extent of both wheat coleoptile growth retardation and wheat and barley seedling blight caused by F. culmorum (by 53 to 91%). Trichodiene synthase is a Fusarium enzyme necessary for trichothecene mycotoxin biosynthesis; expression of the gene encoding this enzyme in wheat was 33% lower in stem base tissue coinoculated with Pseudomonas sp. strain MKB 158 and F. culmorum than in wheat treated with bacterial culture medium and F. culmorum. When wheat and barley were grown in soil amended with either chitosan, P. fluorescens strain MKB 249, Pseudomonas sp. strain MKB 158, or culture filtrates of these bacteria, the level of disease symptoms on F. culmorum-inoculated stem base tissue (at 12 days post- F. culmorum inoculation) was >/=31% less than the level on F. culmorum-inoculated plants grown in culture medium-amended soil. It seems likely that at least part of the biocontrol activity of these bacteria and chitosan may be due to the induction of systemic disease resistance in host plants. Also, in coinoculation studies, Pseudomonas sp. strain MKB 158 induced the expression of a wheat class III plant peroxidase gene (a pathogenesis-related gene).
RESUMEN
We run several experiments which allow us to compare cooperation under perfect and imperfect information in a centralized and decentralized punishment regime. Under perfect and extremely noisy information, aggregate behavior does not differ between institutions. Under intermediate noise, punishment escalates in the decentralized peer-to-peer punishment regime which badly affects efficiency while sustaining cooperation for longer. Only decentralized punishment is often directed at cooperators (perverse punishment). We report several, sometimes subtle, differences in punishment behavior, and how contributions react.