Long-term effects of human amniotic membrane in a rat model of biliary fibrosis.

Liver fibrosis is the most common outcome of chronic liver diseases, and its progression to cirrhosis can only be effectively treated with liver transplantation. The amniotic membrane (AM) has been studied as an alternative therapy for fibrosis diseases mainly for its favorable properties, including anti-inflammatory, anti-scaring and immunomodulatory properties. It was recently demonstrated that the AM reduces the progression of biliary fibrosis to its advanced stage, cirrhosis, when applied on the liver for 6 weeks after fibrosis induction. Here, we investigated the effects of AM on rat fibrotic liver, during a prolonged period of time. Fibrosis was induced by bile duct ligation (BDL), and at the same time, a fragment of AM was applied around the liver. After 1, 3, 6, and 9 weeks, the degree of fibrosis was assessed by qualitative Knodell scoring, and by quantitative image analysis to quantify the area of collagen deposition in hepatic tissue. While fibrosis progressed rapidly in untreated BDL animals, leading to cirrhosis within 6 weeks, AM-treated livers showed confined fibrosis at the periportal area with few and thin fibrotic septa, but without cirrhosis. In addition, collagen deposition was reduced to about 36 and 55% of levels observed in BDL at 6 and 9 weeks after BDL, respectively, which shows that the longer the period of AM application, the lower the collagen deposition. These results suggested that AM applied as a patch onto the liver surface for longer periods attenuated the severity of biliary fibrosis and protected against liver degeneration caused by excessive collagen deposition.

Long-term effects of human amniotic membrane in a rat model of biliary fibrosis

Liver fibrosis is the most common outcome of chronic liver diseases, and its progression to cirrhosis can only be effectively treated with liver transplantation. The amniotic membrane (AM) has been studied as an alternative therapy for fibrosis diseases mainly for its favorable properties, including anti-inflammatory, anti-scaring and immunomodulatory properties. It was recently demonstrated that the AM reduces the progression of biliary fibrosis to its advanced stage, cirrhosis, when applied on the liver for 6 weeks after fibrosis induction. Here, we investigated the effects of AM on rat fibrotic liver, during a prolonged period of time. Fibrosis was induced by bile duct ligation (BDL), and at the same time, a fragment of AM was applied around the liver. After 1, 3, 6, and 9 weeks, the degree of fibrosis was assessed by qualitative Knodell scoring, and by quantitative image analysis to quantify the area of collagen deposition in hepatic tissue. While fibrosis progressed rapidly in untreated BDL animals, leading to cirrhosis within 6 weeks, AM-treated livers showed confined fibrosis at the periportal area with few and thin fibrotic septa, but without cirrhosis. In addition, collagen deposition was reduced to about 36 and 55% of levels observed in BDL at 6 and 9 weeks after BDL, respectively, which shows that the longer the period of AM application, the lower the collagen deposition. These results suggested that AM applied as a patch onto the liver surface for longer periods attenuated the severity of biliary fibrosis and protected against liver degeneration caused by excessive collagen deposition.

Estimation of genetic structure of a Mycosphaerella musicola population using inter-simple sequence repeat markers.

Among the diseases affecting banana (Musa sp), yellow Sigatoka, caused by the fungal pathogen Mycosphaerella musicola Leach, is considered one of the most important in Brazil, causing losses throughout the year. Understanding the genetic structure of pathogen populations will provide insight into the life history of pathogens, including the evolutionary processes occurring in agrosystems. Tools for estimating the possible emergence of pathogen variants with altered pathogenicity, virulence, or aggressiveness, as well as resistance to systemic fungicides, can also be developed from such data. The objective of this study was to analyze the genetic diversity and population genetics of M. musicola in the main banana-producing regions in Brazil. A total of 83 isolates collected from different banana cultivars in the Brazilian states of Bahia, Rio Grande do Norte, and Minas Gerais were evaluated using inter-simple sequence repeat markers. High variability was detected between the isolates, and 85.5% of the haplotypes were singletons in the populations. The highest source of genetic diversity (97.22%) was attributed to variations within populations. Bayesian cluster analysis revealed the presence of 2 probable ancestral groups, however, showed no relationship to population structure in terms of collection site, state of origin, or cultivar. Similarly, we detected noevidence of genetic recombination between individuals within different states, indicating that asexual cycles play a major role in M. musicola reproduction and that long-distance dispersal of the pathogen is the main factor contributing to the lack of population structure in the fungus.

Sudden cardiac arrest due to puerperal transient left ventricular apical ballooning syndrome.

A 37 year old woman with chest pain was admitted to the emergency room 40 days after normal delivery with ventricular fibrillation due to Takotsubo cardiomyopathy.

N-acetylcysteine does not prevent contrast induced nephropathy after cardiac catheterisation with an ionic low osmolality contrast medium: a multicentre clinical trial.

OBJECTIVE: To evaluate oral N-acetylcysteine in the prevention of contrast induced nephropathy (CIN) in patients at low to moderate risk undergoing cardiac catheterisation with ionic low osmolality contrast medium. METHODS: In a multicentre double blind clinical trial 156 patients undergoing coronary angiography or percutaneous coronary intervention with serum creatinine > or = 106.08 micromol/l or creatinine clearance < 50 ml/min or diabetes mellitus were randomly assigned to receive N-acetylcysteine 600 mg orally twice daily for two days or placebo. Only low osmolality ionic contrast medium was used. RESULTS: Sixteen patients developed CIN, defined as an increase of 44.2 micromol/l in creatinine in 48 hours: eight of 77 patients (10.4%) in the N-acetylcysteine group and eight of 79 patients (10.1%) in the placebo group (p = 1.00). The mean (SD) change in serum creatinine was similar in both groups: 7.96 (35.36) micromol/l in the N-acetylcysteine group and 6.19 (25.64) micromol/l in the placebo group (p = 0.67). No difference was observed in the change in endogenous creatinine clearance (-0.54 (10.4) ml/min v -2.52 (12.3) ml/min, N-acetylcysteine and placebo, respectively, p = 0.28). CONCLUSION: Oral N-acetylcysteine did not prevent CIN in patients at low to moderate risk undergoing cardiac catheterisation with ionic low osmolality contrast medium.

Padronizaçäo da monitorizaçäo eletrocardiográfica por 24 horas em cäes / Standardization of the 24-hour electrocardiographic monitoring in dogs

O principal objetivo deste estudo foi propor um padräo normal da monitorizaçäo eletrocardiográfica dinâmica em cäes das raças Doberman, Boxer e Cocker Spaniel (10 animais de cada raça), possibilitando sua utilizaçäo como meio de diagnóstico precoce em cäes com cardiomiopatia dilatada. O número de complexos QRS foi maior nos cäes Cocker Spaniel. Os batimentos ectópicos ventriculares foram mais freqüentes nos da raça Boxer, entretanto as três raças apresentaram menos de 1 por cento de batimentos ectópicos supraventriculares em relaçäo ao total de batimentos. As freqüências cardíacas mínima, média e máxima foram mais altas na raça Cocker Spaniel. Essa raça permaneceu em taquicardia (freqüência igual ou superior a 120bpm) por maior tempo do que as outras duas raças e em bradicardia (freqüência igual ou menor a 50bpm) por menor tempo, além de apresentar menor quantidade e pausas mais curtas. A variaçäo da freqüência cardíaca demonstrou ser um padräo entre esses animais: na raça Cocker Spaniel, o número de contrações ectópicas isoladas supraventriculares e ventriculares foi inferior a 50 por monitoriçäo de 24 horas; na Boxer, foi inferior a 50 por 24 horas; as assistolias ou pausas maiores do que dois segundos foram freqüentes nas raças Boxer e Doberman e ausentes na Cocker Spaniel; comumente as pausas duraram mais do que três segundos; näo se observaram alterações do segmento ST nas três raças

Intracoronary brachytherapy in the treatment of in-stent restenosis. Initial experience in Brazil.

Intracoronary brachytherapy using beta or gamma radiation is currently the most efficient type of therapy for preventing the recurrence of coronary in-stent restenosis. Its implementation depends on the interaction among interventionists, radiotherapists, and physicists to assure the safety and quality of the method. The authors report the pioneering experience in Brazil of the treatment of 2 patients with coronary in-stent restenosis, in whom beta radiation was used as part of the international multicenter randomized PREVENT study (Proliferation REduction with Vascular ENergy Trial). The procedures were performed rapidly and did not require significant modifications in the traditional techniques used for conventional angioplasty. Alteration in the radiological protection devices of the hemodynamic laboratory were also not required, showing that intracoronary brachytherapy using beta radiation can be incorporated into the interventional tools of cardiology in our environment.

High versus low-pressure balloon inflation during multilinktrade mark stent implantation: acute and long-term angiographic results.

We compared the impact of low and high-pressure balloon inflation on acute and late angiographic results of Multilink stent. Low-pressure balloon inflation (9.5 +/- 1.9 atm) was used in 43 stents and high pressure (17.1 +/- 1.5 atm) in 44. A larger immediate luminal gain was achieved in stents with high-pressure balloon inflation (1.80 +/- 0.26 vs. 1.47 +/- 0.62; P = 0.002), resulting in a larger mean diameter in this group (2.71 +/- 0.37 vs. 2.48 +/- 0.47; P = 0.017). At follow-up, a larger luminal diameter was achieved in the high pressure group (1.93 +/- 0.72 vs. 1.45 +/- 0.66; P = 0.002) and a trend to a lower rate of angiographic restenosis (15% vs. 38%, P = 0.08).

Single coronary arteries: two cases with distinct and previously undescribed angiographic patterns.

Single coronary artery is a rare congenital anomaly, sometimes associated with myocardial ischemia. We present the clinical and angiographic features of two symptomatic patients with documented myocardial ischemia and with distinct and previously undescribed patterns of single right coronary arteries. These cases are new variants of the types R-I and R-II-A, in which the most probable mechanisms of ischemia are the insufficient blood supply, due to the long trajectories of the single arteries and the presence of underdeveloped vessels. Also, our second case presented with a fistulae from the LCX to the left ventricle, which is another determinant of myocardial ischemia.

Regression of ST segment elevation after thrombolysis in acute aortic dissection.

A 55-year-old man was admitted to the hospital with chest pain and electrocardiogram consistent with the diagnosis of evolving myocardial infarction. Treatment with streptokinase was administered, resulting in clinical and electrocardiographic signs of reperfusion. Hypotension and ST segment elevation occurred 2 hours later and cardiac catheterization was done. At catheterization the diagnosis of aortic dissection was made, but the patient died before surgery. Thus, clinical and electrocardiographic signs of reperfusion after streptokinase may occur in patients with aortic dissection and myocardial infarction.

Arritmias e exercício / Cardiac arrhythmias and exercise

A importância das arritmias cardíacas em sua relaçäo com o exercício físico cresceu de forma exponencial após o advento da reabilitaçäo cardíaca e da massificaçäo da prática regular de exercício pela populaçäo geral com finalidade preventivas. Nesta revisäo, os autores abordam os mecanismos pelos quais o exercício físico pode interferir no ritmo cardíaco, dividindo-os em neuro-humorais, eletrofisiológicos e he modinâmicos. Säo comentados as alteraçöes funcionais e estruturais que a prática regular exercício e o treinamento atlético produzem, com suas repercussöes vistas pelos métodos näo-invasivos representados pela eletrocardiografia, ecocardiografia, eletrocardiografia ambulatorial pelo sistema Holter e testes ergométrico. Por meio desses métodos é que se faz a avaliaçäo dos indivíduos que apresentam sintomas suspeitos de dependerem de arritmias induzidas por esforço ou daqueles assintomáticos que tiveram arritmia fortuitamente detectada durante ou imediatamente após a prática de exercício. Asaritmias graves e a morte súbita provocadas pelo exercício geralmente dependem de cardiopatia orgânica e as principais cardiopatias e síndromes arritmogênicas säo a miocardiopatia hipertrófica, a displasia ventricular direita, a síndrome do QT longo, a síndrome de Wolff-Parkinson-White e a cardiopatia isquemica. Todas säo analisadas quanto a ocorrência, diagnóstico, comportamento durante o exercício e conduta em relaçäoà prática de exercício. Como causa de arritmias graves ou morte durante o exercício, téa idade de 30 anos, a miocardiopatia hipertrófica é a mais importante; após essa idade , a cardiopatia isquêmica responde por cerca de 98,5 por cento dos casos. Na experiência dos autores, o condicionamento físico em portadores de cardiopatia isquêmica foi benéfico, reduzindo em 82 por cento as arritmias ventriculares induzidas por esforço. Em 21 anos de experiência com reabilitaçäo cardíaca para coronarianos, houve 10 casos de fibrilaçäo ventricular durante o exercício, todos recuperados e representado penas um evento para cada 50 mil horas-exercício, o que indica serem os programas de condicionamento físico procedimentos, além de benéficos, seguros.