Anti-Ascaris suum immunoglobulin Y as a novel biotechnological tool for the diagnosis of human ascariasis.

Human ascariasis is a neglected tropical disease of great relevance to public health and is considered the most frequent helminthiasis in poor regions. Accurately diagnosing this parasite has been challenging due to limitations of current diagnostic methods. Immunoglobulin Y (IgY) technology is a very effective alternative for the production of highly specific and profitable antibodies. This study aimed to produce and apply anti-Ascaris suum IgY antibodies in the immunodiagnosis of human ascariasis. Five immunizations comprising total saline extract from A. suum adult life forms were given at 14-day intervals to Gallus gallus domesticus hens of the Isa Brown line. Eggs and blood samples were collected weekly and fortnightly, respectively, to monitor the production of antibodies. The specificity of antibodies was confirmed by dot-blot, kinetic enzyme-linked immunosorbent assay (ELISA), avidity ELISA, immunoblotting and indirect immunofluorescence antibody tests. The application for disease diagnosis was performed through the detection of immune complexes in human serum samples by sandwich ELISA. Peaks of IgY anti-A. suum production occurred at weeks 6 and 8. IgY showed high avidity levels after the second dose of immunization, ranging from 64% to 93%, with a mean avidity index of 78.30%. Purified IgY recognized 12 bands of proteins from A. suum saline extract. Eggs, the uterine portion and cuticles of A. suum female adult are reactive in immunofluorescence. The detection of immune complexes showed diagnostic values of 80% sensitivity and 90% specificity. In conclusion, specific IgY have been shown to be a potential immunodiagnostic tool with promising future applications in human ascariasis.

Polymorphisms of leptin, beta-lactoglobulin and pituitary transcription factor have no effect on milk characteristics in crossbred cows / Polimorfismos da leptina, beta-lactoglobulina e fator de transcrição da hipófise não afetam as características do leite em vacas mestiças

O objetivo deste trabalho foi identificar polimorfismos genéticos de leptina, ß-lactoglobulina e fator de transcrição pituitária (PIT1) e avaliar seus efeitos na composição química e na contagem de células somáticas de leite de vacas leiteiras mestiças que vivem em um clima quente. Um total de 291 vacas leiteiras mestiças foram investigadas. Foram coletadas amostras de sangue para extração de DNA e amostras de leite. As amostras foram classificadas em três grupos genéticos: 12/ (42), 34/ (83) e 78/ (166) Holandês x Guzerá. As frequências de alelos e genótipos foram determinadas e o equilíbrio Hardy-Weinberg foi avaliado. Foram realizadas análises da composição do leite (gordura, proteína, lactose e extracto seco desengordurado), contagem de células somáticas e rendimento leiteiro. Os grupos genéticos e os polimorfismos genéticos para cada gene foram utilizados como efeitos fixos na análise. O único polimorfismo encontrado em equilíbrio de Hardy-Weinberg foi para o genótipo da ß-lactoglobulina. No presente estudo, era esperado que a maioria das variáveis de composição variasse entre os genótipos. Já se sabe que os cruzamentos dão origem a animais com características fenotípicas e genotípicas. No entanto, os polimorfismos não influenciaram a composição e a qualidade do leite nas vacas 12/ , 34/ e 78/ Holstein x Guzerá mantidas em um clima quente.(AU)

Diagnosis of the pinworm Syphacia muris in the Wistar rat Rattus norvegicus.

This study aimed to compare three qualitative parasitological methods for the diagnosis of Syphacia muris infection in 30 Wistar rats (Rattus norvegicus) infected naturally. Methods of spontaneous sedimentation (Hoffman, Pons and Janer, or HPJ) and spontaneous flotation (Willis) for faecal samples and a method of taping (Graham) were performed and compared. The Graham and Willis methods were more sensitive than the HPJ method (P< 0.05). The Graham method was able to detect S. muris eggs in 100% of the samples. Eggs were detected in 83% and 60% of the samples using the Willis and HPJ methods, respectively. Method choice is important for screening for parasites of rats kept under laboratory conditions, as accurate diagnosis helps prevent future environmental contamination and infection. We concluded that the Graham method was the most efficient of those tested in this study for detection of S. muris infection in rats. This method is also rapid, inexpensive and practical, and should be implemented as a necessary measure for infection control.

Impact of arterial injury on neointimal hyperplasia after Zotarolimus-eluting stent implantation: an IVUS study

The amount of neointimal hyperplasia (NIH) correlates with the degree ofarterial injury after bare-metal stent (BMS) implantation. With first generationdrug-eluting stent (DES) this effect of arterial overstretch as assessed by balloonto-artery ratio (BAR) on NIH formation appears to be diminished; however theimpact of BAR on NIH following second generation DES remains unknown.Methods and results: From January to December 2006, 86 pts with 98 lesions(115 stents) underwent percutaneous coronary intervention (PCI) withintravascular ultrasound (IVUS) evaluation twelve months after zotarolimus-elutingstent (ZES) implantation. Arterial injury was defined as BAR, which wascategorised into two groups: high BAR (>1.15, n=47) and low BAR (<1.15, n=39).The aim of this study was to investigate the impact of arterial injury on NIHfollowing implantation of ZES. Least-squares linear regression was use to assessthe association between NIH and BAR at twelve months. Overall, mean age was60 years and 33% had diabetes mellitus, there were no significant differencesregarding other baseline characteristics between groups. At baseline, meanreference vessel diameter (2.62±0.5 mm vs. 2.35±0.4 mm, p=0.006) and nominalstent diameter (3.15±0.5 mm vs. 2.85±0.3 mm, p=0.002) were smaller in the highBAR group; and at twelve-month evaluation, lumen volume (110.7±91.9 mm3 vs.154.3±91.3 mm, p=0.002), stent volume (134.0±113.8 mm vs. 174.9±98.0 mm,p=0.005) and vessel volume (249.2±207.5 mm vs. 325.0±161.8 mm, p=0.003)were higher in high BAR group as compared to the low BAR group. Regardingpercentage of NIH obstruction, there was no significant difference in low BAR vs.high BAR group (15.2±14.3% vs. 12.5±10.1%, p=0.62). Finally, arterial injury asassessed by BAR was not significantly associated with the amount of NIH (R20.0025, p=0.88).

Continuous neointimal hyperplasia formation after five years ofdifferent generations of DES: is there enough evidence of late‘catch-up’?

Aims: The amount of neointimal hyperplasia (IH) following drug-eluting stent (DES)implantation correlates with the potency of the anti-proliferative drug, its kineticrelease as well as some individual characteristics, as the presence of diabetesmellitus (DM). Recently, some publications have suggested a continuous growth ofIH following DES, which in some cases, might result in late “catch-up”. The aim ofthis study was to assess, by means of serial intravascular ultrasound (IVUS) thetemporal course of IH formation following the implantation of two differentgeneration of DES (durable-polymer sirolimus-eluting stent [SES] andbiodegradable-polymer biolimus-eluting stent [BES]); and the role of diabetesmellitus in this scenario.Methods and results: Patients included in this study represent our single centerinitial experience with SES and BES. Twenty-five pts with single de novo lesions innative coronary arteries, with reference vessel diameter between 2.5 and 3.5 mmwere treated with Cypher-SES (n=12) and Biomatrix-BES (n=13), and underwentIVUS evaluation post procedure, at a mean of 9 months and 5 years. We onlyincluded patients with at least three serial IVUS acquisitions (post procedure, midand very long-term). Comparisons between baseline, first and second follow-up(FU) were done using the Friedman test and comparison between early and lateFU were done using the Wilcoxon test. The mean age was 59 years, with 28% ofDM. Stable coronary syndrome was the initial clinical indication for the majority ofthe cases (88%). Baseline characteristics did not differ between the groups.Overall, percentage of IH obstruction and IH volume markedly increased from midto long-term FU (percentage IH obstruction of 1.3% at 1st FU vs. 4.8% 2nd FU...

Angiographic and intravascular ultrasound predictors of sidebranch failure during PCI with provisional side branch stentingapproach in complex coronary bifurcation lesions

Previous randomised trials comparing single vs. double stenting inbifurcation lesions demonstrated cross-over from one to two stent strategy up to30% when single “provisional” stenting was primarily attempted. We sought toinvestigate the predictors of side branch (SB) failure in complex bifurcation lesionstreated with provisional stenting...

First-in-man, multicentre assessment of the novel Acrobat Svelt balloon-expandable stent-on-a-wire system

Recently developed, the Acrobat SOAW (Stent-On-A-Wire) coronarysystem combines a very-thin (81 μ) balloon-expandable, Cro-Co (L605) stentmounted on a delivery system with a 0.012” integrated guidewire tip (distance fromthe tip of the wire to the stent is 22mm). We sought to determine the efficacyprofile of this novel device.Methods and results: SVELTE trial is a multicenter, international (Brazil,Netherlands and Colombia), prospective, non-randomised, single-arm study of theAcrobat SOAW for the treatment of de novo coronary lesions no longer than 18mmand located in native vessels of 2.5 to 3.5mm. DS was highly recommended andpost-dilatation was at operator’s discretion. Patients were oriented to stay on dualanti-platelet regimen for at least 1 month. Main exclusion criteria were PCI in thesetting of acute ST-elevation MI and bifurcation lesions. All patients werescheduled to undergo angiographic follow-up at 6 months. The primary endpoint ofthe study was the survival-free of combined MACE (cardiac death, myocardiuminfarction and target-lesion revascularisation) at 30 days. Secondary endpointsincluded 6-month in-stent late lumen loss and binary restenosis as well ascombined MACE rate.A total of 46 patients were enrolled with mean age of 63years old, 76.6% of male and 21.3% of diabetics. Mean RVD and lesion lengthwere 3.03mm and 12.67mm, respectively. The Acrobat stent was deployed in100% of the cases (89.6% of DS) achieving a procedure success rate of 97.8%.Up to 30 days there were no deaths, Q-Wave MIs or urgent TLR. Six-monthinvasive follow-up is ongoing and complete QCA assessment will be available atthe meeting.Conclusions: The Acrobat SOAW may potentially facilitate PCI by reducingtime/cost and minimising peri-procedural complications. The present trialrepresents the first-in-man assessment of this innovative concept.

Preliminary results of the multicentric, double-blinded,randomised, Vestasync II trial

Aims: Durable polymers in 1st generation DES have been linked to local coronaryinflammation that could ultimately result in life-threatening adverse events.Polymer-free DES systems have been developed as an attractive alternative tominimise these undesired effects. We sought to assess the safety and efficacy ofthe novel VESTAsync™ Eluting Stent (VES) combining a Cro-Co platform with ananothin-microporous hydroxyapatite surface coating impregnated with apolymer-free low-dose of Sirolimus (55μg). In its first-in-man (FIM) assessment, 15patients were enrolled and at the end of 8 months, late loss and% of stentobstruction considerably low (0.36mm and 4.0%, respectively) with this novelDES.Methods and results: The Vestasync II trial is a randomised (2:1), double-blindedmulticenter comparison of the VES to its platform, the Gen X stent, withmicroporous hydroxyapatite surface coating but without sirolimus. Patients wereeligible if they presented single de novo lesions in native coronary arteries with3.0-3.5mm diameter and ≤ 14mm in length. Primary endpoint was 9-month in-stentlate loss and% of stent obstruction. Lifelong AAS and 6-month clopidogrel wereprescribed to all pts. Seventy-five patients were enrolled. Baseline characteristicsincluded mean age of 57 years and 23% of diabetics. RVD and lesion length were2.67±0.4mm and 14.0±2.0mm. Procedure success was obtained in all cases.Three patients (4.2%) presented non-Q wave MI during hospitalisation with noother MACE. After discharge, there were two cases of TLR and no MI, death orstent thrombosis. Complete invasive follow-up was achieved for all patients. QCAand IVUS analysis are being processed by independent corelabs and detailedresults will be available at the meeting.Conclusions: In confirming the enthusiastic results of its FIM evaluation, theVESTAsync™ Sirolimus-Eluting Stent should be next evaluated in a larger trial withmore complex angiographic profile and clinical endpoints.

Interação genótipo x ambiente e estimativas de parâmetros genéticos dos pesos aos 205 e 365 dias de idade de bovinos Nelore / Genotype by environment interaction and genetic parameter estimates for 205 and 365 body weight of Nelore cattle

Dados de pesos aos 205 (P205) e 365 (P365) dias de idade, de 46.408 animais Nelore, nascidos entre 1976 e 2000, provenientes de 530 rebanhos dos diversos estados brasileiros, foram utilizados para avaliar as interações genótipo x ambiente (IGA) e estimar herdabilidades direta e materna dos pesos pelo método da máxima verossimilhança restrita. O modelo estatístico utilizado incluiu efeitos fixos de grupo contemporâneo, idade da vaca ao parto (covariável) e efeitos aleatórios genéticos aditivo direto e materno. As correlações genéticas, estimadas para as características P205 e P365, cada uma considerada como característica distinta em cada uma das regiões Sul (S), Sudeste (SE), Centro-Oeste (CO), Norte (N) e Nordeste (NE), foram, respectivamente, 0,86 e 0,84, 0,64 e 0,35, 0,75 e 0,42, 0,79 e 0,86, 0,92 e 0,81, 0,95 e 0,83, 0,83 e 1,00, 0,88 e 0,81, 0,33 e 0,85, 0,63 e 0,99 para S e SE, S e CO, S e N, S e NE, SE e CO, SE e N, SE e NE, CO e N, CO e NE e N e NE. As baixas correlações genéticas indicaram que há efeito da interação genótipo x ambiente nas combinações que envolvem as regiões S/CO, S/N, S/NE, CO/NE e N/NE para P205 dias de idade e S/CO e S/N para P365 dias de idade, havendo, portanto, necessidade de avaliação genética regional quando se consideram regiões bastante distintas.

Body weight records at 205 (205BW) and 365 (365BW) days of age of 46,408 Nelore animals, born from 1976 to 2000 period in 530 Nelore herds of several states of Brazil, were used to evaluate genotype by environment interactions and to estimate genetic and maternal heritability by restricted maximum likelihood methodology. The statistical model included the fixed effects of contemporary group and age of cow (covariate), and the random direct and maternal additive genetic effects. The genetic correlation for 205BW and 365BW, each one considered as different traits in each of the South (S), Southeast (SE), Central west (CO), North (N) and Northeast (NE) regions were 0.86 and 0.84, 0.64 and 0.35, 0.75 and 0.42, 0.79 and 0.86, 0.92 and 0.81, 0.95 and 0.83, 0.83 and 1.00, 0.88 and 0.81, 0.33 and 0.85, 0.63 and 0.99 for S/SE, S/CO, S/N, S/NE, SE/CO, SE/N, SE/NE, CO/N, CO/NE and N/NE, respectively. There is a significant genotype by environment interaction for 205BW in the combination involving the S/CO, S/N, S/NE, CO/NE, and N/NE regions. There are significant genotype by environment interaction effects in the combination involving the S/CO and S/N regions for 365BW. Based on genetic x environment interaction results, regional genetic evaluation is recommend for the very distinct regions.

Desempenho de codornas de corte EV1 alimentadas com diferentes níveis de lisina na dieta / Performance of EV1 meat type quail line fed different lysine level diets

Estudou-se a exigência de lisina total para a linha EV1 de codornas de corte na fase de crescimento utilizando-se 288 aves, de ambos os sexos, em delineamento experimental inteiramente ao acaso, cujos tratamentos consistiram de dietas com seis níveis de lisina total, 1,4; 1,5; 1,6; 1,7; 1,8 e 1,9 por cento, e quatro repetições de 12 codornas por unidade experimental. Estudaram-se o ganho de peso (g), o peso corporal ao final de cada período (g), o consumo alimentar (g) e a conversão alimentar (g de alimento/g de peso) nos períodos inicial (do nascimento ao 21º dia) e total (do nascimento ao 42º dia de idade). No período inicial não se observou efeito do nível de lisina sobre o consumo alimentar, mas houve efeito quadrático sobre o peso corporal, ganho de peso e conversão alimentar, com máximo desempenho nos níveis de 1,74; 1,75 e 1,70 por cento de lisina total, respectivamente. Para o período total houve efeito quadrático do nível de lisina da dieta sobre o peso no 42º dia, ganho de peso, consumo e conversão alimentar, com máximo desempenho das codornas nos níveis de 1,65; 1,65; 1,62 e 1,64 por cento de lisina total, respectivamente. A exigência de lisina total para ganho de peso de machos e fêmeas de codornas de corte do nascimento ao 21º dia foi estimada em 1,75 por cento e do nascimento ao 42º dia, em 1,65 por cento da dieta

Total lysine requirements for EV1 meat type quail line, during the growing phase were evaluated in a completely randomized experimental design with four level of lysine (1.4, 1.5, 1.6, 1.8, 1.9 percent) and four replicates of 12 quails per experimental unit. The recorded traits were weight gain (g), body weight (g), feed intake (g), feed:weight gain ratio (g/g) for the initial (from hatch to 21days of age) and total period (from hatch to 42 days of age). The effects of lysine level on body weight, weight gain and feed:weight gain ratio were quadratic and significant with maximum values estimated for 1.74, 1.75 and 1.70 percent of total lysine respectively, but no effect on feed intake from hatch to 21 days of age was observed. Significant effects of lysine level on feed intake and feed : weight gain ratio from hatch to 42 days of age and on body at 42 days of age were observed, with maximum values estimated for 1.65, 1.65, 1.62, 1.64 percent of total lysine in the diets . The total lysine requirements for weight gain (males and females) from hatch to 21 days of age were estimated in 1.75 percent and from hatch to 42 days of age in 1.65 percent of the diet

Use of covered stents in the management of coarctation of the aorta.

We report our experience with the use of covered stents for the management of coarctation of the aorta. From December 2001 to March 2004, nine patients (seven males; median age, 31 years; mean weight, 65 +/- 15 kg) underwent implantation. Indications included critical or atretic native coarctation (n = 4), patients >50 years of age (n = 2), associated patent ductus arteriosus (n = 1) or adjacent aneurysm (n = 1), and the presence of a circumferential fracture within a previously implanted stent (n = 1). The covered balloon-expandable Cheatham-Platinum stent and the self-expandable stent graft Braile were employed. Adequate implantation was observed in all patients. Gradients were reduced from 54 +/- 14 to 3 +/- 8 mmHg and the coarctation site increased from 2.4 +/- 2.9 to 15.9 +/- 4.3 mm. The patent ductus arteriosus was immediately closed and the aneurysm excluded. Two patients >35 years with aneurysmal ascending aorta and metallic aortic prosthesis had aneurysm formation at follow-up, with one undergoing aneurysm exclusion using a Braile stent. Although covered stents are useful in the management of selected patients with coarctation, aneurysm formation may still occur in patients with markers of aortic wall weakness. Refinements in the deployment technique and/or the stent design are needed to eliminate this risk.

Use of rapamycin-impregnated stents in coronary arteries.

FIM STUDY: We investigated the 2-year safety and efficacy of sirolimus-eluting stents. Thirty patients had a single 18-mm sirolimus-eluting coronary stent implanted. Twenty-eight patients underwent angiographic and intravascular ultrasound follow-up at 2 years. No death occurred during the study period. No patient developed in-stent restenosis. One patient had a 52% in-lesion stenosis that required repeated revascularization and another patient underwent target vessel revascularization. Neointimal hyperplasia volume was minimal at 2 years in both groups. This study demonstrates the 2-year safety and efficacy of sirolimus-eluting stenting. The slow release formulation showed slight superiority over the fast-release formulation in preventing late lumen loss, which was minimal in both groups. RAVEL TRIAL: This-study was a randomized, double-blind study that included 238 patients at 19 medical centers (15 in Europe, 3 in Brazil, and 1 in Mexico). Patients were eligible for the study if they were between 18 and 85 years of age, and had been given a diagnosis of stable or unstable angina or silent ischemia. Additional eligibility criteria were presence of a single primary target lesion in a native coronary artery that was 2.5 to 3.5 mm in diameter and that could be covered by an 18-mm stent stenosis of 51% to 99% of the luminal diameter and a flow rate of grade 1 or higher according to the Thrombolysis in Myocardial Infarction. RESULTS: One hundred twenty patients were randomly assigned to receive the sirolimus-eluting stent, and 118 were assigned to receive the standard stent. At 6 months, the degree of neointimal proliferation, manifested as the mean (+/-SD) late luminal loss, was significantly lower in the sirolimus-stent group (-0.01 +/- 0.33 mm) than in the standard-stent group (0.80 +/- 0.53 mm, P <.001). None of the patients in the sirolimus-stent group, as compared with 26.6% of those in the standard-stent group, had restenosis of >/=50% of the luminal diameter (P <.001). There were no episodes of stent thrombosis. During a follow-up period of up to 1 year, the overall rate of major cardiac events was 5.8% in the sirolimus-stent group and 28.8% in the standard-stent group (P <.001). The difference was due entirely to the higher rate of revascularization of the target vessel in the standard-stent group. CONCLUSION: Patients with angina who received sirolimus-eluting stents for the treatment of single, primary lesions in native coronary arteries had no angiographic evidence of late luminal loss or in-stent restenosis at 6 months, no episodes of thrombosis, and a very low rate of cardiac events at 1 year.

Use of Rapamycin-Impregnated Stents in Coronary Arteries

We investigated the 2-year safety and efficacy of Sirolimus-eluting stents. Thirty patients had a single 18-mm sirolimus-eluting coronary stent implanted.Twentyeight patients underwent angiographic and intravascularultrasound follow-up at 2 years.No death occurred during the study period. No patient developed in-stent restenosis. One patient had a 52% in-lesion stenosis that required repeated revascularization and another patient underwent target vessel revascularization. Neointimal hyperplasia volume was minimal at 2 years in both groups. This study demonstrates the 2-year safety and efficacy of sirolimus-eluting stenting. The slow release formulation showed slight superiority over the fast-release formulation in preventing late lumen loss, which was minimal in both groups. RAVEL Trial. This-study was a randomized, double-blind study that included 238 patients at 19 medical centers (15 in Europe, 3 in Brazil, and 1 in Mexico). Patients were eligible for the study if they were between 18 and 85 years of age, and had been given a diagnosis of stable or unstable angina or silent ischemia. Additional eligibility criteria were presence of a single primary target lesion in a native coronary artery that was 2.5 to 3.5 mm in diameter and that could be covered by an 18-mm stent stenosis of 51% to 99% of the luminal diameter and a flow rate of grade 1 or higher according to the Thrombolysis in Myocardial Infarction. Results. One hundred twenty patients were randomly assigned to receive the sirolimuseluting stent, and 118 were assigned to receive the standard stent. At 6 months, the degree of neointimal proliferation, manifested as the mean ( SD) late luminal loss, was significantly lower in the sirolimus-stent group ( 0.01 0.33 mm) than in the standardstent group (0.80 0.53 mm, P .001). None of the patients in the sirolimus-stent group,as compared with 26.6% of those in the standard-stent group, had restenosis of 50% of the luminal diameter (P .001). There were no episodes of stent thrombosis. During a follow-up period of up to 1 year, the overall rate of major cardiac events was 5.8% in the sirolimus-stent group and 28.8% in the standard-stent group (P .001). The difference was due entirely to the higher rate of revascularization of the target vessel in the standard-stent group...

Coronary flow velocity reserve after percutaneous interventions is predictive of periprocedural outcome.

BACKGROUND: Because heterogeneous results have been reported, we assessed coronary flow velocity changes in individuals who underwent percutaneous transluminal coronary angioplasty (PTCA) and examined their impact on clinical outcome. METHODS AND RESULTS: As part of the Doppler Endpoints Balloon Angioplasty Trial Europe (DEBATE) II study, 379 patients underwent Doppler flow-guided angioplasty. All patients were evaluated according to their coronary flow velocity reserve (CFVR) results (> or =2.5 or < 2.5) at the end of the procedure. A CFVR < 2.5 after angioplasty was associated with an elevated baseline blood flow velocity in both the target artery and reference artery. CFVR before PTCA and CFVR in the reference artery were independent predictors of an optimal CFVR after balloon angioplasty (CFVR before PTCA: odds ratio [OR], 2.26; 95% confidence interval [CI], 1.57 to 3.24; CFVR in reference artery: OR, 1.90; 95% CI, 1.21 to 2.98; both P<0.001) and stent implantation (before PTCA: OR, 2.54; 95% CI, 1.47 to 4.36; reference artery: OR, 1.97; 95% CI, 1.07 to 3.87; both P<0.05). A low CFVR at the end of the procedure was an independent predictor of major adverse cardiac events (MACE) at 30 days (OR, 4.71; 95% CI, 1.14 to 25.92; P=0.034) and at 1 year (OR, 2.06; 95% CI, 1.16 to 3.66; P=0.014). After excluding MACE at 30 days, no difference in MACE at 1 year was observed between the patients with and without a CFVR < 2.5 at the end of the procedure. CONCLUSIONS: A low postprocedural CFVR was associated with a worse periprocedural outcome (which was related to microcirculatory disturbances), but there was no significant difference at late follow-up.

Coronary flow velocity reserve after percutaneous interventions is predictive of periprocedural outcome

Background—Because heterogeneous results have been reported, we assessed coronary flow velocity changes in individuals who underwent percutaneous transluminal coronary angioplasty (PTCA) and examined their impact on clinical outcome. Methods and Results—As part of the Doppler Endpoints Balloon Angioplasty Trial Europe (DEBATE) II study, 379 patients underwent Doppler flow– guided angioplasty. All patients were evaluated according to their coronary flow velocity reserve (CFVR) results ( 2.5 or 2.5) at the end of the procedure. A CFVR 2.5 after angioplasty was associated with an elevated baseline blood flow velocity in both the target artery and reference artery. CFVR before PTCA and CFVR in the reference artery were independent predictors of an optimal CFVR after balloon angioplasty (CFVR before PTCA: odds ratio [OR], 2.26; 95% confidence interval [CI], 1.57 to 3.24; CFVR in reference artery: OR, 1.90; 95% CI, 1.21 to 2.98; both P 0.001) and stent implantation (before PTCA: OR, 2.54; 95% CI, 1.47 to 4.36; reference artery: OR, 1.97; 95% CI, 1.07 to 3.87; both P 0.05). A low CFVR at the end of the procedure was an independent predictor of major adverse cardiac events (MACE) at 30 days (OR, 4.71; 95% CI, 1.14 to 25.92; P 0.034) and at 1 year (OR, 2.06; 95% CI, 1.16 to 3.66; P 0.014). After excluding MACE at 30 days, no difference in MACE at 1 year was observed between the patients with and without a CFVR 2.5 at the end of the procedure. Conclusions—A low postprocedural CFVR was associated with a worse periprocedural outcome (which was related to microcirculatory disturbances), but there was no significant difference at late follow-up...

New percutaneous techniques for perforating the pulmonary valve in pulmonary atresia with intact ventricular septum.

We report new percutaneous techniques for perforating the pulmonary valve in pulmonary atresia with intact ventricular septum, in 3 newborns who had this birth defect. There was mild to moderate hypoplastic right ventricle, a patent infundibulum, and no coronary-cavitary communications. We succeeded in all cases, and no complications related to the procedure occurred. The new coaxial radiofrequency system was easy to handle, which simplified the procedure. Two patients required an additional source of pulmonary flow (Blalock-Taussig shunt) in the first week after catheterization. All patients had a satisfactory short-term clinical evolution and will undergo recatheterization within 1 year to define the next therapeutic strategy. We conclude that this technique may be safely and efficiently performed, especially when the new coaxial radiofrequency system is used, and it may become the initial treatment of choice in select neonates with pulmonary atresia and intact ventricular septum.

Ventricular endocardial right bifocal stimulation in the treatment of severe dilated cardiomyopathy heart failure with wide QRS.

The QRS widening by ventricular conventional pacing impairs the systolic and diastolic functions and increases mitral regurgitation. The aim of this study was to compare conventional pacing to an alternative stimulation mode with a narrower QRS using two leads in the RV. Thirty-nine (25 men, 14 women; mean age 60.1 +/- 15.1 years) dilated cardiomyopathy patients (Chagas' disease [n = 17], coronariopathy [n = 9], AV ablation for tachycardiomyopathy [n = 3], and other [n = 10]) with cardiac failure (NYHA 3.1 +/- 0.8), pacemaker indication, and chronic AV block (22 AF) had endocardial pacemaker implantations (27 Biotronik, 12 Guidant). Two RV leads (one septal, one conventional [RV apex] were connected, respectively, to the atrial and ventricular pacemaker plugs. After clinical stabilization they were studied under three stimulation modes in the same session: AAI (septal), VVI (conventional), and ventricular endocardial right bifocal stimulation (VERBS) (DDT/DVI/DDD = AV interval = 15/10 ms). In comparison to conventional pacing, VERBS increased ejection fraction (0.124), cardiac output (19.5%), and peak filling rate (31.0%), and decreased QRS duration (24.7%), left atrium area (11.9%), mitral regurgitation area (32.3%), the diastolic transmitral flow (E/A relation) (19.3%), and the propagation flow time (18.0%) from the mitral valve to the left ventricular apex (tE_col), (P < 0.05). The quality-of-life showed an impressive score reduction of 50.4%. The septal stimulation alone showed a less expressive benefit. In severe dilated cardiomyopathy with classic pacemaker indication, VERBS showed significantly better performance than the septal or the conventional stimulation alone. There was a good systolic and a remarkable diastolic improvement causing an important reduction in the quality-of-life score.

Sustained suppression of neointimal proliferation by sirolimus-eluting stents: one-year angiographic and intravascular ultrasound follow-up.

BACKGROUND: We have previously reported a virtual absence of neointimal hyperplasia 4 months after implantation of sirolimus-eluting stents. The aim of the present investigation was to determine whether these results are sustained over a period of 1 year. METHODS AND RESULTS: Forty-five patients with de novo coronary disease were successfully treated with the implantation of a single sirolimus-eluting Bx VELOCITY stent in São Paulo, Brazil (n=30, 15 fast release [group I, GI] and 15 slow release [GII]) and Rotterdam, The Netherlands (15 slow release, GIII). Angiographic and volumetric intravascular ultrasound (IVUS) follow-up was obtained at 4 and 12 months (GI and GII) and 6 months (GIII). In-stent minimal lumen diameter and percent diameter stenosis remained essentially unchanged in all groups (at 12 months, GI and GII; at 6 months, GIII). Follow-up in-lesion minimal lumen diameter was 2.28 mm (GIII), 2.32 mm (GI), and 2.48 mm (GII). No patient approached the >/=50% diameter stenosis at 1 year by angiography or IVUS assessment, and no edge restenosis was observed. Neointimal hyperplasia, as detected by IVUS, was virtually absent at 6 months (2+/-5% obstruction volume, GIII) and at 12 months (GI=2+/-5% and GII=2+/-3%). CONCLUSIONS: This study demonstrates a sustained suppression of neointimal proliferation by sirolimus-eluting Bx VELOCITY stents 1 year after implantation.