Role of the left coronary artery geometry configuration in atherosusceptibility: CFD simulations considering sPTT model for blood.

The achievement of clinically viable methodologies to simulate the hemodynamics in patient-specific coronary arteries is still a major challenge. Therefore, the novelty of this work is attained by the introduction of the viscoelastic property of blood in the numerical simulations, to study the role of the left coronary artery (LCA) geometry configuration in the atherosusceptibility. Apparently healthy patients were used and four different methodologies were tested. The methodology giving the most accurate results at the same time of having the lowest computational time is the one considering the viscoelastic property of blood and computational fluid dynamics. A Pearson correlation analysis was used to highlight relationships between geometric configuration and hemodynamic descriptors based on the simulated wall shear stress (WSS). The left main stem (LMS) has the greatest atherosusceptibility followed by the left anterior descending artery (LAD) since the relative residence time (RRT) average values are 3.81 and 3.70 Pa-1, respectively. The geometric parameters with relevant contribution to directional flow change are the cross-sectional areas, especially the one of LMS segment (ALMS), and the curvature of LMS segment. For LMS and LAD segments, when ALMS increases, blood flow disturbance (r = 0.81 in LMS and r = 0.74 in LAD) and atherosusceptibility (r = 0.84 in LMS and r = 0.85 in LAD) increases. When the LMS curvature decreases, the WSS magnitude (r = 0.80 in LMS and r = 0.83 in LAD) decreases, and disturbance (r=-0.80 in LMS and r=-0.91 in LAD) and atherosusceptibility (r=-0.74 in LMS and r=-0.74 in LAD) increases.

Effects of dietary energy content and source using by-products on carcass and meat quality traits of cull ewes.

In cull ewes, energy supply by time short periods can affect growth, carcass traits, and meat quality. The objective of this study was to evaluate the effect of biscuit bran (BB) and cashew nut bran (CNB) in diets with different total digestible nutrient (TDN) content on animal performance and carcass and meat traits of cull ewes. Twenty Morada Nova cull ewes, with the initial BW of 30.1 ±â€¯3.56 kg, and three years of age were distributed in a completely randomized design into factorial scheme 2 × 2, with two energy sources (BB and CNB) × two levels of TDN. All diets were isoproteic with variations in TDN content increased by 10% (TDN10) and 25% (TDN25) above the recommended requirement for the study category, which was 66.0% TDN. The experimental period lasted 56 days, in which daily intake in relation to metabolic weight and weight performance of the animals was determined. The hot carcass, the cold carcass, commercial cuts, loin eye area, and subcutaneous fat thickness were measured, obtained, or calculated. A sample of the Longissimus lumborum (LL) muscle was used by determination of physical-chemical composition, sensory, and fatty acid (FA) profile analysis. The ANOVA was performed to access the effect of diet and energy level on the characteristics studied, and means were compared by the Turkey and Kruskal Wallis tests at 5% of probability. A higher daily gain weight was observed from TDN25 (P = 0.006). Among by-products, higher nutrient intakes were observed in animals fed with BB diets (P < 0.01), except for crude protein. The same patterns have been observed for live weight, reconstituted half-carcass, higher yield in fat thickness, and internal carcass length. Cashew nut bran produced darker colored meat (P = 0.017) and higher cooking weight loss (P = 0.008). Higher lipid content was observed in animals submitted to diets with CNB and TDN25 (P = 0.001). The internal length of the carcass was higher in animals fed with BB (P = 0.041). All diets did not effect on sensory characteristics (P > 0.05). Total digestible nutrient in 25% above recommended promotes higher weight gain and meat with higher lipid content and less weight loss by cooling. The inclusion of BB, compared to CNB, provides a higher weight of carcasses and better conformation, in addition to lower total lipid content with higher proportion for monounsaturated FAs in meat, providing more attractive features for the consumer market.

PAH Profiles in Suspended Particulate Matter from an Urbanized River Within the Brazilian Amazon.

The distribution, seasonal variation and sources of 16 polycyclic aromatic hydrocarbons (PAH) from suspended particulate matter (SPM) of the Aurá River, a small amazon typical river located in Northern Brazil, were determined. Gas chromatography-mass spectrometry analysis of SPM revealed a mixture of PAH from different origins and a seasonal variation of PAH primary source for the studied area. Pyrene was the dominant PAH in both studied periods. Total PAH content (ΣPAH) ranged from lower than quantification limit (< LOQ) to 2498.2 ng g-1 dw during the dry season and < LOQ to 2865.8 ng g-1 dw during the wet season. Low molecular weight PAH (LMW) represented 51% of ΣPAH during the dry season and 29% during the wet season. It was noted, by comparing previous data, that the main source of these compounds was altered after the deactivation of an irregular landfill next to the river.

Numerical simulation of lateral and transforaminal lumbar interbody fusion, two minimally invasive surgical approaches.

The present study aims to compare spinal stability after two different minimally invasive techniques, the lateral lumbar interbody fusion (LLIF) and the transforaminal lumbar interbody fusion (TLIF) approaches. Two nonlinear three-dimensional finite element (FE) models of the L4-L5 functional spinal unit (FSU) were subjected to the loads that usually act on the lumbar spine. Findings show that the LLIF approach yields better results for torsion load case, due to the larger surface area of the implant. For extension, flexion and lateral bending loads, the TLIF approach presents smaller displacements probably due to the anterior placement of the cage and to the smaller damaged area of the annulus fibrosus.

Minimally invasive transforaminal and anterior lumbar interbody fusion surgery at level L5-S1.

This paper presents a finite element analysis to investigate the biomechanical changes caused by transforaminal (TLIF) and anterior lumbar interbody fusion (ALIF) at the L5-S1 level, applying two different implants: T_PAL (TLIF) and SynFix (ALIF). The main objective is to determine which one is more stable for patients. Numerical simulations of segmental motion show that, in the early postoperative phase, displacements and rotation angles obtained in ALIF are greater than the corresponding ones obtained in TLIF, as well as the principal stress values on the ligaments. So, TLIF performed with T_PAL is more stable than ALIF, especially during the recovery phase.

The Impact of the Right Coronary Artery Geometric Parameters on Hemodynamic Performance.

PURPOSE: Coronary artery geometry can have a significant impact in the hemodynamic behavior of coronary blood flow, influencing atherosclerotic plaque formation. The present work focuses on, through a statistical study, the connection between several geometric parameters of the right coronary artery-ostium cross-sectional area, angles between the common trunk and the side-branches, tortuosity, curvature and cross-sectional area in each side-branch-and their influence on hemodynamic descriptors. Parameters such as low wall shear stress and local disturbed flow, which are associated with atherosclerosis formation, were analysed. METHODS: Computed tomography images of ten healthy individuals were selected to reconstruct in vivo three-dimensional models of right coronary arteries. Blood flow was simulated through a compliant model with realistic boundary conditions. Calculated hemodynamic descriptors values were correlated with the geometric parameters using the Pearson correlation coefficient (r) and the p value. RESULTS: The strongest correlations were found in the middle and distal segments of the right coronary artery. A decrease in the ostium area promotes a decrease in the WSS magnitude from the proximal to the distal segment (r = 0.82). Very strong correlations (r > 0.90) were achieved between geometric parameters (cross-sectional area, angle, tortuosity) of the right-ventricular branch and the wall shear stress magnitude in the middle and distal segments. CONCLUSIONS: Low values of tortuosity, smaller cross-sectional area and higher angle of the right-ventricular branch leads to a hemodynamic behavior more propitious to atherosclerosis formation, within the study cases. The right-ventricular branch seems to have the highest influence in the hemodynamic behavior of the right coronary artery.

Second update of the International Registry of HLA Epitopes. I. The HLA-ABC Epitope Database.

The International Registry of HLA Epitopes (http://www.epregistry.com.br) is a website-based resource for HLA epitopes important in transplant rejection and platelet transfusion refractoriness. Its primary goal is to document epitopes that are verified experimentally with specific antibodies. Such epitopes can be defined by single eplets and by eplets paired with certain polymorphic residues within a 15-Å radius, the dimension of the corresponding structural epitope. This report is an update of the HLA-ABC repertoire including descriptions of 72 antibody-verifications of epitopes defined by eplets and/or eplet pairs. The newly updated version 2.0 EpRegistry shows also the polymorphic residue compositions of structural epitopes corresponding to eplets shared between groups of alleles. At present, 151 eplets have not been antibody-verified, and we ranked them with a so-called ElliPro score as a potential predictor of immunogenicity. Sixty eplets with low ElliPro scores might be considered non-epitopes incapable of inducing specific antibodies.

Correlation between geometric parameters of the left coronary artery and hemodynamic descriptors of atherosclerosis: FSI and statistical study.

The hemodynamics conditioned by coronary geometry may play an important role in the creation of a pro-atherogenic environment in specific locations of the coronary tree. The aim of this study is to identify how several geometric parameters of the left coronary artery - cross-section areas, proximal left anterior descending artery length, angles between the branches and the septum, curvature and tortuosity - can be related with hemodynamic descriptors, using a computational fluid-structure interaction method. It is widely accepted that the hemodynamic indicators play an important role in identifying possible pro-atherogenic locations. A statistical study, using Pearson correlation coefficient and P value, was performed for a population study of 8 normal human left coronary arteries presenting right-dominant circulation. Within the study cases, arteries with high caliber (r = 0.88), high angles LMS-LAD (r = 0.49), LAD-LCx (r = 0.57) and LAD-Septum (r = 0.52), and high tortuosity LMS-LCx (r = 0.63) were correlated with a hemodynamic behavior propitious to plaque formation in the left anterior descending artery. In contrast, high proximal left anterior descending artery length (r = -0.41), high angle LMS-LCx (r = -0.59), high tortuosity LMS-LAD (r = -0.56) and LAD-LCx (r = -0.55) and high curvature of LMS (r = -0.60) and LCx (r = -0.56) can lead to non-favorable hemodynamic conditions for atheroma formation. Graphical abstract.

Numerical study on the hemodynamics of patient-specific carotid bifurcation using a new mesh approach.

The definition of a suitable mesh to simulate blood flow in the human carotid bifurcation has been investigated. In this research, a novel mesh generation method is proposed: hexahedral cells at the center of the vessel and a fine grid of tetrahedral cells near the artery wall, in order to correctly simulate the large blood velocity gradients associated with specific locations. The selected numerical examples to show the pertinence of the novel generation method are supported by carotid ultrasound image data of a patient-specific case. Doppler systolic blood velocities measured during ultrasound examination are compared with simulated velocities using 4 different combinations of hexahedral and tetrahedral meshes and different fluid dynamic simulators. The Lin's test was applied to show the concordance of the results. Wall shear stress-based descriptors and localized normalized helicity descriptor emphasize the performance of the new method. Another feature is the reduced computation time required by the developed methodology. With the accurate combined mesh, different flow rate partitions, between the internal carotid artery and external carotid artery, were studied. The overall effect of the partitions is mainly in the blood flow patterns and in the hot-spot modulation of atherosclerosis-susceptible regions, rather than in their distribution along the bifurcation.

The use of a potential novel tool in virtual crossmatching for platelet transfusion in platelet refractoriness.

BACKGROUND AND OBJECTIVES: Transfusion support for immune-mediated platelet refractoriness (PR) is clinically challenging, technically laborious and costly. The development of 'EpHLA/EpVix software' has been used successfully to select kidney donors. Here, we sought to evaluate this new software as a tool for platelet virtual crossmatch (VxM). MATERIALS AND METHODS: This is a prospective study from 2007 to 2014 of PR patients in a tertiary hospital. Platelet components selected by HLAMatchmaker program were crossmatched by EpHLA/EpVix, anti-human globulin complement-dependent lymphocytotoxicity test (AHG-CDC), flow cytometry platelet crossmatch (FCxM) and then compared. Effectiveness of platelet components transfused was evaluated by CCI. RESULTS: Ninety-seven crossmatched platelet transfusions for 27 patients were enrolled. Partial matches were analysed for 75 transfusions by the 3 methods, and 22% showed discrepant results among the assays. After further analysis, data showed that all divergent cases could be explained by HPA alloimmunization, prozone effect (FCxM), low sensitivity of AHG-CDC and possible interference in FCxM/AHG-CDC assays. Notably, sensitivity and specificity of VxM analysis was excellent (100%). Satisfactory CCI counts were obtained for the majority (22/30) of the transfusions. CONCLUSION: The new EpHLA/EpVix method showed to be effective, feasible and fast for VxM at no cost and able to minimize labour on donor identification. However, platelet crossmatching may be a necessary step because EpHLA/EpVix does not formally exclude HPA alloimmunization.

First report on the antibody verification of MICA epitopes recorded in the HLA epitope registry.

The International Registry of HLA Epitopes (http://epregistry.com.br) has been recently established as a tool to understand antibody responses to HLA mismatches. These epitopes are defined structurally by three-dimensional molecular modelling and amino acid sequence differences between HLA antigens. A major goal was to identify HLA epitopes that have been verified experimentally with informative antibodies. This report addresses the identification of MICA epitopes. Our analysis included published information about MICA antibody reactivity in sera from sensitized patients as well as data from our own laboratories. This report describes twenty-one MICA epitopes verified with antibodies which have primarily been tested in Luminex assays with single alleles. The epitopes correspond to distinct eplets that are often defined by single residues. The Registry is still a work-in-progress and will become a useful resource for HLA professionals interested in histocompatibility testing at the epitope level and investigating antibody responses to HLA mismatches in transplant patients.

First report on the antibody verification of HLA-ABC epitopes recorded in the website-based HLA Epitope Registry.

The International Registry of Antibody-Defined HLA Epitopes ( http://www.epregistry.com.br) has been recently established as a tool to understand humoral responses to human leukocyte antigen (HLA) mismatches. These epitopes are defined structurally by three-dimensional molecular modeling and amino acid sequence differences between HLA antigens. So-called eplets represent essential components of HLA epitopes and they are defined by polymorphic residues. A major goal is to identify HLA epitopes that have been verified experimentally with informative antibodies. Our analysis has also included data in many publications. As of 1 November 2013, 95 HLA-ABC antibody-verified epitopes have been recorded, 62 correspond to eplets and 33 are defined by eplets paired with other residue configurations. The Registry is still a work-in-progress and will become a useful resource for HLA professionals interested in histocompatibility testing at the epitope level and investigating antibody responses to HLA mismatches in transplant patients.

HLA-A, HLA-B and HLA-DRB1 haplotype frequencies in Piauí's volunteer bone marrow donors enrolled at the Brazilian registry.

This study aimed to report the antigen and haplotype frequencies (HFs) of volunteer bone marrow donors (VBMDs) from the state of Piauí who were enrolled in the National Volunteer Bone Marrow Donor Registry (REDOME). The research subjects were 21,943 volunteer bone marrow donors, predominantly young adult women (53.3%). The most frequent allelic group was HLA-A2, followed by -DRB1*13, -DRB1*04, -DRB1*07, -B*15, -B∗35, -B*44, -A*24 and -A*03. Of the 2,704 haplotypes observed, the three most frequent haplotypes were A*29 B*44 DRB1*07 (1.45%), A*01 B*08 DRB1*03 (1.4%) and A*03 B*07 DRB1*15 (0.92%). These three haplotypes were in linkage disequilibrium. PCA showed that 98% of the VBMDs have HLA allele frequencies that are very similar to those from Teresina, the capital city of Piauí. According to the PCA results, these municipalities are distributed with a close proximity to Teresina, which in turn has a close genetic proximity to the Hispanic ethnicity, intermediate proximity to Caucasians and Africans and a distant kinship to Amerindians. The hierarchical proximity of the population of Piauí to the Portuguese and Hispanic populations to shows the strong influence of the latter on the former.

16th IHIW: a website for antibody-defined HLA epitope Registry.

The concept that HLA antibodies are specific for epitopes rather than HLA antigens is important not only for the determination of mismatch acceptability for sensitized patients but also for a better understanding of the antibody response to an HLA mismatch. Numerous publications describe epitope-specific antibodies, but there is no standardized information about the repertoire of clinically relevant HLA epitopes. Under auspices of the 16th IHIW, we have developed a website-based registry of antibody-verified HLA epitopes. Epitope notations are based on HLA molecular modelling of amino acid residues in polymorphic sequence positions. Informative epitope-specific antibodies had been induced by a transplant, transfusion or pregnancy and were monoclonal antibodies or eluates of sera absorbed with single HLA alleles. Antibody reactivity was determined in binding assays with single-allele panels. Antibody producer/immunizer HLA types enhanced the characterization of specific epitopes. The Registry also includes epitopes described in original research publications. Based on the extent of antibody reactivity information, we assigned epitope status as confirmed (well documented) or provisional (more data are needed). At present, the Registry has 69 HLA-ABC, 53 DRB1/3/4/5, 17 DQ, 8 DP and 22 MICA antibody-verified epitopes and will be updated on a quarterly basis. Laboratories worldwide continue to submit data about previously unreported antibody-specific epitopes. For each epitope, the website shows its amino acid composition and HLA alleles that share the epitope. Links show antibody reactivity patterns, sensitization information and references. Other links show molecular modelling of corresponding structural epitopes and polymorphic residue information for epitope-carrying alleles. The website will also have a link to epitope frequency information in different populations. Search functions will list mismatched epitopes on mismatched alleles for selected HLA types. The HLA Epitope Registry will become a valuable resource for researchers interested in HLA compatibility at the epitope level and investigating antibody responses to HLA mismatches.

Molecular characterization of an opossum Didelphis albiventris (Marsupialia: Didelphidae) population in an urban fragment of the Brazilian Atlantic rainforest and support to species barcode identification.

We made a molecular study of 40 opossums, Didelphis albiventris, from an urban fragment of the Atlantic Rainforest in southeastern Brazil, analyzing a 653-bp sequence of cytochrome c oxidase, subunit I. We found three close connected haplotypes, with low nucleotide diversity and a haplotype diversity of 59.1% and confirmed sympatry between D. albiventris and D. aurita in this region. The clear phylogenetic separation shows the appropriateness of DNA barcode identification methodology for effectively discriminating between these opossum species.

Chemical composition of Eucalyptus spp. essential oils and their insecticidal effects on Lutzomyia longipalpis.

The chemical composition of essential oils from three species of plants belonging to the Eucalyptus genus was determined and, their insecticidal effects on egg, larva and adult phases of Lutzomyia longipalpis were assessed. The insects were collected in the municipality of Sobral in the State of Ceará, Brazil. Five treatments with different concentrations were performed along with two negative controls, distilled water and Tween 80 (3%), and a positive control, cypermethrin (0.196mg/ml). The tests were carried out in plastic pots internally coated with sterile plaster and filled with a substrate made of rabbit feces and crushed cassava leaves. The eggs, larvae and adults were sprayed with the oils. The hatched larvae were counted for 10 consecutive days and observed until pupation. Insect mortality was observed after 24, 48 and 72h. E. staigeriana oil was the most effective on all three phases of the insect, followed by E. citriodora and E. globulus oils, respectively. The major constituents of the oils were Z-citral and alpha-citral (E. staigeriana), citronellal (E. citriodora) and 1,8-cineole (E. globulus). The Eucalyptus essential oils constitute alternative natural products for the control of L. longipalpis since the median effective concentration (EC(50)) values revealed relevant action as compared with other natural products, some of their chemical constituents are already known for their insecticidal activity and these oils are produced in commercial scale in Brazil.

[Coronary sinus atrial septal defect, ventricular septal defect and absence of left superior vena cava]. / Comunicação interatrial do tipo seio coronário, comunicação interventricular e ausência de veia cava superior esquerda.

We report a rare case of a 21 month old child with a coronary sinus atrial septal defect associated with perimembranous ventricular septal defect and no left superior vena cava. The diagnosis was made by transthoracic echocardiogram and confirmed by angiography. The patient was operated on uneventfully, both defects were closed with bovine pericardial patches and the flow from the coronary veins was directed towards the left atrium. An echocardiogram revealed complete closure of both defects.

[Infective endocarditis in children and adolescents]. / Endocardite infecciosa na infância e adolescência.

PURPOSE: To assess infective endocarditis (IE) predisposing factors, etiologic agents and hospital course in infants and adolescents. METHODS: We Studied 222 patients admitted under compatible IE diagnosis, from 1985 to 1990. The population of this study is fifty patients (23%) under 16 years of age. RESULTS: Rheumatic valvular disease, as predisposing cardiopathy was proeminent within 9 to 16 years of age, markedly Statistical difference when compared to age range of 0 to 8 years (p < 0.05). Among congenital cardiopathies, the most frequent were: interventricular septal defect (26.0%) and tetralogy of Fallot (21.7%). Blood cultures, surgical material or emboli cultures were positive in 35 (70.0%) assessed patients. Streptococcus viridans (45.7%) and Staphylococcus aureus (42.8%) were the etiologic agents most often isolated. It was found that endocarditis by Staphylococcus aureus had mortality rate of 53.3% [(clinical (66.6%) and surgical (44.4%)], (p < 0.05) when compared to those by Streptococcus viridans; with total mortality of 6.2% (no clinical death and 16.6% in the surgical group). Total in-hospital mortality (clinical and surgical) was 26.0% (13 deaths). CONCLUSION: IE in infants and adolescents in this studied population presented Streptococcus viridans responsible for 46.7% of patients with endocarditis and the Staphylococcus aureus for 42.8% were the etiologic agents most often found. Total, clinical and surgical mortality was greater in patients with endocarditis by Staphylococcus aureus when compared with those by Streptococcus viridans. Among the congenital cardiopathies, whether operated on or not, ventricular septal defect and of Fallot's tetralogy were the most involved ones; rheumatic cardiopathy Still remains a significant predisposing factor to infective IE in our country.

[Phako-small port]. / Faco "smallport".

The smallport system is a new technology that brings to surgeons who begin in phacoemulsification more advantages and control in surgery, more security and less time required for learning. The authors show the differences (advantages and disadvantages) between standard systems and the endocapsular "smallport". In nuclei up to grade 3 hardness we have good results with low phaco power (5-10%) and higher linear aspiration (200 mmHg) causing minimal loss of endothelial cells and quick visual rehabilitation.

[Seroprevalence and risk factors for hepatitis B virus infection by AgHBs and anti-HBs markers in prisoners and prime blood donors]. / Soroprevalência e fatores de risco para a infecção pelo vírus da hepatite B pelos marcadores AgHBs e anti-HBs em prisioneiros e primodoadores de sangue.

Two cross-sectional surveys on hepatitis B virus (HBV) infection were carried out among 1,033 volunteer first-time blood donors in five blood banks (3 private, 2 public) and among 201 prisoners in the Penitentiary Center of Industrial Activity, in Goiania, Central Brazil, between June 1988 and February 1989. Those surveys were part of a major study designed to estimate seroprevalence of HBsAg and anti-HBsAg markers by ELISA test, and to study risk factors associated with seropositivity. The presence of any serum marker was considered as previous exposure to HBV. A standard questionnaire was applied to both populations to evaluate previous blood transfusion, number of sexual partners, homo/bisexual activity, history of sexually transmitted diseases, drug abusers, use of parenteral medicine, acupuncture, tattooing and VDRL seropositivity. Seroprevalence varied from 12.8% to 26.4% in blood donors and prisoners, respectively, (p less than 0.05) and increased with age (X2 trend=14.0 p less than 0.05%). Prisoners had higher percentages of all risk factors investigated than blood donors, with the exception of number of sexual partners. Among all risk factors studied, age, imprisonment and tattooing were statistically associated with seropositivity, even after multivariate analysis controlling for age and reclusion. The paper discusses the methodologic issues related to this epidemiologic investigation.