Molecular Hallmarks of Ischemia with Non-Obstructive Coronary Arteries: The "INOCA versus Obstructive CCS" Challenge.

Up to 4 million patients with signs of myocardial ischemia have no obstructive coronary artery disease (CAD). The absence of precise guidelines for diagnosis and treatment in non-obstructive CAD encourages the scientific community to fill the gap knowledge, to provide non-invasive and less expensive diagnostic tools. The aim of our study was to explore the biological profile of Ischemia with Non-Obstructive Coronary Arteries (INOCA) patients with microvascular dysfunction compared to patients presenting with obstructive chronic coronary syndrome (ObCCS) in order to find specific hallmarks of each clinical condition. We performed a gene expression array from peripheral blood mononuclear cells (PBMCs) isolated from INOCA (n = 18) and ObCCS (n = 20) patients. Our results showed a significantly reduced gene expression of molecules involved in cell adhesion, signaling, vascular motion, and inflammation in INOCA as compared to the ObCCS group. In detail, we found lower expression of Platelet and Endothelial Cell Adhesion Molecule 1 (CD31, p < 0.0001), Intercellular Adhesion Molecule-1 (ICAM1, p = 0.0004), Tumor Necrosis Factor (TNF p = 0.0003), Transferrin Receptor (TFRC, p = 0.002), and Vascular Endothelial Growth Factor A (VEGFA, p = 0.0006) in the INOCA group compared with ObCCS. Meanwhile, we observed an increased expression of Hyaluronidase (HYAL2, p < 0.0001) in INOCA patients in comparison to ObCCS. The distinct expression of molecular biomarkers might allow an early and non-invasive differential diagnosis between ObCCS and INOCA, improving clinical management and treatment options, in the era of personalized medicine.

A Novel Monocyte Subset as a Unique Signature of Atherosclerotic Plaque Rupture.

The evaluation of monocyte subset distribution among acute coronary syndrome (ACS) patients according to culprit coronary plaque morphology has never been explored. We evaluated whether there were significant differences in frequency of circulating monocyte subsets isolated from ACS patients according to optical coherence tomography (OCT) investigation of plaque erosion and rupture. We enrolled 74 patients with non-ST-elevation ACS (NSTE-ACS), 21 of them underwent OCT investigation of the culprit coronary plaque and local macrophage infiltration (MØI) assessment. As control, we enrolled 30 chronic coronary syndrome (CCS) patients. We assessed the frequency of monocyte subsets in the whole study population, in reliance on their CD14 and CD16 expression (classical, CM: CD14++CD16-; intermediates, IM: CD14++CD16+; non-classical, NCM: CD14+CD16++). Then, we tested the effect of lipopolysaccharide (LPS) (a CD14 ligand) on peripheral blood mononuclear cells (PBMCs) of NSTE-ACS patients, quantifying the inflammatory cytokine levels in cell-culture supernatants. Our data proved that monocyte subsets isolated from NSTE-ACS patients represent a peculiar biological signature of the pathophysiological mechanism lying beneath atherosclerotic plaque with a ruptured fibrous cap (RFC) as compared with plaque erosion. Moreover, the magnitude of LPS-mediated effects on IL-1ß, IL-6, and IL-10 cytokine release in cell-culture supernatants appeared to be greater in NSTE-ACS patients with RFC. Finally, we described a fourth monocyte population never explored before in this clinical setting (pre-classical monocytes, PCM: CD14+CD16-) that was prevalent in NSTE-ACS patients as compared with CCS and, especially, in patients with RFC and culprit plaque with MØI.

Monocyte-Platelet Aggregates Triggered by CD31 Molecule in Non-ST Elevation Myocardial Infarction: Clinical Implications in Plaque Rupture.

Despite the recent innovations in cardiovascular care, atherothrombosis is still a major complication of acute coronary syndromes (ACS). We evaluated the involvement of the CD31 molecule in thrombotic risk through the formation of monocyte-platelet (Mo-Plt) aggregates in patients with ACS with no-ST-segment elevation myocardial infarction (NSTEMI) on top of dual anti-platelet therapy (DAPT). We enrolled 19 control (CTRL) subjects, 46 stable angina (SA), and 86 patients with NSTEMI, of which, 16 with Intact Fibrous Cap (IFC) and 19 with Ruptured Fibrous Cap (RFC) as assessed by the Optical Coherence Tomography (OCT). The expression of CD31 on monocytes and platelets was measured. Following the coronary angiography, 52 NSTEMIs were further stratified according to thrombus grade (TG) evaluation. Finally, a series of ex vivo experiments verified whether the CD31 participates in Mo-Plt aggregate formation. In patients with NSTEMI, CD31 was reduced on monocytes and was increased on platelets, especially in NSTEMI presented with RFC plaques compared to those with IFC lesions, and in patients with high TG compared to those with zero/low TG. Ex vivo experiments documented an increase in Mo-Plt aggregates among NSTEMI, which significantly decreased after the CD31 ligation, particularly in patients with RFC plaques. In NSTEMI, CD31 participates in Mo-Plt aggregate formation in spite of optimal therapy and DAPT, suggesting the existence of alternative thrombotic pathways, as predominantly displayed in patients with RFC.

Transtornos de ansiedade na infância e adolescência / Anxiety disorders in childhood and adolescence

Os transtornos de ansiedade são os transtornos psiquiátricos mais comuns na infância e adolescência, com uma prevalência entre 10 a 20

. Diferentes fatores de risco, fatores genéticos, temperamento, tipo de apego e influências parentais estão implicados nestes transtornos. Os aspectos relevantes dos diferentes transtornos de ansiedade, manifestações somáticas de ansiedade,bem como os tratamentos preconizados: psicoeducação, psicoterápico, cognitivo-comportamental, familiar e a psicofarmacoterapia foram revisados (AU)

Transtornos de ansiedade na infância e adolescência / Anxiety disorders in childhood and adolescence

Os transtornos de ansiedade são os transtornos psiquiátricos mais comuns na infância e adolescência, com uma prevalência entre 10 a 20.

Cisto lepotomeníngeo pós-traumático: relato de dois casos / Post-traumatic arachnoid cyst: report of 2 cases

Os autores apresentam dois casos de cisto leptomeníngeo. Por ser uma patologia infreqüente, foram encontrados poucos relatos, sendo a maioria casos isolados. Este trabalho objetiva fazer uma revisao dos dados bibliográficos, discutindo aspectos como etiologia, diagnóstico e tratamento.

Uso terapêutico anti-hipertensiva nos hospitais de Caxias do Sul / Use of hypertensive therapy in hospitas in Caxias do Sul

Os autores realizaram um estudo prospectivo e aleatorio na area de Cardiologia dos Hospitais Saude, Nossa Senhora de Fatima e Nossa Senhora de Pompeia, objetivando analisar a frequencia do emprego dos farmacos anti-hipertensivos naqueles nosocomios. No total, foram analisados 189 prontuarios, sendo que o principal criterio de inclusao em nosso protocolo foi o de que estes pacientes apresentassem hipertensao arterial sistemica essencial.

Drogas parassimpaticolíticas na terapêutica ocular / Parasympatholytics drugs in ocular therapeutic

Os autores fazem uma revisao dos aspectos farmacológicos de drogas anticolinérgicas na terapia ocular. É demonstrado o fármaco de escolha para algumas situaçoes práticas dentro da clínica oftalmológica e também se procede a um estudo comparativo entre essas mesmas drogas. Com isso, procura-se trazer ao clínico uma visao prática do uso desses fármacos, o que, certamente, contribuirá para esclarecer alguma situaçoes do dia-a-dia da práxis médica.

Cisto hidático hepático: revisäo bibliográfica / Hepatic echinococcosis: bibliographic review

Os autores apresentam uma revisao da literatura considerando os aspectos relativos à infecçao hepática por Echinococcus granulosus, constituindo o cisto hidático hepático. Sao analisados fatores como: etiologia, incidência, aspectos do exame físico e laboratorial, tratamento clínico-cirúrgico, complicaçoes e problemas associados.

Autotransplante esplênico: revisäo bibliográfica / Splenic autologous transplantation: bibliographic review

Os estudos atuais comprovam a alta suscetibilidade para infecçoes em pacientes asplênicos, principalmente pela bactéria Streptococcus pneumoniae. Um dos métodos conservadores da funçao esplênica, responsável por boa parte da resposta imune do organismo contra estas bactérias, é o autotransplante esplênico. Este é sugerido, atualmente, em casos de asplenia congênita e de traumatismos esplênicos onde a indicaçao para a esplenectomia total é inevitável. O presente trabalho expoe um revisao bibliográfica acerca do transplante esplênico, suas indicaçoes, principais localizaçoes e complicaçoes.