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At the beginning of the 21st century, approximately 2.3 million US adults had atrial fibrillation (AF), and there has been a 60% increase in hospital admissions for AF. Given that the expectancy is a continuous increase in incidence, it portends a severe healthcare problem. Considerable evidence supports the immune system and inflammatory response in cardiac tissue, and circulatory processes are involved in the physiopathology of AF. In this regard, finding novel inflammatory biomarkers that predict AF recurrence after catheter ablation (CA) is a prime importance global healthcare problem. Many inflammatory biomarkers and natriuretic peptides came out and were shown to have predictive capabilities for AF recurrence in patients undergoing CA. In this regard, some studies have shown that red blood cell distribution width (RDW) is associated with the risk of incident AF. This review aimed to provide an update on the evidence of the RDW as a biomarker of red cell dysfunction and its association with high systemic inflammation, and with the risk of incident AF. Through the literature review, we will highlight the most relevant studies of the RDW related to AF recurrence after CA. Many studies demonstrated that RDW is associated with all cause-mortality, heart failure, cardiovascular disease, and AF, probably because RDW is a biomarker of red blood cell dysfunction associated with high systemic inflammation, reflecting an advanced heart disease with prognostic implications in heart failure and cardiovascular disease. Thus, suggesting that could be a potential predictor for AF recurrence after CA. Moreover, the RDW is a parameter included in routine full blood count, which is low-cost, quick, and easy to obtain. We provided an update on the evidence of the most relevant studies of the RDW related to AF recurrence after CA, as well as the mechanism of the high RDW and its association with high systemic inflammation and prognostic marker in cardiovascular disease and heart failure.
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We used bench-scale tests and mathematical modeling to explore chemical oxygen demand (COD) removal rates in a moving-bed biofilm reactor (MBBR) for winery wastewater treatment, using either urea or nitrate as a nitrogen source. With urea addition, the COD removal fluxes ranged from 34 to 45 gCOD/m2-d. However, when nitrate was added, fluxes increased up to 65 gCOD/m2-d, twice the amount reported for aerobic biofilms for winery wastewater treatment. A one-dimensional biofilm model, calibrated with data from respirometric tests, accurately captured the experimental results. Both experimental and modelling results suggest that nitrate significantly increased MBBR capacity by stimulating COD oxidation in the deeper, oxygen-limited regions of the biofilm. Our research suggests that the addition of nitrate, or other energetic and broadly used electron acceptors, may provide a cost-effective means of covering peak COD loads in biofilm processes for winery or another industrial wastewater treatment.
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Eliminação de Resíduos Líquidos , Purificação da Água , Eliminação de Resíduos Líquidos/métodos , Nitratos , Biofilmes , Reatores Biológicos , Compostos Orgânicos , Purificação da Água/métodos , Nitrogênio , Ureia , DesnitrificaçãoRESUMO
BACKGROUND: Myocardial strain is a promising marker for the detection of early left or right ventricular (LV or RV) dysfunction in pediatric populations. The reference standard for MR strain measurement is myocardial tagging (MT); however, MT has limited clinical utility because the additional acquisitions needed are time-consuming. In contrast, MR-feature tracking (FT) allows strain quantification from routinely acquired cine sequences. Studies providing reference values obtained with both FT and MT for adolescents are lacking. PURPOSE: To use MR-FT and MT to define sex-specific LV and RV strain reference values for adolescents. STUDY TYPE: Cross-sectional, prospective. POPULATION: One hundred twenty-three adolescents aged 15-18 years (52% girls) without known cardiovascular disease. FIELD STRENGTH/SEQUENCE: Balanced steady-state free-precession sequence for FT analysis and a spatial modulation of magnetization hybrid TFE-EPI sequence for MT acquisitions at 3.0-T. ASSESSMENT: Segment Medviso software was used to obtain longitudinal (LS) and circumferential (CS) strain for both ventricles, and radial strain (RS) for LV. STATISTICAL TESTS: The Student t-test was used for between-sex comparisons of continuous variables. Sex-specific percentiles were calculated using the weighted average method. Intraobserver and interobserver agreement was assessed in 30 randomly selected studies using intraclass correlation coefficients (ICC). A P-value <0.05 was considered statistically significant. RESULTS: FT-derived LVLS and LVCS were significantly higher in girls than in boys (-19.8% vs. -17.8% and -22.2% vs. -21.0%, respectively), as they were with MT (LVLS: -18.1% vs. -16.8%; LVCS: -20.8% vs. -19.7%). FT-LVRS was higher in girls than in boys (44.8% vs. 35.1%), while MT-LVRS was the opposite (18.6% vs. 22.7%). FT-RVLS was higher in girls (-23.4% vs. -21.3%), but there were no between-sex differences in MT-derived RVLS or RVCS. ICC values for intraobserver agreement were ≥0.89, whereas for interobserver agreement were <0.80 for MT-LVRS and ≥0.80 for all remaining parameters. DATA CONCLUSION: This study provides sex-specific reference biventricular strain values obtained with MR-MT and MR-FT for adolescents aged 15-18 years. MR-FT may be a valid method for obtaining strain values in pediatric populations. EVIDENCE LEVEL: 1 TECHNICAL EFFICACY: Stage 3.
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This study aimed to evaluate the presence of subclinical myocardial damage in adolescents who were vaccinated against SARS-CoV-2. One hundred twenty asymptomatic adolescents with a mean age of 16.0 ± 0.4 years (51% girls) underwent cardiac magnetic resonance (CMR) imaging. SARS-CoV-2 IgG/IgM antibody testing was performed, and self-reported dates of confirmed SARS-CoV-2 infection and/or vaccination were collected. Participants were classified according to SARS-CoV-2 status as naïve (non-infected and unvaccinated, n = 74), infected (unvaccinated, n = 23), and vaccinated (independently of past infection status, n = 23). Biventricular volumes and ejection fraction and myocardial T2 relaxation time were similar in the three groups. T1 relaxation time was slightly higher in vaccinated adolescents (1249 ± 35 ms) than in naïve and infected participants (1231 ± 30 ms and 1227 ± 29 ms, respectively; p = 0.035), although this difference was considered clinically irrelevant. This observational study found no evidence of relevant subclinical myocardial involvement after SARS-CoV-2 vaccination in asymptomatic adolescents.
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Vacinas contra COVID-19 , COVID-19 , Vacinação , Humanos , Feminino , Adolescente , Masculino , COVID-19/prevenção & controle , SARS-CoV-2/imunologia , Doenças Assintomáticas , Imageamento por Ressonância Magnética , Imagem Cinética por Ressonância Magnética , Infecções Assintomáticas/epidemiologiaRESUMO
PURPOSE: To describe the clinical course and evaluate treatment of ocular surface changes in patients receiving immune checkpoint inhibitor (ICI) therapy. METHODS: Multiple markers of ocular surface dryness were evaluated in 16 patients on ICI therapy. The Wilcoxon rank-sum test was used to determine the significant change in the initial and final ocular surface indices. RESULTS: Fifty percent of the eyes demonstrated worsening Schirmer I scores; 29% showed an increase in lissamine green staining. During follow-up, 43% of patients experienced a decline in OSDI scores. Treatments included preservative-free artificial tears (88%), cyclosporine (25%), topical corticosteroids (31%), warm compresses (25%); punctal plugs (13%). Median follow-up time was 3.4 months (range:0-79 ); median ICI treatment duration was 7 months (range:1-40). Four patients died during the observation period. CONCLUSION: A significant proportion of patients experience changes in ocular surface markers while treated with ICIs. Medical intervention can lead to stabilization of ocular surface disease.
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Perchlorate and chlorate are endocrine disruptors considered emerging contaminants (ECs). Both oxyanions are commonly associated with anthropogenic contamination from fertilizers, pesticides, explosives, and disinfection byproducts. However, the soils of the Atacama Desert are the most extensive natural reservoirs of perchlorate in the world, compromising drinking water sources in northern Chile. Field campaigns were carried (2014-2018) to assess the presence of these ECs in the water supply networks of twelve Chilean cities. Additionally, the occurrence of perchlorate, chlorate and other anions typically observed in drinking water matrices of the Atacama Desert (i.e., nitrate, chloride, sulfate) was evaluated using a Spearman correlation analysis to determine predictors for perchlorate and chlorate. High concentrations of perchlorate (up to 114.48 µg L-1) and chlorate (up to 9650 µg L-1) were found in three northern cities. Spatial heterogeneities were observed in the physicochemical properties and anion concentrations of the water supply network. Spearman correlation analysis indicated that nitrate, chloride, and sulfate were not useful predictors for the presence of perchlorate and chlorate in drinking water in Chile. Hence, this study highlights the need to establish systematic monitoring, regulation, and treatment for these EC of drinking water sources in northern Chilean cities for public health protection.
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Água Potável , Poluentes Químicos da Água , Água Potável/química , Cloratos/análise , Chile , Nitratos/análise , Percloratos , Cidades , Cloretos/análise , Poluentes Químicos da Água/análiseRESUMO
Cerebral white-matter lesions (cWML) can be caused by dilation of Virchow-Robin spaces or may correspond to true lacunar ischemic lesions. The aim of our study was to evaluate in asymptomatic divers the relationship between the presence of patent foramen ovale (PFO) and cWML, as well as their possible effects on cortical cerebral blood flow (CBF) by magnetic resonance (MRI) through the arterial spin labeling (ASL) sequence. Transthoracic echocardiography was performed for the identification of PFO, and cerebral magnetic resonance including the 3D-ASL sequence for CBF quantification. Thirty-eight divers, with a mean age 45.8 ± 8.6 years, were included. Nineteen healthy volunteers, mean age 41 ± 15.2 years, served as the control group. A total of 28.9% of divers had completed more than 1000 dives. It was found that 26.3% of divers presented with PFO in the echocardiographic study. cWML was evidenced in 10.5% of diver MRI studies. There was no statistically significant relationship between the presence of PFO and cWML (p = 0.95). We observed a lower blood flow in all brain areas assessed by the 3D-ASL sequence in the group of divers, compared with the control group. We did not find statistical differences in CBF as a function of the presence or absence of PFO, number of dives, or cWML evidence.
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Background: Cardiovascular magnetic resonance (CMR) is a precise tool for the assessment of cardiac anatomy, function, and tissue composition. However, studies providing CMR reference values in adolescence are scarce. We aim to provide sex-specific CMR reference values for biventricular and atrial dimensions and function and myocardial relaxation times in this population. Methods: Adolescents aged 15-18 years with no known cardiovascular disease underwent a non-contrast 3-T CMR scan between March 2021 and October 2021. The imaging protocol included a cine steady-state free-precession sequence for the analysis of chamber size and function, as well as T2-GraSE and native MOLLI T1-mapping for the characterization of myocardial tissue. Findings: CMR scans were performed in 123 adolescents (mean age 16 ± 0.5 years, 52% girls). Mean left and right ventricular end-diastolic indexed volumes were higher in boys than in girls (91.7 ± 11.6 vs 78.1 ± 8.3 ml/m2, p < 0.001; and 101.3 ± 14.1 vs 84.1 ± 10.5 ml/m2, p < 0.001), as was the indexed left ventricular mass (48.5 ± 9.6 vs 36.6 ± 6.0 g/m2, p < 0.001). Left ventricular ejection fraction showed no significant difference by sex (62.2 ± 4.1 vs 62.8 ± 4.2%, p = 0.412), whereas right ventricular ejection fraction trended slightly lower in boys (55.4 ± 4.7 vs. 56.8 ± 4.4%, p = 0.085). Indexed atrial size and function parameters did not differ significantly between sexes. Global myocardial native T1 relaxation time was lower in boys than in girls (1215 ± 23 vs 1252 ± 28 ms, p < 0.001), whereas global myocardial T2 relaxation time did not differ by sex (44.4 ± 2.0 vs 44.1 ± 2.4 ms, p = 0.384). Sex-stratified comprehensive percentile tables are provided for most relevant cardiac parameters. Interpretation: This cross-sectional study provides overall and sex-stratified CMR reference values for cardiac dimensions and function, and myocardial tissue properties, in adolescents. This information is useful for clinical practice and may help in the differential diagnosis of cardiac diseases, such as cardiomyopathies and myocarditis, in this population. Funding: Instituto de Salud Carlos III (PI19/01704).
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This study sought to examine the correlation between left ventricular (LV) myocardial feature tracking (FT) and deep learning-based strain (DLS) analysis in the diagnostic (CMRd) and follow-up (CMRf) cardiac magnetic resonance imaging of patients with acute myocarditis. The retrospective study included 17 patients with acute myocarditis and 20 healthy controls. The CMRd took place within 14 days of symptom onset, while the CMRf took place at least 2 months after the event. The global-circumferential FT (FTc) and global-circumferential DLS (DLSc) were analyzed. The continuous variables were compared using paired t-tests or the Wilcoxon test, whereas Pearson's test or Spearman's test was used to evaluate the correlation between the continuous variables. The time between the CMRd and CMRf was 5 months [3-11]. The LV ejection fraction (LVEF) was 55 ± 6 and 59 ± 4%, p = 0.008, respectively, and 94.1% of the patients showed late gadolinium enhancement (LGE) and myocardial edema on the CMRd. Significantly lower FTc (-16.1 ± 2.2% vs. -18.9 ± 1.9%, p = 0.001) and DLSc (-38.1 ± 5.2% vs. -41.3 ± 4.5%, p = 0.015) were observed with respect to the controls. Significant increases in the FTc (-16.1 ± 2.2 vs. -17.5 ± 1.9%, p = 0.016) and DLSc (-38.1 ± 5.2 vs. -39.8 ± 3.9%, p = 0.049) were found between the CMRd and CMRf, which were unrelated to the LGE. The LVEF correlated well with the FTc (r = 0.840) and DLSc (r = 0.760). Both techniques had excellent reproducibility, with high intra- (FTc = 0.980, DLSc = 1.000) and inter-observer (FTc = 0.970, DLSc = 0.980) correlation. There was correlation between the LV DLSc/FTc and LVEF in the patients with acute myocarditis according to the CMRd and CMRf.
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OBJECTIVES: Perioperative and adjuvant chemotherapy have demonstrated clinical benefits in localized gastric cancer. Nevertheless, the reports on their effects on patient's health-related quality of life (HRQoL) are scarce. Here, we prospectively assessed quality of life and the incidence of chemotherapy-induced peripheral neuropathy (CIPN) in a cohort of patients treated with adjuvant FOLFOX. METHODS: Localized stomach or gastroesophageal junction adenocarcinoma patients who underwent curative resection were recruited at a single center. All patients received adjuvant FOLFOX6, and HRQoL and CIPN were assessed using the European organization for research and treatment of cancer quality life (EORTC) C30 and the EORTC CIPN20 questionnaires, respectively. Clinically significant deterioration of HRQoL was also assessed as a coprimary outcome in a longitudinal analysis. RESULTS: We recruited a total of 63 patients. Median age was 62.5 years, and 75% had stomach tumors. Twenty-four weeks after the start of treatment, the probability of being free from HRQoL deterioration and CIPN was 29% (95% confidence interval [CI] 18%-42%) and 6% (95% CI 2%-17%), respectively. Five-year disease-free survival was 45% (95% CI 24%-64%) and 5-year overall survival was 63% (95% CI 48%-76%). CONCLUSIONS: Adjuvant FOLFOX is associated with a high rate of long-term survival in localized gastric cancer; nevertheless, it has detrimental effects on patients' quality of life.
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Doenças do Sistema Nervoso Periférico , Neoplasias Gástricas , Humanos , Pessoa de Meia-Idade , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/epidemiologia , Qualidade de Vida , Estudos Prospectivos , Incidência , Doenças do Sistema Nervoso Periférico/induzido quimicamente , Doenças do Sistema Nervoso Periférico/epidemiologia , Doenças do Sistema Nervoso Periférico/patologiaRESUMO
The passive film depends on the alloy's composition and the exposure conditions. How the surface composition affects the selection of microbial biofilms though, has not been fully elucidated or incorporated into the analysis of corrosive biofilms. The degradation of stainless steel (SS) exposed to natural seawater was studied to understand how the oxide layer composition of SS could affect the selection and variability of the bacterial community. To accomplish this goal, austenitic and superferritic SS grades were exposed to natural seawater on the central coast of Chile. The deterioration of steel and qualitative description of biofilm formation was monitored at different exposure periods. Biofilms were evaluated based on massive sequencing analysis of the bacterial community and subsequent ecological studies. The results revealed that variability of the calculated corrosion rate correlated with the similarity of the bacterial community within samples from each SS and its corrosion inferred capacity. The associated bacterial families showed a higher representation in SSs with a more significant increase in the Fe/Cr ratio over the exposure time. These findings revealed that iron content in the oxide layer represents a key feature of the surface composition for selecting bacterial assemblages in marine environments.
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Aço Inoxidável , Aço , Humanos , Ciência dos Materiais , Corrosão , Água do Mar/microbiologia , Biofilmes , Bactérias , ÓxidosRESUMO
Background: Early-onset gastric cancers (EOGC) are poor prognosis hard-to treat malignancies that affect young individuals (<45 years old). Case Description: Herein we describe the case of a 26-year-old female EOGC patient that initially displayed stable disease after first-line CAPOX plus immunotherapy. However, patient eventually developed progressive disease and was consecutively switched to paclitaxel plus ramucirumab, and palliative irinotecan. In search for therapeutic alternatives a proteo-genomic analysis was performed in a tissue biopsy taken after the first progression. Our analyses found a total of 18 somatic mutations, including TP53 and PIK3R1, and a previously unreported germline alteration in the tumor suppressor SMAD4. Also, our proteomic analysis found 62 proteins previously documented as "enriched in stomach cancer" and AKT/mTOR and EGFR as pathways with therapeutic potential. Unfortunately, the clinical utility of AKT/mTOR inhibitors or EGFR targeted therapies could not be assessed. Conclusions: As explained above EOGC is a growing health concern that affects young individuals. Furthermore, the reported case displayed a poor response to standard therapy including checkpoint inhibitors and chemotherapy despite the presence of biomarkers that predict a favorable outcome. Future studies should adopt alternative approaches to find novel, more effective therapies.
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Introduction: Recently, contrast-enhanced mammography (CEM) has emerged as a reliable alternative to breast magnetic resonance imaging (MRI) for the assessment of pathological response in breast cancer patients. Our study sought to determine the diagnostic accuracy of CEM to predict pathological complete response (pCR) in patients who received neoadjuvant chemotherapy (NACT). Methods: We retrieved the medical records of patients who underwent NACT at our institution. Using post-surgery pCR, morphological evidence and CEM enhancement tumours were classified as follows: 1) radiologic complete response (rCR); 2) functional radiological complete response (frCR); and 3) non-complete response. Initially, we used multivariate analyses adjusted by clinical variables and frCR or rCR to determine which variables affected pathological response. Then, CEM diagnostic accuracy to discriminate pCR was assessed using receiver operating characteristic curves in univariate and multivariate models including either frCR or rCR. Results: A total of 48 patients were included in our study. Most patients (68.7%) were hormone receptor (HR)+ and 41.6% (20) of the patients achieved pCR. Using univariate logistic regression analyses we found that HR status, HER2 status, rCR and frCR had a significant impact on CEM diagnostic accuracy. Exploratory analyses found that CEM sensitivity was higher for HR- tumours. Multivariate logistic regression analyses found 60% sensitivity, 92.9% specificity and 79.2% accuracy in a model that included clinical variables and rCR. Conclusion: CEM is a reliable alternative to high-cost, time-consuming breast MRI that predicts pCR in patients undergoing NACT; CEM diagnostic accuracy was higher among patients who harboured HR- tumours.
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Sulfate-reducing bacteria (SRB) are the most studied microorganisms related to severe episodes of microbially influenced corrosion (MIC). A mechanism used by SRB to corrode steel alloys is the extracellular electron transfer (EET), which was described by the biocatalytic cathodic sulfate reduction (BCSR) theory. This theory was supported by several experimental research and some mathematical approaches. However, mathematical modelling that represents the effect of the EET on pit development and the subsequent changes in surface topography has not been reported. In this study, a mechanistic mathematical model of microbial corrosion induced by SRB through EET was developed and implemented. The developed model used data from previously reported experiments to describe the phenomenon and define stoichiometric and kinetic parameters. Results of biofilm development and growth-associated corrosion (i.e. weight loss and maximum pit depths) obtained by simulations were similar to experimental evidence reported in the literature. These simulations reveal that the main parameters that control MIC are the maintenance coefficient of SRB, the initial planktonic cell concentration, and the probability of surface colonization.
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Desulfovibrio , Aço , Biofilmes , Carbono , Corrosão , Desulfovibrio/metabolismo , Elétrons , Modelos Teóricos , Sulfatos/metabolismoRESUMO
AIMS: There is a lack of evidence regarding the benefits of ß-blocker treatment after invasively managed acute myocardial infarction (MI) without reduced left ventricular ejection fraction (LVEF). METHODS AND RESULTS: The tREatment with Beta-blockers after myOcardial infarction withOut reduced ejection fracTion (REBOOT) trial is a pragmatic, controlled, prospective, randomized, open-label blinded endpoint (PROBE design) clinical trial testing the benefits of ß-blocker maintenance therapy in patients discharged after MI with or without ST-segment elevation. Patients eligible for participation are those managed invasively during index hospitalization (coronary angiography), with LVEF >40%, and no history of heart failure (HF). At discharge, patients will be randomized 1:1 to ß-blocker therapy (agent and dose according to treating physician) or no ß-blocker therapy. The primary endpoint is a composite of all-cause death, non-fatal reinfarction, or HF hospitalization over a median follow-up period of 2.75 years (minimum 2 years, maximum 3 years). Key secondary endpoints include the incidence of the individual components of the primary composite endpoint, the incidence of cardiac death, and incidence of malignant ventricular arrhythmias or resuscitated cardiac arrest. The primary endpoint will be analysed according to the intention-to-treat principle. CONCLUSION: The REBOOT trial will provide robust evidence to guide the prescription of ß-blockers to patients discharged after MI without reduced LVEF.