Clinical Evolution of Patients Using Ventricular Assist Devices as a Bridge for Transplantation.

OBJECTIVE: To evaluate the clinical evolution of patients with implantation of ventricular assist device (VAD) and identify the intervening factors for death. METHODS: This analytical, retrospective study was carried out in a public reference hospital in cardiopulmonary diseases located in northeastern Brazil. The study population encompassed the medical records of 16 patients who underwent VAD implantation. Data collection took place from January to August 2016, through the consultation of medical records. Descriptive analysis, odds ratio, and the Fisher's Exact, Wilcoxon, Friedman and t-tests were used to analyze the data. RESULTS: All patients experienced complications during the use of the device, with bleeding being the main cause (11 [68.8%]). There was a significant decrease in noradrenaline (P = .025), milrinone (Primacor; P = .007), and dobutamine (P = .046) flow rates with the clinical evolution of patients. Regarding hematologic parameters, the use of VAD promoted a significant improvement in hemoglobin (P < .001), hematocrit (P = .003), activated partial thromboplastin time (P = .013), and fibrinogen (P = .049) values at the 3 time points analyzed. Regarding the clinical outcome of the patients, the majority (10 [62.5%]) underwent cardiac transplantation. CONCLUSIONS: This study allowed for better knowledge of the clinical evolution of patients with VAD implantation, highlighting the benefits of this type of device as a bridge for heart transplantation.

Proteins differentially expressed by Shiga toxin-producing Escherichia coli strain M03 due to the biliar salt sodium deoxycholate.

Shiga toxin-producing Escherichia coli (STEC) can cause conditions ranging from diarrhea to potentially fatal hemolytic uremic syndrome. Enteropathogen adaptation to the intestinal environment is necessary for the development of infection, and response to bile is an essential characteristic. We evaluated the response of STEC strain M03 to the bile salt sodium deoxycholate through proteomic analysis. Cell extracts of strain M03 grown with and without sodium deoxycholate were analyzed by two-dimensional electrophoresis; the differentially expressed proteins were identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Three proteins were found to be differentially expressed due to sodium deoxycholate. Glycerol dehydrogenase and phosphate acetyltransferase, which are involved in carbon metabolism and have been associated with virulence in some bacteria, were downregulated. The elongation factor Tu (TufA) was upregulated. This protein participates in the translation process and also has chaperone activities. These findings help us understand strategies for bacterial survival under these conditions.