Differential expression of SofDIR16 and SofCAD genes in smut resistant and susceptible sugarcane cultivars in response to Sporisorium scitamineum.

Proteomic profiling of the stalk of a smut resistant and a susceptible sugarcane cultivars revealed the presence of dirigent and dirigent-like proteins in abundance in the pool of high molecular mass (HMMG) and mid-molecular mass (MMMG) glycoproteins, produced as part of the defensive response to the fungal smut pathogen. Quantitative RT-PCR analysis showed that expression levels of SofDIR16 (sugarcane dirigent16) and SofCAD (sugarcane cinnamyl alcohol dehydrogenase) were higher in the smut resistant My 55-14 cultivar than in the sensitive B 42231 cultivar prior to infection. Inoculation with fungal sporidia or water decreased the level of SofCAD transcripts in My 55-14, indicating that regulation of SofCAD expression does not take part of the specific response to smut infection. In contrast, SofDIR16 expression was almost nullified in My 55-14 after inoculation with fungal sporidia, but not after water injection. It is proposed that the decreased expression of dirigent proteins induces the formation of lignans, which are involved in the defense response of the smut resistant My 55-14 cultivar.

Preoperative levosimendan decreases mortality and the development of low cardiac output in high-risk patients with severe left ventricular dysfunction undergoing coronary artery bypass grafting with cardiopulmonary bypass.

BACKGROUND: The calcium sensitizer levosimendan has been used in cardiac surgery for the treatment of postoperative low cardiac output syndrome (LCOS) and difficult weaning from cardiopulmonary bypass (CPB). OBJECTIVES: To evaluate the effects of preoperative treatment with levosimendan on 30-day mortality, the risk of developing LCOS and the requirement for inotropes, vasopressors and intra-aortic balloon pumps in patients with severe left ventricular dysfunction. METHODS: Patient with severe left ventricular dysfunction and an ejection fraction <25% undergoing coronary artery bypass grafting with CPB were admitted 24 h before surgery and were randomly assigned to receive levosimendan (loading dose 10 µg/kg followed by a 23 h continuous infusion of 0.1µg/kg/min) or a placebo. RESULTS: From December 1, 2002 to June 1, 2008, a total of 252 patients were enrolled (127 in the levosimendan group and 125 in the control group). Individuals treated with levosimendan exhibited a lower incidence of complicated weaning from CPB (2.4% versus 9.6%; P<0.05), decreased mortality (3.9% versus 12.8%; P<0.05) and a lower incidence of LCOS (7.1% versus 20.8%; P<0.05) compared with the control group. The levosimendan group also had a lower requirement for inotropes (7.9% versus 58.4%; P<0.05), vasopressors (14.2% versus 45.6%; P<0.05) and intra-aortic balloon pumps (6.3% versus 30.4%; P<0.05). CONCLUSION: Patients with severe left ventricle dysfunction (ejection fraction <25%) undergoing coronary artery bypass grafting with CPB who were pretreated with levosimendan exhibited lower mortality, a decreased risk for developing LCOS and a reduced requirement for inotropes, vasopressors and intra-aortic balloon pumps. Studies with a larger number of patients are required to confirm whether these findings represent a new strategy to reduce the operative risk in this high-risk patient population.

[The calcium sensitizer levosimendan gives superior results to dobutamine in postoperative low cardiac output syndrome]. / Superioridad del sensibilizante al calcio levosimendán comparado con dobutamina en el síndrome de bajo gasto cardiaco postoperatorio.

INTRODUCTION AND OBJECTIVES: The use of levosimendan to treat postoperative low cardiac output syndrome (LCOS) has been studied in only small patient series and in randomized trials focusing on hemodynamic variables. The objective of the present study was to assess the effectiveness of levosimendan, compared with dobutamine, as a treatment for postoperative LCOS. METHODS: Patients with LCOS were randomly assigned to receive either levosimendan (loading dose, 10 microg/kg, followed by 0.1 microg/kg per min for 24 h) or dobutamine (starting dose, 5 microg/kg per min). Hemodynamic and clinical parameters (including postoperative mortality and major complications), the need for the coadministration of another drug (such as an inotrope or a vasopressor) or for balloon counterpulsation, and length of stay in intensive care were all monitored. RESULTS: The study included 137 patients: 69 received levosimendan, while 68 were treated with dobutamine. Although both agents improved hemodynamic parameters, the effect of levosimendan was greater and occurred earlier than that of dobutamine. In addition, levosimendan use resulted in lower postoperative mortality (8.7% vs. 25%; P< .05), a lower incidence of major postoperative complications, and less need for an additional inotropic drug (8.7% vs. 36.8%; P< .05), a vasopressor (11.6% vs. 30.9%; P< .05), or balloon counterpulsation (2.9% vs. 14.7%; P<0.05). The length of stay in intensive care was also less (66 vs. 158 h; P< .05). CONCLUSIONS: In this randomized study, levosimendan proved more effective than dobutamine. Postoperative morbidity and mortality were lower, fewer patients required either an additional inotropic drug, a vasopressor or intra-aortic balloon counterpulsation, and the length of stay in intensive care was shorter.

Methylene blue reduces mortality and morbidity in vasoplegic patients after cardiac surgery.

BACKGROUND: The discovery of nitric oxide as mediator in cardiac postoperative vasoplegia encourages the use of inhibitory drugs such as methylene blue. This drug has been used with favorable results in isolated cases. The purpose of this article is to analyze the incidence of the postoperative vasoplegic syndrome, to consider its prognosis, and to evaluate the effect of intravenous methylene blue on mortality. METHODS: Cardiac surgery patients were consecutively included. Vasoplegic syndrome was defined by the presence of the following five criteria: (1) hypotension, (2) low filling pressures, (3) high or normal cardiac index, (4) low peripheral resistance, and (5) vasopressor requirements. Those with vasoplegia were randomized to receive 1.5 mg/Kg of methylene blue or a placebo. A p value less than 0.05 was considered significant. RESULTS: Six hundred thirty eight cardiac surgery patients were consecutively included in this study. Fifty-six of these patients fulfilled vasoplegia criteria (8.8%) resulting in higher mortality (10.7% or 6 of 56 patients vs 3.6% or 21 of 582 patients; p value = 0.02). Those treated with methylene blue showed morbidity and mortality reductions (0% versus 21.4% or 6 of 28 patients; p value = 0.01). The duration of the vasoplegic syndrome was shorter in those patients treated with the drug, lasting less than 6 hours in all patients. Patients in the control group showed a slower recovery, lasting more than 48 hours in 8 patients (p value = 0.0007). CONCLUSIONS: Vasoplegic postoperative syndrome was seen in 8.8% of all patients. Outcome in patients with vasoplegia was worse with increased morbidity and mortality. The use of methylene blue reduced the high mortality in this population.

Empleo preoperatorio preventivo (profiláctico) de balón de contrapulsación (EPPreBa) / Preoperatory (prophylactic) employment of counterpulsation intraortic ballon

Introducción: En los últimos años, diversos estudios postulan el empleo preoperatorio del balón de contrapulsación. La mayoría de ellos resultan consideraciones retrospectivas ó estudios unicéntricos que incluyeron en su población pacientes con indicaciones terapéuticas del dispositivo (angina refractaria). Objetivo: Valorar la utilización preoperatoria (profiláctica) del balón considerando: a)mortalidad, b)síndrome de bajo volumen minuto y c)complicaciones asociadas con el dispositivo. Material y métodos: Entre el 1° de mayo de 1999 y el 1° de febrero de 2002 se incluyó el total de cirugías cardíacas bajo circulación extracorpórea. Se definieron de alto riesgo los pacientes portadores de dos de las siguientes variables: deterioro severo de la función ventricular, lesión severa de tronco, reoperación, anatomía coronaria difusa y edad mayor de 75 años. Los mismos fueron aleatorizados a empleo preoperatorio de balón versus su utilización según necesidad en el intraoperatorio o el posoperatorio. Se excluyeron los pacientes con indicaciones terapéuticas. Se consideró significativo un valor de p menor de 0,05. Resultados: Doscientos veintrés (223) pacientes reunieron los criterios de alto riesgo, los cuales fueron aleatorizados a balón preoperatorio (111 pacientes) versus su empleo según necesidad (112 pacientes, grupo control). La mortalidad total fue de 25 pacientes (11,2 por ciento), 8 del grupo balón preoperatorio (7,2 por ciento) y 17 del grupo control (15,2 por ciento; p = 0,05). En el grupo preoperatorio también fue inferior la incidencia de bajo volumen minuto: 11 pacientes (9,9 por ciento) versus 27 pacientes (24,1 por ciento; p = 0,004). Se observaron 7 complicaciones vinculadas al dispositivo (3,1 por ciento), isquemia del miembro en 5 casos e infecciones localizadas en el acceso vascular en 2. No se observaron muertes vinculadas al dispositivo. Conclusiones: 1. El empleo preoperatorio del balón se asoció con la reducción en la mortalidad e incidencia menor de bajo volumen minuto perioperatorio. 2. La incidencia de complicaciones resultó baja: 7 pacientes (3,1 por ciento)

Empleo preoperatorio preventivo (profiláctico) de balón de contrapulsación (EPPreBa) / Preoperatory (prophylactic) employment of counterpulsation intraortic ballon

Introducción: En los últimos años, diversos estudios postulan el empleo preoperatorio del balón de contrapulsación. La mayoría de ellos resultan consideraciones retrospectivas ó estudios unicéntricos que incluyeron en su población pacientes con indicaciones terapéuticas del dispositivo (angina refractaria). Objetivo: Valorar la utilización preoperatoria (profiláctica) del balón considerando: a)mortalidad, b)síndrome de bajo volumen minuto y c)complicaciones asociadas con el dispositivo. Material y métodos: Entre el 1º de mayo de 1999 y el 1º de febrero de 2002 se incluyó el total de cirugías cardíacas bajo circulación extracorpórea. Se definieron de alto riesgo los pacientes portadores de dos de las siguientes variables: deterioro severo de la función ventricular, les