Ana Rita G. Francisco

Comparative structure of the labellum in Ophrys fusca and O. lutea (Orchidaceae)

The morphology and anatomy of the labellar epidermal cells and the way in which they are arranged are described in an attempt to locate and characterize the osmophore in Ophrys fusca and O. lutea. The micromorphology of the labellum of these two species is similar. Four types of epidermal cells are present on the adaxial surface of the labellum. Long unicellular trichomes with straight tips cover the basal region of the labellum, whereas short unicellular trichomes with polygonal flattened bases form the reflective median speculum. The apical region of the labellum possesses a villous indumentum of long acuminate trichomes with bent or sinuate tips. Large smooth-walled, dome-shaped papillae occur on the margins and on the distal region of the abaxial surface of the labellum. These remarkable papillae have high polarity; the protoplasm at the apex of each cell contains several small vacuoles, while a prominent nucleus surrounded by numerous hypertrophied amyloplasts occurs at the opposite end of the cell. Positive reactions to Vogels staining test and to Sudan black B enabled us to conclude that the osmophores of both species are composed of these peculiar secretory epidermal cells and by two or three subsecretory layers of parenchyma cells.

Grasses of different C4 subtypes reveal leaf traits related to drought tolerance in their natural habitats: Changes in structure, water potential, and amino acid content

Three grasses (Poaceae) of different C(4) subtypes, Paspalum dilatatum (NADP-malic enzyme [ME]), Cynodon dactylon (NAD-ME) and Zoysia japonica (phosphoenolpyruvate carboxykinase), occur in natural habitats that differ in annual rainfall. Their leaf characteristics were studied to identify traits related to drought tolerance. Plants were grown in pots, and water deficit was gradually induced by withholding water. Leaves of Z. japonica had the greatest and P. dilatatum the lowest relative dry matter content. Transverse sections of leaves that developed during the water deficit showed little change compared to control leaves, consistent with low phenotypic plasticity. Anatomical features distinguished the three species, with xeromorphic characteristics most strongly represented in Z. japonica. The leaf relative water content (RWC) decreased with the soil water content similarly for the three grasses. However, at 80% RWC, the leaf water potential was -3.1 MPa for Z. japonica and only -1.3 MPa for P. dilatatum and C. dactylon. Soluble amino acids, especially proline, increased as RWC decreased in leaves of C. dactylon and Z. japonica. Phenylalanine, valine, leucine, and isoleucine increased more in Z. japonica than in the other two species. The results provide evidence that C. dactylon and, especially, Z. japonica have evolved leaf traits better suited to arid habitats.

Structure of the Osmophore and Labellum Micromorphology in the Sexually Deceptive Orchids Ophrys Bombyliflora and Ophrys tenthredinifera (Orchidaceae)

Premise of research. The insect-like flowers of the Ophrys orchids are adapted to sexually deceptive pollination through pseudocopulation, providing chemical, visual, and tactile stimuli for male insects. Although the chemical composition of the odor bouquet of several species has long been identified, the precise site of fragrance production in the labellum remains unknown for most species, and little attention has been given to the visual and tactile signals provided by the labellum for pollinators. Here, the occurrence of an osmophore is investigated and the labellum micromorphology is characterized in detail for Ophrys bombyliflora and Ophrys tenthredinifera, two closely related species pollinated by Eucera bees. Methodology. Labella of flowers before and at anthesis were studied with scanning electron microscopy, light microscopy, and histochemistry. Pivotal results. The labellum of O. bombyliflora presents a distinctive hidden apical appendix that forms a concavity with a multicellular protuberance and a tuft of trichomes at the tip. An osmophore occurs in the apical region of the labellum in both species; in O. bombyliflora it is confined mostly to the adaxial surface of the appendix, and in O. tenthredinifera it comprises the labellum margin and the abaxial surface of both the appendix and the adjacent region of the labellum. A terpene-rich lipophilic secretion likely containing a phenolic fraction was found. The two species have a great diversity of epidermal cell types in the adaxial surface of the labellum and differ mainly in the micromorphology of the basal field, speculum, labellum margins, and appendix. Conclusions. This study demonstrates for the first time that a specialized secretory structure (osmophore) occurs in the labellum of both species and synthesizes a secretion that probably includes highly volatile long-range attractants for pollinators. This finding seems to suggest that two sources of potential semiochemicals have evolved in the Ophrys labellum for pollinator attraction.

Combined MitraClip implantation and left atrial appendage occlusion using the Watchman device: A case series from a referral center

INTRODUCTION Patients referred for percutaneous transcatheter mitral valve repair using the MitraClip® system frequently have atrial fibrillation, which imposes additional challenges due to the need for oral anticoagulation. Left atrial appendage occlusion is currently regarded as a non-inferior alternative to anticoagulation in patients with non-valvular atrial fibrillation and both high thromboembolic and bleeding risk. Considering that both MitraClip implantation and left atrial appendage occlusion are percutaneous techniques that require transseptal puncture, it is technically attractive to consider their concomitant use. OBJECTIVES We aim to evaluate the feasibility of a combined approach with MitraClip implantation and left atrial appendage occlusion in a single procedure. METHODS We report the first case series regarding this issue, discussing the specific advantages, pitfalls and technical aspects of combining these two procedures. RESULTS Five patients underwent left atrial appendage occlusion with the Watchman® device followed by MitraClip implantation in the same procedure. All patients experienced significant reduction in mitral valve regurgitation of at least two grades, optimal occluder position, no associated complications and significant clinical improvement assessed by NYHA functional class (reduction of at least one functional class, with four patients in class I at one-month follow-up). CONCLUSION In selected patients rejected for surgical mitral valve repair, with atrial fibrillation and increased risk of bleeding and embolic events, a combined approach with MitraClip implantation and left atrial appendage occlusion in a single procedure is feasible, safe and effective.

Progressão da desnervação simpática cardíaca avaliada por cintigrafia com MIBG‐I123 na polineuropatia amiloidótica familiar e o impacto da transplantação hepática

INTRODUCTION Familial amyloid polyneuropathy (FAP) is a rare disease caused by systemic deposition of amyloidogenic variants of the transthyretin (TTR) protein. The TTR-V30M mutation is caused by the substitution of valine by methionine at position 30 and mainly affects the peripheral and autonomic nervous systems. Cardiovascular manifestations are common and are due to autonomic denervation and to amyloid deposition in the heart. Cardiac sympathetic denervation detected by iodine-123 labeled metaiodobenzylguanidine (MIBG) is an important prognostic marker in TTR-V30M FAP. Liver transplantation, widely used to halt neurological involvement, appears to have a varying effect on the progression of amyloid cardiomyopathy. Its effect on the progression of cardiac denervation remains unknown. METHODS In this observational study, patients with the TTR-V30M mutation underwent annual cardiac assessment and serial MIBG imaging with quantification of the late heart-to-mediastinum (H/M) ratio. RESULTS We studied 232 patients (median age 40 years, 54.7% female, 37.9% asymptomatic at the time of inclusion) who were followed for a median of 4.5 years and underwent a total of 558 MIBG scans. During follow-up, 47 patients (20.3%) died. MIBG scintigraphy at inclusion was a strong predictor of prognosis, with the risk of death increasing by 27.8% for each one-tenth reduction in the late H/M ratio. The late H/M ratio decreased with age (0.082/year, p<0.001), but progression of cardiac denervation was so slow that annual repetition of MIBG imaging did not increase its prognostic accuracy. During follow-up, 70 symptomatic patients underwent liver transplantation. The late H/M ratio decreased by 0.19/year until transplantation but no statistically significant differences were detected after the procedure. CONCLUSIONS Cardiac denervation is common during the progression of TTR-V30M FAP and quantification of the late H/M ratio on MIBG scintigraphy is valuable for prognostic stratification of these patients. Liver transplantation stabilizes cardiac denervation, without recovery or further deterioration in cardiac MIBG uptake after the procedure.

Flora-On: Occurrence data of the vascular flora of mainland Portugal

Abstract The Flora-On dataset currently includes 253,310 occurrence records for the class Embryopsidae (vascular plants), comprising data collated via the platform http://flora-on.pt/ relating to observation records of vascular plants across mainland Portugal. Observations are uploaded directly to the database primarily by experienced botanists and naturalists, typically on a weekly basis, and consist of geo-referenced data points for species (or infraspecific taxa) along with their date of observation and phenological state. The Flora-On project aims to compile and make publicly accessible chorological, ecological, morphological and photographic information for the entire vascular flora of Portugal. The project’s website offers powerful query and visualization capabilities, of which we highlight the probabilistic bioclimatic and phenological queries which operate based on the empirical density distributions of species in those variables. Flora-On was created and continues to be maintained by volunteers who are Associate members of Sociedade Portuguesa de Botânica (Botanical Society of Portugal). Given its focus on research-grade and current data, the Flora-On project represents a significant contribution to the knowledge of the present distribution and status of the Portuguese flora.

Hypertriglyceridemia: Is there a role for prophylactic apheresis? A case report

Severe hypertriglyceridemia has been consistently associated with an increased risk of cardiovascular disease and other complications, namely acute pancreatitis. We report a case of a 64 year-old woman with hypertrophic cardiomyopathy and metabolic syndrome with triglyceride level of 3260 mg/dL. Plasma exchange was performed with simultaneous medical treatment to achieve a rapid and effective lowering of triglycerides in order to prevent clinical complications. After three plasmapheresis sessions a marked reduction in triglyceride and total cholesterol levels was observed. Several cases have shown the importance of plasmapheresis in the treatment of acute pancreatitis. We intend to demonstrate the applicability of this technique as primary prophylaxis in the presence of extremely high serum triglyceridemia levels. Resumo A hipertrigliceridemia grave tem sido associada de forma consistente ao aumento do risco cardiovascular e a outras complicações, nomeadamente, pancreatite aguda. Descrevemos um caso de uma mulher de 64 anos, com miocardiopatia hipertrófica e síndrome metabólica com valor sérico de triglicerídeos de 3260 mg/dL. Foi efectuada plasmaferese e optimizado o tratamento médico para alcançar uma redução rápida e efectiva dos níveis dos triglicerídeos, prevenindo complicações clínicas. Após três sessões de plasmaferese, verificou-se uma redução marcada dos triglicerídeos e do colesterol total. Existem alguns casos descritos na literatura demonstrado a importância da plasmaferese no tratamento da pancreatite aguda em contexto de hipertrigliceridemia grave. Os autores pretendem com este caso demonstrar a aplicabilidade desta técnica em contexto de prevenção primária em doentes com níveis de triglicerídeos extremamente aumentados.

ST Segment Elevation Myocardial Infarction in Coronary Arteries with Massive Ectasy

A 69-year-old caucasian male with a history of hypertension, dyslipidemia, obesity and tobacco use was admitted due to an inferior ST-segment elevation myocardial infarction with two hours evolution. He was treated with aspirin, clopidogrel and unfractioned heparin, and an emergent transradial coronary angiography was performed. Ectasic dilatation of left main, left anterior descending and circumflex arteries were documented, with distal TIMI 2 flow (Figure 1A). The dominant right coronary artery (RCA) was massively dilated proximally and occluded in the mid segment (Figure 1B). Figure 1 Percutaneous coronary intervention of RCA was attempted, using an AL 1 6 Fr catheter. Thrombus aspiration and balloon dilation of the mid/distal segments were performed, with distal flow recovery (TIMI 2) (Figure 1C). Given the massive ectasy, no stent was implanted. After five days of triple therapy (aspirin, clopidogrel and warfarin) a new coronariography was performed: intracoronary echocardiography revealed an ectasic RCA, with recanalyzed thrombus. The maximum diameter was 14 mm proximally and 8 mm in the middle segment, at the previous occlusion site (Figure 1D). The patient was managed conservatively with long-term anticoagulation. Giant coronary artery aneurysms (CAA) are rare and convey a risk of acute coronary syndromes, usually due to local thrombosis. In addition to antiplatelet therapy, anticoagulation is recommended, with surgical or percutaneous excision of CAA in patients with ischemia or a significant change in dimension over time. In this case, given the diffuse character of these lesions, this approach was unsuitable. In recurrent cases, the use of peripheral, self-expanding stents, may be considered. Video Watch the videos here: http://www.arquivosonline.com.br/2016/english/10703/video_ing.asp

Port-A-Cath Catheter Embolization to Distal Pulmonary Artery Branches: Two Tailored Percutaneous Retrieval Approaches

Several types of intravascular devices and catheters are frequently used for long-term drug therapy, especially for oncological patients. As a result, complications are becoming increasingly common, namely catheter embolization. Retrieving these devices is important, as embolized fragments may lead to serious consequences, such as arrhythmias, myocardial injury, thrombosis, infection, and even perforation and death. We describe 2 cases of long-term drug catheter (Port-A-Cath) fracture, incidentally documented in a routine chest radiograph. In both cases, percutaneous extraction was attempted, yet the procedure was complicated by embolization of smaller fragments into the arterial pulmonary vasculature. We describe unusual approaches in successfully retrieving the remaining fragments. The ideal approaches for removal of foreign bodies from the cardiovascular system differ from case to case, but percutaneous extraction should be preferred in most of the cases. Less common techniques may be helpful in challenging cases.

Análise comparativa do fractional flow reserve (FFR) e do instantaneous wave‐free ratio (iFR): resultados de um registo de 5 anos

INTRODUCTION AND OBJECTIVE Assessment of coronary lesions by the instantaneous wave free ratio (iFR) has generated significant debate. We aimed to assess the diagnostic performance of iFR and its impact on the decision to use fractional flow reserve (FFR) and on procedural characteristics. METHODS In this single-center registry of patients undergoing functional assessment of coronary lesions, FFR was used as a reference for assessing the diagnostic performance of iFR. An iFR value <0.86 was considered positive and a value >0.93 was considered negative. RESULTS Functional testing was undertaken of 402 lesions, of which 154 were assessed with both techniques, 222 with FFR only, and 26 with iFR only. Using a cut-off of ≤0.80 for iFR, the area under the curve was 0.73 (95% CI 0.65-0.81), with an optimal value of ≤0.91. FFR was undertaken in 93 out of 94 lesions with an inconclusive iFR and was performed in 69.1% of the remaining iFR-tested lesions. Concordance between iFR and FFR was 87% (chi-square=22.43; p<0.001). Notwithstanding, there were four out of 13 cases (30.7%) of positive iFR with negative FFR and three out of 42 (7.1%) cases of negative iFR and positive FFR. This difference was significant (p=0.026). iFR had no impact on procedure time, fluoroscopy time or radiation dose. CONCLUSION iFR had a reasonable diagnostic performance. Operators often chose to perform FFR despite conclusive iFR results. iFR and FFR were highly concordant, but a non-negligible proportion of lesions classified as ischemic by iFR were classified as non-ischemic by FFR. iFR had no impact on procedural characteristics.