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Stroke recurrence despite optimal oral anticoagulation (OAC) might represent a novel indication for left atrial appendage occlusion (LAAO). The heterogeneity of these patients is generally high, as the presence of valvular atrial fibrillation (VAF) is common. The aim of this study was to explore the role of LAAO as an adjunctive therapy to OAC in patients with recurrent stroke despite optimal OAC.The study screened consecutive patients who underwent percutaneous LAAO at nine centers between 2009 and 2017. Patients with recurrent stroke despite optimal OAC were selected and those with an absolute or relative contraindication to OAC were not included in the study.Among 837 patients who underwent LAAO between the study period, a total of 22 (2.6%) met the inclusion criteria. There was a high percentage of VAF (38%) and 59% presented more than one cardioembolic event before LAAO. All patients underwent successful implantation of the device and no procedural major adverse events were reported. In all but 3 patients, anticoagulation was continued after LAAO. With a median clinical follow-up of 1.8 years (range, 0.7-2.8 years), only 1 stroke and 1 transient ischemic attack were reported, translating into a significant reduction of cerebrovascular events before and after LAAO (2.0 ± 1.0 events vs 0.1 ± 0.3 events; P.01). Imaging follow-up revealed only 1 case of device thrombosis.LAAO as an adjunctive therapy to OAC seems to be feasible and safe in patients with previous cardioembolic events despite optimal OAC. In our series, this strategy was associated with a low rate of cerebrovascular events after LAAO.

This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). New technologies, namely eHealth platforms, are being used more than ever before. These platforms enable older people to have a more independent lifestyle, enhance their participation, and improve their well-being. Information and communication technologies are expected to be linked to the triad of aging, social inclusion, and active participation, which is in line with the implementation of Smart Healthy and Age-Friendly Environments. This scoping review aimed to map eHealth platforms designed to promote autonomous life and active aging. The Joanna Briggs Institute methodology and the PRISMA-ScR checklist were used. A search was conducted on MEDLINE (via PubMed), CINAHL Complete (via EBSCOhost), Scopus, Cochrane Database of Systematic Reviews (via EBSCOhost), SciELO, DART-Europe, CAPES, and MedNar databases. Fourteen studies were included. This scoping review synthesized information on eHealth platforms designed to promote active living, their domains of intervention, and the outcomes assessed in those studies that have implemented and evaluated these eHealth platforms.

The aim of this study was to investigate the prognostic role of heart failure (HF) history in patients with secondary mitral regurgitation (SMR) underwent MitraClip. We retrospectively analyzed 186 patients with SMR undergoing MitraClip at 4 centres. HF history was defined as number or days of HF hospitalizations in the 12-month before MitraClip, or as time from last HF hospitalization to MitraClip, or time between first SMR diagnosis and MitraClip. More severe symptoms were observed in patients with1 HF hospitalization compared with those with ≤1 HF hospitalizations, in those with ≥10 days versus10 days of HF hospitalization and in those with shortest time from the last HF hospitalization. No significant differences were observed for procedural data in the population stratified according to the different definitions. In variables related with HF history, only the number of HF hospitalizations before MitraClip was associated with an increased risk of clinical events (hazard ratio 1.59; 95% confidence interval [1.09 to 2.12]; p = 0.015), whereas days of previous HF hospitalization, time from last HF hospitalization and from first diagnosis of SMR do not impact on prognosis. A significant decrease in the number and days of HF hospitalizations was observed in the 12-month after MitraClip compared with the 12-month before. In conclusion, in variables related with HF history, recurrence (1) of HF hospitalizations before MitraClip was the most powerful predictor of prognosis. Latency of intervention did not affect outcomes.

OBJECTIVES The aim of this study was to compare transcatheter aortic valve replacement (TAVR) with the Acurate neo (NEO) and Evolut PRO (PRO) devices. BACKGROUND The NEO and PRO bioprostheses are 2 next-generation self-expanding devices developed for TAVR. METHODS The NEOPRO (A Multicenter Comparison of Acurate NEO Versus Evolut PRO Transcatheter Heart Valves) registry retrospectively included patients who underwent transfemoral TAVR with either NEO or PRO valves at 24 centers between January 2012 and March 2018. One-to-one propensity score matching resulted in 251 pairs. Pre-discharge and 30-day Valve Academic Research Consortium (VARC)-2 defined outcomes were evaluated. Binary logistic regression was performed to adjust the treatment effect for propensity score quintiles. RESULTS A total of 1,551 patients (n = 1,263 NEO; n = 288 PRO) were included. The mean age was 82 years, and the mean Society of Thoracic Surgeons score was 5.1%. After propensity score matching (n = 502), VARC-2 device success (90.6% vs. 91.6%; p = 0.751) and pre-discharge moderate to severe (II+) paravalvular aortic regurgitation (7.3% vs. 5.7%; p = 0.584) were comparable between the NEO and PRO groups. Furthermore, there were no significant differences in any 30-day clinical outcome between matched NEO and PRO pairs, including all-cause mortality (3.2% vs. 1.2%; p = 0.221), stroke (2.4% vs. 2.8%; p = 1.000), new permanent pacemaker implantation (11.0% vs. 12.8%; p = 0.565), and VARC-2 early safety endpoint (10.6% vs. 10.4%; p = 1.000). Logistic regression on the unmatched cohort confirmed a similar risk of VARC-2 device success, paravalvular aortic regurgitation II+, and 30-day clinical outcomes after NEO and PRO implantation. CONCLUSIONS In this multicenter registry, transfemoral TAVR with the NEO and PRO bioprostheses was associated with high device success, acceptable rates of paravalvular aortic regurgitation II+, and good 30-day clinical outcomes. After adjusting for potential confounders, short-term outcomes were similar between the devices.

BACKGROUND Tricuspid regurgitation is associated with increased rates of heart failure (HF) and mortality. Transcatheter tricuspid valve interventions (TTVI) are promising, but the clinical benefit is unknown. OBJECTIVES The purpose of this study was to investigate the potential benefit of TTVI over medical therapy in a propensity score matched population. METHODS The TriValve (Transcatheter Tricuspid Valve Therapies) registry collected 472 patients from 22 European and North American centers who underwent TTVI from 2016 to 2018. A control cohort formed by 2 large retrospective registries enrolling medically managed patients with >= moderate tricuspid regurgitation in Europe and North America (n = 1,179) were propensity score 1:1 matched (distance +/- 0.2 SD) using age, EuroSCORE II, and systolic pulmonary artery pressure. Survival was tested with Cox regression analysis. Primary endpoint was 1-year mortality or HF rehospitalization or the composite. RESULTS After matching, 268 adequately matched pairs of patients were identified. Compared with control subjects, TTVI patients had lower 1-year mortality (23 +/- 3% vs. 36 +/- 3%; p = 0.001), rehospitalization (26 +/- 3% vs. 47 +/- 3%; p < 0.0001), and composite endpoint (32 +/- 4% vs. 49 +/- 3%; p = 0.0003). TTVI was associated with greater survival and freedom from HF rehospitalization (hazard ratio [HR]: 0.60; 95% confidence interval [CI]: 0.46 to 0.79; p = 0.003 unadjusted), which remained significant after adjusting for sex, New York Heart Association functional class, right ventricular dysfunction, and atrial fibrillation (HR: 0.39; 95% CI: 0.26 to 0.59; p < 0.0001) and after further adjustment for mitral regurgitation and pacemaker/defibrillator (HR: 0.35; 95% CI: 0.23 to 0.54; p < 0.0001). CONCLUSIONS In this propensity-matched case-control study, TTVI is associated with greater survival and reduced HF rehospitalization compared with medical therapy alone. Randomized trials should be performed to confirm these results. (C) 2019 by the American College of Cardiology Foundation.

Made available in DSpace on 2018-08-01T23:37:15Z (GMT). No. of bitstreams: 1 tese_12275_DISSERTAÇÃO DAIANE FRANCIS F. FERREIRA (2).pdf: 5071378 bytes, checksum: 69706bae3ff50c8a76e8091cf5aa6a0b (MD5) Previous issue date: 2018-06-08 Esta pesquisa, caracterizada como qualitativa exploratória e comparativa (BOGDAN, BIKLEN, 2010; MICHEL, 2015), possui como objetivo principal compreender como o estudo dos contos maravilhosos foi proposto em três manuais didáticos de língua portuguesa destinados para o quarto ano do Ensino Fundamental de diferentes períodos da educação brasileira (décadas de 1950, 1980 e 2010), visando a identificar possíveis contribuições por parte destes manuais na formação de sujeitos críticos e emancipados. Desse modo, o trabalho de pesquisa dedicou-se à tarefa de investigar a frequência com que os contos maravilhosos aparecem nos livros em questão, a qualidade conteudista desses contos e as semelhanças e diferenças entre os manuais no que diz respeito ao trabalho com o ficcional, concentrando-se em responder as seguintes questões: como os contos de fadas, gênero ficcional tão importante para o desenvolvimento de uma consciência mais elevada da criança, vêm sendo proposto para leitura e estudo ao longo dos últimos sessenta anos dentro dos livros didáticos? E, em consequência, quais são as reais contribuições destes livros na formação do pensamento crítico dos sujeitos considerando a assiduidade deles nas práticas educacionais e os elevados investimentos para se continuar garantindo a sua presença nas escolas? Para responder tais questões, recorreu-se às contribuições de diferentes perspectivas: Bruno Bettelheim (1980), no que se refere aos contos de fadas na infância; Annie Rouxel (2013a, 2013b), Regina Zilberman (2005, 2006) e Maria Amélia Dalvi (2010, 2011, 2013a, 2013b, 2015) acerca da literatura no contexto escolar; e Dermeval Saviani (1991, 1993, 1999, 2000, 2009, 2011) e Lígia Márcia Martins (2015, 2016) no que tange o desenvolvimento das funções psíquicas superiores e do conceito de consciência crítica e imaginação. Assim, o percurso metodológico foi constituído por três momentos: o primeiro, uma apreciação dos registros históricos sobre o surgimento do livro didático no Brasil e sua relação com o nascimento da literatura infantil brasileira; o segundo, a seleção e estudo de três livros didáticos de Língua Portuguesa que fossem destinados para o quarto ano da educação básica, fossem chancelados pelo poder público e datassem, especificamente, as décadas de 1950, 1980 e 2010; e, por fim, a terceira etapa, que constituiu na apresentação, análise e problematização dos dados produzidos, nos permitindo concluir a urgência e relevância desta temática, bem como um possível engessamento no trabalho com o texto ficcional.

Made available in DSpace on 2018-03-22T15:34:37Z (GMT). No. of bitstreams: 1 tese_11681_Tese Jorge Verly - vers_o final em 21-12-17 - Defesa em 19-02-2018.pdf: 1681100 bytes, checksum: 598dfc4c36814f30d23510e7657bca7c (MD5) Previous issue date: 2018-02-19 Esta tese se propõe a discutir o cancioneiro de Sérgio Sampaio, compositor capixaba (1947-1994), a partir da filosofia de Theodor W. Adorno. Partindo da revisita aos pressupostos centrais do pensamento adorniano concernentes à música popular em especial aqueles contidos nos ensaios O fetichismo na música e a regressão da audição (1938), Sobre música popular (1941) e Moda intemporal sobre o jazz (1953) e também valendo-se das propostas presentes em obras como Dialética do esclarecimento (1947), Minima Moralia (1955), Dialética negativa (1966) e Teoria Estética (1970), intenta-se numa visada que se ampare no movimento de mediação indicado pelo autor alemão como o basilar de toda atividade filosófica e toda relação entre os sujeitos e os objetos provenientes da empiria social uma abordagem das canções de Sampaio que evidencie tanto o potencial de crítica do existente e de uso criativo das relações estandardizadas inerentes aos produtos da indústria cultural (e da qual faz parte a própria canção popular), como aclarem a compreensão das ideias-forças pertencentes à constelação do pensamento de Adorno, promovendo a atualidade e a validade de ambos. Acionando conceitos como estandardização, esquematismo, regressão da audição, esclarecimento, fetichismo, glamorização, reificação, autonomia da arte, conteúdo de verdade, emancipação, dentre outros, e reavaliando-os numa atitude a contrapelo da cristalização conceitual na aplicação a uma porção significativa da produção sampaiana, pretende-se destacar como o compositor de Cachoeiro de Itapemirim, também ele marcado pela barbárie e pelo arbítrio da história brasileira na década de 1970 (sob o regime militar), foi capaz de transferir para os momentos formais de sua obra os dados opressivos e inerentes a ele como indivíduo e ao coletivo social. Enquanto artista representante, sua obra realizou um movimento emancipatório por uma via autônoma, antiengajada, transferindo ao material musical o horror de seu tempo. Suas canções estão marcadas por uma historicidade imanente, isto é, mensurável no plano estético, nos momentos de sua constituição, o que é a intenção deste trabalho discutir.