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Resumo Fundamento A Sociedade Brasileira de Cardiologia promove anualmente a prova para obtenção do título de especialista em Cardiologia, sendo a Comissão Julgadora do Título de Especialista em Cardiologia responsável pela sua organização e aplicação. A análise psicométrica dos itens de uma prova, por meio da Teoria de Resposta ao Item (TRI) pode fornecer informações robustas e contribuir para o aprimoramento contínuo dessa avaliação. Objetivos Avaliar as propriedades psicométricas da prova do Título de Especialista em Cardiologia no ano de 2019, em relação aos parâmetros da TRI. Métodos Estudo observacional, com a análise psicométrica das 120 questões da prova realizada por 1120 (mil cento e vinte) candidatos para a obtenção do título de especialista em Cardiologia, no ano de 2019. Resultados A análise da prova pela TRI mostrou 32,2% dos itens com poder de discriminação “alto” ou “muito alto”, 49,2% dos itens categorizados como “fácil” ou “muito fácil” e 41,5% apresentavam alta probabilidade de acerto ao acaso . Foram identificados 69 itens com problemas em relação aos parâmetros da TRI e, portanto, com baixo poder de avaliar a proficiência do candidato. Conclusões A análise psicométrica da prova de título de Especialista em Cardiologia pela TRI demonstrou um alto percentual de questões fáceis, com cerca de dois terços dos itens com alta probabilidade de acerto ao acaso. Esses dados poderão desencadear uma série de discussões e propostas para a construção das futuras provas em cardiologia. Abstract Background The Cardiology Certification Exam is issued annually by the Brazilian Cardiology Society and set and applied by the Judging Committee for the Cardiologist Title (CJTEC). The psychometric analysis of the exam items using the Item Response Theory (IRT) may provide robust data that can help in the continuous improvement of this instrument. Objectives To evaluate the psychometric properties of the 2019 Cardiology Certification Exam in relation to the IR parameters. Methods This was an observational study, with psychometric analysis of the 120 questions of the exam taken by 1,120 candidates for the title of Cardiologist in 2019. Results The IRT analysis revealed that 32.2% of the items had a “high” or “very high” discriminating power, 49.2% were categorized as “easy” or “very easy”, and 41.5% showed a high probability of a correct guessing. Sixty-nine deficient items in terms of the IRT parameters were identified, which were then considered poorly effective in evaluating the candidate’s ability. Conclusions The psychometric analysis of the 2019 Cardiology Certification Exam by the IRT revealed a high percentage of easy questions, with nearly two thirds of the items with a high probability of correct guessing. These data may serve as a basis for a series of discussions and proposals for the elaboration of future certificate exams in Cardiology.

The Cardiology Certification Exam is issued annually by the Brazilian Cardiology Society and set and applied by the Judging Committee for the Cardiologist Title (CJTEC). The psychometric analysis of the exam items using the Item Response Theory (IRT) may provide robust data that can help in the continuous improvement of this instrument.To evaluate the psychometric properties of the 2019 Cardiology Certification Exam in relation to the IR parameters.This was an observational study, with psychometric analysis of the 120 questions of the exam taken by 1,120 candidates for the title of Cardiologist in 2019.The IRT analysis revealed that 32.2% of the items had a "high" or "very high" discriminating power, 49.2% were categorized as "easy" or "very easy", and 41.5% showed a high probability of a correct guessing. Sixty-nine deficient items in terms of the IRT parameters were identified, which were then considered poorly effective in evaluating the candidate's ability.The psychometric analysis of the 2019 Cardiology Certification Exam by the IRT revealed a high percentage of easy questions, with nearly two thirds of the items with a high probability of correct guessing. These data may serve as a basis for a series of discussions and proposals for the elaboration of future certificate exams in Cardiology.A Sociedade Brasileira de Cardiologia promove anualmente a prova para obtenção do título de especialista em Cardiologia, sendo a Comissão Julgadora do Título de Especialista em Cardiologia responsável pela sua organização e aplicação. A análise psicométrica dos itens de uma prova, por meio da Teoria de Resposta ao Item (TRI) pode fornecer informações robustas e contribuir para o aprimoramento contínuo dessa avaliação.Avaliar as propriedades psicométricas da prova do Título de Especialista em Cardiologia no ano de 2019, em relação aos parâmetros da TRI.Estudo observacional, com a análise psicométrica das 120 questões da prova realizada por 1120 (mil cento e vinte) candidatos para a obtenção do título de especialista em Cardiologia, no ano de 2019.A análise da prova pela TRI mostrou 32,2% dos itens com poder de discriminação “alto” ou “muito alto”, 49,2% dos itens categorizados como “fácil” ou “muito fácil” e 41,5% apresentavam alta probabilidade de acerto ao acaso . Foram identificados 69 itens com problemas em relação aos parâmetros da TRI e, portanto, com baixo poder de avaliar a proficiência do candidato.A análise psicométrica da prova de título de Especialista em Cardiologia pela TRI demonstrou um alto percentual de questões fáceis, com cerca de dois terços dos itens com alta probabilidade de acerto ao acaso. Esses dados poderão desencadear uma série de discussões e propostas para a construção das futuras provas em cardiologia.

Introduction: Faculty development in medical education has shown an increasing focus on universities. Changes in the learning style, the broad access to digital knowledge and new society demands in terms of medical competences have induced the need for updates in teaching practices, especially during the Covid-19 pandemic. Objective: To evaluate the needs of faculty development, reported educational practices and the view on teaching and learning from medical teachers’ perspectives. Methods: this study has a cross-sectional design with a convenience sample of undergraduate medical teachers from a medical school in São Paulo, who coordinate educational units in the curricula. Data collection took place between August and September 2020, by completing an electronic questionnaire. The data were analyzed using proportions, the chi-square test or Fisher’s exact test, with p

Currently, the Friedewald formula (FF) is the main method for evaluating low-density lipoprotein cholesterol (LDL-c). Recently, many limitations have emerged regarding its use, including patients with triglyceride levels ≥400 mg/dL, diabetes mellitus, and kidney or hepatic chronic diseases. We analyzed the use of the FF in patients with metabolic syndrome. We selected patients with known metabolic syndrome that fulfilled the National Cholesterol Education Program Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Final Report and excluded patients with triglyceride levels ≥400 mg/dL and chronic liver and/or kidney disease. Using direct assays, we measured total cholesterol, high-density lipoprotein cholesterol, triglycerides, and LDL-c. Then, LDL-c was estimated using the FF and compared with the LDL-c by direct assay. The sample size was 135 patients. Using the FF, the mean LDL-c value was 124.4±42.1 mg/dL; it was 125.1±38.5 mg/dL by direct assay. The correlation coefficient between these two methods was 0.89, with statistical significance (P value<0.001). There were no significant differences between the patients with triglyceride levels >150 mg/dL (P=0.618). In conclusion, FF is a good method for estimating LDL-c in patients with metabolic syndrome.

Delirium is a neurological disorder manifested by patients who are hospitalized. It is a syndrome characterized as acute disorder of attention and cognitive function. This study aimed to identify the difficulties in the literature in the early diagnosis of the patient with delirium, and what are the behaviors performed by health professionals when the diagnosis is made. For data collection, used the literature review, by reviewing the database of the Virtual Health Library during the first half of 2010, using descriptors standards. The results denote that sometimes this disorder is not recognized properly and timely treatment. Another relevant factor is found the prevalence of several risk in hospitalized elderly. We believe that patients in delirium should be constantly evaluated, even if not to make complaints, as this disorder is swinging and can not be diagnosed in the first sessions. We consider it important to continue the training of interdisciplinary team to complete the diagnosis.

OBJETIVO: O objetivo deste trabalho é estudar o comportamento da pressão arterial através da monitorização ambulatorial da pressão arterial (MAPA) em jovens normotensos que possuam história familiar de hipertensão. MÉTODOS: Foram avaliados pela MAPA 31 universitários normotensos, com idade entre 17 e 25 anos, cujos pais (ambos ou um deles) estivessem sendo tratados por hipertensão arterial (grupo I) e 30 indivíduos, também normotensos, cujos pais não apresentavam diagnóstico de HAS - hipertensão arterial sistêmica (grupo II). Todos os participantes tiveram dados epidemiológicos coletados e os valores de pressão arterial (PA) obtidos pela MAPA foram comparados. RESULTADOS: Não houve diferença estatística entre os grupos estudados quanto à análise das médias de PA sistólica (PAS) (p=0,195) e diastólica (PAD) (p=0,958), descenso noturno da PAS (p=0,61) e da PAD (p=0,289) e variabilidade da PAS (p=0,24) e da PAD (p=0,497). Houve significância estatística na comparação da pressão de pulso (42,74 mmHg no grupo I e 45,53 mmHg no grupo II, p=0,032) e da PAS mínima na vigília (85,00 mmHg no grupo I e 90,27 mmHg no grupo II, p=0,048). Ambos os parâmetros mencionados foram maiores nos filhos de normotensos. CONCLUSÃO: Na população estudada, houve diferença estatística significativa na pressão de pulso e PAS mínima na vigília, sendo maior nos filhos de normotensos. Os demais parâmetros da MAPA não apresentaram diferença significativa entre os grupos.OBJECTIVE: This study intended to evaluate blood pressure monitoring (BPM) data in young hypertensive offspring. METHODS: We evaluated 31 students, of ages ranging from 17 to 25 years, whose parents (one or both) were being treated for hypertension (group I) and 30 normotensive subjects, whose parents were not hypertensive (group II). Epidemiological data were collected from all participants and the blood pressure (BP) measurements obtained by BPM were compared. RESULTS: There were no statistical differences between both groups when mean systolic blood pressure (SBP) (p=0.195) and mean diastolic blood pressure (DBP) (p=0.958); SBP decrease (p=0.61) and DBP decrease (p=0.289); SBP variability (p=0.24) and DBP variability (p=0.497) were compared. There were statistical differences, when pulse pressures (42.74 mmHg in group I and 45.53 in group II) and in the minimum SBP during the awake period (85.00 mmHg in group I and 90.27 mmHg in group II, p=0.048) were compared. Both parameters were higher in the group whose parents were not hypertensive individuals. CONCLUSION: In this population, there were statistical differences in pulse pressure and in minimum SBP during the awake period, being higher in the group whose parents were not hypertensive. There were no differences between the two groups in the other parameters analyzed.

OBJETIVO: A neoproliferação intimal e o remodelamento têm sido implicados como os maiores fatores causadores de reestenose. O objetivo deste trabalho é estudar a ação da L-arginina por via oral, nesses dois fatores, após lesão por balão, em artérias ilíacas de coelhos hipercolesterolêmicos. MÉTODOS: Foram utilizados dezenove coelhos, que foram divididos em dois grupos: controle (GC) e arginina (GA), respectivamente com dezenove e dezessete artérias estudadas. Os animais foram submetidos a lesão por balão de angioplastia, em suas artérias ilíacas, quinze dias após início de dieta hipercolesterolêmica a 2%. A seguir, os animais do GA passaram a receber uma solução de L-arginina, por via oral, na dose de 1 g/kg/dia. Após o sacrifício, no 15º dia após a lesão por balão, procedeu-se a cortes histológicos das artérias, as quais foram coradas e fixadas. Utilizou-se como representativa do desenvolvimento da lesão a razão da área da neoíntima (em mm²) pela camada média (em mm²). Por sua vez, a razão da área total do vaso em sua porção medial (de maior contato com o balão) pela área total do vaso no segmento referencial (de menor contato com o balão) foi a definidora do remodelamento. RESULTADOS: A média do espessamento neointimal (NI/M) foi de 0,8151±0,2201 no GC e de 0,3296±0,1133 no GA. Não houve diferença entre os tipos de remodelamento entre os dois grupos estudados. CONCLUSÃO: No modelo experimental utilizado, a L-arginina foi capaz de reduzir o espessamento intimal em coelhos hipercolesterolêmicos e não teve ação sobre o remodelamento arterial. OBJECTIVE: It has been implied that neointimal proliferation and remodeling are the major causes of restenosis. The objective of this study is to assess the effect of orally administered L-arginine on these two factors in hypercholesterolemic rabbits that had suffered an injury to their iliac arteries caused by a catheter balloon. METHODS: The study included nineteen rabbits that were divided in two groups: control (CG) and arginine (AG). There were 19 arteries studied from the control group and 17 in the arginine group. The animals were placed on a 2% hypercholesterolemic diet for 15 days and then submitted to a balloon angioplasty in order to produce a lesion in their iliac arteries. Next, the AG animals were given a 1g/kg/day oral dose of a L-arginine solution. The animals were sacrificed 15 days after the angioplasty procedure and histological artery sections were prepared, stained and fixed. The ratio between the neointimal area (in mm²) and the media layer (in mm²) was used to represent lesion development. In order to determine remodeling, the ratio between the total area of the medial portion of the vessel (greater balloon contact) and the total area of the reference segment of the vessel (less balloon contact) was used. RESULTS: Mean neointimal thickness (NI/M) was 0.8151±0.2201 in CG and 0.3296±0.1133 in AG. Remodeling patterns for the two groups studied were similar. CONCLUSION: In the experimental model used, L-arginine was able to reduce intimal tissue thickness in hypercholesterolemic rabbits but did not act on artery remodeling.

A lesao da parede arterial provocada por balao de angioplastia ou implante de proteses endovasculares em modelos experimentais e humanos pode provocar a reestenose do vaso, principalmente por migracao e proliferacao de celulas musculares lisas e sintese de matriz extracelular. Varios estudos demonstraram que a braquiterapia intra-arterial atua nestes fatores e, consequentemente, no tratamento da reestenose coronariana. Este estudo tem por objetivo avaliar as alteracoes vasculares morfologicas e morfometricas induzidas pela braquiterapia com samario-153 (153Sm), utilizando uma dose considerada ideal e outra elevada em coelhos hipercolesterolemicos. Foram analisados 43 coelhos hipercolesterolemicos e um total de 86 arterias iliacas submetidas a lesao por balao de angioplastia, divididos em tres grupos, sendo irradiados com as doses de 15Gy (n = 14) e 60Gy (n = 36) e controle (n = 36). Foram realizadas analise morfometrica (area neo-intimal, area da camada media, area do vaso) e analise histologica qualitativa para avaliacao tecidual. O colesterol medio foi de 1.362 ± 497mg/dl nos tres grupos. O achado mais relevante foi uma significativa inibicao da hiperplasia neo-intimal no grupo irradiado com a dose de 15Gy, maior do que o controle e com a dose de 60Gy. Na dose de 60 Gy, alem de ineficaz para inibir a proliferacao neo-intimal, teve caracteristicas tissulares e estruturais sugestivas de radiolesao, como presenca de celulas xantomatosas, tecidos hialino e amorfo, proliferacao vascular. Estas celulas, bem como o aumento das dimensoes morfometricas do vaso, foram proporcionais aos graus de lesao nas lâminas elasticas interna e externa, sendo observados principalmente com a dose de 60Gy. Os segmentos medios das arterias iliacas, representando o local de maior contato com o balao, tiveram maiores alteracoes morfometricas e celulares em relacao aos segmentos referenciais (proximal e distal) nos tres grupos. Em conclusao, o grupo de arterias submetidas a irradiacao de 15Gy foi eficaz para a inibicao da proliferacao neo-intimal. O grupo irradiado com a maior dose de 60Gy foi ineficaz para inibir a hiperplasia neo-intimal e apresentou caracteristicas morfometricas e teciduais compativeis com a radiolesao vascular.

O termo holoprosencefalia (HPC) é usado para o complexo de deformidades hemisféricas causadas por falha no desenvolvimento da vesícula prosencefálica. Este estudo tem como objetivo relatar o espectro morfológico de 12 casos de HPC, classificá-los e compará-los com a literatura pertinente. Avaliadas 5837 necrópsias realizadas entre 1960 e 1995, 12 apresentavam HPC. Dados como sexo, idade, e presenças de outras malformações associadas foram avaliados e comparados com as demais malformações e com o total de necrópsias. A maioria dos casos era de masculinos (66,66%) e neomortos (75%). A forma de HPC mais frequentemente encontrada foi a lobar (58,3%) e a alteração facial mais frequente foi a ciclopia (25%). Houve tendência estatística de que a HPC possa, dentro das malformações do sistema nervo central (SNC), acometer mais o sexo masculino e de que a neomortalidade seja maior na HPC do que nas outras malformações do SNC. The term holoprosencephaly (HPC) is used to indicate the group of hemispheric deformities caused by a failure in the development of the prosencephalic vesicle. The purpose of this study is to explain the morphologic specter of twelve cases of HPC, qualify them, and compare them to the literature. It was evaluated 5837 pediatrics necropsies, and there were 12 cases of HPC. Data like gender, age and the presence of another associated malformations were evaluated and compared to another malformations and to the total number of necropsies. The majority of the cases was male (66.66%), and stillborns (75%). The most frequently type of HPC found was the lobar type (58.3%), and the most frequently type of facial alteration was the ciclopy (25%). There is a statistic tendency to HPC affect the male sex, in comparison with other neurologic malformations. Besides, the stillborns are more frequently observed in HPC than in other neurologic malformations.

The transumbilical breast augmentation procedure has proved to be highly effective and safe when performed properly, as outlined herein. In the author's opinion, the popularity of the procedure will continue to increase among both surgeons and patients. This article focuses on the steps necessary to maximize the continuing safety of the procedure. The three most critical points are that no sharp instruments are used, the surgeon's handling of the instrument prevents any long thrusts, and at no time does any instrument point toward the abdominal or thoracic cavity. These and numerous other safety tips are presented here.

Association between epistaxis and hypertension is controversial. In this study, we evaluated in hypertensive patients the incidence of epistaxis according to stages of hypertension and compared blood pressure (BP) readings in these episodes to routine readings. Thirty-six patients admitted to the Emergency Department (ED) with epistaxis were enrolled and divided into 3 groups according to hypertension severity (JNC-VI criteria). BP readings were obtained weekly (routine BP) and in the setting of a new episode of epistaxis (epistaxis BP). No difference in the incidence of epistaxis was found: patients with hypertension stage 1 had 7.6+/-4.1 episodes/year, those in stage 2 had 8.0+/-4.0 and in stage 3 the incidence was 8.2+/-3.9 (p=ns). The average SBP for all 36 patients was 154+/-19 mmHg on routine readings and 157+/-22 mmHg on epistaxes episodes (p=ns). No difference was also observed regarding DBP: 104+/-18 mmHg vs. 105+/-18 mmHg (p=ns). In conclusion, epistaxis incidence in hypertensive patients is not associated to hypertension severity. Moreover, BP readings in the setting of epistaxis are similar to readings obtained in routine situations.

Modelo do estudo: estudo transversal de base populacional realizado em ambulatórios e unidades de saúde em Curitiba - Paraná - Brasil. Objetivo: evidenciar quais são os principais fatores de risco cardiovascular da síndrome metabólica(SM) associados à esteatose hepática (EH. Metodologia: 75 pacientes com SM, sob tratamento ou não, após preencher os critérios de inclusão ou exclusão da pesquisa, foram submetidos à ultrassonografia hepática para investigar a presença de EH.Em seguida, foi avaliada a relação entre EH e fatores de risco cardiovasculares da SM. Resultados: independente da idade, gênero e hipertensão arterial, pacientes com intolerância à glicose ou diabetes mellitus têm maior risco de EH que os pacientes com glicose sérica normal (p

In the 1960s, carbon dioxide (CO2) laser therapy started to be applied to eliminate wrinkles, actinic scars, and acne because of its capacity of induce intracellular water vaporization. However, recent studies have shown the efficacy of the erbium laser in removing delicate and moderate scars. Furthermore, the postoperative lesions induced by the erbium laser seem to resolve faster and with less erythematous pattern compared with lesions induced by the CO2 laser. The purpose of this study was to determine the immediate pathologic alterations caused by single applications of CO2 and erbium lasers and their association in human skin shreds. Ten white female patients aged 30 to 63 years underwent rhytidectomy, and their respective shreds, which were prepared for excision, were tattooed with the CO2 laser, the erbium laser, or a combination of both in random order and number of applications, before final removal. This project was approved by the local ethical committee. After surgical removal, these tattooed shreds were fixed in 10% buffered formalin and submitted to histopathologic analysis. Morphometric studies demonstrated the normal skin thickness and thickness of the laser-treated area, and their subtraction resulted in the ablation damage values. Residual thermal damage corresponded to the thickness of the affected skin from the most superficial layer of tissue in the laser-treated area down to the deepest dermal area with basophilic degeneration of collagen fibers. Our results showed that two CO2 applications resulted in greater ablation and residual thermal damage when compared with only one CO2 application. The same was true in comparisons of one and two applications of the erbium laser. Both results were statistically significant (p < 0.05). When one isolated erbium and one isolated CO2 application were compared, ablation damage was greater in the former group, although with no statistical significance. One CO2 plus one erbium application compared with one isolated CO2 application showed similar ablation damage but greater residual thermal damage in the latter group (p < 0.05). These observations might contribute to our understanding of the lesions caused in the human skin by erbium and CO2 lasers and eventually help determine the ideal laser combination for the appropriate surgical treatment.

OBJETIVO: O objetivo deste trabalho é estudar o comportamento da pressão arterial através da monitorização ambulatorial da pressão arterial (MAPA) em jovens normotensos que possuam história familiar de hipertensão. MÉTODOS: Foram avaliados pela MAPA 31 universitários normotensos, com idade entre 17 e 25 anos, cujos pais (ambos ou um deles) estivessem sendo tratados por hipertensão arterial (grupo I) e 30 indivíduos, também normotensos, cujos pais não apresentavam diagnóstico de HAS - hipertensão arterial sistêmica (grupo II). Todos os participantes tiveram dados epidemiológicos coletados e os valores de pressão arterial (PA) obtidos pela MAPA foram comparados. RESULTADOS: Não houve diferença estatística entre os grupos estudados quanto à análise das médias de PA sistólica (PAS) (p=0,195) e diastólica (PAD) (p=0,958), descenso noturno da PAS (p=0,61) e da PAD (p=0,289) e variabilidade da PAS (p=0,24) e da PAD (p=0,497). Houve significância estatística na comparação da pressão de pulso (42,74 mmHg no grupo I e 45,53 mmHg no grupo II, p=0,032) e da PAS mínima na vigília (85,00 mmHg no grupo I e 90,27 mmHg no grupo II, p=0,048). Ambos os parâmetros mencionados foram maiores nos filhos de normotensos. CONCLUSÃO: Na população estudada, houve diferença estatística significativa na pressão de pulso e PAS mínima na vigília, sendo maior nos filhos de normotensos. Os demais parâmetros da MAPA não apresentaram diferença significativa entre os grupos. OBJECTIVE: This study intended to evaluate blood pressure monitoring (BPM) data in young hypertensive offspring. METHODS: We evaluated 31 students, of ages ranging from 17 to 25 years, whose parents (one or both) were being treated for hypertension (group I) and 30 normotensive subjects, whose parents were not hypertensive (group II). Epidemiological data were collected from all participants and the blood pressure (BP) measurements obtained by BPM were compared. RESULTS: There were no statistical differences between both groups when mean systolic blood pressure (SBP) (p=0.195) and mean diastolic blood pressure (DBP) (p=0.958); SBP decrease (p=0.61) and DBP decrease (p=0.289); SBP variability (p=0.24) and DBP variability (p=0.497) were compared. There were statistical differences, when pulse pressures (42.74 mmHg in group I and 45.53 in group II) and in the minimum SBP during the awake period (85.00 mmHg in group I and 90.27 mmHg in group II, p=0.048) were compared. Both parameters were higher in the group whose parents were not hypertensive individuals. CONCLUSION: In this population, there were statistical differences in pulse pressure and in minimum SBP during the awake period, being higher in the group whose parents were not hypertensive. There were no differences between the two groups in the other parameters analyzed.

This study intended to evaluate blood pressure monitoring (BPM) data in young hypertensive offspring.We evaluated 31 students, of ages ranging from 17 to 25 years, whose parents (one or both) were being treated for hypertension (group I) and 30 normotensive subjects, whose parents were not hypertensive (group II). Epidemiological data were collected from all participants and the blood pressure (BP) measurements obtained by BPM were compared.There were no statistical differences between both groups when mean systolic blood pressure (SBP) (p=0.195) and mean diastolic blood pressure (DBP) (p=0.958); SBP decrease (p=0.61) and DBP decrease (p=0.289); SBP variability (p=0.24) and DBP variability (p=0.497) were compared. There were statistical differences, when pulse pressures (42.74 mmHg in group I and 45.53 in group II) and in the minimum SBP during the awake period (85.00 mmHg in group I and 90.27 mmHg in group II, p=0.048) were compared. Both parameters were higher in the group whose parents were not hypertensive individuals.In this population, there were statistical differences in pulse pressure and in minimum SBP during the awake period, being higher in the group whose parents were not hypertensive. There were no differences between the two groups in the other parameters analyzed.

OBJETIVO: Este estudo tem por objetivo avaliar as alterações vasculares morfológicas e morfométricas induzidas pela braquiterapia com Samário-153 (153 Sm) em coelhos hipercolesterolêmicos, com doses elevadas. MÉTODOS: Foram analisados 43 coelhos hipercolesterolêmicos, brancos, da raça New Zealand, e o total de 86 artérias ilíacas submetidas a lesão por balão de angioplastia. Divididos em três grupos: dois (GI) irradiados com as doses de 15Gy (n=14) e 60Gy (n=36) e um grupo controle (n=36). Foram realizadas avaliação histológica morfométrica e análise histológica qualitativa para análise tecidual. RESULTADOS: Foram observadas uma redução significativa da neoproliferação intimal (NPI) no GI 15 Gy (p

This study was designed to evaluate vascular morphological and morphometric changes induced by brachytherapy with samarium-153 (Sm-153) at high doses in hypercholesterolemic rabbits.Forty-three New Zealand White hypercholesterolemic rabbits were analyzed, and the total of 86 iliac arteries underwent balloon angioplasty injury. The rabbits were divided into three different groups: two irradiation groups (IG) assigned to 15 Gy (n=14) and 60 Gy (n=36) irradiation doses, respectively, and a control group (n = 36). Histomorphometric and qualitative histological analyses were performed for tissue evaluation.Significant reductions were found in neointimal proliferation (NIP) (p0.0001), media area (MA) (p0.0001) and percent stenosis (p0.0001) in the 15-Gy IG, compared to the other groups. The 60-Gy IG had the higher rate of NIP, increase in media and vessel areas (VA) and percent stenosis. The 60-Gy IG also showed the greatest number of xanthomatous cells (60-Gy IG: 86.11% and 15-Gy IG: 14.29%, p0.0001) and the highest amount of hyaline amorphous tissue (60-Gy IG:58.33% and 15-Gy IG:0%, p=0.0001) and vascular proliferation (60-Gy IG:30.56% and 15-Gy IG:0%, p=0.0221). No statistically significant differences were found among groups concerning other tissue analyses.The high-dose irradiation of 60 Gy resulted in intense cell proliferation considered vascular radiolesion, unlike the 15-Gy dose, which was associated with an excellent inhibition of neointimal proliferation.

OBJECTIVE: To determine the influence of stress on teaching medical emergencies in an Advanced Cardiac Life Support (ACLS) course and to verify this influence on learning, and the efficiency of emergency care training. METHODS: Seventeen physicians signed up for an ACLS course. Their pulses were taken and blood pressure (BP) verified on the first day, before the beginning of the course, and on the second day, during the theoretical and practical test (TPT). Variations in pulse rates and BP were compared with students' test grades. Then, students answered a questionnaire of variables (QV) about the amount of sleep they had during the course, the quantity of study material and the time spent studying for the course, and a stress scale graphic. RESULTS: Seven students had a pulse variation less than 10% between the 2 periods and 10 had a 10% or more variation. Grades on TPT were, respectively, 91.4±2.4 and 87.3±5.2 (p