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Introduction and objectives: Deliberate self-poisoning (DSP) is a frequent cause of admission at the emergency department during adolescence. Since the beginning of the COVID-19 pandemic, a higher number of cases was reported. This retrospective study aimed to determine DSP prevalence, between 2018 and 2022, as well as the medication used and the method for obtaining it, within the catchment area of a Tertiary Pediatric Hospital Emergency Department (ED) in Portugal. Methods: Retrospective study, including patients aged 10 to 17 that lived in the catchment area of the ED and were admitted for DSP less than 7 days prior. By searching with the keywords “DSP” and “deliberate self-poisoning”, 2975 records were found, of which 1403 cases were included. Statistical analysis was performed in SPSS with a significance level of 0.01. Results: Out of 1403 cases, 87.9% were female, mostly in mid-adolescence and with a previous follow-up appointment with a child and adolescent psychiatrist. The patient’s own psychotropic medication were the most used drugs. Episodes with no suicidal intention were more frequent. After the ED, most cases were discharged with a referral for psychiatric follow-up. There was a higher number of DSP in 2021 (p < 0.01), with a prevalence of 123.8/100,000. Discussion: DSP is growing among adolescents. Cases increased significantly in 2021. We highlight the need for prevention campaigns and vigilance systems to monitor and modify this trend.

The field of Cardio-Oncology has grown significantly, especially during the last decade. While awareness of cardiotoxicity due to cancer disease and/or therapies has greatly increased, much of the attention has focused on myocardial systolic disfunction and heart failure. However, coronary and structural heart disease are also a common issue in cancer patients and encompass the full spectrum of cardiotoxicity. While invasive percutaneous or surgical intervention, either is often needed or considered in cancer patients, limited evidence or guidelines are available for dealing with coronary or structural heart disease. The Society for Cardiovascular Angiography and Interventions consensus document published in 2016 is the most comprehensive document regarding this particular issue, but relevant evidence has emerged since, which render some of its considerations outdated. In addition to that, the recent 2022 ESC Guidelines on Cardio-Oncology only briefly discuss this topic.As a result, the Portuguese Association of Cardiovascular Intervention and the Cardio-Oncology Study Group of the Portuguese Society of Cardiology have partnered to produce a position paper to address the issue of cardiac intervention in cancer patients, focusing on percutaneous techniques. A brief review of available evidence is provided, followed by practical considerations. These are based both on the literature as well as accumulated experience with these types of patients, as the authors are either interventional cardiologists, cardiologists with experience in the field of Cardio-Oncology, or both. Resumo: A Cardio-Oncologia cresceu consideravelmente, particularmente ao longo da última década. Não obstante o aumento de sensibilização relativamente à cardiotoxicidade secundária ao cancro e/ou a terapêuticas oncológicas, muita da atenção tem-se focado na disfunção sistólica e insuficiência cardíaca. Todavia, a doença coronária e estrutural cardíaca representam também um desafio comum em doentes oncológicos, fazendo assim parte do abrangente conceito de Cardio-Oncologia. Apesar da necessidade de intervenção invasiva, percutânea ou cirúrgica ser frequentemente necessária ou considerada em doentes com cancro, é escassa a evidência ou recomendações relativas à doença coronária ou estrutural neste subgrupo. O documento de consenso da Society for Cardiovascular Angiography and Interventions, publicado em 2016, é a referência mais completa relativamente a esta problemática. Contudo, alguma evidência que entretanto surgiu torna necessária uma atualização. Adicionalmente, as recentes recomendações de 2022 em Cardio-Oncologia da Sociedade Europeia de Cardiologia abordam este assunto somente de forma muito sucinta.Por este motivo, a Associação Portuguesa de Intervenção Cardiovascular e o Grupo de Estudos de Cardio-Oncologia associaram-se para produzir um Artigo de Posição sobre Intervenção Cardíaca em doentes com cancro, com foco nas técnicas percutâneas. Procedeu-se a uma breve revisão da literatura, seguida de considerações práticas. Estas baseiam-se na evidência disponível, bem como na experiência acumulada dos autores, que são Cardiologistas de Intervenção, Cardiologistas dedicados à área da Cardio-Oncologia, ou ambos.

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Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome, especially among young to middle-aged women with few traditional cardiovascular risk factors and low pretest probability for atherosclerotic coronary artery disease. Diagnosis by invasive coronary angiography is the gold standard and conservative therapy is generally recommended, with percutaneous or surgical revascularization being reserved for cases of clinical instability, high-risk anatomy or as bailout. Unlike atherothrombotic coronary artery disease, strong evidence on optimal medical therapy is scarce, posing unique challenges in cases of pregnancy-associated SCAD. The follow-up strategy is also of major importance, as recurrent SCAD is not infrequent, lifestyle changes and pharmacological therapy should be planned for the long term, and SCAD-associated conditions need to be addressed. This review aims to provide a practical management approach to SCAD patients for both clinical and interventional cardiologists. Resumo: A dissecção coronária espontânea é uma causa cada vez mais reconhecida de síndrome coronária aguda, especialmente entre mulheres jovens ou de meia-idade com poucos fatores de risco cardiovascular tradicionais e baixa probabilidade pré-teste de doença coronária aterosclerótica. O diagnóstico por coronariografia invasiva é o gold standard e a terapêutica conservadora é geralmente recomendada, optando pela revascularização percutânea ou cirúrgica em casos de instabilidade clínica, anatomia de alto risco ou como bailout. Ao contrário da doença coronária aterotrombótica, não existe evidência científica robusta sobre a terapêutica médica mais adequada nestes casos, representando ainda desafios particulares em casos de dissecção coronária espontânea associada à gravidez. A estratégia de seguimento é também fundamental, dado que a recorrência de dissecção coronária espontânea não é rara, as alterações de estilo de vida e terapêutica farmacológica devem ser planeados em longo prazo e devem ser investigadas as condições subjacentes associadas à dissecção coronária espontânea. Esta revisão pretende oferecer um guia de abordagem prática ao doente com dissecção coronária espontânea, do ponto de vista do cardiologista clínico e do cardiologista de intervenção.

New iron and cobalt bis(dithiolene) complexes [M(3cbdt)2] (3cbdt = 3-cyanobenzene-1,2-dithiolate) were prepared as tetraphenylphosphonium (Ph4P+) salts for Fe in the monoanionic state and for Co in both the dianionic and monoanionic states: (Ph4P)2[Fe(III)(3cbdt)2]2 (1); (Ph4P)2[Co(III)(3cbdt)2]2 (2); (Ph4P)2[Co(II)(3cbdt)2] (3). These compounds were characterized by single-crystal X-ray diffraction, cyclic voltammetry, EPR, and static magnetic susceptibility. Their properties are discussed in comparison with the corresponding complexes based on the isomer ligand 4-cyanobenzene-1,2-dithiolate (4cbdt) and 4,5-cyanobenzene-1,2-dithiolate (dcbdt), previously described by us. The Fe(III) and the Co(III) compounds (1 and 2) are isostructural, crystallizing in the triclinic P1¯ space group, with cis [M(III)(3cbdt)2] complexes dimerized in a trans fashion, and the transition metal (M = Fe, Co) has a distorted 4+1 square pyramidal coordination geometry. The Co(II) compound (3) crystallizes in the triclinic P1¯ space group, with the unit cell containing one cis and three trans inequivalent [Co(II)(3cbdt)2] complexes with the transition metal (Co) and having a square planar coordination geometry. The Fe(III) complex (1) is EPR-silent, and the static magnetic susceptibility shows a temperature dependence typical of dimers of antiferromagnetically coupled S = 3/2 spins with −J/kB = 233.6 K and g = 1.8. Static magnetic susceptibility measurements of compound (3) show that this Co(II) complex is paramagnetic, corresponding to an S = ½ state with g = 2, in agreement with EPR spectra showing in solid state a hyperfine structure typical of the I(59Co) = 7/2. Static susceptibility measurements of Co(III) complex (2) showed an increase in the paramagnetic susceptibility upon warming above 100 K, which is consistent with strong AFM coupling between dimerized S = 1 units with a constant −J/kB ~1286 K.

Introduction: Proportionality of secondary mitral regurgitation (sMR) may be a key factor in deciding whether a patient may benefit from mitral intervention. The aim of this study was to evaluate the prognostic value of two different concepts of proportionality and assess their ability to improve MR stratification proposed by the American Society of Echocardiography (ASE) guidelines. Methods: We conducted a retrospective analysis in patients with reduced left ventricular ejection fraction (LVEF) (0.14; b) Lopes et al. – disproportionate sMR whenever measured EROA>theoretical EROA (determined as 50%×LVEF×LVEDVMitralVTI). Primary endpoint was all-cause mortality. Results: A total of 572 patients (69±12 years; 76% male) were included. Mean LVEF was 33±9%, with a median left ventricular end-diastolic volume of 174 mL [136;220] and a median effective regurgitant orifice area of 14 mm2 [8;22]. During mean follow-up of 4.1±2.7 years, there were 254 deaths. There was considerable disagreement (p0.14; b) Lopes et al. – sMR desproporcional quando o EROA medido>EROA teórico (determinado por 50%×LVEF×LVEDVMitralVTI). O endpoint primário foi mortalidade por qualquer causa. Resultados: Foram incluídos 572 pacientes (69±12 anos; 76% sexo masculino). LVEF média foi de 33±9%, com um LVEDV mediano de 174 mL [136;220] e um EROA mediano de 14 mm2 [8;22]. Após um follow-up médio de 4,1±2,7 anos, ocorreram 254 mortes. Verificou-se marcada discordância (p

Introduction: During the Covid-19 pandemic there has been a general belief that hospital admissions for non-infectious causes, especially cardiovascular diseases, have fallen. Objectives: To assess the impact of the pandemic on admissions for ST-elevation myocardial infarction (STEMI) during the first pandemic wave. Methods: We performed a multicenter retrospective analysis of consecutive patients presenting with STEMI in two Portuguese hospital centers in two sequential periods – P1 (March 1 to April 30) and P2 (May 1 to June 30). Patient's clinical data and hospital outcomes were compared between the years 2017 to 2019 and 2020 for both periods. Results: During P1 in 2020, a reduction in the number of STEMI patients was observed in comparison with previous years (26.0±4.2 vs. 16.5±4.9 cases per month; p=0.033), as well as an increase in the number of mechanical complications (0.0% vs. 3.0%; p=0.029). Percutaneous coronary interventions in the setting of failed thrombolysis were more frequent (1.9% vs. 9.1%; p=0.033). An overall trend for longer delays in key timings of STEMI care bundles was noted. Mortality was higher during P1 compared to previous years (1.9% vs. 12.1%; p=0.005). Conclusions: During the first Covid-19 wave fewer patients presented with STEMI at the catheterization laboratory for percutaneous coronary intervention. These patients presented more mechanical complications and higher mortality. Resumo: Introdução: Recentemente durante a pandemia por Covid-19 houve uma perceção global de uma diminuição de admissões hospitalares por causas não infeciosas, em particular por doenças cardiovasculares. Objetivos: Avaliar o impacto da pandemia nas admissões por enfarte agudo do miocárdio com supradesnivelamento de ST (STEMI), na primeira onda da pandemia. Métodos: Análise multicêntrica e retrospetiva de doentes consecutivos admitidos em dois hospitais portugueses por STEMI em dois períodos sequenciais - P1 (1 de março a 30 de abril) e P2 (1 de maio a 30 de junho). Foi realizada uma comparação dos dados clínicos e de evolução hospitalar entre 2017 a 2019 e 2020 para os dois períodos. Resultados: No P1 de 2020 observou-se, relativamente a anos prévios, uma redução do número de doentes com STEMI (26,0±4,2 versus 16,5±4,9 casos por mês; p=0,033) e um aumento do número de complicações mecânicas (0,0% versus 3,0%; p=0,029). Os casos de angioplastia após trombólise falhada foram mais frequentes (1,9% versus 9,1%; p=0,033). Observou-se uma tendência global para um maior atraso nos tempos-chave de abordagem de doentes com STEMI. A taxa de mortalidade destes doentes no P1 foi superior comparativamente a anos prévios (1,9% versus 12,1%; p=0,005). Conclusões: Durante a primeira onda da pandemia Covid-19 houve uma redução do número de doentes submetidos a angioplastia coronária por STEMI. Esses apresentaram mais complicações mecânicas e uma maior mortalidade.

Cancer is one of the leading causes of death worldwide. Conventional treatments such as surgery, chemotherapy, and radiotherapy have limitations and severe side effects. Magnetic hyperthermia (MH) is an alternative method that can be used alone or in conjunction with chemotherapy or radiotherapy to treat cancer. Cobalt ferrite particles were synthesized using an innovative biogenic sol–gel method with powder of coconut water (PCW). The obtained powders were subjected to heat treatments between 500 °C and 1100 °C. Subsequently, they were characterized by thermal, structural, magnetic, and cytotoxic analyses to assess their suitability for MH applications. Through X-ray diffraction and Raman spectroscopy, it was possible to confirm the presence of the pure phase of CoFe2O4 in the sample treated at 1100 °C, exhibiting a saturation magnetization of 84 emu/g at 300 K and an average grain size of 542 nm. Furthermore, the sample treated at 1100 °C showed a specific absorption rate (SAR) of 3.91 W/g, and at concentrations equal to or below 5 mg/mL, is non-cytotoxic, being the most suitable for biomedical applications.

The non-surgical treatments are being required to reconstruct damaged tissue, prioritizing our body’s natural healing process. Thus, the use of bioactive materials such as bioactive glass has been studied to support the repair and restoration of hard and soft tissue. Thus, in this work Bioglass 45S5 was developed, adding 1 and 2%mol of SrO or MgO and the physical and biological properties were evaluated. The addition of MgO and SrO at the studied concentrations promoted the slight increase in non-bridging oxygens number, observed through the temperature shift in phase transitions to lower values compared to Bioglass 45S5. The insertion of the ions also showed a positive effect on Saos-2 cell viability, decreasing the cytotoxic of Bioglass 45S5. Besides the Ca/P ratio on the pellets surface demonstrating no evidence of higher reactivity between Bioglass 45S5 and Bioglass with Sr and Mg, micrographs show that at 24 h the Ca/P rich layer is denser than in Bioglass 45S5 after the contact with simulated body fluid. The samples with Sr and Mg show a higher antibacterial effect compared to Bioglass 45S5. The addition of the studied ions may benefit the biological response of Bioglass 45S5 in dental applications as scaffolds or coatings.

Introduction and Objectives: Use of invasive physiological assessment in patients with coronary artery disease varies widely and is perceived to be low. We aimed to examine adoption rates as well as patterns and determinants of use in an unselected population undergoing invasive coronary angiography over a long time frame. Methods: We retrospectively determined the per-procedure prevalence of physiological assessment in 40 821 coronary cases performed between 2007 and 2018 in two large-volume centers. Adoption was examined according to procedure type and patient- and operator-related variables. Its association with relevant scientific landmarks, such as the release of clinical trial results and practice guidelines, was also assessed. Results: Overall adoption was low, ranging from 0.6% in patients undergoing invasive coronary angiography due to underlying valve disease, to 6% in the setting of stable coronary artery disease (CAD); it was 3.1% in patients sustaining an acute coronary syndrome. Of scientific landmarks, FAME 1, the long-term results of FAME 2 and the 2014 European myocardial revascularization guidelines were associated with changes in practice. Publication of instantaneous wave-free ratio (iFR) trials had no influence on adoption rates, except for a higher proportion of iFR use. In 42.9% of stable CAD patients undergoing percutaneous coronary intervention there was no objective non-invasive evidence of ischemia, nor was physiological assessment performed. Younger operator age (4.5% vs. 4.0% vs. 0.9% for ages 55 years, respectively; p 55 anos, respetivamente; p < 0,001) e a hora de realização do procedimento (2,9% entre as 6-8PM versus 4,4% durante o restante dia) relacionaram-se inversamente com a utilização de fisiologia durante os procedimentos. Conclusões: Esta análise confirma a baixa de utilização da avaliação funcional invasiva na prática clínica. A disponibilidade de evidência sobre o uso de índices não hiperémicos não aumentou a adoção. São necessárias estratégias dirigidas que potenciem a implantação das recomendações, de forma que o manejo dos doentes com doença coronária e os benefícios clínicos da estratificação invasiva possam ser aprimorados.

Biofilm-related implant infections pose a substantial threat to patients, leading to inflammation in the surrounding tissue, and often resulting in implant loss and the necessity for additional surgeries. Overcoming this implantology challenge is crucial to ensure the success and durability of implants. This study shows the development of antibacterial materials for implant coatings by incorporating copper into 45S5 Bioglass®. By combining the regenerative properties of Bioglass® with the antimicrobial effects of copper, this material has the potential to prevent infections, enhance osseointegration and improve the long-term success of implants. Bioglasses modified with various concentrations of CuO (from 0 to 8 mol%) were prepared with the melt-quenching technique. Structural analysis using Raman and FTIR spectroscopies did not reveal significant alterations in the bioglasses structure with the addition of Cu. The antibacterial activity of the samples was assessed against Gram-positive and Gram-negative bacteria, and the results demonstrated significant inhibition of bacterial growth for the bioglass with 0.5 mol% of CuO. Cell viability studies indicated that the samples modified with up to 4 mol% of CuO maintained good cytocompatibility with the Saos-2 cell line at extract concentrations up to 25 mg/mL. Furthermore, the bioactivity assessment demonstrated the formation of a calcium phosphate (CaP)-rich layer on the surfaces of all bioglasses within 24 h. Our findings show that the inclusion of copper in the bioglass offers a significant enhancement in its potential as a coating material for implants, resulting in notable advancements in both antibacterial efficacy and osteointegration properties.

Resumo: A angina refratária define‐se como a persistência de sintomas superior a três meses apesar da terapêutica médica otimizada e revascularização. É uma entidade em crescimento, resultado da melhoria do prognóstico da doença coronária com a terapêutica farmacológica e com as técnicas de revascularização contemporâneas. A mortalidade a longo prazo enquadra‐se no espetro prognóstico da doença estável assintomática, contudo interfere com a qualidade de vida do doente e tem um impacto significativo nos sistemas de saúde.Múltiplos alvos terapêuticos têm sido investigados, contudo, a maioria com resultados dececionantes. Muitas das técnicas foram abandonadas por ausência de eficácia, problemas de segurança e limitações tanto logísticas como económicas à sua implantação.Esta revisão incide essencialmente sobre o dispositivo de redução do seio coronário, cuja evidência, embora ainda escassa, é promissora relativamente à segurança e eficácia na redução dos sintomas anginosos e na melhoria da qualidade de vida. Para além do seu efeito terapêutico, é uma opção virtualmente acessível a todos os serviços de cardiologia de intervenção. Abstract: Refractory angina is defined as persistent angina (≥3 months) despite optimal medical and interventional therapies. It is increasing in frequency, due to the success of current medical and interventional therapies in improving the prognosis of coronary artery disease. Long‐term mortality is similar to that of patients with asymptomatic stable disease, but it affects patients’ quality of life, and has a significant impact on health care resources.Several therapeutic targets have been investigated, most with disappointing results. Many of the techniques have been abandoned because of lack of efficacy, safety issues, or economic and logistic limitations to wider applicability.The primary focus of this review is the coronary sinus Reducer, supporting evidence for which, although scarce, is promising regarding safety and efficacy in improving anginal symptoms and quality of life. It is also accessible to virtually all interventional cardiology departments.

Introduction: Compared to bare-metal stents (BMS), drug-eluting stents reduce stent restenosis and improve subsequent revascularization rates. The impact on patients’ survival has been the subject of debate. Objective: To assess the long-term (10-year) survival of patients undergoing percutaneous coronary intervention (PCI) with first-generation sirolimus-eluting stents (SES) in comparison with BMS. Methods: In a single-center registry, 600 consecutive patients who underwent successful PCI with SES between April 2002 and February 2003 were compared to 594 patients who underwent PCI with BMS between January 2002 and April 2002, just before the introduction of SES. Clinical and procedural data were collected at the time of intervention and 10-year survival status was assessed via the national life status database. Results: All baseline characteristics were similar between groups except for smaller stent diameter (2.84±0.38 vs. 3.19±0.49 mm; p

Abstract Aims Right heart catheterization (RHC) is indicated in all candidates for heart transplantation (HT). An acute vasodilator challenge is recommended for those with pulmonary hypertension (PH) to assess its reversibility. The effects of inhaled nitric oxide (iNO) on pulmonary and systemic haemodynamics have been reported only in small series. Our purpose was to describe the response to iNO in a larger population and its potential clinical implications. Methods and results From 210 RHC procedures performed between 2010 and 2019, vasodilator challenge with iNO was used in 108 patients, of which 66 had advanced heart failure undergoing assessment for HT (55±11 years old; 74.2% male gender; 43.9% ischaemic cardiomyopathy; left ventricular ejection fraction 28.4 ± 11,4%; and peak VO2 12.1 ± 3.0 mL/kg/min). iNO was administered through a tight‐fitting facial mask regardless of baseline pulmonary pressures. Clinical endpoints (all‐cause mortality and acute right heart failure) were assessed according to baseline haemodynamic findings over the available follow‐up period. There were no side effects from iNO administration. Typical response consisted of a reduction in pulmonary vascular resistance, consequent to an increase in left ventricular filling pressures, no significant change in mean pulmonary artery pressure (resulting in a lower mean transpulmonary gradient) and a mild increase in cardiac ouput. Pulmonary arterial compliance increased significantly, whereas systemic vascular resistance was only mildly affected. In five cases (7.6%), pulmonary vascular resistance increased paradoxically. All‐cause mortality and post‐HT right heart failure events were overall low and similar in patients without PH or reversible PH. Conclusions Vasodilator challenge with iNO is safe in advanced heart failure patients undergoing RHC prior to HT listing. It produces a reasonably predictable haemodynamic response, which occurs predominantly at the pulmonary circulation level. Clinical implications of iNO‐induced reversibility may be relevant, but further systematic validation is warranted in larger cohorts.

Gold(III) bisdithiolate complexes have been reported as potential antimicrobial and antitumoral agents. The complex [Au(cdc)2]− (cdc=cyanodithioimido carbonate) displayed antimicrobial and outstanding antitumor activity against the ovarian cancer cells A2780 and A2780cisR, which are sensitive and resistant to cisplatin, respectively. However, poor water solubility may hamper its clinical use. Block copolymer micelles (BCMs) may solubilize hydrophobic drugs, improving their bioavailability and circulation time in blood. Aiming to provide water solubility, prolonged availability, and enhanced therapeutic indexes, BCMs loaded with [Au(cdc)2]− were synthesized and characterized. The BCM-[Au(cdc)2] micelles were prepared with a loading efficiency of 64.6% and a loading content of 35.3 mg [Au(cdc)2]−/gBCM. A hydrodynamic diameter of 77.31 ± 27.00 nm and a low polydispersity index of 0.18 indicated that the micelles were homogenous and good candidates for drug delivery. Cytotoxic activity studies against A2780/A2780cisR cells showed that BCM-[Au(cdc)2] maintained relevant cytotoxic activity comparable to the cytotoxicity observed for the same concentration of gold complexes. The Au uptake in A2780 cells, determined by PIXE, was ca. 17% higher for BCMs-[Au(cdc)2] compared to [Au(cdc)2]−. The BCMs-[Au(cdc)2] presented antimicrobial activity against S. aureus Newman and C. glabrata CBS138. These results evidenced the potential of BCM-[Au(cdc)2] for drug delivery and its promising anticancer and antimicrobial activities.

An 80-year-old woman with rheumatic valve disease and two previous cardiac surgeries was admitted for heart failure exacerbation. The patient presented stenotic aortic 19-mm Mitroflow and mitral 31-mm Carpentier-Edwards bioprostheses, and was deemed inoperable due to frailty and prohibitive surgical risk. The heart team decided on a compassionate double valve-in-valve procedure, with transfemoral implantation of a 23-mm aortic CoreValve Evolut R and transapical implantation of a 29-mm mitral Edwards SAPIEN 3. During the procedure, after extreme difficulty in retrograde crossing of the aortic valve, a transapical-transfemoral loop was successfully performed. The procedure was without complications and the patient was discharged in NYHA class II with normally functioning valves. Resumo: Uma mulher de 80 anos com valvulopatia reumática e duas cirurgias cardíacas prévias foi internada por insuficiência cardíaca agudizada. A doente apresentava estenose de biopróteses Mitroflow 19 em posição aórtica e Carpentier-Edwards 31 em posição mitral, sendo considerada inoperável devido a fragilidade e a risco cirúrgico proibitivo. A Heart Team decidiu por um duplo procedimento valve-in-valve compassionate: implantação de Corevalve Evolut R 23 em posição aórtica via transfemoral e de Edwards Sapiens 3 29 em posição mitral por via apical. Durante o procedimento e após dificuldades extremas na progressão por via retrógrada aórtica, uma ansa transapical-femoral foi bem-sucedida. O procedimento correu sem complicações. A doente teve alta em classe NYHA II com biopróteses normofuncionantes.

Methyl-ethylenedithio-tetrathiafulvalene (Me-EDT-TTF (1) and dimethyl-ethylenedithio-tetrathiafulvalene (DM-EDT-TTF (2) are valuable precursors for chiral molecular conductors, which are generally obtained by electrocrystallization in the presence of various counter-ions. The number of the stereogenic centers, their relative location on the molecule, the nature of the counter-ion and the electrocrystallization conditions play a paramount role in the crystal structures and conducting properties of the resulting materials. Here, we report the preparation and detailed structural characterization of the following series of radical cation salts: (i) mixed valence (1)2AsF6 as racemic, and (S) and (R) enantiomers; (ii) [(S)-1]AsF6·C4H8O and [(R)-1]AsF6·C4H8O where a strong dimerization of the donors is observed; (iii) (1)I3 and (2)I3 as racemic and enantiopure forms and (iv) [(meso)-2]PF6 and [(meso)-2]XO4 (X = Cl, Re), based on the new donor (meso)-2. In the latter, the two methyl substituents necessarily adopt axial and equatorial conformations, thus leading to a completely different packing of the donors when compared to the chiral form (S,S)/(R,R) of 2 in its radical cation salts. Single crystal resistivity measurements, complemented by thermoelectric power measurements in the case of (1)2AsF6, suggest quasi-metallic conductivity for the latter in the high temperature regime, with σRT ≈ 1–10 S cm–1, while semiconducting behavior is observed for the (meso)-2 based salts.

Introduction: Aortic stenosis is the most prevalent type of valvular disease in Europe. Surgical aortic valve replacement (SAVR) is the standard therapy, while transcatheter aortic valve implantation (TAVI) is an alternative in patients at unacceptably high surgical risk. Assessment by a heart team is recommended by the guidelines but there is little published evidence on this subject. The purpose of this paper is to describe the experience of a multidisciplinary TAVI program that began in 2008. Methods: The heart team prospectively assessed 473 patients using a standardized approach. A total of 214 patients were selected for TAVI and 80 for SAVR. Demographic, clinical and procedural characteristics and long-term success rates were compared between the groups. Results: TAVI patients were older than the SAVR group (median 83 vs. 81 years), and had higher surgical risk scores (median EuroSCORE II 5.3 vs. 3.6% and Society of Thoracic Surgeons score 5.1 vs. 3.1%), as did the patients under medical treatment only. These scores were unable to assess multiple comorbidities. Patients’ outcomes were different between the three groups (mortality with SAVR 25% vs. TAVI 37.6% vs. conservative therapy 57.6%, p=0.001). Conclusions: The heart team program was able to select candidates appropriately for TAVI, SAVR and conservative treatment, taking into account the risk of both invasive treatments. The use of a prospective standardized heart team approach is recommended, but requires continuous monitoring to ensure effectiveness in a timely manner. Resumo: Introdução: A estenose aórtica é atualmente a doença valvular mais prevalente na Europa. A substituição valvular aórtica cirúrgica (SVAC) é atualmente considerada a terapêutica de primeira linha, a implantação de válvula aórtica percutânea (VAP) é considerada uma opção em doentes com elevado risco cirúrgico. A avaliação dos doentes pelo Heart Team encontra-se preconizada pelas recentes guidelines publicadas de doenças valvulares, contudo existem poucas publicações acerca dessa temática. O objetivo deste manuscrito é descrever a experiência de um programa multidisciplinar VAP, iniciado em 2008. Métodos: O Heart Team avaliou de forma prospetiva e padronizada 473 doentes. Desses, 214 foram selecionados para VAP e 80 para SVAC. Os grupos foram comparados no que respeita às suas características demográficas, clínicas, de procedimento e quanto à sua evolução (mortalidade). Resultados: O grupo VAP apresentou maior idade do que o grupo SVAC (mediana 83 versus 81 anos) e apresentou scores de risco cirúrgico mais elevados (mediana Euroscore II 5,3 versus 3,6% e STS 5,1 versus 3,1%), tal como o grupo de doentes apenas sob terapêutica médica. Esses scores não foram capazes de avaliar múltiplas comorbilidades. A mortalidade entre os três grupos apresentou diferenças com significado estatístico (SVAC 25% versus VAP 37,6% versus terapêutica conservadora 57,6%, p=0,001). Conclusões: O programa Heart Team foi capaz de selecionar de forma adequada os doentes para as diversas estratégias terapêuticas tendo em conta o risco de ambos os procedimentos invasivos. Uma abordagem eficiente e standardizada pela Heart Team deve ser estimulada, necessitando de reavaliação continua. Keywords: Severe aortic stenosis, Transcatheter aortic valve implantation, Surgical aortic valve replacement, Heart team, Standardization, Palavras-chave: Estenose aórtica grave, Válvula aórtica percutânea, Substituição valvular aórtica cirúrgica, Heart Team, Standardização

The physical properties of the cubic and ferrimagnetic spinel ferrite LiFe5O8 has made it an attractive material for electronic and medical applications. In this work, LiFe5O8 nanosized crystallites were synthesized by a novel and eco-friendly sol-gel process, by using powder coconut water as a mediated reaction medium. The dried powders were heat-treated (HT) at temperatures between 400 and 1000 °C, and their structure, morphology, electrical and magnetic characteristics, cytotoxicity, and magnetic hyperthermia assays were performed. The heat treatment of the LiFe5O8 powder tunes the crystallite sizes between 50 nm and 200 nm. When increasing the temperature of the HT, secondary phases start to form. The dielectric analysis revealed, at 300 K and 10 kHz, an increase of ε′ (≈10 up to ≈14) with a tanδ almost constant (≈0.3) with the increase of the HT temperature. The cytotoxicity results reveal, for concentrations below 2.5 mg/mL, that all samples have a non-cytotoxicity property. The sample heat-treated at 1000 °C, which revealed hysteresis and magnetic saturation of 73 emu g−1 at 300 K, showed a heating profile adequate for magnetic hyperthermia applications, showing the potential for biomedical applications.

Resumo: Introdução e objetivos: Foi nosso objetivo reportar a evolução da angioplastia coronária no tratamento do enfarte agudo do miocárdio com supradesnivelamento do segmento ST (EAMCST), entre 2002‐2013. Métodos: Os dados prospetivos multicêntricos do Registo Nacional de Cardiologia de Intervenção (RNCI) e os dados oficiais da Direção Geral de Saúde (DGS) foram conjugados para estudar os procedimentos no EAMCST entre 2002 e 2013. Resultados: Em 2013 realizaram‐se 3524 angioplastias primárias (ICP‐P), representando um crescimento de 315% relativamente ao ano de 2002. Em 2002 a ICP‐P representava 16% do total de angioplastias coronárias, passando a representar 25% nos anos de 2012‐2013. Entre 2002‐2013 o número de procedimentos por milhão de habitantes aumentou de 106 para 338 e a angioplastia de recurso decresceu de 70,7 para 2%. Durante o período em análise, a utilização de stents eluidores de fármaco cresceu de 9,9 para 69,5%. Após 2008, observou‐se uma utilização crescente da trombectomia de aspiração, atingindo 46,7% em 2013. Os inibidores das glicoproteínas IIb/IIIa registaram um decréscimo no seu uso, sendo de 73,2% em 2002 e de 23,6% em 2013. O acesso radial cresceu de 8,3% em 2008 até 54,6% em 2013. Conclusões: Durante o período em análise, a taxa de angioplastia coronária por milhão de habitantes triplicou. A angioplastia de recurso foi ultrapassada pela angioplastia primária a partir de 2006. Observaram‐se novas tendências no tratamento do enfarte agudo do miocárdio com supradesnivelamento do segmento ST, salientando‐se a utilização de stents eluidores de fármacos e o acesso radial. Abstract: Introduction and Objectives: The aim of the present paper was to report trends in coronary angioplasty for the treatment of ST‐elevation myocardial infarction (STEMI) in Portugal. Methods: Prospective multicenter data from the Portuguese National Registry of Interventional Cardiology (RNCI) and official data from the Directorate‐General for Health (DGS) were studied to analyze percutaneous coronary intervention (PCI) procedures for STEMI from 2002 to 2013. Results: In 2013, 3524 primary percutaneous coronary intervention (p‐PCI) procedures were performed (25% of all procedures), an increase of 315% in comparison to 2002 (16% of all interventions). Between 2002 and 2013 the rate increased from 106 to 338 p‐PCIs per million population per year. Rescue angioplasty decreased from 70.7% in 2002 to 2% in 2013. During this period, the use of drug‐eluting stents grew from 9.9% to 69.5%. After 2008, the use of aspiration thrombectomy increased, reaching 46.7% in 2013. Glycoprotein IIb‐IIIa inhibitor use decreased from 73.2% in 2002 to 23.6% in the last year of the study. Use of a radial approach increased steadily from 8.3% in 2008 to 54.6% in 2013. Conclusion: During the reporting period there was a three‐fold increase in primary angioplasty rates per million population. Rescue angioplasty has been overtaken by p‐PCI as the predominant procedure since 2006. New trends in the treatment of STEMI were observed, notably the use of drug‐eluting stents and radial access as the predominant approach. Palavras‐chave: Registo, Cardiologia de intervenção, Enfarte do miocárdio, Coronariografia, Angioplastia primária, Stent, Keywords: Registry, Interventional cardiology, Myocardial infarction, Coronary angiography, Primary angioplasty, Stent

Abstract Background: The revascularization strategy of the left main disease is determinant for clinical outcomes. Objective: We sought to 1) validate and compare the performance of the SYNTAX Score 1 and 2 for predicting major cardiovascular events at 4 years in patients who underwent unprotected left main angioplasty and 2) evaluate the long-term outcome according to the SYNTAX score 2-recommended revascularization strategy. Methods: We retrospectively studied 132 patients from a single-centre registry who underwent unprotected left main angioplasty between March 1999 and December 2010. Discrimination and calibration of both models were assessed by ROC curve analysis, calibration curves and the Hosmer-Lemeshow test. Results: Total event rate was 26.5% at 4 years.The AUC for the SYNTAX Score 1 and SYNTAX Score 2 for percutaneous coronary intervention, was 0.61 (95% CI: 0.49-0.73) and 0.67 (95% CI: 0.57-0.78), respectively. Despite a good overall adjustment for both models, the SYNTAX Score 2 tended to underpredict risk. In the 47 patients (36%) who should have undergone surgery according to the SYNTAX Score 2, event rate was numerically higher (30% vs. 25%; p=0.54), and for those with a higher difference between the two SYNTAX Score 2 scores (Percutaneous coronary intervention vs. Coronary artery by-pass graft risk estimation greater than 5.7%), event rate was almost double (40% vs. 22%; p=0.2). Conclusion: The SYNTAX Score 2 may allow a better and individualized risk stratification of patients who need revascularization of an unprotected left main coronary artery. Prospective studies are needed for further validation.

In this paper we present the impedance spectroscopy of ternary solid solutions of BiFeO3, TbFeO3 and PbTiO3, prepared by solid-state reaction method. The preliminary structural studies were carried out by x-ray diffraction technique, showing the formation of polycrystalline sample with ABO3 type of perovskite structure with hexagonal symmetry for Bi0.8Tb0.1Pb0.1Fe0.9Ti0.1O3system at room temperature. Dielectric and impedance study of this ceramic has been characterized in the temperature range 175 - 325 0C and frequency range 100 Hz - 1 MHz. The maximum ferroelectric transition temperature (Tc) of this system was in the range 210 - 225 0C with the dielectric constant having maximum value ~2480 at 1 kHz. The complex impedance graph exhibited one impedance semicircle arc at all reported temperatures, which indicates that the impedance response is a Cole-Cole type relaxation. Single semicircle indicate that the grain effect of the bulk in ceramic. The bulk resistance of the material decreases with increasing temperature showing negative temperature showing a typical semiconducting property, i.e. negative temperature coefficient of resistance (NTCR) behavior.

Some dialectologists reject the idea that the language spoken in the Canary Islands can be considered a dialect. The reasons given to support this thesis are two: the first one is that such a variety has no exclusive language features, and the second is that this speech variety is characterised by a great internal variation. This article explores these arguments, but at the same time puts forward some other arguments which oppose this idea; in others words, it is held that the Canary Island speech variety can be viewed as a dialect.

Introduction of chirality in the field of molecular conductors has received increasing interest in recent years in the frame of modulation of the crystal packing, and hence conducting properties, with the number of stereogenic centers and absolute configuration, e.g., racemic or enantiopure forms. Here, we describe the preparation by electrocrystallization of chiral radical cation salts, based on the donors methyl-ethylenedithio-tetrathiafulvalene (Me-EDT-TTF) 1 and ethyl-ethylenedithio-tetrathiafulvalene (Et-EDT-TTF) 2 containing one stereogenic center, with the perchlorate anion. Donor 1 provided the series of crystalline materials [(rac)-1]ClO4, [(S)-1]2ClO4 and [(R)-1]2ClO4, while for donor 2 only the 1:1 salts [(rac)-2]ClO4 and [(R)-2]ClO4 could be prepared as suitable single crystals for X-ray analysis. The enantiopure salts of 1 show β-type packing and metallic conductivity in the high temperature regime, with room temperature conductivity values of 5–10 S cm−1, whereas compound [(rac)-2]ClO4 is a very poor semiconductor. Tight-binding extended Hückel band structure calculations support the metallic conductivity of the enantiopure salts of 1 and suggest that small structural changes, possibly induced by thermal contraction or pressure, could lead to a pseudo-elliptic closed Fermi surface, typical for a 2D metal.

Resumo: Introdução e objetivos: Foi nosso objetivo estudar as tendências da intervenção coronária percutânea entre 2004‐2013 e comparar Portugal com outros países europeus. Métodos: Análise dos procedimentos coronários efetuados entre 2004‐2013 com base num registo prospetivo, multicêntrico, voluntário, doente a doente – Registo Nacional de Cardiologia de Intervenção (RNCI) da Associação Portuguesa de Intervenção Cardiovascular da Sociedade Portuguesa de Cardiologia (APIC‐SPC) – e dos dados oficiais publicados pela Direção Geral de Saúde (DGS). Resultados: Em 2013 realizaram‐se 36 810 cateterismos diagnósticos (3529 coronariografias por milhão de habitantes), representando um aumento significativo de 34% relativamente ao ano de 2007 (p

A dissymmetric TTF-type electron donor, cyanobenzene-ethylenedithio-tetrathiafulvalene (CNB-EDT-TTF), was obtained in high yield, by a cross-coupling reaction with triethyl phosphite between 2-thioxobenzo[d][1,3]dithiole-5-carbonitrile and 5,6-dihydro-[1,3]dithiolo[4,5-b][1,4]dithiin-2-one. This new donor was characterized namely by single crystal X-ray diffraction, cyclic voltammetry, NMR, UV-visible and IR spectroscopy.

Two new dithiolene ligand precursors, containing fused TTF and alkyl thiophenic moieties 3,3'-{[2-(5-(tert-butyl)thieno[2,3-d][1,3]dithiol-2-ylidene)-1,3-dithiole-4,5-diyl]bis[sulfanediyl]}dipropanenitrile (α-tbtdt, 1), and 3,3'-{[2-(5-methylthieno[2,3-d][1,3]dithiol-2-ylidene)-1,3-dithiole-4,5-diyl]bis[sulfanediyl]}dipropanenitrile (α-mtdt, 2), were synthesized and characterized. The electrochemical properties of these electronic donors were studied by cyclic voltammetry (CV) in dichloromethane. Both compounds show two quasi-reversible oxidation processes, versus Ag/AgCl, typical of TTF donors at E11/2 = 279 V and E21/2 = 680 V for 1 and E11/2 = 304 V and E21/2 = 716 V in the case of 2. The single-crystal X-ray structure of 1 and of a charge transfer salt of 2, (α-mtdt)[Au(mnt)2] (3), are reported.

Background: Fewer bleeding complications and early ambulation make radial access a privileged route for cardiac catheterization. However, transradial (TR) approach is not always successful, requiring its conversion into femoral access. Objectives: To evaluate the rate of conversion from radial into femoral access in cardiac catheterization and to identify its predictors. Methods: Prospective dual-center registry, including 7632 consecutive patients undergoing catheterization via the radial access between Jan/2009 and Oct/2012. We evaluated the incidence of conversion into femoral access and its predictors by logistic regression analysis. Results: The patients’ mean age was 66 ± 11 years, and 32% were women. A total of 2969 procedures (38.4%) were percutaneous coronary interventions (PCI), and the most used first intention arterial access was the right radial artery (97.6%). Radial access failure rate was 5.8%. Independent predictors of conversion from radial into femoral access were the use of short introducer sheaths (OR 3.047, CI: 2.380-3.902; p < 0.001), PCI (OR 1.729, CI: 1.375-2.173; p < 0.001), female sex (OR 1.569, CI: 1.234-1.996; p < 0.001), multivessel disease (OR 1.457, CI: 1.167-1.819; p = 0.001), body surface area (BSA) ≤ 1.938 (OR 1.448, CI: 1.120-1.871; p = 0.005) and age > 66 years (OR 1.354, CI: 1.088-1.684; p = 0.007). Conclusion: Transradial approach for cardiac catheterization has a high success rate and the need for its conversion into femoral access in this cohort was low. Female sex, older age, smaller BSA, the use of short introducer sheaths, multivessel disease and PCI were independent predictors of conversion into femoral access.

Introduction and Objectives: The aim of this study was to analyze the incidence of drug-eluting stent thrombosis (sirolimus or everolimus) in patients with chronic total coronary occlusions (CTO) and to determine its clinical implications and related factors. Methods: Data from the 12-month follow-up of the 207 patients included in the CIBELES trial with CTO were analyzed. Results: Stent thrombosis occurred in three patients, two definite and one probable (overall thrombosis rate: 1.4%). However, there were no cases of death or Q-wave myocardial infarction. In univariate analysis, patients with a higher incidence of stent thrombosis were those in whom the target vessel was the left anterior descending, who had single-vessel disease, were assigned to treatment with sirolimus-eluting stents, and those with smaller minimum luminal diameter immediately after the procedure. In multivariate analysis, the only independent predictor of stent thrombosis was minimal luminal diameter immediately after the procedure. Conclusions: The rate of drug-eluting stent thrombosis in patients with CTO is relatively low (1.4%). The only independent predictor of stent thrombosis in this context was minimal luminal diameter after the procedure and the clinical presentation was in all cases relatively benign. Resumo: Introdução e objetivos: o objetivo do nosso estudo foi analisar a incidência de trombose de stent com eluição de fármaco (sirolimus ou everolimus) em pacientes com oclusões coronárias crónicas e identificar as suas implicações clínicas e fatores relacionados. Métodos: 12 meses de acompanhamento dos 207 pacientes incluídos no ensaio Cibeles com oclusão total coronária crónica. Resultados: a trombose de stent ocorreu em três doentes: duas definitivas e uma provável (taxa global de trombose 1,4%). No entanto, não surgiu nenhum caso de morte ou enfarte do miocárdio com onda Q. Na análise univariada, os doentes com maior incidência de trombose de stent foram aqueles em que o vaso-alvo foi a descendente anterior, os que tinham a doença de um vaso, os que foram considerados para tratamento com stent com sirolimus, e aqueles com diâmetro luminal mínimo menor imediatamente após o procedimento. Na análise multivariada, o único preditor independente de trombose do stent foi o diâmetro luminal mínimo imediatamente após o procedimento. Conclusões: a taxa de trombose de stent farmacológico em pacientes com oclusão coronária crónica foi relativamente baixa (1,4%).O único preditor independente de trombose de stent neste contexto foi o diâmetro luminal mínimo após o procedimento, tendo a apresentação clínica em todos os casos sido relativamente benigna. Keywords: Stent, Thrombosis, Everolimus, Sirolimus, Chronic total coronary occlusion, Palavras-chave: Stent, Trombose, Everolimus, Sirolimus, Oclusão coronária crónica total

Transcatheter aortic valve implantation (TAVI) has become an important treatment in high surgical risk patients with severe aortic stenosis (AS), whose complications need to be managed promptly.The authors report the case of an 86-year-old woman presenting with severe symptomatic AS, rejected for surgery due to advanced age and comorbidities. The patient underwent a first TAVI, with implantation of a Medtronic CoreValve®, which became dislodged and migrated to the ascending aorta. Due to the previous balloon valvuloplasty, the patient's AS became moderate, and her symptoms improved. After several months, she required another intervention, performed with a St. Jude Portico® repositionable self-expanding transcatheter aortic valve. There was a good clinical response that was maintained at one-year follow-up.The use of a self-expanding transcatheter bioprosthesis with repositioning features is a solution in cases of valve dislocation to avoid suboptimal positioning of a second implant, especially when the two valves have to be positioned overlapping or partially overlapping each other. Resumo: A implantação de válvula aórtica percutânea (VAP) tornou-se um procedimento importante no tratamento de doentes com estenose aórtica grave com elevado risco cirúrgico, cujas complicações devem ser avaliadas e tratadas de forma adequada.Os autores relatam o caso de uma doente de 86 anos, com estenose aórtica grave sintomática, recusada para intervenção cirúrgica dada a idade avançada e comorbilidades. A doente foi submetida a uma primeira implantação de VAP com uma válvula Medtronic CoreValve®, a qual sofreu um deslocamento para a aorta ascendente durante o procedimento. Devido à angioplastia de balão previamente efetuada, a estenose aórtica tornou-se moderada, com melhoria da sintomatologia da doente. Vários meses depois, por agravamento clínico, houve necessidade de reintervenção, a qual foi realizada com um sistema reposicionável Portico®. Verificou-se um segundo posicionamento valvular adequado, com boa resposta clínica da doente, que persiste após um ano de follow-up.A utilização de sistemas reposicionáveis de implantação de VAP constitui, atualmente, uma solução em casos de deslocamento da válvula, de forma a evitar uma segunda implantação subótima, sobretudo quando as duas válvulas têm de ficar em sobreposição. Keywords: Severe aortic stenosis, Transcatheter aortic valve implantation complications, Valve dislocation, Palavras-chave: Estenose aórtica grave, Complicações da válvula aórtica percutânea, Deslocamento da válvula

Aims: Portugal has one of the lowest rates of primary percutaneous coronary intervention (p-PCI) in Western Europe. This study assessed the progress of Portuguese p-PCI performance indicators one year after Portugal joined the Stent for Life (SFL) initiative. Methods and Results: Two national surveys were carried out, each covering a period of one month: the first when Portugal joined the SFL in 2011 (Moment Zero), and the second one year later (Moment One). A total of 397 consecutive patients with probable ST-segment elevation myocardial infarction were enrolled (201 at Moment Zero and 196 at Moment One) from 15 centers. During this period, the number of patients who arrived at a local hospital without p-PCI decreased (62–47%; p=0.004) and transportation to a p-PCI hospital by the National Institute for Medical Emergencies (INEM) increased significantly (13–37%; p

Dentro del género Salmonella, la especie Salmonella enterica, subsp enterica es una de las de mayor interés por su efecto patógeno sobre los animales. El trabajo se realizó con el objetivo de evaluar el efecto in vitro de la acetamida furánica bromada (AFB) sobre Salmonella enterica aviar. La AFB se obtuvo en el Centro de Bioactivos Químicos de la Universidad Central de las Villas, Cuba. La actividad antimicrobiana del producto sobre los aislados de Salmonella entérica se determinó por el método de macrodilución en caldo, según el “National Comité for Clinical Laboratory Standards”, NCCLS, documento M7-A2. La concentración letal mínima se determinó según NCCLS, documento M26-A, 1999. Las pruebas bioquímicas y serológicas confirmaron la presencia de Salmonella gallinarum en el 100 % de las muestras. Los valores de la mínima concentración inhibitoria (MCI) y mínima concentración bactericida (MCB) de la AFB fueron ambas de 12.5 mg/ml, para las cepas de Salmonella gallinarum y “American Type Culture Collection” de E. coli. Se concluye que la MCI y MCB de la Salmonella enterica frente a la acetamida furánica bromada in vitro fue de 12.5 mg/ml, demostrando la acción bactericida del producto.

Two new members of the family of bilayer compounds (CNB-EDT-TTF)4X, (CNB-EDT-TTF = 5-cyanobenzene-ethylenedithio-tetrathiafulvalene) with anions X = ReO4− and SbF6− are reported, their electron transport and optical properties investigated, and then compared to the ClO4− salt that was previously described. These compounds share the same structural type, i.e. bilayers of donors, which are packed in a β”-type pattern and then separated by layers of highly disordered anions. The absolute values of the electrical resistivity measured in single crystals within the layers were found in the range of 5 to 18 (cm)−1, with a significantly sample dependence being ascribed to intrinsic disorder effects. The ClO4− and SbF6− salts exhibit metallic behavior with the resistivity decreasing upon cooling almost linearly with temperature until a broad minimum is reached between 15 and 80 K, depending on crystal quality; this is followed by an upturn of resistivity reaching values at T = 1.5 K that were comparable to those attained at room temperature. The electrical resistivity of the ReO4− salt follows a thermally activated behavior already at T = 300 K, although with a small activation energy in the range 16−18 meV. Thermoelectric power measurements yield large positive values (75−80 µV/K) at ambient temperature with a metallic behavior that is identical for all compounds. Temperature and polarization dependent infrared reflection measurements on single crystals of (CNB-EDT-TTF)4X salts, with X = ClO4−, ReO4−, and SbF6−, have been performed to obtain the optical conductivity and analyze the electronic and vibrational properties. For (CNB-EDT-TTF)4ClO4 the molecular vibrations exhibit a significant variation below T = 23 K, which suggests a charge localization phenomena.

Resumo: Introdução: Os suportes vasculares restaurativos transitórios (sVRT) foram recentemente aprovados para intervenção coronária percutânea (ICP) na Europa e possuem propriedades muito inovadoras. O objetivo desta declaração de posição é rever criticamente a informação e os estudos com os sVRT disponíveis e contribuir para uma reflexão científica que promova o seu uso racional com orientações estruturadas para a sua aplicação inicial em Portugal. Métodos e resultados: Foi constituído um grupo de trabalho para alcançar um consenso com base na evidência científica conhecida, na discussão de casos clínicos modelo e na experiência individual. A evidência reunida sugere que os sVRT disponíveis podem produzir uma melhoria fisiológica e clínica em doentes selecionados. Os dados relativos à sua durabilidade e segurança a longo prazo são animadores. As indicações iniciais foram agrupadas em três categorias: a) consensuais e apropriadas – jovens, diabéticos, descendente anterior, lesões longas, doença difusa; b) menos consensuais mas possíveis – lesões com pequeno colateral, síndromas coronárias agudas estabilizadas; c) inapropriadas – tronco comum, tortuosidade, calcificação grave. Conclusão: Os suportes vasculares restaurativos transitórios constituem uma terapêutica válida pela evidência científica encorajadora da sua aplicabilidade, da melhoria fisiológica e clínica. Devemos privilegiar as indicações aconselhadas e adequar as técnicas de angioplastia coronária, bem como monitorizar e avaliar os resultados para evitar uma adoção inapropriada. É recomendável o desenvolvimento expedito de normas de orientação clínica pelas sociedades científicas apoiada em registos de elevada qualidade. Abstract: Background: Bioresorbable vascular scaffolds (BVS) were recently approved for percutaneous coronary intervention in Europe. The aim of this position statement is to review the information and studies on available BVS, to stimulate discussion on their use and to propose guidelines for this treatment option in Portugal. Methods and Results: A working group was set up to reach a consensus based on current evidence, discussion of clinical case models and individual experience. The evidence suggests that currently available BVS can produce physiological and clinical improvements in selected patients. There are encouraging data on their durability and long-term safety. Initial indications were grouped into three categories: (a) consensual and appropriate - young patients, diabetic patients, left anterior descending artery, long lesions, diffuse disease, and hybrid strategy; (b) less consensual but possible - small collateral branches, stabilized acute coronary syndromes; and (c) inappropriate - left main disease, tortuosity, severe calcification. Conclusion: BVS are a viable treatment option based on the encouraging evidence of their applicability and physiological and clinical results. They should be used in appropriate indications and will require technical adaptations. Outcome monitoring and evaluation is essential to avoid inappropriate use. It is recommended that medical societies produce clinical guidelines based on high-quality registries as soon as possible. Palavras-chave: Suportes vasculares restaurativos transitórios, Angioplastia coronária, Intervenção coronária percutânea, Diabetes, Stent, Keywords: Bioersorbable vascular scaffolds, Coronary angioplasty, Percutaneous coronary intervention, Diabetic, Stent

In this work a novel procedure of synthesis of compounds analogues to curcumin with halogens atoms in its structure is described, which can increase its solubility and biological activity. Four halogenated curcuminoids were obtained with great pharmacological interest, none of them reported in literature before. Synthesis was carried out by means of the aldol condensation assisted by microwaves of halogenated aromatic aldehydes and acetylacetona, using morpholine as basic catalyst, in absence of solvent, and the reaction just needed 1 min. The products were purified by treatment of the reaction mixture with methanol under ultrasound irradiation, followed by chromatographic column. All obtained compounds were characterized by infrared spectroscopy, nuclear magnetic resonance, quantitative elementary analysis and high resolution mass spectrometry. The RMN-1H data demonstrate in all structures of synthesized curcuminoids the enol form is the most favored.

Introduction: Diagnostic tests that use ionizing radiation play a central role in cardiology and their use has grown in recent years, leading to increasing concerns about their potential stochastic effects.The aims of this study were to compare the radiation dose of three diagnostic tests: single photon emission computed tomography (SPECT), invasive coronary angiography (ICA) and cardiac computed tomography (cardiac CT) and their evolution over time, and to assess the influence of body mass index on radiation dose. Methods: We assessed consecutive patients included in three prospective registries (SPECT, ICA and cardiac CT) over a period of two years. Radiation dose was converted to mSv and compared between the three registries. Differences over time were evaluated by comparing the first with the fourth semester. Results: A total of 6196 exams were evaluated: 35% SPECT, 53% ICA and 22% cardiac CT. Mean radiation dose was 10.7±1.2 mSv for SPECT, 8.1±6.4 mSv for ICA, and 5.4±3.8 mSv for cardiac CT (p

Los curcuminoides son heptatrienonas naturales o sintéticas de gran interés biológico por su potencial empleo como anticancerígenos, anti VIH y antioxidantes. En el laboratorio, estos compuestos se obtienen mediante la condensación de aldehídos aromáticos y acetilacetona. En este trabajo, se describe un estudio comparativo de la síntesis de cuatro nuevos curcuminoides, mediante condensación de aldehídos aromáticos halogenados y acetilacetona por dos métodos diferentes. En el método A, la mezcla de reacción se agita en dimetilformamida durante 4 h, a 85 ºC, con rendimientos entre 9 y 14 %. Cuando la reacción es asistida por microondas (método B), no se emplea disolvente, el tiempo de reacción es solo de un minuto, al tratar la mezcla de reacción con ultrasonido se facilita considerablemente el aislamiento del producto por ruptura del complejo-boro-curcuminoide a temperatura ambiente sin necesidad de emplear condiciones ácidas y se logran rendimientos entre 36 y 48 %. El método B, resultó operacionalmente más simple, presenta ventajas económicas y ecológicas, que lo hacen un procedimiento atractivo para la síntesis de curcuminoides. Todos los compuestos sintetizados fueron caracterizados inequívocamente mediante espectroscopia de Resonancia Magnética Nuclear (RMN1-H), análisis elemental cuantitativo y Espectrometría de Masas de Alta Resolución. En el espectro RMN-1H de cada uno de los compuestos aparece un singuleto sobre 16 ppm correspondiente al protón hidróxílico del grupo OH enólico, lo que demuestra que en estas estructuras la forma enólica es la más favorecida

Resumo: Objetivo: Avaliar as indicações e recomendações clínicas sobre a implantação de válvulas aórticas percutâneas (VAP) e propor adaptações para a sua aplicabilidade em Portugal. Métodos e resultados: O grupo de trabalho analisou a epidemiologia da estenose aórtica, avaliou as recomendações clínicas existentes à luz da evidência científica conhecida e baseou-se na sua experiência em Portugal.A evidência demonstra que as biopróteses valvulares percutâneas reduzem de forma muito significativa a mortalidade dos doentes com estenose aórtica grave considerados inoperáveis. Comparada com a cirurgia convencional, esta técnica apresenta um padrão comparável de segurança, de eficácia e de melhoria da qualidade de vida em doentes de elevado risco cirúrgico, devidamente selecionados por equipas multidisciplinares. Porém há preocupações relativamente à sua durabilidade e segurança a longo prazo.De forma a ser proficiente, a implantação de válvulas aórticas percutâneas deve ser realizada no âmbito de programas multidisciplinares integrados desenvolvidos em centros médico-cirúrgicos com equipas experientes, em número não inferior a 50 casos por centro/ano.Em Portugal observa-se uma utilização muito reduzida desta terapêutica, com sete implantes/ano por milhão de habitantes, o que corresponde a cerca de sete vezes menos do que a média europeia, constituindo a taxa mais baixa da mesma.Para a sociedade, é necessário avaliar os resultados clínicos e estudar o custo incremental associado para definir quais as indicações em que esta técnica pode e deve ser selecionada. Conclusão: A implantação transcatéter de válvulas aórticas percutâneas constitui a única terapêutica para doentes inoperáveis portadores de estenose aórtica grave. Em casos selecionados pode ser aplicada também em doentes considerados de alto risco cirúrgico.Os doentes candidatos a este tratamento devem ser avaliados em centros de excelência que realizam estas técnicas e possuam um programa formal de funcionamento com uma equipa multidisciplinar. Esta deve ser assessorada nos primeiros casos, até estar rotinada. O programa deve assegurar o mínimo recomendado de casos anuais para manter a sua proficiência, elaborando um registo prospetivo monitorizável. Abstract: Objective: To evaluate the clinical indications and guidelines for transcatheter aortic valve implantation (TAVI) and to propose adaptations for its use in Portugal. Methods and Results: The working group analyzed the epidemiology of aortic stenosis and current clinical recommendations in the light of current evidence, taking into consideration their own experience in Portugal.The evidence shows that TAVI significantly reduces mortality in patients with severe aortic stenosis considered unsuitable for surgery. This technique has a comparable safety profile, efficacy and quality of life improvement to conventional surgery in patients with high surgical risk, when carefully selected by multidisciplinary teams.TAVI procedures should be performed within multidisciplinary programs in centers with on-site cardiac surgery by experienced teams treating no fewer than 50 cases per year in order to maintain proficiency.The technique is little used in Portugal, with seven implantations/year per million population, a seventh of the European average and the lowest rate in Europe.From a societal standpoint, it is important to evaluate clinical outcomes and analyze the incremental cost involved in order to define the situations in which the technique is appropriate and should be used. Conclusion: TAVI is the only treatment for severe aortic stenosis in patients unsuitable for surgery, and can also be applied in selected cases with high surgical risk.Patients who are considered for this treatment should be evaluated in centers of excellence performing the technique and with a formal program of multidisciplinary team work. The first cases should be supervised until the team has established its routine. The program should perform the recommended minimum number of procedures per year in order to maintain proficiency and must keep a prospective clinical registry for monitoring purposes. Palavras-chave: Estenose aórtica, Válvulas aórticas percutâneas transcatéter, Recomendações, Consenso, Peritos, Grupo de trabalho, Keywords: Aortic stenosis, Transcatheter aortic valve implantation, Recomendations, Consensus, Experts, Working group

FUNDAMENTO: O benefício clínico de intervenção coronária percutânea (ICP) para lesões coronárias longas é incerto; além disso, foram levantadas dúvidas questões sobre a sua segurança. OBJETIVO: Avaliar os preditores de eventos cardíacos adversos maiores (ECAM) associados à ICP utilizando Full Metal Jacket (FMJ), definido como a sobreposição de stents farmacológicos (SF) medindo >60 mm de comprimento, para lesões muito longas. MÉTODOS: Foram incluídos 136 pacientes consecutivos com lesões coronárias longas, requerendo FMJ em nosso cadastro de centro único. O desfecho primário incluiu a ocorrência combinada de todas as causas de morte, infarto do miocárdio (IM) e revascularização do vaso alvo (RVA). Variáveis demográficas, clínicas, angiográficas e de procedimento foram avaliadas por meio de análise de regressão de Cox para determinar os preditores independentes de desfecho. RESULTADOS: O comprimento médio do stent por lesão foi de 73,2 ± 12,3 mm e o diâmetro médio do vaso de referência foi de 2,9 ± 0,6 mm. O sucesso angiográfico foi de 96,3%. A ausência de ECAM foi de 94,9% em 30 dias e 85,3% em um ano. No acompanhamento de um ano, a taxa de mortalidade por todas as causas foi de 3,7% (1,5% por mortes cardíacas), a taxa de IM foi de 3,7%, e a incidência de trombose de stent (TS) definitiva ou provável foi de 2,9%. O gênero feminino [risco relativo (RR), 4,40; intervalo de confiança de 95% (IC), 1,81-10,66, p = 0,001) e ICP de artéria coronária não direita (RR, 3,49; p = 0,006; IC 95%, 1,42-8,59) foram preditores independentes de ECAM em um ano. A ausência de eventos adversos em um ano foi maior em pacientes com angina estável submetidos à ICP (RR, 0,33; IC 95% 0,13-0,80, p = 0,014). CONCLUSÕES: A ICP utilizando FMJ com SF para lesões muito longas foi eficaz, mas associada a uma alta taxa de TS em acompanhamento de um ano. No entanto, a taxa de mortalidade cardíaca, IM não relacionado a procedimento, e ECAM foi relativamente baixa. ICP de vaso coronário alvo, apresentação clínica, e gênero feminino são novos fatores clínicos contemporâneos que parecem apresentar efeitos adversos sobre o resultado da ICP utilizando FMJ para lesões longas.

Introduction: In recent years, various specific techniques and materials have been developed for the treatment of coronary chronic total occlusions (CTO). Objective: To evaluate the current situation in the treatment of CTO (techniques and material) in our setting. Methods: We evaluated data on techniques and material used in the CIBELES (ChronIc coronary occlusion treated By EveroLimus Eluting Stent) trial, a randomized comparison of sirolimus- and everolimus-eluting stents in 207 patients with CTO in 13 centers in Spain and Portugal. Results: A radial approach was used in 23% of patients, and retrograde techniques were used in only 5%. A high number of balloons were used (2.2 ± 0.9 per patient). Microcatheters were used in 33% of patients, and post-dilatation balloons in only 25%. The mean number of stents implanted per patient was 2.1 ± 1.0, with a mean total stent length of 49 ± 24 mm. Other devices and techniques used were: Tornus penetration catheter in 4% of patients, rotational atherectomy in 2%, and cutting balloon in 1%. Intracoronary ultrasound was used in only 6% of patients. In 34% of cases, operators used guidewires that were not specifically for CTO. Considerable variability between centers was detected in the use of different techniques, the highest and lowest variability being observed in the use of intracoronary ultrasound and the use of CTO guidewires, respectively. Conclusions: In the CIBELES trial, techniques and devices specifically designed for the treatment of CTO were used in a relatively low proportion of patients. Considerable variability between centers was detected. Resumo: Introdução: Durante os últimos anos foram desenvolvidos materiais e técnicas específicos para o tratamento de oclusões totais crónicas (OTC). Objetivo: Avaliar a situação atual no tratamento de OTC (técnicas e material) na nossa realidade. Métodos: Avaliámos os dados relacionados com as técnicas e material usados no estudo CIBELES (ChronIc coronary occlusion treated By EveroLimus Eluting Stent) que comparou de forma aleatororizada stents eluidores de sirolimus e everolimus em 207 doentes com OTC em 13 centros de Espanha e Portugal. Resultados: A abordagem radial foi usada em 23% dos doentes e as técnicas retrógradas foram usadas em apenas 5%. Foi usado um elevado número de balões (2,2 ± 0,9 por doente). Microcatéteres foram usados em 33% e balões de pós-dilatação apenas em 25% dos doentes. O número médio de stents implantados por doente foi de 2,1 ± 1,0, com um comprimento total médio de 49 ± 24 mm. Outro material foi: tornus 4%, aterectomia rotacional 2% e cutting balloon em 1% dos doentes. Ecografia intra-coronária foi usada em apenas 6% dos doentes. Em 34% dos casos os operadores usaram fios-guia que não eram específicos de OTC. Uma alta variabilidade entre centros foi detetada no uso de diferentes técnicas, sendo a variabilidade observada mais alta e mais baixa no uso de ecografia intra-coronária e no uso de guias de OTC, respetivamente. Conclusões: No estudo CIBELES, técnicas e material especificamente desenvolvidos para o tratamento de OTC foram usados numa proporção relativamente baixa dos doentes. Foi detetada uma alta variabilidade entre centros. Keywords: Coronary stents, Coronary angioplasty, Chronic occlusion, Coronary artery disease, Palavras-chave: Stents coronários, Angioplastia coronária, Oclusões crónicas, Doença coronária

Introduction and Objectives: The purpose of this study was to assess the diagnostic yield of current referral strategies for elective invasive coronary angiography (ICA). Methods: We performed a cross-sectional observational study of consecutive patients without known coronary artery disease (CAD) undergoing elective ICA due to chest pain symptoms. The proportion of patients with obstructive CAD (defined as the presence of at least one ≥50% stenosis on ICA) was determined according to the use of noninvasive testing. Results: The study population consisted of 1892 individuals (60% male, mean age 64±11 years), of whom 1548 (82%) had a positive noninvasive test: exercise stress test (41%), stress myocardial perfusion imaging (36%), stress echocardiogram (3%) or coronary computed tomography angiography (3%). Referral without testing occurred in 18% of patients. The overall prevalence of obstructive CAD was 57%, higher among those with previous testing (58% vs. 51% without previous testing, p=0.026) and when anatomic rather than functional tests were used (81.3% vs. 57.1%, p=0.001). A positive test and conventional risk factors were all independent predictors of obstructive CAD, with adjusted odds ratios (95% confidence interval) of 1.34 (1.03–1.74) for noninvasive testing, 1.05 (1.04–1.06) for age, 3.48 (2.81–4.29) for male gender, 1.86 (1.32–2.62) for current smoking, 1.74 (1.38–2.20) for diabetes, 1.30 (1.04–1.62) for hypercholesterolemia, and 1.39 (1.08–1.80) for hypertension. Conclusions: More than 40% of patients without known CAD undergoing elective ICA did not have obstructive lesions, even though four out of five had a positive noninvasive test. These exams were relatively weak gatekeepers; functional tests were more often used but appeared to be outperformed by the anatomic test. Resumo: Introdução e objetivos: O objetivo do estudo foi avaliar o rendimento das atuais estratégias de referenciação eletiva para coronariografia invasiva. Métodos: Estudo transversal de indivíduos consecutivos sem doença coronária conhecida submetidos a coronariografia por dor torácica. Determinação da prevalência de doença coronária obstrutiva (definida pela presença de pelo menos uma estenose ≥ 50%) de acordo com a utilização de testes não-invasivos para despiste de cardiopatia isquémica. Resultados: Foram avaliados 1892 indivíduos (60% homens, idade média 64 ± 11 anos), dos quais 1548 (82%) tinham um teste não-invasivo positivo: prova de esforço (41%), cintigrafia de perfusão miocárdica (36%), ecocardiograma de stress (3%) e angiografia coronária por tomografia computorizada (3%). Ocorreu referenciação sem teste prévio em 18% dos doentes. A prevalência global de doença obstrutiva foi 57%, sendo mais elevada nos doentes submetidos a testes não-invasivos (58% versus 51% nos doentes sem testes prévios, p = 0,026) e naqueles em que o teste era anatómico versus funcional (81,3% versus 57,1%, p = 0,001). Um teste não-invasivo positivo e fatores de risco convencionais foram preditores independentes de doença obstrutiva, com odds-ratio ajustado (intervalo confiança 95%) de: teste não-invasivo 1,34 (1,03-1,74), idade 1,05 (1,04-1,06), sexo masculino 3,48 (2,81-4,29), tabagismo ativo 1,86 (1,32-2,62), diabetes 1,74 (1,38-2,20), hipercolesterolemia 1,30 (1,04-1,62) e hipertensão 1,39 (1,08-1,80). Conclusões: Mais de 40% dos doentes sem doença coronária conhecida que realizam coronariografia eletiva não têm doença obstrutiva, apesar de quatro em cada cinco ter um teste não-invasivo positivo. Estes testes são gatekeepers relativamente fracos; os funcionais foram utilizados mais frequentemente mas o anatómico pareceu ter melhor desempenho. Keywords: Coronary angiography, Chest pain/diagnosis, Stable angina, Myocardial ischemia, Palavras-chave: Angiografia coronária, Dor torácica/diagnóstico, Angina estável, Isquémia miocárdica

Resumo: Os autores descrevem o caso de um doente do sexo masculino, de 59 anos, hipertenso, ex-fumador, insuficiente renal crónico em hemodiálise, com antecedentes de endoprótese por aneurisma da aorta abdominal e história de tuberculose miliar no passado, a quem é diagnosticado pericardite constritiva e aneurisma da aorta torácica. Num doente com antecedentes patológicos tão diversos, são várias as etiologias a considerar. O tratamento consistiu numa pericardiectomia e numa técnica híbrida de debranching dos ramos supra-aórticos com posterior implantação de endoprótese aórtica. Abstract: The authors describe the case of a 59-year-old man, a former smoker, with hypertension, chronic renal failure undergoing hemodialysis, and a history of stent grafting for repair of an abdominal aortic aneurysm and miliary tuberculosis, who was diagnosed with constrictive pericarditis and a thoracic aortic aneurysm. In a patient with such a complex medical history, there were several etiologies to consider. The treatment consisted of pericardiectomy and a hybrid technique of supra-aortic debranching and subsequent endovascular stent-graft repair. Palavras-chave: Pericardite constritiva, Aneurisma aórtico, Debranching aórtico, Keywords: Constrictive pericarditis, Aortic aneurysm, Aortic debranching

En este trabajo se describe un novedoso procedimiento de síntesis de compuestos análogos a la curcumina con átomos de halógenos en su estructura que pudieran incrementar su solubilidad y actividad biológica. Fueron obtenidos cuatro curcuminoides halogenados con gran interés farmacológico, no reportados en la literatura. La síntesis se realizó mediante la condensación aldólica asistida por microondas de aldehídos aromáticos halogenados y acetilacetona, empleando morfolina como catalizador básico, en ausencia de disolventes y necesitando solo 1 min. de reacción. Los productos fueron purificados por tratamiento de la mezcla de reacción con metanol bajo la acción de ultrasonido, seguido por cromatografía de columna. Todos los compuestos obtenidos fueron caracterizados por espectroscopía infrarroja, resonancia magnética nuclear, análisis elemental cuantitativo y espectrometría de masas de alta resolución. Los datos de RMN-1H demuestran que en todas las estructuras de los curcuminoides sintetizados la forma enólica es la más favorecida.

Resumo: A principal limitação da sobrevida a longo prazo após-transplante cardíaco é a doença vascular do aloenxerto que consiste na hiperplasia concêntrica e difusa da íntima arterial. A doença continua a ter uma incidência significativa estimada em 30% aos 5 anos pós-transplante cardíaco. Por ser uma doença clinicamente silenciosa, o seu diagnóstico é um desafio. A angiografia coronária complementada pela ecografia intravascular é o método de diagnóstico mais sensível. No entanto, novas técnicas de diagnóstico não invasivas podem vir a ter relevância clínica no futuro. O seu diagnóstico, o mais precocemente possível, é essencial de forma a permitir atrasar a progressão da doença a fim de melhorar o seu prognóstico. Em Julho de 2010, foi publicada uma nova nomenclatura recomendada para a vasculopatia do aloenxerto, elaborada pela Internacional Society for Heart and Lung Transplantation (ISHLT) e que permite uma uniformização da definição. Em simultâneo, foram publicadas as novas recomendações da ISHLT que procuram uma uniformização no diagnóstico e no manejo destes doentes. Este artigo faz uma revisão dos conceitos atuais da fisiopatologia, diagnóstico, prevenção e tratamento da vasculopatia do aloenxerto, realçando áreas em investigação. Abstract: The major limitation of long-term survival after cardiac transplantation is allograft vasculopathy, which consists of concentric and diffuse intimal hyperplasia. The disease still has a significant incidence, estimated at 30% five years after cardiac transplantation. It is a clinically silent disease and so diagnosis is a challenge. Coronary angiography supplemented by intravascular ultrasound is the most sensitive diagnostic method. However, new non-invasive diagnostic techniques are likely to be clinically relevant in the future. The earliest possible diagnosis is essential to prevent progression of the disease and to improve its prognosis. A new nomenclature for allograft vasculopathy has been published in July 2010, developed by the International Society for Heart and Lung Transplantation (ISHLT), establishing a standardized definition. Simultaneously, the ISHLT published new guidelines standardizing the diagnosis and management of cardiac transplant patients. This paper reviews contemporary concepts in the pathophysiology, diagnosis, prevention and treatment of allograft vasculopathy, highlighting areas that are the subject of ongoing research. Palavras-chave: Transplante cardíaco, Vasculopatia do aloenxerto, Ecografia intracoronária, Microcirculação, Keywords: Heart transplantation, Cardiac allograft vasculopathy, Intravascular ultrasound, Microcirculation

Resumo: Introdução: Segundo as recomendações atuais para o tratamento do enfarte agudo do miocárdio com supra-desnivelamento do segmento ST a intervenção coronária percutânea deve ser efetuada dentro de 90 min após o primeiro contacto médico e o tempo total de isquémia não deve exceder os 120 min.O objetivo deste trabalho foi analisar a adequação da implementação destas recomendações para o enfarte do miocárdio com supra-desnivelamento do segmento ST num centro terciário de intervenção coronária percutânea. Métodos: Registo prospetivo de centro único de 223 doentes consecutivos referenciados para intervenção coronária percutânea primária entre 2003 e 2007. Resultados: Nesta população (idade média 60 ± 12 anos, 76% de sexo masculino), a mediana do tempo total de isquémia foi 4 h 30 min (< 120 min em 4% dos doentes). O intervalo de tempo com menor atraso foi desde o primeiro contacto médico até à realização do ECG (mediana 8 min,

1H and 195Pt NMR are used to probe the spin ½ anion chain in the quasi-one-dimensional conductor Per2[Pt(mnt)2], which exhibits nearly simultaneous charge density wave (CDW) and spin-Peierls (SP) transitions at low temperatures (Tc ~ 8 K). Below Tc the [Pt(mnt)2] chain forms a spin-singlet state that is evident in 1H NMR spectra and spin relaxation (1/T1) rates; however minority unpaired Pt spins may remain in the SP ground state. With increasing magnetic field, the SP and CDW order parameters decrease in unison, indicating they are coupled up to a critical field Bc ~ 20 T. Above Bc, the spin singlet evolves into a spin-polarized configuration. The 195Pt NMR signals vanish as either Tc or Bc are approached from within the SP ground state, suggesting the hyperfine field of the Pt nucleus is significantly stronger than at the proton sites. Simulations yield a consistent picture of the angular, temperature, and magnetic field-dependent spectral features.

Resumo: A biópsia endomiocárdica continua a ser o principal método de monitorização da rejeição em recetores de transplante cardíaco. No entanto, este procedimento pode estar associado, ainda que raramente, a complicações potencialmente graves.Descreve-se o caso de um doente com enfarte anterior extenso não revascularizado, com evolução em choque cardiogénico e necessidade de transplante cardíaco. Na fase pós-transplante é detetada fístula coronária para o ventrículo direito com aneurisma associado e duas comunicações interventriculares restritivas. Abstract: Endomyocardial biopsy is still the principal method for diagnosing cardiac allograft rejection. However, this procedure can be associated, albeit rarely, with potentially serious complications.We describe the case of a patient with extensive anterior myocardial infarction without revascularization, who developed cardiogenic shock and required heart transplantation. Post-transplantation, a coronary artery fistula to the right ventricle associated with an aneurysm and two restrictive ventricular septal defects were detected. Palavras-chave: Transplante cardíaco, Biópsia do endomiocárdio, Fístula coronária, Comunicação interventricular restritiva, Keywords: Heart transplantation, Endomyocardial biopsy, Coronary artery fistula, Restrictive ventricular septal defect

Introducción: Cassia uniflora Mill tiene una alta biodisponibilidad; se utiliza en el tratamiento de dolores espasmódicos, erupciones cutáneas e infecciones de origen bacteriano. Sus partes más empleadas son las hojas y las semillas. Objetivo: Determinar las especificaciones del control de la calidad para las tinturas a 20 % de las hojas y las semillas de Cassia uniflora Mill. Material y Métodos: Las tinturas a 20 % se prepararon a partir de los polvos de las hojas y las semillas, utilizando como menstruo una solución hidroetanólica. La determinación de las especificaciones del control de la calidad de las tinturas se realizó para cuatro parámetros: pH, índice de refracción, sólidos totales y densidad relativa. Resultados: Los datos obtenidos en el control de la calidad de las tinturas a 20 % se encuentran dentro de los rangos de calidad establecidos en las normas utilizadas. Discusión: Los parámetros de calidad muestran que las tinturas a 20 % de hojas y semillas de Cassia uniflora Mill no tuvieron cambios relevantes que afecten su calidad farmacéutica, por tanto, poseen un determinado grado de estabilidad. Conclusiones: Las especificaciones del control de la calidad de las tinturas indican que, bajo las condiciones aplicadas, los productos elaborados presentan inocuidad, y constituyen una garantía de calidad para su empleo terapéutico.Introduction: Cassia uniflora Mill has a high biological availability; It is used in treatments for spasmodic pains, cutaneous eruptions and some infections of bacteriological origin. The most useful parts are its leaves and seeds. Objectives: To determine the specifications of quality control for tinctures made up from leaves and seeds of Cassia uniflora Mill at 20%. Material and methods: Tincture at 20% was made up of the powders of leaves and seeds, using as menses a hydroethanolic solution. Determination of quality control specifications of the tinctures were made taking into account four parameters: pH, refraction index, total solids and relative density. Results: Data obtained in the quality control of the tinctures at 20% are among the ranks of quality established by the standards. Discussion: Quality parameters show that tinctures at 20% from leaves and seeds of Cassia uniflora Mill had no relevant changes that could affect its pharmacological quality, therefore they have a certain degree of stability. Conclusions: The specifications of the quality control made to the tinctures indicate that under the conditions applied the elaborated products are innocuous, so they are totally guaranteed for therapeutically use.

Introduction: Primary percutaneous coronary intervention (PPCI) has become the treatment of choice in patients with ST-segment elevation myocardial infarction (STEMI). Drug-eluting stents (DES) reduce restenosis compared to bare-metal stents (BMS) but there is conflicting data concerning their use in the setting of STEMI. We aimed to evaluate the influence of the type of stent on the outcomes of PPCI. Methods: This was a single-center longitudinal study including 213 consecutive patients (76% men, mean age 60±12 years) with STEMI undergoing PPCI between 2003 and 2007, divided into two groups: BMS (43.7%) and DES (56.3%). We assessed clinical and demographic features as well as angiographic and electrocardiographic signs of myocardial reperfusion. The composite outcome of death, myocardial infarction (MI) or target-lesion revascularization (TLR) was evaluated. Results: At a median follow-up of 26 months there were no differences in the composite outcome of death/MI/TLR (BMS 18.3% vs DES 15.8%) or in the incidence of stent thrombosis. Angiographic results of the procedure were also similar. Independent predictors of the composite outcome were age (HR=1.06, 95% CI [1.02-1.11], left anterior descending artery as infarct-related vessel (HR=2.69, 95% CI [1.17-6.19]) and use of glycoprotein IIb/IIIa inhibitors (HR=0.33, 95% CI [0.13-0.83]). Conclusions: There was no benefit in angiographic outcomes or major cardiac events after treatment with drug-eluting stents compared to bare-metal stents in this group of patients with STEMI. Resumo: Introdução: A angioplastia primária (ICPP) é o tratamento de eleição para enfarte agudo do miocárdio com elevação de ST (EAM ST). Os stents farmacológicos (DES) permitem reduzir a taxa de restenose coronária, sendo controverso o seu uso no contexto de EAM ST. O objectivo deste estudo foi avaliar os resultados clínicos da ICPP em função do tipo de stent usado (não revestido versus DES). População e métodos: Estudo longitudinal de centro único, incluindo 213 doentes consecutivos, idade média 60 ± 12 anos, 76% homens, submetidos a ICPP no contexto de EAM ST, entre 2003 e Novembro 2007. Foram considerados 2 grupos: stent não revestidos (BMS) (43,7%) e DES (56,3%). Analisaram-se as características clínicas e demográficas dos 2 grupos, comparando-se também variáveis angiográficas, de perfusão miocárdica, grau de resolução de segmento ST pós-ICPP e pico de troponina. Determinou-se no seguimento a incidência do evento combinado: morte, enfarte do miocárdio (EAM) ou revascularização de lesão alvo (TLR). Resultados: No seguimento mediano de 26 meses não se encontraram diferenças no evento combinado Morte/EAM/TLR (BMS 18,3% versus 15,8%) nem na trombose de stent. Os resultados angiográficos foram também semelhantes. Os preditores independentes de morte/EAM/TLR foram a frequência cardíaca (HR = 1.06 95% IC [1.02-1.11], descendente anterior como vaso culprit (HR = 2.69 95% IC [1.17-6.19]) e utilização de inibidores da glicoproteína IIbIIIa (HR = 0.33 95% IC [0.13-0.83]). Conclusão: O tipo de stent utilizado não parece ter influência na ocorrência de eventos cardíacos em doentes submetidos a angioplastia primária, no contexto de EAM ST. Keywords: Stents, Myocardial infarction, Percutaneous coronary intervention, Coronary disease/therapy, Palavras-chave: Stents, Enfarte do miocárdio, Intervenção coronária percutânea, Doença coronária/terapêutica