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Rice is one of the most important crops worldwide, being the primary source of calories for more than half of the world population and a very sensitive species to water deficit. The identification of important molecular mechanisms modulating drought response, for enhanced water and nutrient capture, will play a key role towards a more sustainable rice production. The Ubiquitin-Proteasome system (UPS) is a key regulator of the proteome pool and has been established as a potential candidate for crop improvement towards abiotic stress tolerance (Melo et al., 2021). Nevertheless, several of its components remain uncharacterized. In our group, we are following a candidate gene approach to identify and functionally characterize rice E3-ubiquitin ligases in stress response. After in silico analysis, we selected (and validated by RT-qPCR) 16 genes showing differential gene expression under stress. Among those, the most promising 4 were selected for a deeper functional characterization using both a knock-out (CRISPR/cas9 gene edition) and an overexpression approach. One of those genes, RiP4g, is up-regulated by ABA. To characterize its role in ABA signaling, we have performed germination and post-germination assays, using the KO and OX plants. These assays indicated that OX-RiP4g confers hypersensitivity and KO-RiP4g hyposensitivity to ABA. Furthermore, using a whole plant water loss assay, we observed a differential behavior that can involve RiP4g in the regulation of stomatal aperture through ABA sensitivity. Taken together, our results will enhance our understanding of the molecular mechanisms underlying the rice response to drought, particularly regarding the function of RiP4g.

Introduction: Reports of cardiovascular complications related to the COVID-19 infection have been frequent. Methods: Narrative review for relevant articles on the topic. The classic cardiovascular risk factors, like age, obesity, diabetes, and hypertension are associated with adverse outcomes in COVID-19 patients. Cardiovascular complications can have a diverse clinical presentation including silent myocardial injury, acute coronary syndromes, thromboembolism, cardiac arrhythmias, and heart failure. There are multiple mechanisms of cardiac injury that are not mutually exclusive. The approach to diagnosis and management should be carried out according to usual practice, while considering the particularities of COVID-19 infection. Conclusion: The interaction between SARS-CoV-2 and the heart is complex and is manifested in multiple ways. Regardless of the clinical presentation, cardiac complications convey a worse prognosis. Patients should be actively monitored and treated accordingly. info:eu-repo/semantics/publishedVersion

Submitted by Ana Quininha (ana.quininha@chlc.min-saude.pt) on 2021-05-06T15:57:38Z No. of bitstreams: 1 Arq Bras Cardiol 2020 14.pdf: 818957 bytes, checksum: 81250e03b4df56b7ae17541a7d787c17 (MD5) Made available in DSpace on 2021-05-06T15:57:38Z (GMT). No. of bitstreams: 1 Arq Bras Cardiol 2020 14.pdf: 818957 bytes, checksum: 81250e03b4df56b7ae17541a7d787c17 (MD5) Previous issue date: 2020 info:eu-repo/semantics/publishedVersion

AIMS: The ESC EORP EHRA Atrial Fibrillation (AF) Ablation Long-Term registry was designed to assess management and outcomes of AF catheter ablation procedures in Europe. To investigate the current ablation approaches and their outcomes for patients with paroxymal AF (PAF) and non-PAF in Europe. METHODS AND RESULTS: Data from index ablations were collected in 27 European countries at 104 centres in a prospective fashion. Pre-procedural, procedural, and 1-year follow-up data were captured on a web-based electronic case record form. Data on the ablation procedure were available for 3446 patients. Of these, 2513 patients and 933 patients underwent pulmonary vein isolation (PVI) or PVI plus (PVIplus) additional ablation, respectively. The ablation strategy was limited to PVI in 81% and 56% of patients in the PAF and non-PAF group, respectively (P < 0.001). In the non-PAF group, left atrial linear ablation and ablation of complex fragmented atrial electrograms were more commonly performed. Arrhythmias recurrence after PVI was 29% and 39% in the PAF and non-PAF group, respectively (P < 0.001) and 42% after PVIplus in both groups. Atrial fibrillation related hospital admissions were more common in the PVIplus group (20% vs. 14%). A very low procedural complication rate was observed. No relevant differences were observed with regard to repeat ablation (PVI 9% and PVIplus 11%). CONCLUSION: In patients with PAF and non-PAF, the ablation strategies of PVI and PVIplus led to similar arrhythmia-free survival rates after 1 year. A considerable hospital readmission rate was noted.

Object In recent years, the role of decompressive craniectomy for the treatment of traumatic brain injury (TBI) in patients with refractory intracranial hypertension has been the subject of several studies. The purpose of this review was to evaluate the contribution of decompressive craniectomy in reducing intracranial pressure (ICP) and increasing cerebral perfusion pressure (CPP) in these patients. Methods Comprehensive literature searches were performed for articles related to the effects of decompressive craniectomy on ICP and CPP in patients with TBI. Inclusion criteria were as follows: 1) published manuscripts, 2) original articles of any study design except case reports, 3) patients with refractory elevated ICP due to traumatic brain swelling, 4) decompressive craniectomy as a type of intervention, and 5) availability of pre- and postoperative ICP and/or CPP data. Primary outcomes were ICP decrease and/or CPP increase for assessing the efficacy of decompressive craniectomy. The secondary outcome was the persistence of reduced ICP 24 and 48 hours after the operation. Results Postoperative ICP values were significantly lower than preoperative values immediately after decompressive craniectomy (weighted mean difference [WMD] −17.59 mm Hg, 95% CI −23.45 to −11.73, p < 0.00001), 24 hours after (WMD −14.27 mm Hg, 95% CI −24.13 to −4.41, p < 0.00001), and 48 hours after (WMD −12.69 mm Hg, 95% CI −22.99 to −2.39, p < 0.0001). Postoperative CPP was significantly higher than preoperative values (WMD 7.37 mm Hg, 95% CI 2.32 to 12.42, p < 0.0001). Conclusions Decompressive craniectomy can effectively decrease ICP and increase CPP in patients with TBI and refractory elevated ICP. Further studies are necessary to define the group of patients that can benefit most from this procedure.

The objective of the present study was to characterise the floristic and phytosociological composition on a stretch of dense “Terra Firme” rainforest located in the Belo Monte hydroelectric plant area of influence, located in the state of Pará, Brazil. All trees with DAP >10 cm situated in 75 permanent plots of 1 ha were inventoried. 27,126 individuals trees (361 ind.ha-1), distributed in 59 botanical families, comprising 481 species were observed. The families with the largest number of species were Fabaceae (94), Araceae (65) and Arecaceae (43), comprising 43.7% of total species. The species Alexa grandiflora (4.41), Cenostigma tocantinum (2.50) and Bertholletia excelsa (2.28) showed the highest importance values (IV). The ten species with greater IV are concentrated (22%). The forest community has high species richness and can be classified as diverse age trees, heterogeneous and of medium conservation condition. Resumo O presente estudo teve como objetivo caracterizar a composição florística e fitossociológica de um trecho de Floresta Ombrófila Densa de terra firme na área de influência da Usina Hidrelétrica Belo Monte, Pará, Brasil. Foram inventariadas todas as árvores com DAP > 10 cm em 75 parcelas permanentes de 1 ha. Foram observados 27.126 indivíduos arbóreos (361 ind.ha-1), distribuídos em 59 famílias botânicas, perfazendo 481 espécies. As famílias com maior número de espécies foram Fabaceae (94), Araceae (65) e Arecaceae (43), perfazendo 43,7% do total de espécies amostradas. As espécies Alexa grandiflora (4,41), Cenostigma tocantinum (2,50), Bertholletia excelsa (2,28), apresentaram os maiores valores de importância (VI), sendo que nas dez espécies com maiores IV, estão concentrados 22%. A comunidade florestal apresenta elevada riqueza florística e pode ser classificada como multiâneas, heterogêneas e com médio estado de conservação.

Introdução: A fibrilhação auricular é uma arritmia comum e com risco tromboembólico bem documentado, estando definidas nas recomendações internacionais indicações referentes ao uso de anticoagulantes orais. Existem, contudo, lacunas de informação nomeadamente no que se refere à duração dos episódios de fibrilhação auricular e sua relação com o risco de tromboembolismo. Esta questão tem particular interesse em doentes com dispositivos electrónicos cardíacos implantados com documentação contínua da duração de episódios de taquidisritmias auriculares, que são frequentemente curtos e assintomáticos. Material e Métodos: Foi feita uma análise crítica da evidência disponível sobre a relação da duração dos episódios de FA paroxística e a ocorrência de eventos embólicos, com base numa pesquisa na base de dados bibliográfica PubMed. Resultados: Foram selecionados oito artigos com abordagens diferentes no estudo deste tema; sete com recurso a monitorização cardíaca com dispositivos electrónicos cardíacos implantados (pacemakers, cardioversores-desfibilhadores implantáveis e ressincronizadores cardíacos) e um com base em registo de Holter. Metade destas publicações, correspondendo globalmente às maiores amostragens, aborda a questão do ponto de vista do somatório diário de episódios de fibrilhação auricular (carga diária) e não da duração de cada episódio. O risco tromboembólico aumenta gradualmente com a carga arrítmica, tendo sido demonstrado um aumento significativo do risco quando esta ultrapassa os cinco minutos num dia. Discussão: A formação de um trombo intracavitário, e consequente potencial embólico, é um processo dinâmico que resulta da interacção de várias condicionantes anatómicas e funcionais. O risco individual dependerá da interacção destes factores. A associação entre fenómenos embólicos e curtos períodos de fibrilhação auricular é inequívoca, apesar do mecanismo não ser óbvio, tendo em conta a discrepância frequentemente observada entre os períodos de fibrilhação auricular e os eventos clínicos. Conclusões: O risco de eventos tromboembólicos aumenta significativamente mesmo para períodos curtos de fibrilhação auricular (≥ cinco minutos de fibrilhação auricular em um dia), apesar da relação causa-efeito não estar definida. A decisão final sobre o recurso à anticoagulação oral deve basear-se na avaliação clínica individualizada.

Catheter ablation is an established treatment option for symptomatic atrial fibrillation (AF), with circumferential pulmonary vein isolation being considered the cornerstone of the procedure. However, this is a complex intervention with potential major complications and with common arrhythmia recurrences. There is consensus among experts that all patients should be seen in follow-up regularly after AF ablation. To date there are limited data regarding the best methodology for routine clinical follow-up of this population. This review summarizes a contemporary insight into management of late complications following AF ablation, post-procedural anticoagulation and arrhythmia monitoring strategies, in order to prevent thromboembolic events, detect and treat arrhythmia recurrences, and discuss the use of upstream therapies after AF ablation.

The demonstrated benefits of cardiac resynchronization therapy (CRT) in reducing mortality and hospitalizations for heart failure, improving NYHA functional class and inducing reverse remodeling have led to its increasing use in clinical practice. However, its potential contribution to complex ventricular arrhythmias is controversial.We present the case of a female patient with valvular heart failure and severe systolic dysfunction, in NYHA class III and under optimal medical therapy, without previous documented ventricular arrhythmias. After implantation of a CRT defibrillator, she suffered an arrhythmic storm with multiple episodes of monomorphic ventricular tachycardia (VT), requiring 12 shocks. Subsequently, a pattern of ventricular bigeminy was observed, as well as reproducible VT runs induced by biventricular pacing. Since no other vein of the coronary sinus system was accessible, it was decided to implant an epicardial lead to stimulate the left ventricle, positioned in the left ventricular mid-lateral wall. No arrhythmias were detected in the following six months. This case highlights the possible proarrhythmic effect of biventricular pacing with a left ventricular lead positioned in the coronary sinus venous system.

We report the case of a 52-year-old man who presented to our emergency department (ED) after three episodes of syncope in the seven hours before admission. During his stay in the ED he had recurrent ventricular tachycardia (VT) requiring external electrical cardioversion. A 12-lead electrocardiogram (ECG) showed a short QT (SQT) interval (270 ms, QTc 327 ms), with frequent R-on-T extrasystoles triggering sustained polymorphic VT. After exclusion of other precipitating causes, the patient was diagnosed as having SQT syndrome (SQTS) according to the Gollob criteria. To our knowledge, this is the first known documentation of an SQT-caused arrhythmic episode on a 12-lead ECG, as well as the first reported case of SQTS in Portugal. The patient received an implantable cardioverter-defibrillator and was discharged. At a follow-up assessment 14 months later he was symptom-free, interrogation of the device showed no arrhythmic events, and the ECG showed a QT interval of 320 ms (QTc 347 ms).

O aumento significativo registado nas implantações de dispositivos cardíacos, sobretudo como consequência dos benefícios demonstrados com a utilização de cardioversoresdesfibrilhadores e sistemas de ressincronização cardíaca na redução da mortalidade, trouxe para a prática clínica hospitalar o problema da gestão de recursos para responder ao crescimento exponencial do número de doentes em consultas regulares de seguimento especializado. A era das tecnologias da comunicação permitiu desenvolver sistemas de monitorização à distância, que são hoje uma realidade em franca expansão na Europa e nos Estados Unidos, com diversas vantagens e níveis de eficácia e segurança bem documentados. A sua utilização tem permitido obter um elevado grau de satisfação para o doente e médico, reduzindo o número de visitas hospitalares e os custos inerentes ao seguimento desta população. Os resultados dos diferentes estudos têm mostrado elevada capacidade na deteção mais precoce de problemas clínicos, arrítmicos ou de descompensação da insuficiência cardíaca, e de anomalias no funcionamento do dispositivo implantado. Apesar da experiência favorável com o recurso a esta metodologia de follow-up, são necessários estudos para avaliar o seu impacto clínico a longo prazo, em comparação com as consultas convencionais, bem como a introdução e adaptação da legislação referente a este tipo de evolução tecnológica aplicada à saúde. No presente artigo, revimos os aspetos técnicos e a evidência recente da relevância clínica da monitorização à distância em portadores de dispositivos cardíacos implantados.

Submitted by Ana Quininha (ana.quininha@chlc.min-saude.pt) on 2013-05-03T11:44:32Z No. of bitstreams: 1 RPC 2013 185.pdf: 194873 bytes, checksum: 02e014f9f5e1d692b35d58dd7e9f747c (MD5) Made available in DSpace on 2013-05-03T11:44:32Z (GMT). No. of bitstreams: 1 RPC 2013 185.pdf: 194873 bytes, checksum: 02e014f9f5e1d692b35d58dd7e9f747c (MD5) Previous issue date: 2013

Submitted by Ana Quininha (ana.quininha@chlc.min-saude.pt) on 2012-12-07T15:21:02Z No. of bitstreams: 1 RPC 2012 321.pdf: 280544 bytes, checksum: 9c19acba46b57ce7164b87b2ad1d6adc (MD5) Made available in DSpace on 2012-12-07T15:21:02Z (GMT). No. of bitstreams: 1 RPC 2012 321.pdf: 280544 bytes, checksum: 9c19acba46b57ce7164b87b2ad1d6adc (MD5) Previous issue date: 2012

INTRODUCTION: Recent clinical trials have studied parameters that could predict response to cardiac resynchronization therapy (CRT) in patients with advanced heart failure. Left ventricular end-diastolic dimension (LVEDD) is regarded as a possible predictor of response to CRT. OBJECTIVE: To study the response to CRT in patients with very dilated cardiomyopathy, i.e. those at a more advanced stage of the pathology, analyzing both the responder rate and reverse remodeling in two groups of patients classified according to LVEDD. METHODS: We performed a retrospective analysis of 71 patients who underwent CRT (aged 62 +/- 11 years; 65% male; 93% in NYHA functional class > or = III; 31% with ischemic cardiomyopathy; left ventricular ejection fraction [LVEF] 25.6 +/- 6.8%; 32% in atrial fibrillation; QRS 176 +/- 31 ms). Twenty-two (31%) patients with LVEDD > or = 45 mm/m2 (49.2 +/- 3.5 mm/m2) were considered to have very dilated cardiomyopathy (Group A) and 49 patients had LVEDD > 37 mm/m2 and < 45 mm/m2 (39.4 +/- 3.8 mm/m2) (Group B). All patients were assessed by two-dimensional echocardiography at baseline and six months after CRT. The following parameters were analyzed: NYHA functional class, LVEF and LVEDD. Responders were defined clinically (improvement of > or = 1 NYHA class) and by echocardiography, with a minimum 15% increase over baseline LVEF combined with a reduction in LVEDD (reverse remodeling). RESULTS: There were no significant differences in baseline demographic characteristics between the two groups. At six-month followup, we observed an improvement in LVEF (delta 8.5 +/- 11.8%) and a reduction in LVEDD (delta 3.7 +/- 6.8 mm/m2), with fifty-seven (79%) patients being classified as clinical responders. The percentage of patients with reverse remodeling was similar in both groups (64% vs. 73%, p = NS), as were percentages of improved LVEF (delta 6.3 +/- 11% vs. delta 9.6 +/- 12%; p = NS) and decreased LVEDD (delta 3.7 +/- 5.5 mm/m2 vs. delta 3.7 +/- 7.4 mm/m2; p = NS). We found a higher percentage of clinical responders in patients with very dilated cardiomyopathy (96% vs. 72%, p < 0.05). CONCLUSION: In this study, a significant number of responders showed reverse remodeling after CRT. Although a higher percentage of patients with very dilated cardiomyopathy showed improvement in functional class, the extent of reverse remodeling was similar in both groups.

Submitted by Ana Quininha (ana.quininha@chlc.min-saude.pt) on 2011-11-08T13:14:08Z No. of bitstreams: 1 RPC 2011 559.pdf: 145921 bytes, checksum: ef393a2c54a440dde823ac9be87bc092 (MD5) Made available in DSpace on 2011-11-08T13:14:09Z (GMT). No. of bitstreams: 1 RPC 2011 559.pdf: 145921 bytes, checksum: ef393a2c54a440dde823ac9be87bc092 (MD5) Previous issue date: 2011

Submitted by Ana Quininha (ana.quininha@chlc.min-saude.pt) on 2011-07-26T14:29:27Z No. of bitstreams: 1 RPC 2010 139.pdf: 228931 bytes, checksum: 79b62e897bf1b200b08c319425128960 (MD5) Made available in DSpace on 2011-07-26T14:29:27Z (GMT). No. of bitstreams: 1 RPC 2010 139.pdf: 228931 bytes, checksum: 79b62e897bf1b200b08c319425128960 (MD5) Previous issue date: 2010

Submitted by Ana Quininha (ana.quininha@chlc.min-saude.pt) on 2012-12-12T12:21:43Z No. of bitstreams: 1 RPC 2010 1847.pdf: 975458 bytes, checksum: 5e69e733a44630654de41c85aeb63d12 (MD5) Made available in DSpace on 2012-12-12T12:21:43Z (GMT). No. of bitstreams: 1 RPC 2010 1847.pdf: 975458 bytes, checksum: 5e69e733a44630654de41c85aeb63d12 (MD5) Previous issue date: 2010

A síncope neurocardiogénica é uma entidade com prevalência e incidência significativas. Apesar da baixa mortalidade relacionada com esta entidade, são significativas as implicações na qualidade de vida dos doentes. A metodologia para o seu diagnóstico está hoje claramente estabelecida nas recomendações internacionais e o teste de inclinação é um elemento útil na abordagem diagnóstica, em particular na síncope recorrente de causa desconhecida e frequente. Vários protocolos têm vindo a ser descritos nos últimos anos, inicialmente passivos e posteriormente com introdução de agentes provocativos, dos quais os nitratos sub-linguais são os mais largamente aceites, pela simplicidade e bons resultados da sua utilização. O recurso ao teste de inclinação na avaliação da terapêutica está limitado por problemas relacionados com a reprodutibilidade, que contudo estão na base de uma forma de tratamento – o treino de ortostatismo (tilt training) – embora com taxas de sucesso variáveis. Na presente revisão, iremos abordar os vários aspectos relacionados com a aplicação do teste de inclinação na prática clínica.

INTRODUCTION: Adults with repaired tetralogy of Fallot (TOF) may be at risk for progressive right ventricular (RV) dilatation and dysfunction, which is commonly associated with arrhythmic events. In frequently volume-overloaded patients with congenital heart disease, tissue Doppler imaging (TDI) is particularly useful for assessing RV function. However, it is not known whether RV TDI can predict outcome in this population. OBJECTIVE: To evaluate whether RV TDI parameters are associated with supraventricular arrhythmic events in adults with repaired TOF. METHODS: We studied 40 consecutive patients with repaired TOF (mean age 35 +/- 11 years, 62% male) referred for routine echocardiographic exam between 2007 and 2008. The following echocardiographic measurements were obtained: left ventricular (LV) ejection fraction, LV end-systolic volume, LV end-diastolic volume, RV fractional area change, RV end-systolic area, RV end-diastolic area, left and right atrial volumes, mitral E and A velocities, RV myocardial performance index (Tei index), tricuspid annular plane systolic excursion (TAPSE), myocardial isovolumic acceleration (IVA), pulmonary regurgitation color flow area, TDI basal lateral, septal and RV lateral peak diastolic and systolic annular velocities (E' 1, A' 1, S' 1, E' s, A' s, S' s, E' rv, A' rv, S' rv), strain, strain rate and tissue tracking of the same segments. QRS duration on resting ECG, total duration of Bruce treadmill exercise stress test and presence of exercise-induced arrhythmias were also analyzed. The patients were subsequently divided into two groups: Group 1--12 patients with previous documented supraventricular arrhythmias (atrial tachycardia, fibrillation or flutter) and Group 2 (control group)--28 patients with no previous arrhythmic events. Univariate and multivariate analysis was used to assess the statistical association between the studied parameters and arrhythmic events. RESULTS: Patients with previous events were older (41 +/- 14 vs. 31 +/- 6 years, p = 0.005), had wider QRS (173 +/- 20 vs. 140 +/- 32 ms, p = 0.01) and lower maximum heart rate on treadmill stress testing (69 +/- 35 vs. 92 +/- 9%, p = 0.03). All patients were in NYHA class I or II. Clinical characteristics including age at corrective surgery, previous palliative surgery and residual defects did not differ significantly between the two groups. Left and right cardiac chamber dimensions and ventricular and valvular function as evaluated by conventional Doppler parameters were also not significantly different. Right ventricular strain and strain rate were similar between the groups. However, right ventricular myocardial TDI systolic (Sa: 5.4+2 vs. 8.5 +/- 3, p = 0.004) and diastolic indices and velocities (Ea, Aa, septal E/Ea, and RV free wall tissue tracking) were significantly reduced in patients with arrhythmias compared to the control group. Multivariate linear regression analysis identified RV early diastolic velocity as the sole variable independently associated with arrhythmic history (RV Ea: 4.5 +/- 1 vs. 6.7 +/- 2 cm/s, p = 0.01). A cut-off for RV Ea of < 6.1 cm/s identified patients in the arrhythmic group with 86% sensitivity and 59% specificity (AUC = 0.8). CONCLUSIONS: Our results suggest that TDI may detect RV dysfunction in patients with apparently normal function as assessed by conventional echocardiographic parameters. Reduction in RV early diastolic velocity appears to be an early abnormality and is associated with occurrence of arrhythmic events. TDI may be useful in risk stratification of patients with repaired tetralogy of Fallot.

A miocardiopatia não compactada isolada é uma doença geneticamente determinada cuja patogénese parece envolver uma paragem no desenvolvimento do endomiocárdio. Morfologicamente caracteriza-se pela presença de trabeculações proeminentes separadas por profundos recessos preenchidos por fluxo e como tal por Doppler a cor no estudo ecocardiográfico. No sentido de melhor caracterizar esta entidade recentemente descrita, de prognóstico pouco esclarecido, fazemos uma revisão dos casos diagnosticados no nosso hospital, descrevendo as características clínicas, electrocardiográficas e ecocardiográficas, bem como a terapêutica instituída e seguimento clínico. A propósito da revisão dos casos, é feita uma exposição e discussão da literatura mais relevante relativamente a etiopatogenia, clínica, critérios de diagnóstico, terapêutica e prognóstico.

Submitted by Ana Quininha (ana.quininha@chlc.min-saude.pt) on 2011-06-22T11:19:45Z No. of bitstreams: 1 RPC 2010 375.pdf: 199332 bytes, checksum: 805aa7ab7fcf27a92cd1c0421afea3de (MD5) Made available in DSpace on 2011-06-22T11:19:45Z (GMT). No. of bitstreams: 1 RPC 2010 375.pdf: 199332 bytes, checksum: 805aa7ab7fcf27a92cd1c0421afea3de (MD5) Previous issue date: 2010

INTRODUCTION: The significant risk of sudden arrhythmic death in patients with congestive heart failure and electromechanical ventricular dyssynchrony has led to increased use of combined cardiac resynchronization therapy defibrillator (CRT-D) devices. OBJECTIVES: To evaluate the echocardiographic variables in patients undergoing CRT-D that predict the occurrence of appropriate therapies (AT) for ventricular tachyarrhythmia. METHODS: We analyzed 38 consecutive patients (mean age 60 +/- 12 years, 63% male) with echocardiographic evaluation before and 6 months after CRT-D implantation. Patients with AT were identified in a mean follow-up of 471 +/- 323 days. A standard echocardiographic study was performed including tissue Doppler imaging (TDI). Responders were defined as patients with improvement in NYHA class of < or = 1 in the first six months, and reverse remodeling as a decrease in left ventricular end-systolic volume of < or = 15% and/or an increase in left ventricular ejection fraction of > 25%. RESULTS: The responder rate was 74%, and the reverse remodeling rate was 55%. AT occurred in 21% of patients, who presented with greater left ventricular end-diastolic internal diameter (LVEDD) before implantation (86 +/- 8 vs. 76 +/- 11 mm, p = 0.03) and at 6 months (81 +/- 8 vs. 72 +/- 14 mm, p = 0.08), and increased left ventricular end-systolic internal diameter (66 +/- 14 vs. 56 +/- 14 mm, p = 0.03) and lower ejection fraction (24 +/- 6 vs. 34 +/- 14%, p = 0.08) at 6 months. In the group with AT, the responder rate was lower (38 vs. 83%, p = 0.03), without significant differences in reverse remodeling (38% for the AT group vs. 60%, p = 0.426) or in the other variables. By univariate analysis, predictors of AT were LVEDD before implantation and E' after implantation. Age, gender, ischemic etiology, use of antiarrhythmic drugs, reverse remodeling and the other echocardiographic parameters did not predict AT. In multivariate logistic regression analysis, both LVEDD before implantation (OR 1.24, 95% CI 1.04-1.48, p = 0.019) and postimplantation E' (OR 0.27, 95% CI 0.09-0.76, p = 0.014) remained as independent predictors of AT. CONCLUSIONS: In patients undergoing CRT-D, episodes of ventricular tachyarrhythmia occur with high incidence, independently of echocardiographic response, with LVEDD before implantation and E' after implantation as the only independent predictors of AT in the medium-term. These results highlight the importance of combined devices with defibrillation capability.

Submitted by Ana Quininha (ana.quininha@chlc.min-saude.pt) on 2011-06-22T11:39:56Z No. of bitstreams: 1 RPC 2010 1009.pdf: 85567 bytes, checksum: 3a9145cfabbc3516a4b61f578a20d571 (MD5) Made available in DSpace on 2011-06-22T11:39:56Z (GMT). No. of bitstreams: 1 RPC 2010 1009.pdf: 85567 bytes, checksum: 3a9145cfabbc3516a4b61f578a20d571 (MD5) Previous issue date: 2010

Submitted by Ana Quininha (ana.quininha@chlc.min-saude.pt) on 2011-12-15T16:44:27Z No. of bitstreams: 1 RPC 2010 1713.pdf: 95050 bytes, checksum: 9e382da5bb1a16557c574a64ec935f91 (MD5) Made available in DSpace on 2011-12-15T16:44:27Z (GMT). No. of bitstreams: 1 RPC 2010 1713.pdf: 95050 bytes, checksum: 9e382da5bb1a16557c574a64ec935f91 (MD5) Previous issue date: 2010

Submitted by Ana Quininha (ana.quininha@chlc.min-saude.pt) on 2011-06-22T12:43:10Z No. of bitstreams: 1 RPC 2009 655.pdf: 554356 bytes, checksum: 07ff70f48837cec82f20927e323ff9ca (MD5) Made available in DSpace on 2011-06-22T12:43:10Z (GMT). No. of bitstreams: 1 RPC 2009 655.pdf: 554356 bytes, checksum: 07ff70f48837cec82f20927e323ff9ca (MD5) Previous issue date: 2009

With the recent technical improvement in echocardiography imaging (second harmonics) the number of interatrial septum aneurysms (ASA) increased and are easily recognized. We assist to an overdiagnosing number of cases and diagnostic criteria emerged to face this problem. In the great majority of the cases ASA are small and inoffensive, but as ASA is considered a risk factor for cardioembolism when associated with persistence of foramen oval (PFO), an examination by transesophageal echocardiography (TEE) for exclusion of PFO makes the sense and is a common testing in patients with cryptogenic stroke. Besides these frequent ASA, other forms exist; the authors describe two cases of uncommon and huge ASA, one mimicking a right atrial tumor and the other a quistic, hipoechoic mass. The first case was associated with mitral stenosis and was submitted to surgery and the second was closed with an Amplatzer occluder device usually used in atrial septal defect (ASD).

Submitted by Ana Quininha (ana.quininha@chlc.min-saude.pt) on 2011-07-22T14:40:19Z No. of bitstreams: 1 RPC 2009 243.pdf: 697542 bytes, checksum: b7bf65f81fa8fc11e2050d70a2a29030 (MD5) Made available in DSpace on 2011-07-22T14:40:19Z (GMT). No. of bitstreams: 1 RPC 2009 243.pdf: 697542 bytes, checksum: b7bf65f81fa8fc11e2050d70a2a29030 (MD5) Previous issue date: 2009

Search of new activity substances starting from chemotherapeutic agents, continuously appears in international literature. Perhaps this search has been done more frequently in the field of antitumor chemotherapy on account of the unsuccess in saving advanced stage patients. The new point in this matter during the last decade was computer aid in planning more rational drugs. In near future "the accessibility of super computers and emergence of computer net systems, will open new avenues to rational drug design" (Portoghese, P. S., J. Med. Chem. 1989, 32, 1). Unknown pharmacological active compounds synthetized by plants can be found even without this electronic devices, as traditional medicine has pointed out in many countries, and give rise to a new drug. These compounds used as found in nature or after chemical modifications have produced successful experimental medicaments as FAA, "flavone acetic acid" with good results as inhibitors of slow growing animal tumors currently in preclinical evaluation for human treatment. In this lecture some international contributions in the field of chemical modified compounds as antineoplastic drugs will be examined, particularly those done by Brazilian researches.

Submitted by Ana Quininha (ana.quininha@chlc.min-saude.pt) on 2011-07-22T12:42:13Z No. of bitstreams: 1 RPC 2008 1383.pdf: 219599 bytes, checksum: ee26eb412301ce8cdc6bc84270e1fa43 (MD5) Made available in DSpace on 2011-07-22T12:42:13Z (GMT). No. of bitstreams: 1 RPC 2008 1383.pdf: 219599 bytes, checksum: ee26eb412301ce8cdc6bc84270e1fa43 (MD5) Previous issue date: 2008

The autonomic nervous system (ANS) plays a role as a modulator in the pathogenesis of paroxysmal atrial fibrillation (PAF). The clinical pattern of vagally mediated PAF has been observed mainly in young patients. Neurocardiogenic responses during orthostatic stress are related to autonomic reflexes in which the vagal influence predominates. AIM: To evaluate the susceptibility of elderly patients with PAF to activation of vasovagal syncope mechanisms. METHODS: We performed passive head-up tilt testing (HUT) in 34 patients (62% women, aged 72 +/- 7 years), with > or = 1 year of clinical history of PAF--19 without structural heart disease, 11 with hypertensive heart disease and 4 with coronary artery disease (who had no previous myocardial infarction, had undergone myocardial revascularization, and had no documented ischemia) (PAF group), and compared the results with those obtained in a group of 34 age-matched patients (53% women, aged 74 +/- 6 years), who underwent HUT due to recurrent syncope (Sc group). In this group, 21 had no documented heart disease and none had a clinical history of AF. There was no diabetes, congestive heart failure or syncope in the PAF group. After a supine resting period, the subjects were tilted at 70 degrees for 20 minutes while in sinus rhythm. No provocative agents were used to complement the HUT. ECG and blood pressure were continuously monitored (Task Force Monitor, CNSystems). The test was considered positive when syncope or presyncope occurred with bradycardia and/or arterial hypotension. Abnormal responses were classified as cardioinhibitory, vasodepressor or mixed. RESULTS: HUT was positive in seven patients of the PAF group--vasodepressor response in five and mixed in two (20.5% of the total; 26.3% of those without heart disease)--and in eight patients (vasodepressor in six and mixed in two) of the Sc group (p=NS). During HUT, three patients of the PAF group had short periods of self-limited PAF (in one, after vasodepressor syncope). There were no differences in gender distribution, age or heart disease. No cardioinhibitory responses or orthostatic hypotension were observed. CONCLUSION: In elderly patients with PAF, a significant number of false positive results during passive HUT may be expected, suggesting increased vasovagal reactions despite aging. This suggests that ANS imbalances may be observed in this population.

Atrial electrical remodeling plays a part in recurrence of atrial fibrillation (AF). It has been related to an increase in heterogeneity of atrial refractoriness that facilitates the occurrence of multiple reentry wavelets and vulnerability to AF. AIM: To examine the relationship between dispersion of atrial refractoriness (Disp_A) and vulnerability to AF induction (A_Vuln) in patients with clinical paroxysmal AF (PAF). METHODS: Thirty-six patients (22 male; age 55+/-13 years) with > or =1 year of history of PAF (no underlying structural heart disease--n=20, systemic hypertension--n=14, mitral valve prolapse--n=1, surgically corrected pulmonary stenosis--n=1), underwent electrophysiological study (EPS) while off medication. The atrial effective refractory period (AERP) was assessed at five different sites--high (HRA) and low (LRA) lateral right atrium, high interatrial septum (IAS), proximal (pCS) and distal (dCS) coronary sinus--during a cycle length of 600 ms. AERP was taken as the longest S1-S2 interval that failed to initiate a propagation response. Disp_A was calculated as the difference between the longest and shortest AERP. A_Vuln was defined as the ability to induce AF with 1-2 extrastimuli or with incremental atrial pacing (600-300 ms) from the HRA or dCS. The EPS included analysis of focal electrical activity based on the presence of supraventricular ectopic beats (spontaneous or with provocative maneuvers). The patients were divided into group A--AF inducible (n=25) and group B--AF not inducible (n=11). Disp_A was analyzed to determine any association with A_Vuln. Disp_A and A_Vuln were also examined in those patients with documented repetitive focal activity. Logistic regression was used to determine any association of the following variables with A_Vuln: age, systemic hypertension, left ventricular hypertrophy, left atrial size, left ventricular function, duration of PAF, documented atrial flutter/tachycardia and Disp_A. RESULTS: There were no significant differences between the groups with regard to clinical characteristics and echocardiographic data. AF was inducible in 71% of the patients and noninducible in 29%. Group A had greater Disp_A compared to group B (105+/-78 ms vs. 49+/-20 ms; p=0.01). Disp_A was >40 ms in 50% of the patients without A_Vuln and in 91% of those with A_Vuln (p=0.05). Focal activity was demonstrated in 14 cases (39%), 57% of them with A_Vuln. Disp_A was 56+/-23 ms in this group and 92+/-78 ms in the others (p=0.07). Using logistic regression, the only predictor of A_Vuln was Disp_A (p=0.05). CONCLUSION: In patients with paroxysmal AF, Disp_A is a major determinant of A_Vuln. Nevertheless, the degree of nonuniformity of AERP appears to be less important as an electrophysiological substrate for AF due to focal activation.