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Introduction and Objectives: Atrial fibrillation (AF) and heart failure (HF) often coexist. AF catheter ablation improves left ventricular ejection fraction (LVEF), but its impact varies between patients. We aimed to identify predictors of LVEF improvement in HF patients with impaired LVEF undergoing AF ablation. Methods: We conducted a retrospective single-center study in HF patients with LVEF

Bronchial asthma is a chronic pathology and a global public health problem. However, asthma can be controlled and treated for the most part by patients, so the Portuguese General Directorate of Health recommends shared medical appointments in primary health care (PHC). The present study aims to identify the role of PHC nurses in the control and treatment of asthma in adults. Using the MeSH platform, the following descriptors were validated: asthma, nurses, adults. An individual search was carried out in the following databases: CINAHL (ESBSCO host), MEDLINE (Pubmed host), Web of Science, and Scopus. Out of a total of 280 publications, 79 of which were duplicates and 185 publications which did not meet the inclusion criteria, 16 publications remained readable. Of the eligible articles, there were 13 specialist reports, one mixed study, one quasi-experimental study, and one randomized trial. Education was the intervention most identified in the scientific evidence analyzed, and patient assessment, application of an asthma control questionnaire, verification and training of inhalation technique, empowerment for self-management of the disease, support, promotion of seasonal influenza vaccination, and use of written action plans were also identified. The results reveal that, although the scientific evidence on the intervention of these professionals is poorly developed, nurses play a crucial role in the control and treatment of asthma. The scientific evidence analyzed allowed the identification of interventions that can help the organization of a nursing health appointment, providing nurses with a crucial role in the control and treatment of asthma in adults in the context of PHC.

HbSC disease, a less severe form of sickle cell disease, affects the retina more frequently and patients have higher rates of proliferative retinopathy that can progress to vision loss. This study aimed to identify differences in the expression of endothelial cell-derived molecules associated with the pathophysiology of proliferative sickle cell retinopathy (PSCR). RNAseq was used to compare the gene expression profile of circulating endothelial colony-forming cells from patients with SC hemoglobinopathy and proliferative retinopathy (n = 5), versus SC patients without retinopathy (n = 3). Real-time polymerase chain reaction (qRT-PCR) was used to validate the RNAseq results. A total of 134 differentially expressed genes (DEGs) were found. DEGs were mainly associated with vasodilatation, type I interferon signaling, innate immunity and angiogenesis. Among the DEGs identified, we highlight the most up-regulated genes ROBO1 (log2FoldChange = 4.32, FDR = 1.35E-11) and SLC38A5 (log2FoldChange = 3.36 FDR = 1.59E-07). ROBO1, an axon-guided receptor, promotes endothelial cell migration and contributes to the development of retinal angiogenesis and pathological ocular neovascularization. Endothelial SLC38A5, an amino acid (AA) transporter, regulates developmental and pathological retinal angiogenesis by controlling the uptake of AA nutrient, which may serve as metabolic fuel for the proliferation of endothelial cells (ECs) and consequent promotion of angiogenesis. Our data provide an important step towards elucidating the molecular pathophysiology of PSCR that may explain the differences in ocular manifestations between individuals with hemoglobinopathies and afford insights for new alternative strategies to inhibit pathological angiogenesis.

Abstract Blended Intensive Programmes (BIP’s) represent a valuable tool for gathering knowledge and summarising the latest trends in medicine and dentistry. Blended education has been found, even before the COVID-19 pandemic, to increase the level of education and stimulate effective learning for postgraduate healthcare professionals. Interprofessional education is critical for preparing students to enter the health workforce, where teamwork and collaboration are important competencies. This article outlines the key points of the Blended Intensive Programme’s implementation in dental education organised by Wroclaw Medical University in Poland. BIP involved professors from 12 universities or research institutions from Europe and South America and 28 participants from 8 countries. The course was taught remotely and in person. In addition, it included a visit to the university and practical classes with artificial simulation and practice in dentistry. A structured questionnaire enabled measuring the evaluation of students’ perception of the COVID-19 education before and after the pandemic. The European Region Action Scheme for the Mobility of University Students (ERASMUS) was fundamental to carrying out the BIP with the participation of several countries, allowing the exchange of knowledge, assessing the impact of the pandemic on dental universities, and strengthening international collaborations and the future project of research, education and clinical assistance. We conclude that hybrid teaching programmes broaden the learning spectrum in dental studies by allowing transnational and interdisciplinary approaches that make students aware of the importance of their work within the framework of the general health approach, as this differs from country to country.

Resumo Fundamento: O software ablation index (AI) permitiu melhorar os resultados da ablação de fibrilação atrial (FA), mas as taxas de recorrência permanecem significativas. Biomarcadores séricos específicos têm sido associados a essa recorrência. Objetivos: Avaliar se certos biomarcadores podem ser utilizados (individualmente ou combinados) para predizer a recorrência de FA pós ablação guiada pelo AI. Métodos: Estudo multicêntrico, observacional, prospectivo de pacientes consecutivos, encaminhados para ablação de FA de janeiro de 2018 a março de 2021. Hemoglobina, peptídeo natriurético cerebral (BNP), proteína C reativa, troponina I ultrassensível, clearance de creatinina, Hormônio Tireoestimulante (TSH), e Tiroxina livre (T4) foram avaliados quanto à capacidade de prever a recorrência de arritmias durante o acompanhamento. Valores de p 1,8 μUI/mL [HR=1,82 (IC95%, 1,89-2,80), p=0,006] foi um preditor independente de recorrência. Avaliando-se a combinação de TSH, FT4 e BNP, a adição de cada valor “anormal” foi associada a uma menor sobrevida livre de recorrência (87,1% se nenhum vs. 83,5% se um vs. 75,1% se dois vs. 43,3% se três biomarcadores, p

Abstract Background There is a lack of evidence regarding contemporary implantable cardioverter-defibrillator (ICD) battery longevity. Our aim was to assess battery longevity in ICDs in a real-world setting. Methods Retrospective cross-sectional single center study of a prospectively collected database of consecutive patients who underwent ICD implantation from January 2010 to December 2015. Clinical data and battery longevity of all manufacturers were collected. Results A total of 351 patients (84.6% males, mean age of 61 ± 12 years) were included in the study (292 VVI; 6 VDD; 53 DDD). All manufacturers (Abbott, Biotronik, Boston, Medtronic and Microport) were equally represented in the study (p = 0.110). Median battery longevity was 10.8 years (11 years for VVI and 8.5 for DDD). After a follow-up time of 5 years, 98% of VVI and DDD were still in service (vs. industry-projected longevity of 98%). During this time, 89 patients (25.4%) underwent device replacement − 69 patients (77.5%) due to battery depletion, 6 patients due to infection, 3 patients due to dysfunction and 13 patients due to upgrade to CRT-D. Patients with Medtronic or Biotronik ICDs had a greater probability of being replaced earlier due to battery depletion (Biotronik HR 6.87, 95% CI 2.54–18.58, p

Daylighting simulation software is an important tool to improve the quality of building design and to improve the quality of the built environment. For its application to correspond to reality, its algorithm needs to reflect real behaviour in the best possible way. This paper aims to propose an algorithm to simulate the behaviour of fenestration complex systems, such as the laser-cut panel, based on ray tracing techniques. The algorithm was developed in MatLab as an add-on for the TropLux software, using the physical formulas associated with the concepts of daylight coefficients, ray tracing and Monte Carlo method. After validation it is possible to realize that the developed algorithm can simulate the light behaviour through complex fenestration systems using plane-based modelling with precision and accuracy. The tests using laser cut panel, ordinary glass and prismatic glass obtained behaviour close to that observed in similar measurements and algorithms.

Contexto: A avaliação da resiliência em contextos oncológicos é essencial, mas faltam instrumentos específicos para a população portuguesa. Objetivo: Traduzir e validar a versão reduzida da Escala de Resiliência Específica para o Cancro (ER-EC-10) para a população portuguesa. Métodos: A amostra foi constituída por 120 participantes, com idades compreendidas entre os 26 e 84 anos, de um hospital na Região Autónoma dos Açores. O protocolo incluiu a ER-EC-10, a versão reduzida da Escala de Afetos Positivos e Negativos (PANAS-VRP), a Escala de Ansiedade e Depressão Hospitalar (HADS) e a Escala de Satisfação Subjetiva com a Vida (SWLS). Resultados: A análise fatorial confirmatória mostrou consistência interna e fiabilidade moderada da ER-EC-10. Após ajustes nas covariâncias, o modelo demonstrou bom ajustamento nas duas dimensões. Foram observadas correlações positivas significativas com Afeto Positivo da PANAS-VRP e SWLS, e correlações negativas com o Afeto Negativo e a HADS. Conclusões: A ER-EC-10 mostrou ser um instrumento válido e confiável para medir a resiliência em pacientes com cancro em Portugal, oferecendo uma avaliação sensível e específica dos desafios enfrentados por indivíduos em diagnóstico e tratamento oncológico. Este estudo reforça a importância de ferramentas adaptadas culturalmente para a avaliação psicológica em contextos de saúde.

As Expressões de Tempo Decorrido (ETDs) são um fenômeno de recente estudo no português brasileiro, e inédito no português alagoano em sincronia passada. Dentre as análises realizadas, grande parte tem enfoque sincrônico, investigando o português atual em suas variedades. Logo, este trabalho objetiva analisar essa variação com o aporte teórico da Sociolinguística Variacionista (LABOV, 2008 [1972]) e da Sociolinguística Histórica (ROMAINE, 1982) para explicitar os fatores condicionantes do uso desse fenômeno a partir do corpus de 112 cartas pessoais do escritor alagoano Graciliano Ramos no início do século XX. Assim, o trabalho justifica-se por ampliar as pesquisas sobre a variedade alagoana do português. Como resultado, foram encontrados 77 dados referentes às variantes “Haver” e “Fazer”, que correspondem a um percentual de 86% (66 dados) para a primeira e 14% (11 dados) para a segunda, o que motiva esse estudo a refletir sobre a ausência das variantes “Ter” e “Estar com” nas cartas. Para análise quantitativa dos dados, utilizou-se o programa RStudio, que proporcionou análises univariadas e resultou na significância das variáveis independentes aspecto (p0,05), complementizador (p0,001) e ordem (p0,001) no condicionamento das variantes das ETDs observadas. Já para análise qualitativa, observaram-se os aspectos linguísticos dos dados encontrados, o que resultou preliminarmente na constituição de hipóteses e novos caminhos de pesquisa para futuros trabalhos que investiguem o português alagoano em sua perspectiva histórica para ampliar os dados acerca desse fenômeno e verificar se a ausência de “Ter” e “Estar com” ocorre em outros corpora, além de trazer novas questões sobre as ETDs.

Background SARS-CoV-2 infection affects multiple systems, including musculoskeletal, neurological, and respiratory systems. Changes associated with physical inactivity due to prolonged hospitalization can affect the functional capacity of individuals with long coronavirus disease 2019 (COVID-19) or post-COVID-19 condition and may cause changes in some postural control functions, such as verticality. Objectives This study aimed to evaluate the perception of verticality in individuals with long COVID. Design Cross-sectional study Methods This study included 60 participants with post-COVID-19 condition divided into 2 groups: hospitalized group (n = 24), those hospitalized owing to SARS-CoV-2 infection; and non-hospitalized group (n = 36), those infected with SARS-CoV-2 but not hospitalized. All participants were examined using a post-COVID-19 functional status (PCFS) , sit-to-stand test, grip strength assessment, painful and tactile sensory assessments, visual acuity assessment, and vestibular assessment. Verticality perception was evaluated using the subjective visual vertical (SVV) and subjective haptic vertical (SHV) tests. In both tests, the absolute values (positive values only) and true values (positive and negative values) were considered. To verify potential confounders that could influence the verticality of the results, logistic regression models were used for categorical variables and multiple linear regressions were used for continuous variables. For analysis between groups, the independent samples test (Mann–Whitney U test) was used. Results There were no confounders between clinical variables and verticality in either group. There was a significant increase in absolute SVV (mean deviation [MD]: 2.83; P < .0001) and true SVV (MD: −4.18; P = .005) in the hospitalized group compared to the non-hospitalized group. Furthermore, there was a significant increase in the true SHV (MD: −3.6; P = .026) in the hospitalized group compared to that in the non-hospitalized group. Conclusion Less accurate visual and haptic verticality perception task performance was observed in hospitalized patients with post-COVID-19 condition.

Massive vaccination positively impacted the SARS-CoV-2 pandemic, being a strategy to increase the titers of neutralizing antibodies (NAbs) in the population. Assessing NAb levels and understanding the kinetics of NAb responses is critical for evaluating immune protection. In this study, we optimized and validated a PRNT50 assay to assess 50% virus neutralization and evaluated its accuracy to measure NAbs to the original strain or variant of SARS-CoV-2. The optimal settings were selected, such as the cell (2 × 105 cells/well) and CMC (1.5%) concentrations and the viral input (~60 PFU/well) for PRNT-SARS-CoV-2 with cut-off point = 1.64 log5 based on the ROC curve (AUC = 0.999). The validated PRNT-SARS-CoV-2 assay presented high accuracy with an intraassay precision of 100% for testing samples with different NAb levels (low, medium, and high titers). The method displays high selectivity without cross-reactivity with dengue (DENV), measles (MV), zika (ZIKV), and yellow fever (YFV) viruses. In addition, the standardized PRNT-SARS-CoV-2 assay presented robustness when submitted to controlled variations. The validated PRNT assay was employed to test over 1000 specimens from subjects with positive or negative diagnoses for SARS-CoV-2 infection. Patients with severe COVID-19 exhibited higher levels of NAbs than those presenting mild symptoms for both the Wuhan strain and Omicron. In conclusion, this study provides a detailed description of an optimized and validated PRNT50 assay to monitor immune protection and to subsidize surveillance policies applied to epidemiologic studies of COVID-19.

Objective: To assess one-year outcomes in patients with persistent and long-standing persistent atrial fibrillation (AF) treated by catheter ablation. Methods: A retrospective observational study was conducted of consecutive patients referred for catheter ablation of persistent or long-standing persistent AF between May 2016 and October 2018. Patients underwent two different ablation strategies: pulmonary vein isolation (PVI) plus complex fractionated atrial electrograms (CFAE) (from May 2016 to June 2017) or a tailored approach (from July 2017 to October 2018). The overall recurrence rate at one year was analyzed. The secondary endpoint was arrhythmia recurrence according to the type of AF (persistent vs. long-standing persistent AF) and according to the ablation strategy employed. Results: During the study period, 67 patients were included (40% with long-standing persistent AF). During a mean follow-up of 16±6 months, 27% of the patients had arrhythmia recurrence. Patients with long-standing persistent AF had a higher recurrence rate than those with persistent AF (44.4% vs. 15%, p=0.006), while patients who underwent a tailored approach presented better outcomes than those undergoing PVI plus CFAE ablation (17.5% vs. 40.7%, p=0.024). Ablation strategy (HR 6.457 [1.399-29.811], p=0.017), time in continuous AF (HR 1.191 [1.043-1.259], p=0.010) and left atrial volume index (HR 1.160 [1.054-1.276], p=0.002) were independent predictors of arrhythmia recurrence. Conclusion: Catheter ablation is an effective treatment for patients with persistent and long-standing persistent AF. Patients with persistent AF and those undergoing a tailored approach presented lower arrhythmia recurrence. Resumo: Objetivo: Avaliar os resultados a um ano da ablação por cateter na fibrilhação auricular (FA) persistente e persistente de longa duração. Métodos: Estudo retrospetivo observacional de doentes referenciados para a ablação de FA persistente e persistente de longa duração de maio de 2016 a outubro de 2018. Os doentes foram submetidos a duas estratégias: isolamento de veias pulmonares (PVI) e ablação de eletrogramas auriculares fracionados e complexos (CFAE) (de maio de 2016 a junho de 2017) ou a uma abordagem individualizada (de julho de 2017 a outubro de 2018). Foi avaliada a taxa de recidiva a um ano de seguimento. Os objetivos secundários consistiram na avaliação da taxa de recidiva de acordo com o tipo de FA (persistente versus persistente de longa duração) e de acordo com a estratégia de ablação realizada. Resultados: Durante o período de estudo, 67 doentes foram incluídos (40% dos quais com FA persistente de longa duração). Durante o seguimento médio de 16±6 meses, observou-se recorrência de arritmia em 27% dos doentes. Os doentes com FA persistente de longa duração apresentaram uma maior taxa de recidiva comparativamente aos doentes com FA persistente (44,4% versus 15%, p=0,006). Por sua vez, os doentes submetidos a uma abordagem individualizada apresentaram uma menor recidiva de arritmia, em comparação com os doentes submetidos a PVI+CFAE (17,5% versus 40,7%, p=0,024). A estratégia de ablação (HR 6,457 [1,399–29,811] p=0,017), o tempo em FA (HR 1,191 [1,043–1,259] p=0,010) e o volume indexado da aurícula esquerda (HR 1,160 [1,054–1,276] p=0,002) foram preditores independentes de recidiva de arritmia. Conclusão: A ablação por cateter é um procedimento eficaz em doentes com FA persistente e persistente de longa duração. Doentes submetidos a uma ablação individualizada e doentes com FA persistente apresentaram uma menor taxa de recidiva.

Abstract Background The survival of patients with lung cancer has substantially increased in the last decade by about 15%. This increase is, basically, due to targeted therapies available for advanced stages and the emergence of immunotherapy itself. This work aims to study the situation of biomarker testing in Spain. Patients and methods The Thoracic Tumours Registry (TTR) is an observational, prospective, registry-based study that included patients diagnosed with lung cancer and other thoracic tumours, from September 2016 to 2020. This TTR study was sponsored by the Spanish Lung Cancer Group (GECP) Foundation, an independent, scientific, multidisciplinary oncology society that coordinates more than 550 experts and 182 hospitals across the Spanish territory. Results Nine thousand two hundred thirty-nine patients diagnosed with stage IV non-small cell lung cancer (NSCLC) between 2106 and 2020 were analysed. 7,467 (80.8%) were non-squamous and 1,772 (19.2%) were squamous. Tumour marker testing was performed in 85.0% of patients with non-squamous tumours vs 56.3% in those with squamous tumours (p-value

BackgroundPreterm birth is a global health concern. Its adverse consequences may persist throughout the life course, exerting a potentially heavy burden on families, health systems, and societies. In high-income countries, the first children who benefited from improved care are now adults entering middle age. However, there is a clear gap in the knowledge regarding the long-term outcomes of individuals born preterm. ObjectiveThis study aimed to assess the feasibility of recruiting and following up an e-cohort of adults born preterm worldwide and provide estimations of participation, characteristics of participants, the acceptability of questions, and the quality of data collected. MethodsWe implemented a prospective, open, observational, and international e-cohort pilot study (Health of Adult People Born Preterm—an e-Cohort Pilot Study [HAPP-e]). Inclusion criteria were being an adult (aged ≥18 years), born preterm (

Este estudo objetiva analisar a implementação do Programa de Aprendizagem Complementar (PAC) no contexto pós-pandemia, evidenciando avanços e desafios em relação à alfabetização de crianças matriculadas do 1º ao 3º ano do Ensino Fundamental. Desenvolveu-se pesquisa de abordagem qualitativa e utilizou-se a análise documental como dispositivo de produção de dados. O campo da pesquisa foi a rede municipal de educação de Novo Santo Antônio (PI). Os resultados apontam que, com o retorno do ensino presencial e o desenvolvimento das ações do PAC, ocorridos em 2022, houve melhoria nos índices de alfabetização. No 1º ano do Ensino Fundamental, a ampliação foi de 17,2%, no 2º e 3º ano, o avanço foi de 19,2% e 21%, respectivamente. Conclui-se que, apensar dos avanços, um longo caminho precisa ser percorrido para que os estudantes possam sanar as lacunas na aprendizagem durante a pandemia, sendo necessário investir continuamente em políticas destinadas a garantia dos direitos das crianças e dos adolescentes, com foco na recomposição de aprendizagem.

Abstract Background The use of the Ablation Index (AI) software for paroxysmal atrial fibrillation (AF) has been associated with higher acute effectiveness and higher 1‐year arrhythmia freedom. There is, however, a lack of data concerning longer follow‐up. We aim to evaluate the 2‐year outcomes after a standardized AI‐guided pulmonary vein isolation (PVI). Methods Prospective, multicenter study of consecutive patients referred for paroxysmal AF ablation from January 2018 to July 2019. PVI was guided by a tailored AI value (≥500 for anterior segment, ≥450 for the roof segments and inferior segments, and 400 for the posterior wall) and an ILD ≤6 mm. The primary endpoints were acute and long‐term effectiveness. Results The study included 218 (842 PV) patients (61% males, median age of 60 [IQR 49–68] years) with paroxysmal AF. First‐pass isolation was obtained in 93% of the patients, with an acute reconnection occurring in 10.6% of the patients (3.2% of the PV) following adenosine trial. After a median follow‐up of 26 (IQR 20–30) months, freedom from any documented atrial arrhythmia was 83.4%, off‐AAD. The rate of adverse events was 1.4%. Although procedural parameters differ across centers (p

BackgroundCurrent prognosis in oncology is reduced to the tumour stage and performance status, leaving out many other factors that may impact the patient´s management. Prognostic stratification of early stage non-small-cell lung cancer (NSCLC) patients with poor prognosis after surgery is of considerable clinical relevance. The objective of this study was to identify clinical factors associated with long-term overall survival in a real-life cohort of patients with stage I-II NSCLC and develop a prognostic model that identifies features associated with poor prognosis and stratifies patients by risk.MethodsThis is a cohort study including 505 patients, diagnosed with stage I-II NSCLC, who underwent curative surgical procedures at a tertiary hospital in Madrid, Spain.ResultsMedian OS (in months) was 63.7 (95% CI, 58.7-68.7) for the whole cohort, 62.4 in patients submitted to surgery and 65 in patients submitted to surgery and adjuvant treatment. The univariate analysis estimated that a female diagnosed with NSCLC has a 0.967 (95% CI 0.936 - 0.999) probability of survival one year after diagnosis and a 0.784 (95% CI 0.712 - 0.863) five years after diagnosis. For males, these probabilities drop to 0.904 (95% CI 0.875 - 0.934) and 0.613 (95% CI 0.566 - 0.665), respectively. Multivariable analysis shows that sex, age at diagnosis, type of treatment, ECOG-PS, and stage are statistically significant variables (p1) while adjuvant chemotherapy is a good prognostic variable (HR

INTRODUCTION: The concept of the Nellix endoprosthesis is based on endovascular aneurysm sealing with endobags and was launched in the market for endovascular abdominal aortic aneurysm repair (EVAR). The manufacturer recently issued a hazard alert due to higher rates of endoleaks, migration and aneurysm enlargement. CASE REPORT: The authors present a clinical case of a seventy year-old man previously submitted to EVAR with a Nellix device in another country. The patient presented with an asymptomatic Type Ia endoleak and proximal aortic neck aneurysmatic degeneration. The anatomy was considered unfavourable for further endovascular management. After multidisciplinary discussion and workup, open surgical conversion was selected. Complete endoprosthesis explantation and in-situ reconstruction were performed. The post-operative course was uneventful. CONCLUSION: Once presented with a patient considered fit for open surgical conversion and with aneurysm morphology unfavourable for endovascular, the authors believe that open conversion may constitute a very acceptable method of repair and should be offered.