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Resumo Fundamento O cardioversor-desfibrilador implantável (CDI) pode causar níveis elevados de ansiedade e depressão, resultando em efeitos negativos na qualidade de vida. Objetivos Avaliar a qualidade de vida, a ansiedade e a aceitação do CDI por meio de instrumentos de medida padronizados e identificar preditores de melhores respostas para cada um dos desfechos estudados. Método Coorte prospectiva com pacientes submetidos a implante inicial de CDI ou reoperação para a manutenção do dispositivo. Os desfechos do estudo incluíram: qualidade de vida, ansiedade e aceitação do CDI. A mudança nos escores (30 e 180 dias) foi avaliada por meio da diferença mínima importante (DMI). Foi utilizada a análise univariada e o modelo de regressão logística multivariada para a identificação de preditores de melhores respostas, adotando-se o nível de significância de 5%. Resultados De janeiro/2020 a junho/2021 foram incluídos 147 pacientes, com idade média de 55,3 ± 13,4 anos e predomínio do sexo masculino (72,1%). A DMI para qualidade de vida, a ansiedade e a aceitação do CDI foram observadas em 33 (22,4%), 36 (24,5%) e 43 (29,3%) pacientes, respectivamente. Idade igual ou maior que 60 anos (OR=2,5; IC 95%=1,14-5,53; p=0,022), ausência de fibrilação atrial (OR=3,8; IC 95%=1,26-11,63; p=0,017) e sexo feminino (OR=2,2; IC 95%=1,02-4,97; p=0,045) foram preditores independentes de melhores respostas para qualidade de vida, ansiedade e aceitação do CDI, respectivamente. Conclusão A identificação de preditores para melhores escores de qualidade de vida, ansiedade e aceitação do dispositivo pode subsidiar a implementação de cuidados específicos para os pacientes com maiores chances de apresentar resultados desfavoráveis.

Resumo Fundamento O uso de marca-passos cardíacos artificiais tem crescido constantemente, acompanhando o envelhecimento populacional. Objetivos Determinar as taxas de readmissões hospitalares e complicações após implante de marca-passo ou troca de gerador de pulsos e avaliar o impacto desses eventos nos custos anuais do tratamento sob a perspectiva do Sistema Único de Saúde (SUS). Métodos Registro prospectivo, com dados derivados da prática clínica assistencial, coletados na hospitalização índice e durante os primeiros 12 meses após o procedimento cirúrgico. O custo da hospitalização índice, do procedimento e do seguimento clínico foram estimados de acordo com os valores reembolsados pelo SUS e analisados ao nível do paciente. Modelos lineares generalizados foram utilizados para estudar fatores associados ao custo total anual do tratamento, adotando-se um nível de significância de 5%. Resultados No total, 1.223 pacientes consecutivos foram submetidos a implante inicial (n= 634) ou troca do gerador de pulsos (n= 589). Foram observados 70 episódios de complicação em 63 pacientes (5,1%). A incidência de readmissões hospitalares em um ano foi de 16,4% (IC 95% 13,7% - 19,6%) após implantes iniciais e 10,6% (IC 95% 8,3% - 13,4%) após trocas de geradores. Doença renal crônica, histórico de acidente vascular encefálico, tempo de permanência hospitalar, necessidade de cuidados intensivos pós-operatórios, complicações e readmissões hospitalares mostraram um impacto significativo sobre o custo anual total do tratamento. Conclusões Os resultados confirmam a influência da idade, comorbidades, complicações pós-operatórias e readmissões hospitalares como fatores associados ao incremento do custo total anual do tratamento de pacientes com marca-passo.

Caffeine is a well-described ergogenic aid used to enhance athletic performance. Using animal models can greatly increase our understanding of caffeine’s mechanisms in performance. Here, we adapted an animal weight-lifting exercise model to demonstrate caffeine’s ergogenic effect in rats. Male Wistar rats (315 ± 35 g) were randomly divided into two groups: one group received 5 mg·kg−1 of caffeine (0.5 mL; CEx; n = 5) and the other 0.9% NaCl (0.5 mL; PEx; n = 4) through an orogastric probe (gavage) one hour before exercise. Weight-lifting exercise sessions were performed over three subsequent days, and the number of complete squats performed was counted. Analyses of the area under the curve in all three experiments showed that the CEx group responded more to stimuli, performing more squats (1.7-, 2.0-, and 1.6-fold; p < 0.05) than the control group did. These three days’ data were analyzed to better understand the cumulative effect of this exercise, and a hyperbolic curve was fitted to these data. Data fitting from the caffeine-supplemented group, CEx, also showed larger Smax and Kd (2.3-fold and 1.6-fold, respectively) than the PEx group did. Our study demonstrated an acute ergogenic effect of caffeine in an animal weight-lifting exercise model for the first time, suggesting potential avenues for future research.

Data quality monitoring plays a crucial role in multicenter prospective registries. By maintaining high data accuracy, completeness, and consistency, researchers can improve the overall quality and reliability of the registry data, enabling meaningful conclusions and supporting evidence-based decisions. The purpose of the present study was to evaluate data quality metrics (completeness, accuracy, and temporal plausibility) of a Multicenter Registry of Cardiac Implantable Electronic Devices (CIEDs) and to perform a direct data audit of a random sample of records to assess the agreement levels with the source documents. The CIED Registry was a prospective, multicenter, real-world observational study carried out from January 2020 to December 2022 in five designated centers across Sao Paulo, Brazil. We assessed the data quality of the CIED Registry by using two distinct approaches: • Dynamic data monitoring using features of the REDCap (Research Electronic Data Capture) software, including data reports and data quality rules • Direct data audit in which information from a random sample of 10 % of cases from the coordinating center was compared with original source documentsOur findings suggest that the methodological approach applied to the CIED Registry resulted in high data completeness, accuracy, temporal plausibility, and excellent agreement levels with the source documents.

Device acceptance is a crucial factor in identifying implantable cardioverter defibrillator (ICD) patients at risk for psychosocial distress and unfavorable quality of life outcomes. The purpose of this study was to examine the evidence of the validity of internal structure (construct) and reliability of the Florida Patient Acceptance Survey (FPAS) in a sample of ICD patients, comparing the psychometric indicators of the complete (FPAS-18 item) and abbreviated (FPAS-12 item) versions. The sample included 151 participants (97 males, mean age of 55.7 ± 14.1 years) who completed the cross-culturally adapted version of the FPAS instrument for the Brazilian context. The psychometric properties of both versions of the FPAS instrument were evaluated by two distinct approaches: • Exploratory and confirmatory factor analysis: used to test the internal structure of the instrument • Cronbach's Alpha and McDonald's Omega: used to determine the reliability of the instrumentThe two versions of the FPAS-Br instrument showed consistent evidence of internal structure validity and reliability. However, the FPAS-Br 12-item showed a better psychometric adjustment, confirmed by the analysis of the quality indicators of the models.

ABSTRACT: Carrier water quality is one of the main characteristics for an efficient and safe spraying of pesticides. Overall related to the levels of pH and hardness. The objective was to evaluate the interaction between water pH and storage time of the spray, containing 2,4-D amine, 2,4-D choline and dicamba, on the visible efficacy in Ipomoea triloba, Bidens pilosa, Amaranthus viridis; and water hardness on I. triloba. Three studies were carried out in a greenhouse. Study 1 with a 3x5 factorial, which factor A being pH of 2, 6 and 10 and factor B being 0, 2, 6, 24 and 36 hours of application after the mixture. Study 2 was a 3x5 factorial for each herbicide, whith factor A being the levels of pH (2, 6 and 10) and factor B being 0, 6, 12, 24 and 48 hours of application after the mixture. The study 3 is a 3x7 factorial, with factor A being the herbicides and factor B levels of water hardness: 0, 65, 125, 250, 500, 750 and 1000 parts per million. The pH of all solutions remained stable for 48 hours after preparation. However, did not interfere in efficacy of dicamba in I. triloba. Also, longer time between preparing the spray with 2,4-D formulations and application caused reduction efficacy on I. triloba. Also, the level of water hardness decreased control on I. triloba. The pH of carrier water did not affect efficacy of 2,4-D and dicamba on the weeds; however, longer time of the spray application reduce the visible efficacy.

Ryegrass ( Lolium multiflorum Lam.) is an important forage and suffers negative interference from weeds, like annual bluegrass ( Poa annua L.). The competition of annual bluegrass with ryegrass can interfere with crop growth and reduce the amount of forage for animal feed. We aimed to evaluate the interference of annual bluegrass in ryegrass crops through the differentiation of niche and establishment. Two experiments were carried out testing different competition strata (shoot, root, and both) and ryegrass establishment with or after annual bluegrass, with increasing populations of annual bluegrass (0, 35, 139, 279, 419 plants m –2). The variables were plant height, height length of the root system, stem diameter, and fresh weight of shoot and root systems of ryegrass. The negative interference of growing populations of annual bluegrass occurred when in competition for the shoot and root systems of ryegrass. The fresh weight of shoots and roots were impacted when competing for the same strata. Ryegrass, established after the population of annual bluegrass, showed less competitive capacity. The negative interference of annual bluegrass in ryegrass is greater when the plants fully compete for the resources of the environment, and when the ryegrass establishes after the competitor.

ABSTRACT The use of auxin mimics herbicides in agriculture is widespread in a great diversity of crops. The indiscriminate use of herbicides can cause adverse effects in the plants. Among the plant species that stand out for being highly competitive and resistant to biotic and abiotic stresses, it is the brazilian peppertree (Schinus terebinthifolius Raddi.). The objective of this work was to evaluate the phytotoxic and photosynthetic alteration effects of different rates simulating the drift of the herbicides 2,4-D and Dicamba in brazilian peppertree seedlings. The experiment was carried out in a completely randomized design with four replications. The treatments were arranged in 2 x 8 factorial design (herbicide x doses). The factor herbicide consisted the herbicides 2,4-D and Dicamba, and, the factor doses eight percentages of the herbicide applied. Phytotoxicity and alteration of photosynthetic and fluorescence of chlorophyll a parameters were evaluated. Increased rate of the 2,4-D and Dicamba cause phytotoxicity to the plants, whose Dicamba promotes greater injuries. Dicamba was the herbicide that caused the greatest damage to the photosynthetic apparatus on brazilian peppertree plants, while for 2,4-D the plants showed higher recovery potential after herbicidal exposure.

Mitochondrial diseases, including those caused by defects in complex III of the respiratory chain, lack curative treatments. Here the authors report that the small molecule pyocyanin has beneficial effects in cells derived from patients with complex III-deficiency as well as in fly and zebrafish genetic models with reduced complex III activity.

Abstract TG2 is a multifunctional enzyme involved in several cellular processes and has emerging as a potential regulator of gene expression. In this regard, we have recently shown that TG2 is able to activate HSF1, the master transcriptional regulator of the stress‐responsive genes; however, its effect on the overall gene expression remains unclear. To address this point, we analyzed, by RNA-seq, the effect of TG2 on the overall transcriptome as well as we characterized the TG2 interactome in the nucleus. The data obtained from these omics approaches reveal that TG2 markedly influences the overall cellular transcriptome profile and specifically the Wnt and HSF1 pathways. In particular, its ablation leads to a drastic downregulation of many key members of these pathways. Interestingly, we found that key components of the Wnt/β-catenin pathway are also downregulated in cells lacking HSF1, thus confirming that TG2 regulates the HSF1 and this axis controls the Wnt signaling. Mechanistic studies revealed that TG2 can regulate the Wnt pathway by physically interacts with β-catenin and its nuclear interactome includes several proteins known to be involved in the regulation of the Wnt signaling. In order to verify whether this effect is playing a role in vivo, we ablated TG2 in Danio rerio. Our data show that the zebrafish lacking TG2 cannot complete the development and their death is associated with an evident downregulation of the Wnt pathway and a defective heat-shock response. Our findings show for the first time that TG2 is essential for the correct embryonal development of lower vertebrates, and its action is mediated by the Wnt/HSF1 axis.

Resumo Fundamento Remoção de cabos-eletrodos de dispositivos cardíacos eletrônicos implantáveis (DCEI) é procedimento pouco frequente e sua realização exige longo treinamento profissional e infraestrutura adequada. Objetivos Avaliar a efetividade e a segurança da remoção de cabos-eletrodos de DCEI e determinar fatores de risco para complicações cirúrgicas e mortalidade em 30 dias. Métodos Estudo prospectivo com dados derivados da prática clínica. De janeiro/2014 a abril/2020, foram incluídos, consecutivamente, 365 pacientes submetidos à remoção de cabos-eletrodos, independentemente da indicação e técnica cirúrgica utilizada. Os desfechos primários foram: taxa de sucesso do procedimento, taxa combinada de complicações maiores e morte intraoperatória. Os desfechos secundários foram: fatores de risco para complicações intraoperatórias maiores e morte em 30 dias. Empregou-se análise univariada e multivariada, com nível de significância de 5%. Resultados A taxa de sucesso do procedimento foi de 96,7%, sendo 90,1% de sucesso completo e 6,6% de sucesso clínico. Complicações maiores intraoperatórias ocorreram em 15 (4,1%) pacientes. Fatores preditores de complicações maiores foram: tempo de implante dos cabos-eletrodos ≥ 7 anos (OR= 3,78, p= 0,046) e mudança de estratégia cirúrgica (OR= 5,30, p= 0,023). Classe funcional III-IV (OR= 6,98, p

Este artigo traz a proposta da analisar a viabilidade econômico-financeira de investimento para expansão do terminal de contêineres no complexo portuário de São Sebastião, no Estado de São Paulo. Em termos de objetivo, busca-se demonstrar o estudo do investimento e analisar a oferta de recursos em infraestrutura aquaviária para sanar a demanda de cargas para importação e exportação. Foram utilizadas para a realização deste trabalho a revisão bibliográfica, pesquisa documental e a utilização de ferramentas de análise financeira: Valor Presente Líquido, Taxa Interna de Retorno, Custo Médio Ponderado de Capital e Análise de Cenários. Realizaram-se estimativas de custos de investimentos, receitas, custos operacionais e despesas administrativas. Com base nessa modelagem, foi possível aferir o fluxo de caixa livre. Constata-se que a taxa interna de retorno do projeto nos três cenários – otimista, realista e pessimista – foi superior à taxa mínima de atratividade, referenciada pela ANTAQ. Conclui-se que o investimento em um terminal de contêineres no Porto de São Sebastião é viável.

In the 1980s, the anti-evolutionary turn of humanities and the “vanishing” of primitive cultures and their crafts provoked what Shelly Errington terms as the “double death of authentic primitive art.” In more recent times, Errington continues, the increasing postmodern blur of high and low art have further disconnected the notions of “authentic” and “primitive” from art. In this paper, I contend that the current topicality of these notions in reference to art within the dynamics of the Art Zone, that is, the zone of negotiations between the different (f)actors involved in the art market. To support my argument, I take into examination one of the most iconic art traditions of this category, that of the Asmat of West Papua (Indonesia). By retracing its process of art formation, I investigate the current state of the art of the multifaceted notions of “authenticity” and “primitivism” both in the reality of Asmat land and the hyperreality of the theme park of Taman Mini “Indonesia Indah” in Jakarta. This combined exploration of Asmat art will provide a reassessment in emic terms of the paradigm of authentic primitive art as well as a sketch of the complexities and ambiguities that characterise the Art Zone.

OBJECTIVES:. Data on cardiac arrest survivors from developing countries are scarce. This study investigated clinical characteristics associated with in-hospital mortality in resuscitated patients following cardiac arrest in Brazil. DESIGN:. Retrospective analysis of prospectively collected data. SETTING:. Ninety-two general ICUs from 55 hospitals in Brazil between 2014 and 2015. PATIENTS:. Adult patients with cardiac arrest admitted to the ICU. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. We analyzed 2,296 patients (53% men; median 67 yr (interquartile range, 54–79 yr]). Eight-hundred patients (35%) had a primary admission diagnosis of cardiac arrest suggesting an out-of-hospital cardiac arrest; the remainder occurred after admission, comprising an in-hospital cardiac arrest cohort. Overall, in-hospital mortality was 83%, with only 6% undergoing withholding/withdrawal-of-life support. Random-effects multivariable Cox regression was used to assess associations with survival. After adjusting for age, sex, and severity scores, mortality was associated with shock (adjusted odds ratio, 1.25 [95% CI, 1.11–1.39]; p < 0.001), temperature dysregulation (adjusted odds ratio for normothermia, 0.85 [95% CI, 0.76–0.95]; p = 0.007), increased lactate levels above 4 mmol/L (adjusted odds ratio, 1.33 [95% CI, 1.1–1.6; p = 0.009), and surgical or cardiac cases (adjusted odds ratio, 0.72 [95% CI, 0.6–0.86]; p = 0.002). In addition, survival was better in patients with probable out-of-hospital cardiac arrest, unless ICU admission was delayed (adjusted odds ratio for interaction, 1.63 [95% CI, 1.21–2.21]; p = 004). CONCLUSIONS:. In a large multicenter cardiac arrest cohort from Brazil, we found a high mortality rate and infrequent withholding/withdrawal of life support. We also identified patient profiles associated with worse survival, such as those with shock/hypoperfusion and arrest secondary to nonsurgical admission diagnoses. Our findings unveil opportunities to improve postarrest care in developing countries, such as prompt ICU admission, expansion of the use of targeted temperature management, and implementation of shock reversal strategies (i.e., early coronary angiography), according to modern guidelines recommendations.

Introdução: A água é um recurso natural de importância vital a todos os seres vivos, mas, quando está poluída, pode ser a causa de várias doenças. Uma grande variedade de substâncias contaminantes tem sido encontrada nas águas subterrâneas e o nitrato é o poluente de ocorrência mais frequente. Objetivo: O objetivo deste trabalho foi determinar a concentração de nitrato em amostras de água de poços de sistemas de abastecimento público e soluções alternativas coletivas de 22 municípios das regiões e Marília e Assis, São Paulo. Método: Foram coletadas 157 amostras de água de poços cadastrados nas Vigilâncias Sanitárias municipais e as análises foram realizadas pelo método espectrofotométrico na região Ultravioleta (UV), segundo métodos físicoquímicos para análise de alimentos do Instituto Adolfo Lutz. Resultados: Do total de 157 amostras analisadas, estavam de acordo com a legislação vigente 141 amostras (89,8%) e em desacordo 16 amostras (10,2%). Conclusões: Conclui-se, com os resultados deste estudo, que a análise de nitrato é de extrema importância para avaliar os riscos à saúde humana e ao ambiente. Sugere-se o monitoramento anual dos poços que apresentaram concentrações de nitrato entre 5 e 10 mg/L e a promoção de políticas públicas que garantam à população o acesso à água em conformidade com os padrões legais vigentes.

Abstract Background Zika virus (ZIKV) has been isolated from many mosquito species in nature, but it is believed that the main vectors in urban environments are species of the genus Aedes. Here, we detected and isolated ZIKV in samples from Aedes aegypti, Aedes taeniorhynchus and Culex quinquefasciatus, collected during the Zika epidemic in Vitória, southeast Brazil. Using quantitative real-time polymerase chain reaction, ZIKV detection was performed in mosquito samples collected from February to April 2016. Results Overall, six pools of mosquitoes were positive for ZIKV: four of Cx. quinquefasciatus, one of Ae. aegypti and one of Ae. taeniorhynchus. Their genomes were sequenced. Conclusions These results support and strengthen the hypothesis that other mosquito species can also be involved in ZIKV transmission.

Abstract Background: Considering the potential deleterious effects of right ventricular (RV) pacing, the hypothesis of this study is that isolated left ventricular (LV) pacing through the coronary sinus is safe and may provide better clinical and echocardiographic benefits to patients with bradyarrhythmias and normal ventricular function requiring heart rate correction alone. Objective: To assess the safety, efficacy, and effects of LV pacing using an active-fixation coronary sinus lead in comparison with RV pacing, in patients eligible for conventional pacemaker (PM) implantation. Methods: Randomized, controlled, and single-blinded clinical trial in adult patients submitted to PM implantation due to bradyarrhythmias and systolic ventricular function ≥ 0.40. Randomization (RV vs. LV) occurred before PM implantation. The main results of the study were procedural success, safety, and efficacy. Secondary results were clinical and echocardiographic changes. Chi-squared test, Fisher's exact test and Student's t-test were used, considering a significance level of 5%. Results: From June 2012 to January 2014, 91 patients were included, 36 in the RV Group and 55 in the LV Group. Baseline characteristics of patients in both groups were similar. PM implantation was performed successfully and without any complications in all patients in the RV group. Of the 55 patients initially allocated into the LV group, active-fixation coronary sinus lead implantation was not possible in 20 (36.4%) patients. The most frequent complication was phrenic nerve stimulation, detected in 9 (25.7%) patients in the LV group. During the follow-up period, there were no hospitalizations due to heart failure. Reductions of more than 10% in left ventricular ejection fraction were observed in 23.5% of patients in the RV group and 20.6% of those in the LV group (p = 0.767). Tissue Doppler analysis showed that 91.2% of subjects in the RV group and 68.8% of those in the LV group had interventricular dyssynchrony (p = 0.022). Conclusion: The procedural success rate of LV implant was low, and the safety of the procedure was influenced mainly by the high rate of phrenic nerve stimulation in the postoperative period.

Debates around the significance, function and social value of museums are still challenging museum practices and models. In particular, the demands of “source communities” for self-representation and self-emancipation in the global community continue to call into question the role of the museum as a catalyst for promoting social change across cultures. In this paper, I push this question further by discussing the desires of a group of Roman Catholic woodcarvers in central Asmat (Indonesian Papua) to build a museum for exhibiting their carvings in the Vatican. To them, the Vatican is not only the sacred centre of Catholicism but also an integral part of their mythical world of ancestors. After a brief examination of their considerations, I attempt to put their ambitious museum idea into dialogue with current debates on “the postcolonial museum” to highlight how it can dictate new directions for indigenising museums.

Radar-absorbing materials (RAMs) have been used in military applications for several decades to reduce radar detection of vessels and aircrafts. In the present work, the performance of Ni0.35Zn0.35Cu0.3Fe2O4 ferrite as a RAM is investigated. The ferrite was firstly synthesized by combustion reaction and then calcinated at 1200 °C for 1 h. Composites were prepared with 80:20, 70:30 and 60:40 concentrations in weight of ferrite:polychloroprene. The X-ray diffraction (XRD) analysis showed a single phase ferrite formation and the scanning electron microscopy (SEM) analysis of the composites showed a good dispersion of the ferrite in the polychloroprene matrix. The electromagnetic (EM) characterization of the composites revealed that the EM attenuation is mainly attributed to magnetic losses observed in the material. The 80:20 composite achieved the best performance and presented a reflectivity of -26.7 dB at 10.2 GHz.

BACKGROUND AND OBJECTIVE:In the present study, we compared the effect of diabetic pregnancy on the rectus abdominis muscle (RAM) in humans and rats. We hypothesized that our animal model could provide valuable information about alterations in the RAM of women with Gestational Diabetes (GDM). METHOD:Newborns female rats (n = 10/group) were administered streptozotocin (100 mg/kg body weight) subcutaneously and were mated on reaching adulthood, to develop the mild hyperglycemic pregnant (MHP) rat model. At the end of pregnancy, the mothers were sacrificed, and the RAM tissue was collected. Pregnant women without GDM (non-GDM group; n = 10) and those diagnosed with GDM (GDM group; n = 8) and undergoing treatment were recruited, and RAM samples were obtained at C-section. The RAM architecture and the distribution of the fast and slow fibers and collagen were studied by immunohistochemistry. RESULTS:No statistically significant differences in the maternal and fetal characters were observed between the groups in both rats and women. However, significant changes in RAM architecture were observed. Diabetes in pregnancy increased the abundance of slow fibers and decreased fast fiber number and area in both rats and women. A decrease in collagen distribution was observed in GDM women; however, a similar change was not observed in the MHP rats. CONCLUSION:Our results indicated that pregnancy- associated diabetes- induced similar structural adaptations in the RAM of women and rats with slight alterations in fiber type number and area. These findings suggest that the MHP rat model can be used for studying the effects of pregnancy-associated diabetes on the fiber structure of RAM.

O Registro Brasileiro de Marcapassos (RBM) é uma base de dados nacional. que tem por finalidade coletar e divulgar informaçoes concernentes aos procedimentos cirúrgicos realizados em pacientes que utilizam a estimulação cardíaca artificial permanente em todo o Brasil. No período de 01/01/95 a 31/04/95 foram recebidos 2620 formulários enviados por 113 hospitais e 228 médicos diferentes. Os procedimentos referiam-se a 1911 implantes iniciais (74,1 %); 650 reoperações (25,2%) e 17 formulários exibiam esse campo de cadastramento como dado nao disponível (0,7%). Dos 1911 pacientes submetidos a implante inicial, 50,6% eram do sexo masculino e 77,9% eram da raça branca. Sintomas de hipofluxo cerebral justificaram o implante em 80,6% dos pacientes e a insuficiência cardíaca congestiva esteve presente em 89,2%. Os achados eletrocardiográficos predominantes foram: bloqueio atrioventricular total (58,6%); disfunçao do nó sinusal (15,8%), bloqueio AV do 2º grau (13,5%) e flütter ou fibrilaçao atrial com baixa resposta ventricular (6,9%). A doença de Chagas foi a etiologia predominante (32,5%). Foi realizado implante de marcapasso ventricular em 79,2% dos pacientes e atrioventricular em 20,5%. Dos 650 casos de reoperações informados, 73,9% ocorreram por problema no gerador de pulsos. O tempo transcorrido entre o implante inicial e a cirurgia descrita variou de 1 mês a 25 anos com média de 12,6 anos. A substituição do gerador de pulsos foi informada em 584 pacientes (89,9% dos casos de reoperaçao); sendo a principal causa de troca o esgotamento por fim de vida do gerador em 82,4%. A substituiçao de eletrodo atrial foi relatada em 7 pacientes e de eletrodo ventricular em 100 pacientes.

En 1899 arranca el primer gobierno de Francisco Silvela. Con él, detentando el Ministerio de Gobernación, un prestigioso abogado que había accedido a la política quince años atrás; Eduardo Dato. Tras investigar un asunto de grave corrupción en el consistorio de Madrid como subsecretario de Gobernación, en 1892, había pasado a formar parte de la disidencia conservadora encabezada por Silvela. Tras la pérdida de las colonias, las drásticas reformas económicas emprendidas en 1899 por el ministro Fernández Villaverde, propiciaron en Cataluña una huelga comercial e industrial conocida como «el tancament de caixes». El origen lo constituía una reforma tributaria, pero la confluencia con las tensiones descentralizadoras convirtieron el asunto en una auténtica crisis política; crisis que pasaría a la memoria por las “pitadas” y altercados callejeros durante la visita del propio Dato a la región durante el mes de mayo de 1900. Nuestro objetivo es ahondar en las circunstancias que rodearon dicha visita acudiendo a prensa de época así como a documentos de archivos. In 1899 the first Government of Francisco Silvela began. Included in his government, appointed to the Ministry of the Interior, was Eduardo Dato, a prestigious lawyer who had began his political career fifteen years earlier. After investigating a matter of serious corruption in the town hall of Madrid as an Undersecretary of the Government in 1892, he left his government post to became part of the conservative dissension led by Silvela. After the loss of the colonies, the drastic economic reforms undertaken in 1899 by his Government led to a commercial and industrial strike known as “The Closing of the Cashboxes” in Catalonia. Tax reform was the impetus of the strike, but when combined with the tension of decentralization, the issue evolved into a true political crisis; this crisis would become part of the nationalist history of Catalonia through the "protests" and street riots that occurred during Dato’s visit to the region in the month of May of 1900. Our objective is to delve into the circumstances surrounding the visit going to period press and archival documents. Palabras clave Dato; Catalaluña; Durán y Bas; Silvela; descentralización; La Veu de Catalunya

ABSTRACT Objective Vitamin D has several metabolic functions and possible reproductive functions. This study aimed to determine the prevalence of vitamin D deficiency among Brazilian women of reproductive age, and to evaluate the relationship between serum 25-hydroxyvitamin D [25(OH)D] concentrations and infertility causes. Subjects and methods This retrospective cross-sectional study evaluated data from a private Brazilian assisted reproduction center that were collected between January 1 and May 5, 2012. Serum 25(OH)D concentrations were measured and compared for infertile and fertile women. Concentrations of 25(OH)D that were < 20 ng/mL were defined as deficiency and concentrations of 21-30 ng/mL were defined as hypovitaminosis D. Results Among the 369 evaluated women, 81.1% exhibited hypovitaminosis D and 32.0% exhibited deficiency. The infertile and control patients did not exhibit any significant differences in the prevalence of vitamin D deficiency (30.2% vs. 35%, respectively; p = 0.33) or in the mean 25(OH)D concentrations (24.3 ± 7.9 ng/mL vs. 23.8 ± 8.7 ng/mL, respectively; p = 0.51). Furthermore, there were no significant differences in the mean 25(OH)D concentrations among subgroups of patients with single infertility factors, or between these subgroups and the control group. Conclusions A high proportion of Brazilian women of reproductive age exhibited vitamin D deficiency, regardless of their fertility status. Thus, it may be useful to evaluate this population for vitamin D deficiency, although future studies are needed to determine whether this deficiency might affect the outcomes of treatments for infertility.

Wnt signaling is an important pathway mainly active during embryonic development and controlling cell proliferation. This regulatory pathway is aberrantly activated in several human diseases. Ion channels are known modulators of several important cellular functions ranging from the tuning of the membrane potential to modulation of intracellular pathways, in particular the influence of ion channels in Wnt signaling regulation has been widely investigated. This review will discuss the known links between ion channels and canonical Wnt signaling, focusing on their possible roles in human metabolic diseases, neurological disorders, and cancer.

Mitochondria are key intracellular organelles involved not only in the metabolic state of the cell, but also in several cellular functions, such as proliferation, Calcium signaling, and lipid trafficking. Indeed, these organelles are characterized by continuous events of fission and fusion which contribute to the dynamic plasticity of their network, also strongly influenced by mitochondrial contacts with other subcellular organelles. Nevertheless, mitochondria release a major amount of reactive oxygen species (ROS) inside eukaryotic cells, which are reported to mediate a plethora of both physiological and pathological cellular functions, such as growth and proliferation, regulation of autophagy, apoptosis, and metastasis. Therefore, targeting mitochondrial ROS could be a promising strategy to overcome and hinder the development of diseases such as cancer, where malignant cells, possessing a higher amount of ROS with respect to healthy ones, could be specifically targeted by therapeutic treatments. In this review, we collected the ultimate findings on the blended interplay among mitochondrial shaping, mitochondrial ROS, and several signaling pathways, in order to contribute to the dissection of intracellular molecular mechanisms involved in the pathophysiology of eukaryotic cells, possibly improving future therapeutic approaches.

Summary: Wnt signaling affects fundamental development pathways and, if aberrantly activated, promotes the development of cancers. Wnt signaling is modulated by different factors, but whether the mitochondrial energetic state affects Wnt signaling is unknown. Here, we show that sublethal concentrations of different compounds that decrease mitochondrial ATP production specifically downregulate Wnt/β-catenin signaling in vitro in colon cancer cells and in vivo in zebrafish reporter lines. Accordingly, fibroblasts from a GRACILE syndrome patient and a generated zebrafish model lead to reduced Wnt signaling. We identify a mitochondria-Wnt signaling axis whereby a decrease in mitochondrial ATP reduces calcium uptake into the endoplasmic reticulum (ER), leading to endoplasmic reticulum stress and to impaired Wnt signaling. In turn, the recovery of the ATP level or the inhibition of endoplasmic reticulum stress restores Wnt activity. These findings reveal a mechanism that links mitochondrial energetic metabolism to the control of the Wnt pathway that may be beneficial against several pathologies. : Wnt signaling and mitochondrial fitness are both important for cell fate. Costa et al. demonstrate that the reduction of mitochondrial ATP production leads to the induction of ER stress and, in turn, decreases canonical Wnt/β-catenin signaling in vitro and in vivo. Keywords: mitochondrial fitness, mitochondrial ATP, canonical Wnt signaling, β-catenin, ER stress, colon cancer, SERCA

AbstractBackground:The recording of arrhythmic events (AE) in renal transplant candidates (RTCs) undergoing dialysis is limited by conventional electrocardiography. However, continuous cardiac rhythm monitoring seems to be more appropriate due to automatic detection of arrhythmia, but this method has not been used.Objective:We aimed to investigate the incidence and predictors of AE in RTCs using an implantable loop recorder (ILR).Methods:A prospective observational study conducted from June 2009 to January 2011 included 100 consecutive ambulatory RTCs who underwent ILR and were followed-up for at least 1 year. Multivariate logistic regression was applied to define predictors of AE.Results:During a mean follow-up of 424 ± 127 days, AE could be detected in 98% of patients, and 92% had more than one type of arrhythmia, with most considered potentially not serious. Sustained atrial tachycardia and atrial fibrillation occurred in 7% and 13% of patients, respectively, and bradyarrhythmia and non-sustained or sustained ventricular tachycardia (VT) occurred in 25% and 57%, respectively. There were 18 deaths, of which 7 were sudden cardiac events: 3 bradyarrhythmias, 1 ventricular fibrillation, 1 myocardial infarction, and 2 undetermined. The presence of a long QTc (odds ratio [OR] = 7.28; 95% confidence interval [CI], 2.01–26.35; p = 0.002), and the duration of the PR interval (OR = 1.05; 95% CI, 1.02–1.08; p < 0.001) were independently associated with bradyarrhythmias. Left ventricular dilatation (LVD) was independently associated with non-sustained VT (OR = 2.83; 95% CI, 1.01–7.96; p = 0.041).Conclusions:In medium-term follow-up of RTCs, ILR helped detect a high incidence of AE, most of which did not have clinical relevance. The PR interval and presence of long QTc were predictive of bradyarrhythmias, whereas LVD was predictive of non-sustained VT.

Mitochondria are organelles that are mainly involved in the generation of ATP by cellular respiration. In addition, they modulate several intracellular functions, ranging from cell proliferation and differentiation to cell death. Importantly, mitochondria are social and can interact with other organelles, such as the Endoplasmic Reticulum, lysosomes and peroxisomes. This symbiotic relationship gives advantages to both partners in regulating some of their functions related to several aspects of cell survival, metabolism, sensitivity to cell death and metastasis, which can all finally contribute to tumorigenesis. Moreover, growing evidence indicates that modulation of the length and/or numbers of these contacts, as well as of the distance between the two engaged organelles, impacts both on their function as well as on cellular signaling. In this review, we discuss recent advances in the field of contacts and communication between mitochondria and other intracellular organelles, focusing on how the tuning of mitochondrial function might impact on both the interaction with other organelles as well as on intracellular signaling in cancer development and progression, with a special focus on calcium signaling.

Abstract Background: Venous obstructions are common in patients with transvenous cardiac implantable electronic devices, but they rarely cause immediate clinical problems. The main consequence of these lesions is the difficulty in obtaining venous access for additional leads implantation. Objectives: We aimed to assess the prevalence and predictor factors of venous lesions in patients referred to lead reoperations, and to define the role of preoperative venography in the planning of these procedures. Methods: From April 2013 to July 2016, contrast venography was performed in 100 patients referred to device upgrade, revision and lead extraction. Venous lesions were classified as non-significant (< 50%), moderate stenosis (51-70%), severe stenosis (71-99%) or occlusion (100%). Collateral circulation was classified as absent, discrete, moderate or accentuated. The surgical strategy was defined according to the result of the preoperative venography. Univariate analysis was used to investigate predictor factors related to the occurrence of these lesions, with 5% of significance level. Results: Moderate venous stenosis was observed in 23%, severe in 13% and occlusions in 11%. There were no significant differences in relation to the device side or the venous segment. The usefulness of the preoperative venography to define the operative tactic was proven, and in 99% of the cases, the established surgical strategy could be performed according to plan. Conclusions: The prevalence of venous obstruction is high in CIED recipients referred to reoperations. Venography is highly indicated as a preoperative examination for allowing the adequate surgical planning of procedures involving previous transvenous leads.

Background: Isolated congenital atrioventricular block (CAVB) is a rare condition with multiple clinical outcomes. Ventricular remodeling can occur in approximately 10% of the patients after pacemaker (PM) implantation. Objectives: To assess the functional capacity of children and young adults with isolated CAVB and chronic pacing of the right ventricle (RV) and evaluate its correlation with predictors of ventricular remodeling. Methods: This cross-sectional study used a cohort of patients with isolated CAVB and RV pacing for over a year. The subjects underwent clinical and echocardiographic evaluation. Functional capacity was assessed using the six-minute walk test. Chi-square test, Fisher's exact test, and Pearson correlation coefficient were used, considering a significance level of 5%. Results: A total of 61 individuals were evaluated between March 2010 and December 2013, of which 67.2% were women, aged between 7 and 41 years, who were using PMs for 13.5 ± 6.3 years. The percentage of ventricular pacing was 97.9 ± 4.1%, and the duration of the paced QRS complex was 153.7 ± 19.1 ms. Majority of the subjects (95.1%) were asymptomatic and did not use any medication. The mean distance walked was 546.9 ± 76.2 meters and was strongly correlated with the predicted distance (r = 0.907, p = 0.001) but not with risk factors for ventricular remodeling. (Arq Bras Cardiol. 2014; [online].ahead print, PP.0-0) Conclusions: The functional capacity of isolated CAVB patients with chronic RV pacing was satisfactory but did not correlate with risk factors for ventricular remodeling.

Abstract Background: Few studies have characterized the surgical outcomes following epicardial pacemaker implantation in neonates with congenital complete atrioventricular block (CCAVB). Objective: This study sought to assess the long-term outcomes of a minimally invasive epicardial approach using a subxiphoid access for pacemaker implantation in neonates. Methods: Between July 2002 and February 2015, 16 consecutive neonates underwent epicardial pacemaker implantation due to CCAVB. Among these, 12 (75.0%) had congenital heart defects associated with CCAVB. The patients had a mean age of 4.7 ± 5.3 days and nine (56.3%) were female. Bipolar steroid-eluting epicardial leads were implanted in all patients through a minimally invasive subxiphoid approach and fixed on the diaphragmatic ventricular surface. The pulse generator was placed in an epigastric submuscular position. Results: All procedures were successful, with no perioperative complications or early deaths. Mean operating time was 90.2 ± 16.8 minutes. None of the patients displayed pacing or sensing dysfunction, and all parameters remained stable throughout the follow-up period of 4.1 ± 3.9 years. Three children underwent pulse generator replacement due to normal battery depletion at 4.0, 7.2, and 9.0 years of age without the need of ventricular lead replacement. There were two deaths at 12 and 325 days after pacemaker implantation due to bleeding from thrombolytic use and progressive refractory heart failure, respectively. Conclusion: Epicardial pacemaker implantation through a subxiphoid approach in neonates with CCAVB is technically feasible and associated with excellent surgical outcomes and pacing lead longevity.

A despeito da utilizaçao de profilaxia antibiótica, tanto nos implantes iniciais como nos procedimentos de reoperaçao, as taxas de infecçao relacionada aos dispositivos cardíacos eletrônicos implantáveis têm aumentado progressivamente, causando impacto na mortalidade e custos hospitalares. O tratamento de processos infecciosos relacionados aos dispositivos cardíacos eletrônicos implantáveis consiste na remoçao completa do sistema de estimulaçao cardíaca, associada a terapia antimicrobiana sistêmica e reimplante de um novo dispositivo cardíaco. Neste artigo, relatamos o caso clínico de paciente com infecçao na loja do gerador de pulsos sem evidências de infecçao intravascular. O implante de marcapasso atrioventricular epicárdico subxifoide foi utilizado como estratégia para diminuir o risco de contaminaçao do novo sistema e facilitar a remoçao transvenosa dos eletrodos antigos abandonados sob melhores condiçoes técnicas.

PURPOSE: To assess the effectiveness of bipolar epicardial atrial pacing using an active fixation bipolar endocardial lead implanted on the atrial surface in an experimental model. METHODS: A total of ten Large White adult pigs underwent pacemaker implantation under general anesthesia. Atrial pacing and sensing parameters were obtained at the procedure, immediate postoperative period and on the 7th and the 30th postoperative in unipolar and bipolar configurations. RESULTS: All procedures were successfully performed. There were no perioperative complications and no early deaths. Atrial pacing and sensing parameters for both unipolar and bipolar modes remained stable throughout the study. We observed a progressive increase in atrial thresholds, ranging from 0.49 ± 0.35 (at implantation) to 1.86 ± 1.31 volts (30th postoperative day), in unipolar mode. Atrial impedance measurements decreased slightly over time, ranging from 486.80 ± 126.35 Ohms (at implantation) to 385.0 ± 80.52 Ohms (30th postoperative day). Atrial sensing measures remained stable from the immediate postoperative period until the end of the study. CONCLUSION: The bipolar active fixation endocardial lead implanted epicardially can provide stable conditions of pacing and sensing parameters throughout the postoperative follow-up.

Abstract Background: Complications after surgical procedures in patients with cardiac implantable electronic devices (CIED) are an emerging problem due to an increasing number of such procedures and aging of the population, which consequently increases the frequency of comorbidities. Objective: To identify the rates of postoperative complications, mortality, and hospital readmissions, and evaluate the risk factors for the occurrence of these events. Methods: Prospective and unicentric study that included all individuals undergoing CIED surgical procedures from February to August 2011. The patients were distributed by type of procedure into the following groups: initial implantations (cohort 1), generator exchange (cohort 2), and lead-related procedures (cohort 3). The outcomes were evaluated by an independent committee. Univariate and multivariate analyses assessed the risk factors, and the Kaplan-Meier method was used for survival analysis. Results: A total of 713 patients were included in the study and distributed as follows: 333 in cohort 1, 304 in cohort 2, and 76 in cohort 3. Postoperative complications were detected in 7.5%, 1.6%, and 11.8% of the patients in cohorts 1, 2, and 3, respectively (p = 0.014). During a 6-month follow-up, there were 58 (8.1%) deaths and 75 (10.5%) hospital readmissions. Predictors of hospital readmission included the use of implantable cardioverter-defibrillators (odds ratio [OR] = 4.2), functional class III-IV (OR = 1.8), and warfarin administration (OR = 1.9). Predictors of mortality included age over 80 years (OR = 2.4), ventricular dysfunction (OR = 2.2), functional class III-IV (OR = 3.3), and warfarin administration (OR = 2.3). Conclusions: Postoperative complications, hospital readmissions, and deaths occurred frequently and were strongly related to the type of procedure performed, type of CIED, and severity of the patient's underlying heart disease.

The cynomolgus monkey (Macaca fascicularis) is a well-known non-human primate species commonly used in non-clinical research. It is important to know basal clinical pathology parameters in order to have a reference for evaluating any potential treatment-induced effects, maintaining health status among animals and, if needed, evaluating correct substantiative therapies. In this study, data from 238 untreated cynomolgus monkeys (119 males and 119 females of juvenile age, 2.5 to 3.5 years) kept under laboratory conditions were used to build up a reference database of clinical pathology parameters. Twenty-two hematology markers, 24 clinical chemistry markers and two blood coagulation parameters were analyzed. Gender-related differences were evaluated using statistical analyses. To assess the possible effects of stress induced by housing or handling involved in treatment procedures, 78 animals (35 males and 35 females out of 238 juvenile monkeys and four adult males and four adult females) were used to evaluate cortisol, corticosterone and behavioral assessment over time. Data were analyzed using a non-parametric statistical test and machine learning approaches. Reference clinical pathology data obtained from untreated animals may be extremely useful for investigators employing cynomolgus monkeys as a test system for non-clinical safety studies.

Dentre as complicaçoes relacionadas aos dispositivos cardíacos eletrônicos implantáveis, os processos infecciosos sao os de maior gravidade e de mais difícil tratamento. A taxa média de infecçoes relacionadas a esses dispositivos cardíacos relatada na literatura pode variar de 1% a 7% e resultam em importante impacto na morbimortalidade. Neste artigo relatamos o caso clínico de um paciente com infecçao crônica relacionada a cabo-eletrodo epicárdico abandonado, com manifestaçoes recorrentes, em que os achados da tomografia por emissao de pósitrons acoplada a tomografia computadorizada utilizando 18F-fluoro-2-deoxiglicose ajudaram o correto entendimento do processo e a conduçao do tratamento cirúrgico.

A síndrome do QT longo congênito representa importante distúrbio genético, e está associada a síncope, parada cardíaca e morte súbita. O diagnóstico é baseado principalmente na medida do intervalo QT corrigido associada a critérios clínicos e história familiar. A estratificaçao de risco auxilia na decisao terapêutica. Relatamos o caso de uma paciente com síndrome do QT longo congênito, portadora de marcapasso definitivo e nefropatia espoliadora de magnésio, que evoluiu com necessidade de upgrade para cardiodesfibrilador implantável na ocasiao da troca do gerador do dispositivo.

Processos infecciosos relacionados aos dispositivos cardíacos eletrônicos implantáveis estao entre as complicaçoes mais graves e de difícil tratamento. A incidência de infecçoes relacionadas aos dispositivos cardíacos eletrônicos implantáveis pode variar de 1% a 7%, apresentando considerável impacto na morbimortalidade. Estudos recentes têm demonstrado que a adiçao da tomografia por emissao de pósitrons acoplada à tomografia computadorizada aos critérios da Duke University modificados aumenta a sensibilidade e a especificidade do diagnóstico de infecçao relacionada aos dispositivos cardíacos eletrônicos implantáveis. Neste artigo relatamos o caso clínico de um paciente com suspeita de endocardite relacionada a cabo-eletrodo transvenoso abandonado e ressincronizador cardíaco epicárdico em uso, em que os achados da tomografia por emissao de pósitrons acoplada à tomografia computadorizada utilizando fluordesoxiglucose 18F ajudaram o correto entendimento do processo e a conduçao do tratamento cirúrgico.

The Cordilheira de Santana case, from now on referred to simply as Cordilheira, was conducted and reported with the main purpose of contributing to the understanding of the process of strategy formulation in the winery sector. It presents the case of a recently created small firm aiming to compete in the market by offering high quality based on reduced premium line products, with prices established in accordance. Even so, it has not achieved the expected results. The wine industry with its basis in the wineries of the extreme south of Brazil, which is the most productive sector in the whole country, is also discussed. The case study began in 2008, when Rosana, owner and director of the company, travelled from São Paulo to Porto Alegre and highly concerned that the expected results had not been achieved. Data included as a technical note on the wine industry provides information on the industry as a whole, enabling students to reconsider the firm´s positioning in the market. The teaching note that follows provides the professor with information that will allow him to explore several perspectives that will have to be faced by Rosana further. She may choose to strengthen the present strategy or to take it in a new direction.

In recent years, several experimental evidences have underlined a new role of ion channels in cancer development and progression. In particular, mitochondrial ion channels are arising as new oncological targets, since it has been proved that most of them show an altered expression during tumor development and the pharmacological targeting of some of them have been demonstrated to be able to modulate cancer growth and progression, both in vitro as well as in vivo in pre-clinical mouse models. In this scenario, pharmacology of mitochondrial ion channels would be in the near future a new frontier for the treatment of tumors. In this review, we discuss the new advances in the field, by focusing our attention on the improvements in new drug developments to target mitochondrial ion channels.

FUNDAMENTO: A cirurgia cardiovascular vem passando por transformações em decorrência do avanço das técnicas percutâneas, do tratamento clínico e da prevenção primária. OBJETIVO: Avaliar a incidência e a mortalidade de operações cardiovasculares realizadas no Instituto do Coração (InCor-HCFMUSP). MÉTODOS: A PARtir do banco de dados do Instituto do Coração, foram analisadas as operações cardiovasculares realizadas entre 1984 e 2007, considerando-se a tendência dos principais procedimentos e as taxas de mortalidade. RESULTADOS: Em 24 anos, foram realizadas 71.305 operações cardiovasculares, com uma média anual de 2.971 procedimentos. O número de cirurgias de revascularização miocárdica, que na década de 1980 tinha uma média de 856/ano, atualmente está por volta de 1.106/ano. Os procedimentos das valvas cardíacas passaram de 400 para 597 operações/ano, com um crescimento de 36,7% em relação à década de 1990. As correções das cardiopatias congênitas também tiveram um aumento expressivo de 50,8% em relação à última década. A mortalidade global média, que no início era de 7,5%, atualmente é de 7,0%, sendo de 4,9% entre os procedimentos eletivos. Nas cirurgias de revascularização miocárdica, a mortalidade média atual é de 4,8% e entre as operações valvares é de 8,5%. Nas correções das cardiopatias congênitas corresponde a 5,3%. CONCLUSÃO: A cirurgia cardiovascular continua em ascensão. A revascularização miocárdica ainda é a operação mais realizada. Entretanto, o perfil dos procedimentos vem se alterando com o maior crescimento da abordagem sobre as valvas cardíacas e das cardiopatias congênitas. As taxas de mortalidade são superiores quando comparadas aos índices internacionais, refletindo a alta complexidade apresentada em um serviço terciário e de referência nacional.FUNDAMENTO: La cirugía cardiovascular ha estado pasando por transformaciones como consecuencia del avance de las técnicas percutáneas, del tratamiento clínico y de la prevención primaria. OBJETIVO: Evaluar la incidencia y la mortalidad de operaciones cardiovasculares realizadas en el Instituto do Coração (InCor-HCFMUSP). MÉTODOS: A partir del banco de datos del Instituto do Coração, se analizaron las operaciones cardiovasculares realizadas entre el 1984 y el 2007, y se consideró como la tendencia de los principales procedimientos las tasas de mortalidad. RESULTADOS: En 24 años, se llevaron a cabo 71.305 operaciones cardiovasculares, con un promedio anual de 2.971 procedimientos. El número de cirugía de revascularización miocárdica, que en la década de 1980 tenía un promedio de 856/año, actualmente está por volta de 1.106/año. Los procedimientos de las válvulas cardiacas pasaron de 400 para 597 operaciones/año, con un crecimiento de un 36,7% en relación con la década del 1990. Las correcciones de las cardiopatías congénitas también tuvieron un aumento expresivo de un 50,8% con relación a la última década. La mortalidad global promedio, que en el inicio era de un 7,5%, actualmente es del 7%, con un 4,9% entre los procedimientos electivos. En las cirugías de revascularización miocárdica, la mortalidad promedio actual es de un 4,8% y entre las operaciones valvulares es de un 8,5%. En las correcciones de las cardiopatías congénitas corresponde a un 5,3%. CONCLUSIÓN: La cirugía cardiovascular sigue en ascensión. La revascularización miocárdica todavía es la operación más realizada. Sin embargo, el perfil de los procedimientos se viene alterando con el mayor crecimiento del abordaje sobre las válvulas cardiacas y de las cardiopatías congénitas. Las tasas de mortalidad son superiores cuando comparadas a los índices internacionales, reflejando la alta complejidad presentada en un servicio terciario y de referencia nacional.BACKGROUND: Cardiovascular surgery has been undergoing transformations due to the advancement of percutaneous techniques, clinical treatment and primary prevention. OBJECTIVE: Evaluation of incidence and mortality of heart surgeries performed at the Instituto do Coração (InCor-HCFMUSP). METHODS: Using database from the Instituto do Coração, analysis was carried out on cardiovascular surgeries performed between 1984 and 2007, taking into consideration trends of main procedures and of mortality rates. RESULTS: In 24 years, 71,305 heart surgeries were performed, with an annual average of 2971 procedures. The number of coronary artery bypass graft surgeries, which in the 1980s had an average of 856/year, is currently around 1.106/year. Heart valve procedures increased from 400 to 597 surgeries per year, growing 36.7%, when compared to the 1990s. Repair of congenital heart disease also had a significant increase of 50.8% in relation to the last decade. Global mortality average rate, which at baseline was 7.5%, is currently at 7.0% and 4.9% among elective procedures. In coronary artery bypass graft surgery, current average mortality rate is 4.8% and 8.5% in valve surgery. Repair of congenital heart disease accounts for 5.3%. CONCLUSION: Cardiovascular surgery continues increasing. The coronary artery bypass graft is still the most commonly performed surgery. However, profile of procedures has been undergoing changes with the largest increase of approach to cardiac valves and congenital heart disease. Mortality rates are higher when compared to international rates, reflecting the high complexity presented in tertiary service of national reference.

OBJETIVOS: Avaliar a utilidade da varfarina na prevenção dessas complicações nos pacientes de alto risco. MÉTODOS: Estudo clínico prospectivo, randomizado, cego, em pacientes submetidos ao primeiro implante transvenoso de DCEI, com FEVEOBJECTIVES: To evaluate the efficacy of prophylactic use of warfarin in patients with high risk of lead-associated thrombosis. METHODS: Clinical, prospective, randomized and blinded study, in patients submitted to first transvenous leads implantation with LVEF

FUNDAMENTO: O benefício da estimulação cardíaca em pacientes portadores de cardiomiopatia hipertrófica (CMH) tem sido questionado, sendo escassas as pesquisas sobre este assunto no Brasil. OBJETIVO: Descrever a indicação, a resposta clínica, as complicações e a sobrevida relacionadas ao implante de marcapasso em pacientes portadores de CMH. MÉTODOS: Foram estudados, retrospectivamente, 39 pacientes portadores de cardiomiopatia hipertrófica (41% do sexo masculino) submetidos a implante de marcapasso, no período de maio de 1980 a novembro de 2003. RESULTADOS: Houve 27 portadores da forma obstrutiva e 12 portadores da forma não-obstrutiva com média de idade de 46,4 anos (14-77 anos) seguidos por 6,4 ± 4,1 anos. As principais indicações para implante foram: bloqueio atrioventricular espontâneo ou induzido (54%), refratariedade à terapêutica associada a gradiente elevado (33%), suporte para terapia medicamentosa por bradicardia (8%) e prevenção de fibrilação atrial (5%). Houve melhora na classe funcional de 2,41±0,87 para 1,97±0,92 (p = 0,008), bem como redução do número de sintomas referidos, sem ter havido diferença na utilização da terapia medicamentosa. Não houve óbitos relacionados ao procedimento que, apesar de demonstrar-se seguro, não foi isento de complicações (6 pacientes - 15,4%). Ocorreram três óbitos durante o seguimento, todos em pacientes mulheres, portadoras de fibrilação atrial e com evidências de deterioração funcional. Observou-se uma forte associação de piora clínica com surgimento de fibrilação atrial ou flutter. CONCLUSÃO: A estimulação cardíaca artificial em pacientes com CMH foi bem-sucedida, com evidências de alívio sintomático em pacientes portadores da forma obstrutiva. Não se observou melhora funcional para a forma não-obstrutiva.BACKGROUND: The benefits of heart stimulation in hypertrophic cardiomyopathy (HCM) patients have been questioned. Research work available in Brazil on those benefits is scarce. OBJECTIVE: To describe the indication, clinical response, complications and survival time related to pacemaker implant in HCM patients. METHODS: Thirty-nine hypertrophic cardiomyopathy patients were studied (41% males) and submitted to pacemaker implant from May, 1980 through November, 2003. RESULTS: Twenty-seven patients presented obstructive hypertrophic cardiomyopathy, and 12, non-obstructive. Mean age was 46.4 years of age (range 14 - 77), with follow-up of 6.4 ± 4.1 years. Major indications for implant were: spontaneous or induced atrioventricular block (54%), refractoriness to therapeutic conduct associated to high gradient (33%), support for drug therapy to treat bradychardia (8%), and atrial fibrillation prevention (5%). Functional class was shown to improve from 2.41±0.87 to 1.97±0.92 (p = 0.008), and symptoms referred were reduced. No change was made in drug therapy administration. No procedure-related deaths were reported. Although shown to be safe, the procedure was not free from complications (6 patients - 15.4%). Three deaths occurred in the follow-up period - the three of them were atrial fibrillation female patients, with evidence of functional deterioration. A close association was observed between clinical condition worsening and the onset of atrial fibrillation or flutter. CONCLUSION: Cardiac pacing in HCM patients was successful, with evidence of symptoms relief in obstructive HCM patients. No functional improvement was observed in non-obstructive patients.

In this report, the efficiency of Adultrap under field conditions is compared to a CDC backpack aspirator and to MosquiTRAP. An urban dengue-endemic area of Rio de Janeiro was selected to evaluate the efficiency of mosquito traps in capturing Aedes aegypti females. Adultrap and aspirator captured similar numbers of Ae. aegypti females, with the former showing high specificity to gravid individuals (93.6%). A subsequent mark-release-recapture experiment was conducted to evaluate Adultrap and MosquiTRAP efficiency concomitantly. With a 6.34% recapture rate, MosquiTRAP captured a higher mean number of female Ae. aegypti per trap than Adultrap (Ç2 = 14.26; df = 1; p < 0,05). However, some MosquiTRAPs (28.12%) contained immature Ae. aegypti after 18 days of exposure in the field and could be pointed as an oviposition site for female mosquitoes. Both trapping methods, designed to collect gravid Ae. aegypti females, seem to be efficient, reliable and may aid routine Ae. aegypti surveillance.

FUNDAMENTO: A programação ideal da energia de choque do CDI deve ser pelo menos 10 J acima do limiar de desfibrilação (LDF), necessitando de técnicas alternativas quando o LDF é elevado. OBJETIVO: Avaliar o comportamento clínico dos portadores de CDI com LDF>25 J e a eficácia da terapêutica escolhida. MÉTODOS: Foram selecionados portadores de CDI, entre janeiro de 2000 e agosto de 2004 (banco de dados prospectivo), com LDF>25 J intra-operatório, e analisaram-se: características clínicas, FEVE, resgate de eventos arrítmicos pelo CDI e óbitos. RESULTADOS: dentre 476 pacientes, 16 (3,36%) apresentaram LDF>25J. Idade média de 56,5 anos, sendo 13 pacientes (81%) do sexo masculino. Quanto à cardiopatia de base 09 eram chagásicos, 04 isquêmicos e 03 com etiologia idiopática. A FEVE média dos pacientes foi 37% e 94% utilizavam amiodarona. O seguimento médio foi de 25,3 meses. Em 02 pacientes com LDF > Choque Máximo (CM), foi necessário implante de eletrodo de choque adicional (array), sendo mantido programação com CM em zona de FV (>182bpm) nos demais. Durante o seguimento 03 pacientes apresentaram 67 terapias de choque apropriadas (TCA) com sucesso. Ocorreram 07 óbitos sendo 5 por causas não cardíacas e 2 por insuficiência cardíaca avançada. Os pacientes que foram a óbito apresentaram níveis de LDF maiores (p=0,0446), entretanto sem relação com a causa dos mesmos tendo em vista que não ocorreram TCA sem sucesso. CONCLUSÃO: Nessa coorte de pacientes com CDI, a ocorrência de LDF elevado foi baixa, implicando terapêuticas alternativas. Houve associação com disfunção ventricular grave, entretanto sem correlação com as causas de óbito.BACKGROUND: The ideal programming of the implantable cardioverter defibrillator (ICD) shock energy should be at least 10J above the defibrillation threshold (DFT), requiring alternative techniques when the DFT is elevated. OBJECTIVE: To assess the clinical behavior of ICD patients with DFT>25J and the efficacy of the chosen therapy. METHODS: Patients who had undergone ICD implantation between Jan/00 and Aug/04 (prospective database) and presented intraoperative DFT>25J were selected. The analyzed variables were: clinical characteristics, LVEF, rescue of arrhythmic events from ICD and causes of deaths. RESULTS: among 476 patients, 16 (3.36%) presented DFT>25J. The mean age was 56.5 years, and 13 patients (81%) were men. According to the baseline cardiomyopathy, 09 patients had Chagas' disease, 04 had ischemic cardiomyopathy and 03 had idiopathic cardiomyopathy. Mean LVEF was 0.37 and amiodarone was used by 94% of the patients. Mean follow-up (FU) period was 25.3 months. DFT was higher than maximum energy shock (MES) in 2 patients and it was necessary to implant an additional shock electrode (array). It was programmed MES in ventricular fibrillation zone of ICD therapy in the other patients. In the FU, 03 patients had 67 successful appropriate shock therapies (AST). There were 05 noncardiac and 02 heart failure deaths. The patients who died showed higher DFT levels (p=0.044) without correlation with death because there wasn't unsuccessful AST. CONCLUSION: In this cohort of ICD patients, the occurrence of elevated DFT (>25J) was low, leading to alternative therapies. There was an association with severe ventricular dysfunction, although without correlation to the causes of death.