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Aims: The aim of this study was to determine the rate of major clinical events and its determinants in patients with previous cardiovascular event or not, and with or without diabetes from a middle-income country., Methods: REACT study is a multicenter registry conducted between July 2010 and May 2013 in Brazil. Patients were eligible if they were over 45years old and high cardiovascular risk. Patients were followed for 12months; data were collected regarding adherence to evidence-based therapies and occurrence of clinical events (all-cause mortality, non-fatal cardiac arrest, myocardial infarction, or stroke)., Results: A total of 5006 subjects was included and analyzed in four groups: No diabetes and no previous cardiovascular event, n=430; diabetes and no previous cardiovascular event, n=1138; no diabetes and previous cardiovascular event, n=1747; and diabetes and previous cardiovascular event, n=1691. Major clinical events in one-year follow-up occurred in 332 patients. A previous cardiovascular event was associated with a higher risk of having another event in the follow-up (HR 2.31 95% CI 1.74-3.05, p<0.001), as did the presence of diabetes (HR 1.28 95% CI 1.10-1.73, p=0.005). In patients with diabetes,failure to reach HbA1c targetswas related topoorer event-free survival compared to patients with good metabolic control (HR 1.70 95% CI 1.01-2.84, p=0.044)., Conclusions: In Brazil, diabetes confers high risk for major clinical events, but this condition is not equivalent to having a previous cardiovascular event. Moreover, not so strict targets for HbA1c in patients with diabetes and previous cardiovascular events might be considered., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objective: To evaluate the ability of different parameters of exercise treadmill test to detect autonomic dysfunction in hemodialysis patients., Methods: Cross-sectional study involving hemodialysis patients and a control group. Clinical examination, blood sampling, echocardiogram, 24-hour Holter, and exercise treadmill test were performed. A ramp treadmill protocol symptom-limited with active recovery was employed., Results: Forty-one hemodialysis patients and 41 controls concluded the study. There was significant difference between hemodialysis patients and controls in autonomic function parameters in 24h-Holter and exercise treadmill test. Probability of having autonomic dysfunction in hemodialysis patients compared to controls was 29.7 at the exercise treadmill test and 13.0 in the 24-hour Holter. Chronotropic index, heart rate recovery at the 1st min, and SDNN at exercise were used to develop an autonomic dysfunction score to grade autonomic dysfunction, in which, 83% of hemodialysis patients reached a scoring ≥2 in contrast to 20% of controls. Hemodialysis was independently associated with either altered chronotropic index or autonomic dysfunction scoring ≥2 in every tested model (OR=50.1, P=0.003; and OR=270.9, P=0.002, respectively, model 5)., Conclusion: The exercise treadmill test was feasible and useful to diagnose of the autonomic dysfunction in hemodialysis patients. Chronotropic index and autonomic dysfunction scoring ≥2 were the most effective parameters to differentiate between hemodialysis patients and controls suggesting that these variables portrays the best ability to detect autonomic dysfunction in this setting.

Background: Autonomic dysfunction (AD) is highly prevalent in hemodialysis (HD) patients and has been implicated in their increased risk of cardiovascular mortality., Objective: To correlate heart rate variability (HRV) during exercise treadmill test (ETT) with the values obtained when measuring functional aerobic impairment (FAI) in HD patients and controls., Methods: Cross-sectional study involving HD patients and a control group. Clinical examination, blood sampling, transthoracic echocardiogram, 24-hour Holter, and ETT were performed. A symptom-limited ramp treadmill protocol with active recovery was employed. Heart rate variability was evaluated in time domain at exercise and recovery periods., Results: Forty-one HD patients and 41 controls concluded the study. HD patients had higher FAI and lower HRV than controls (p<0.001 for both). A correlation was found between exercise HRV (SDNN) and FAI in both groups. This association was independent of age, sex, smoking, body mass index, diabetes, and clonidine or beta-blocker use, but not of hemoglobin levels., Conclusion: No association was found between FAI and HRV on 24-hour Holter or at the recovery period of ETT. Of note, exercise HRV was inversely correlated with FAI in HD patients and controls.

Common functional polymorphisms in β-adrenergic receptor (βAR) genes have been associated with heart failure (HF) phenotypes and pharmacogenetic interactions with βAR blockers. This study evaluated the association between βAR polymorphisms and carvedilol drug response and prognosis in patients with HF. In this prospective cohort controlled study, 326 volunteers were enrolled [146 HF patients (ejection fraction (EF)<50% by Simpson) and 180 healthy controls]. Drug response was evaluated by echocardiography and outcomes were mortality and hospitalization. DNA was extracted from peripheral blood leukocytes, fragments were amplified by the polymerase reaction and genotyped by restriction fragment length polymorphism (RFLP) for Ser49Gly and Arg389Gly βAR-1 polymorphisms and Gln27Glu and Arg16Gly βAR-2 polymorphisms. The study population was in Hardy‑Weinberg equilibrium. The survival rate was adjusted using the Kaplan-Meier method. HF patients showed the following characteristics: EF 35±9%, 69.9% male, age 59±13 years, 50.7% self-identified as black, 46% had ischemic etiology. The mean follow-up of 23 months showed 18 mortalities and 46 hospitalizations. The genotypes Glu27Glu (24.7 vs. 6.1%, p=0.0004) and Arg16Arg (72.6 vs. 22.8, p<0.0001) of βAR2 polymorphisms and Gly49Gly (33.6 vs. 4.3%, p<0.0001) of the βAR1 polymorphism were higher in HF patients compared with controls. Patients with hospital admission showed a significantly higher Gly389 allelic frequency (54.9 vs. 42.1%, p=0.039), and the trend prevailed among patients who succumbed to the disease (61.1%, p=0.047). Black patients with the Ser49Ser genotype showed a reduced survival compared with the Gly49Gly or Ser49Gly genotypes (p=0.028). There was no association between improved LVEF >20% and βAR polymorphisms. HF patients with β-blocker therapy and the Gly389 allele have reduced event-free survival compared to those carrying the Arg389 allele. Additionally, systolic HF outpatients undergoing β-blocker therapy, self‑identified as black and homozygous for Ser49Ser may have reduced event-free survival, while Glu27Glu, Arg16Arg and Gly49Gly genotypes may be associated with risk for HF.

Objective: To demonstrate the prevalence of stress hyperglycemia in a cohort of patients with acute coronary syndrome and to determine the correlation of stress hyperglycemia with death, heart failure and/or left ventricular systolic dysfunction during the intrahospital phase., Methods: A prospective initial cohort study of hospitalized patients with acute coronary syndrome with or without ST segment elevation. The groups were compared to demonstrate the correlation between stress hyperglycemia and cardiovascular events. The chi-square test or Fisher's exact test and student's t-test were used to compare the groups with and without stress hyperglycemia. The variables with p<0.20 in the univariate analysis were submitted to logistic regression., Results: In total, 363 patients with an average age of 12.45 ± 62.06 were studied. There was a predominance of males (64.2%). In total, 96 patients (26.4%) presented with stress hyperglycemia. There were no differences between the groups with or without stress hyperglycemia. The area under the ROC curve was 0.67 for the relationship between stress hyperglycemia and the composite outcome heart failure, left ventricular systolic dysfunction or death at the end of the hospital admission. The ROC curve proved that stress hyperglycemia was the predictor of the composite outcome (death, heart failure and/or ventricular dysfunction). The multivariate analysis did not indicate age, stress hyperglycemia or admission heart rate as risk factors., Conclusion: Stress hyperglycemia was common in the studied sample. In the univariate analysis, the presence of stress hyperglycemia was associated with such events as death, heart failure and/or intrahospital ventricular dysfunction in patients with acute coronary syndrome.

Background: Our study set out to determine the prevalence of depressive symptoms and variables that influence its presence in patients hospitalized for heart failure. Depression is associated with a substantially increased risk of developing heart failure in individuals at risk, and has been related to adverse outcomes in patients with established heart failure. It is important to determine its prevalence in different populations and assess related causes., Methods: We conducted a cross-sectional study of 103 patients with heart failure, admitted to public hospital, via a questionnaire that evaluates clinical variables, socio-demographics and we applied the Beck Depression Inventory to determine the prevalence of depressive symptoms and predictors of their presence. We used the chi2, Student test and considered significant when < 0.05 and subjected to logistic regression analysis when between 0.05 and 0.1., Results: The mean age of the patients in our study was 65.4 ± 13.6. Depressive symptoms were present in 69 (67%) patients: 35 (34%) had mild depressive symptoms, 22 (21.3%) had moderate symptoms and 12 (11.6%) patients presented severe symptoms. Marital status was significant when analyzed, and the predictors of depressive symptoms were marital status, sex, living arrangements and heart failure etiology., Conclusions: Because depressive symptoms in patients hospitalized for heart failure are very common, it is important to detect these disorders. The prevalence of these varies according to socio-demographic and clinical data, and these factors should be taken into consideration when planning future studies, as well as screening and intervention programs for co-morbid depressive disorders in hospitalized patients with heart failure.

Objectives: The length of stay after prolonged cardiac surgery has been associated with poor immediate outcomes and increased costs. This study aimed to evaluate the predictive power of the Ambler Score to anticipate the length of stay in the intensive care unit., Methods: This was a retrospective cohort study based on data collected from 110 patients undergoing valve replacement surgery alone or in combination with other procedures. Additive and logistic Ambler Scores were obtained and their predictive performances calculated using the Receiver Operating Characteristic curve. The normal length stay in the intensive care unit was assumed to be <3 days and prolonged >3 days. The areas under the receiver operating curves for both the additive and logistic models were compared using the Hanley-MacNeil test., Results: The mean intensive care unit length of stay was 4.2 days. Sixty-three patients were male. The logistic model showed areas under the receiver operating characteristic curve of 0.73 and 0.79 for hospitalization > 3 days and < 3 days, respectively, showing good discriminative power. For the additive model, the areas were 0.63 and 0.59 for hospitalization > 3 days and < 3 days, respectively, a poor discriminative power., Conclusions: In our database, prolonged length of stay in the intensive care unit was positively correlated with the logistic Ambler score. The performance of the logistic Ambler Score had good discriminative power for correlation with the intensive care unit length of stay.

Objective: To determine the differences in depressive symptoms (DS) among a sample of patients hospitalized with heart failure (HF)., Design: A descriptive, cross-sectional design was used., Methods: The Beck Depression Inventory was used to measure DS, and HF severity was assessed using the New York Heart Association (NYHA) classification system. The sociodemographic and clinical variables examined include age, sex, education, marital status, fixed monthly income, habitation, living arrangement and HF severity. The differences between the presence and absence of the variables were evaluated using the Student's t test., Results: The sample included 103 patients with a mean age of 65.4 years: 38 (36.9%) were men and 65 (63.1%) were women. Forty-three patients (41.7%) were in NYHA class III, and approximately one-half of the patient sample (49.5%) were married. Patients with NYHA class IV HF had significantly more DS than patients with NYHA class II or III. Age was correlated with scores of DS (P=0.002). There were significant differences in DS among the variables of marital status, habitation and living arrangement., Conclusions: Depression is a common and treatable clinical finding in hospitalized patients, requiring an early diagnosis and appropriate treatment for effective management. The implementation and monitoring of treatment are necessary to reduce the costs of treatment of HF.

Background: The laparoscopic transhiatal esophagectomy for benign or malignant disease is a complex operation associated with a high rate of morbidity and mortality. In the last decade this procedure gained popularity and acceptance for treatment of the esophagus cancer and other benign diseases., Aim: To perform a retrospective analysis in patients with esophageal cancer that was underwent a laparoscopic transhiatal esophagectomy, demonstrated pre and post operative complications and immediate result., Methods: From November 1993 to June 2005, 72 patients underwent laparoscopic transhiatal esophagectomy. Sixty-four with malignant neoplasm of esophagus. The males are predominant, and the mean age was 56.5 years. The abdominal part of the operation was totally laparoscopic and the cervical one was made the conventional way. The stomach was pulled up to the neck by the posterior mediastinum., Results: The laparoscopic transhiatal esophagectomy was initiated in 64 patients. Four patients were converted to open surgery. The mean operation time was 153 minutes. The incidence of cervical fistula was 14.06%. The mortality rate 5.6%., Conclusion: Laparoscopic transhiatal esophagectomy is a secure option in experience centers. The morbility is low, with a faster return to normal activity. Maybe in fact this procedure may be reminded and ponder in the treatment of esophageal disease.

Objectives: The Functional Clear Aligner (FCA) is a novel orthodontic appliance designed for the treatment of Class II malocclusion with mandibular retrognathia in adolescents. The aim of this study was to investigate the biomechanical characteristics of the masticatory muscles, jawbone, and temporomandibular joint (TMJ) during mandibular advancement using either FCA or Class II elastics combined with clear aligner (Class II elastics) through finite element analysis. Materials and methods: A 3D finite element model of the 'muscle-jawbone-TMJ-appliance' system was constructed based on CBCT and MRI images of a boy with skeletal Class II malocclusion. Masticatory muscles included masseter, temporal, medial pterygoid, and lateral pterygoid muscles. The TMJ consists of the temporal bone's glenoid fossa, disc, and mandibular condyle. To observe the biomechanical characteristics of the muscles and TMJ during orthodontic appliance wearing and the retention phase, two different protocols were used: Model 1: The mandibular advancement using FCA; Model 2: The mandibular advancement using Class II elastics. Results: The FCA group produced greater and more coordinated masticatory muscle forces compared to the Class II elastics group. Temporal and masseter muscles exhibited the most pronounced variation in muscle strength during mandibular advancement. The FCA group exhibited greater TMJ region stress compared to the Class II elastics group. Interestingly, the stress on the articular discs in both models decreased over time. Tensile stresses were observed in both the condyle and the posterior region of the articular fossa. Conclusion: During skeletal Class II malocclusion treatment, masticatory muscle forces and stress on the TMJ were higher in the FCA group compared to the Class II elastics group. In both models, stress cushioning was provided by the articular disc. [ABSTRACT FROM AUTHOR]

Introduction: Sepsis is a life-threatening condition that poses a globally high mortality rate. Identifying risk factors is crucial. Insulin resistance and the TYG index, associated with metabolic disorders, may play a role. This study explores their correlation with mortality in non-diabetic septic patients. Methods: This retrospective cohort study used data from the MIMIC-IV (version 2.1) database, which includes over 50,000 ICU admissions from 2008 to 2019 at Beth Israel Deaconess Medical Center in Boston. We included adult patients with sepsis who were admitted to the intensive care unit in the study. The primary outcome was to evaluate the ability of TYG to predict death at 28-day of hospital admission in patients with sepsis. Results: The study included 2213 patients with sepsis, among whom 549 (24.8%) died within 28 days of hospital admission. We observed a non-linear association between TYG and the risk of mortality. Compared to the reference group (lower TYG subgroup), the 28-day mortality increased in the higher TYG subgroup, with a fully adjusted hazard ratio of 2.68 (95% CI: 2.14 to 3.36). The area under the curve (AUC) for TYG was 67.7%, higher than for triglycerides alone (AUC = 64.1%), blood glucose (AUC = 62.4%), and GCS (AUC = 63.6%), and comparable to SOFA (AUC = 69.3%). The final subgroup analysis showed no significant interaction between TYG and each subgroup except for the COPD subgroup (interaction P-values: 0.076–0.548). Conclusion: In our study, TYG can be used as an independent predictor for all-cause mortality due to sepsis within 28 days of hospitalization. [ABSTRACT FROM AUTHOR]

The blood glucose level at admission indicates (with some limitations) poor prognosis and thrombus burden in patients with the acute coronary syndrome (ACS). Our study aimed to measure the predictive value of the stress hyperglycemia ratio (SHR), an indicator of stress hyperglycemia, showing increased thrombus burden in patients with ACS. Patients (n = 1222) with ACS were enrolled in this cross-sectional study. Coronary thrombus burden was classified as high and low. SHR was calculated by dividing the admission serum glucose by the estimated average glucose derived from HbA1c. Low thrombus burden was detected in 771 patients, while high thrombus burden (HTB) was detected in 451 patients. SHR was found to be significantly higher in patients with HTB (1.1 ±.3 vs 1.06 ±.4; P =.002). SHR was determined as a predictor of HTB (odds ratio (OR) 1.547 95% CI (1.139–2.100), P <.001) as a result of univariate analysis. According to multivariate analysis, SHR was determined as an independent risk factor for HTB (OR 1.328 CI (1.082–1.752), P =.001). We found that SHR predicted thrombus burden with higher sensitivity than admission glucose level in patients with ACS. [ABSTRACT FROM AUTHOR]

Copyright of Saúde e Pesquisa is the property of Saude e Pesquisa and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To analyse the anterior teeth effects of clear aligners on five different patterns of mandibular molar movement and to define the most effective configuration to be implemented with clear aligners through finite element analysis. Methods: A three-dimensional mandibular model with a deep overbite in the mandible was constructed using cone beam computerized tomography (CBCT) data. The model included the mandibular dentition, mandibular periodontal ligaments, attachments, and aligners. Five models were created: (1) configuration A: second molar distalization (0.25 mm); (2) configuration B: second molar distalization (0.25 mm), first molar extrusion (0.15 mm); (3) configuration C: second molar distalization (0.25 mmm), first and second premolar extrusion(0.15 mm); (4) configuration D: second molar distalization (0.25 mm), first molar and first/second premolar extrusion(0.15 mm); and (5) configuration E: second molar distalization (0.25 mm), first molar and first/second premolar extrusion (0.15 mm), first molar and first/second premolar expansion (0.15 mm). Results: In all configurations, the anterior teeth exhibited labial tipping and the mandibular central incisor of configuration E showed the highest labial tipping. Configuration E demonstrated a relatively minor impact on mandibular molars distalization compared with configuration A. Configuration A showed the highest distal displacement value, and configuration E produced the lowest displacement value. Configuration E caused the highest periodontal ligament (PDL) pressure of the central and lateral incisors. The differences in the canines between configurations C and D,were not significant, and the stress distribution differed among the five groups. Conclusions: All patterns utilizing clear aligners facilitated mandibular molar distalization. Extruding the premolars and second molar distalization at the same time had little impact on second molar distalization; When expansion and extrusion were simultaneously performed during the distalization of mandibular molars, our prime consideration was the alveolar bone on the labial side of the anterior teeth to prevent the occurrence of gingival recession, dehiscence, and fenestration. Due to the lack of consideration for periodontal tissues in this study, clinical protocols should be designed based on the periodontal status of the mandibular anterior teeth. [ABSTRACT FROM AUTHOR]

Background: This study aimed to assess the impact of aligner activation and power arm length and material on canine and aligner displacement, von Mises stress in the power arm, and principal stress in the periodontal ligament (PDL) during canine tooth distalization using finite element analysis (FEA). The effects of aligner activation and power arm length were primary outcomes, while the effect of the power arm material was a secondary outcome. Methods: Aligner activation (0.1 mm or 0.2 mm) was applied without using a power arm in two models. The effects of aligner activation, power arm length (12, 13, or 14 mm) and power arm material (stainless steel [SS] or fiber-reinforced composite [FRC]) on canine distalization were investigated in 12 models by evaluating displacement and stress via ALTAIR OptiStruct analysis. Results: Greater canine displacement was observed in all models with 0.2 mm than 0.1 mm of aligner activation. When models with the same aligner activation were compared, reduced mesiodistal tipping, increased palatal tipping, and increased extrusion of the canine cusp were observed with increasing power arm length. Moreover, the von Mises stress increased as the power arm length increased. Increasing the aligner activation and power arm length increased the maximum principal stress in the PDL. Power arms of the same length in both materials showed the same results in terms of canine displacement, clear aligner displacement, and maximum principal stress in the PDL. However, under conditions of equal length and aligner activation, the von Mises stress of the SS power arm was higher than that of the FRC power arm. Conclusion: Using a power arm in canine distalization reduced mesiodistal tipping but increased palatal tipping and extrusion of the canine cusp. Aligner activation and additional force increased tooth movement and principal stress in the canine PDL. FRC power arms exhibited less von Mises stress than SS power arms. [ABSTRACT FROM AUTHOR]

Introduction: This study aims to investigate the biomechanical effects of anchorage reinforcement using clear aligners (CAs) with microimplants during molar distalization. And also explores potential clinical strategies for enhancing anchorage in the sequential distalization process. Methods: Finite element models were established to simulate the CAs, microimplants, upper dentition, periodontal ligament (PDL), and alveolar bone. In group set I, the 2nd molars underwent a distal movement of 0.25 mm in group set II, the 1st molars were distalized by 0.25 mm after the 2nd molars had been placed to a target position. Each group set consisted of three models: Model A served as the control model, Model B simulated the use of microimplants attached to the aligner through precision cuts, and Model C simulated the use of microimplants attached by buttons. Models B and C were subjected to a series of traction forces. We analyzed the effective contribution ratios of molar distalization, PDL hydrostatic stress, and von Mises stress of alveolar bone. Results: The distalization of the 2nd molars accounted for a mere 52.86% of the 0.25-mm step distance without any reinforcement of anchorage. The remaining percentage was attributed to the mesial movement of anchorage teeth and other undesired movements. Models B and C exhibited an increased effective contribution ratio of molar distalization and a decreased loss of anchorage. However, there was a slight increase in the undesired movement of molar tipping and rotation. In group set II, the 2nd molar displayed a phenomenon of mesial relapse due to the reciprocal force produced by the 1st molar distalization. Moreover, the efficacy of molar distalization in terms of contribution ratio was found to be positively correlated with the magnitude of force applied. In cases where stronger anchorage reinforcement is required, precision cuts is the superior method. Conclusions: The utilization of microimplants in conjunction with CAs can facilitate the effective contribution ratio of molar distalization. However, it is important to note that complete elimination of anchorage loss is not achievable. To mitigate undesired movement, careful planning of anchorage preparation and overcorrection is recommended. [ABSTRACT FROM AUTHOR]

To clarify the effect of attachment types on bodily movement of the maxillary canine in aligner orthodontics. Using an aligner, the canine was moved bodily by 0.1 mm distally as a target position. Orthodontic tooth movement was simulated using the finite element method (FEM). The alveolar socket was displaced in the same manner as the initial movement caused by elastic deformation of the periodontal ligament. First, the initial movement was calculated, and then the alveolar socket was displaced in the same direction and with the same magnitude as the initial movement. These calculations were repeated to move the teeth after placement of the aligner. The teeth and the alveolar bone were assumed to be rigid bodies. A FEM model of the aligner was made based on the crown surfaces. The thickness of the aligner was 0.45 mm, and its Young's modulus was 2 GPa. Three types of attachments—semicircular couple, vertical rectangular, and horizontal rectangular—were placed on the canine crown. Regardless of the type of attachment, upon placement of the aligner on the dentition the crown of the canine moved to the target position, while the apex hardly moved. That is, the canine tipped and rotated. After repeating the calculation, the canine became upright and moved bodily regardless of the attachment type. In the aligner without an attachment, the canine did not become upright. There was almost no difference among attachment types in terms of achieving bodily movement of the canine. [ABSTRACT FROM AUTHOR]

Background: Controlling the 3D movement of central incisors during tooth extraction cases with clear aligners is important but challenging in invisible orthodontic treatment. This study aimed to explore the biomechanical effects of central incisors in tooth extraction cases with clear aligners under different power ridge design schemes and propose appropriate advice for orthodontic clinic. Methods: A series of Finite Element models was constructed to simulate anterior teeth retraction or no retraction with different power ridge designs. These models all consisted of maxillary dentition with extracted first premolars, alveolar bone, periodontal ligaments and clear aligner. And the biomechanical effects were analysed and compared in each model. Results: For the model of anterior teeth retraction without power ridge and for the model of anterior teeth no retraction with a single power ridge, the central incisors exhibited crown lingual inclination and relative extrusion. For the model of anterior teeth no retraction with double power ridges, the central incisors tended to have crown labial inclination and relative intrusion. For the model of anterior tooth retraction with double power ridges, the central incisors exhibited a similar trend to the first kind of model, but as the depth of the power ridge increased, there was a gradual decrease in crown retraction value and an increase in crown extrusion value. The simulated results showed that von-Mises stress concentration was observed in the cervical and apical regions of the periodontal ligaments of the central incisors. The clear aligner connection areas of adjacent teeth and power ridge areas also exhibited von-Mises stress concentration and the addition of power ridge caused the clear aligner to spread out on the labial and lingual sides. Conclusions: The central incisors are prone to losing torque and extruding in tooth extraction cases. Double power ridges have a certain root torque effect when there are no auxiliary designs, but they still cannot rescue tooth inclination during tooth retraction period. For tooth translation, it may be a better clinical procedure to change the one-step aligner design to two-step process: tilting retraction and root control. [ABSTRACT FROM AUTHOR]

Copyright of Revista Cuidarte is the property of Universidad de Santander and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

To analyze the effects of maxillary tooth distalization by clear aligner (CA) treatment with variations in the angular direction of the distalization force, presence of attachments, and force-application method used. A finite element model containing alveolar bone, dentition, and periodontal ligament was constructed. Analytical model groups were as follows: (1) distalization with buttons (without attachments), (2) buttons on canines (with attachments), (3) precision cuts on the canines (without attachments), and (4) precision cuts on the canines (with attachments). A distalization force of 1.5 N was applied to the button or precision cut at −30°, −20°, −10°, 0°, 10°, 20°, and 30° to the occlusal plane. As the direction of force approached +30°, the dentition inclined posteriorly. The posterior movement pattern was significantly influenced by the presence of an attachment and the direction of force, rather than the area where the force was applied. Distal inclination was dramatically reduced with attachments. A disengagement or deformation of the CA may reduce the distalization efficiency of the dentition or move the dentition in an inappropriate direction. Attachments for efficient distalization by the CA are necessary. The use of miniscrews in the direction of force parallel to the occlusal plane is more advantageous than the use of Class II elastics. Due to CA deformation, distalization with the button on the canines can be more effective for distal movement of the maxillary dentition. [ABSTRACT FROM AUTHOR]

Background: The biomechanics generated by the clear aligner (CA) material changes continuously during orthodontic tooth movement, but this factor remains unknown during the computer-aid design process and the predictability of molars movement is not as expected. Therefore, the purpose of this study was to propose an iterative finite element method to simulate the long-term biomechanical effects of mandibular molar mesialization (MM) in CA therapy under dual-mechanical systems. Methods: Three groups including CA alone, CA with a button, and CA with a modified lever arm (MLA) were created. Material properties of CA were obtained by in vitro mechanical experiments. MM was conducted by the rebound force exerted by CA material and the mesial elastic force (2N, 30° to the occlusal plane) applied to the auxiliary devices. Stress intensity and distribution on periodontal ligament (PDL), attachment, button and MLA, and displacement of the second molar (M2) during the iterations were recorded. Results: There was a significant difference between the initial and cumulative long-term displacement. Specifically, compared to the beginning, the maximum stress of PDL decreased by 90% on average in the intermediate and final steps. The aligner was the main mechanical system at first, and then, the additional system exerted by the button and MLA dominated gradually. The stress of attachments and auxiliary devices is mainly concentrated on their interfaces with the tooth. Additionally, MLA provided a distal tipping and extrusive moment, which was the only group that manifested a total mesial displacement of the root. Conclusions: The innovatively designed MLA was more effective in reducing undesigned mesial tipping and rotation of M2 than the traditional button and CA alone, which provided a therapeutic method for MM. The proposed iterative method simulated tooth movement by considering the mechanical characteristic of CA and its long-term mechanical force changes, which will facilitate better movement prediction and minimize the failure rate. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Journal of Tissue Engineering Research / Zhongguo Zuzhi Gongcheng Yanjiu is the property of Chinese Journal of Tissue Engineering Research and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: According to the American Diabetes Association and American Association of Clinical Endocrinologists' consensus on inpatient hyper glycemia, any blood glucose level higher than 7.8 mmol/l (140 mg/dl) without symptoms of preceding diabetes is considered stress hyper glycemia or hospital-related hyper glycemia. Methodology all patient admitted with acute onset of ST elevation myocardial infarction within 12 hours of onset, age more than 18 and less than 80 years at tertiary care hospital were included in this study. Result In case group mean age was 55.4 years while in control group mean age 57.5 years was In case group mean Hba1c 5.6 and SD 1.0 was while in control group mean Hba1c 5.3 and SD was 1.1 with p value 0.234. Conclusion Mortality was commonly noted in the stress hyperglycemic groups. 5(25%) deaths were noted in group, while in euglycemic group 4 (11.4%) death were noted in group. [ABSTRACT FROM AUTHOR]

Introduction: The effects of upper-molar distalization using clear aligners in combination with Class II elastics for anchorage reinforcement have not been fully investigated yet. The objective of this study is to analyze the movement and stress of the whole dentition and further explore guidelines for the selection of traction methods. Methods: Three-dimensional (3D) finite element models are established to simulate the sequential molar distalization process, including the initial distalization of the 2nd molar (Set I) and the initial distalization of the 1st molar (Set II). Each group set features three models: a control model without Class II elastics (model A), Class II elastics attached to the tooth by buttons (model B), and Class II elastics attached to the aligner by precision cutting (model C). The 3D displacements, proclination angles, periodontal ligament (PDL) hydrostatic stress and alveolar bone von Mises stress in the anterior area are recorded. Results: In all of the models, the maxillary anterior teeth are labial and mesial proclined, whereas the distal moving molars exhibit distal buccal inclination with an extrusion tendency. With the combination of Class II elastics, the anchorage was effectively reinforced; model C demonstrates superior anchorage reinforcement with lower stress distribution in comparison with model B. The upper canines in model B present an extrusion tendency. Meanwhile, the mandibular dentition in models B and C experience undesired movement tendencies with little discrepancy from each other. Conclusions: Class II elastics are generally effective for anchorage reinforcement as the upper-molar distalization is performed with clear aligners. Class II elastics attached to an aligner by precision cutting is a superior alternative for maxillary anchorage control in cases that the proclination of upper incisors and extrusion of upper canines are unwanted. [ABSTRACT FROM AUTHOR]

Background: In the invisible orthodontic treatment, composite thermoforming film materials have become the focus of orthodontic clear aligners. The orthodontic efficacy of clear aligners which consisted of multi-layers materials remains unclear. This study aims to evaluate the biomechanical effects of various multi-layers of clear aligners on en-mass retraction of maxillary anterior teeth. Methods: A patient-specific 3D non-linear finite element model numerical analysis was constructed to simulate the en-mass retraction of maxillary anterior teeth with clear aligner after extraction of the first premolars. Four kinds of multi-layers clear aligners with different proportion of film materials were simulated. The biomechanical responses of four different clear aligners on invisible orthodontics were calculated. The tooth displacement in all directions, the hydrostatic pressure of periodontal ligament, the orthodontic deformation of clear aligner, and the stress distribution of alveolar bone were compared and investigated. Results: In all experimental models, the maximum equivalent deformation of alveolar bone, the vector displacement of tooth and the compressive/tensile stress of periodontal ligament decreased with the increase of soft layer thickness. The elastic strain of clear aligners also decreased with the increase of the ratio of soft/hard layers. Conclusions: The multi-layers clear aligner is better than the single-layer clear aligner in tooth movement, stress distribution of periodontal ligament and mechanical loading of alveolar bone, especially when the ratio of soft layer to hard layer is more than 50%. Moreover, the side effects of the multi-layers clear aligner are significantly less than those of the single-layer one. [ABSTRACT FROM AUTHOR]

Introduction: Impact assessment of new technologies in chronic hemodialysis (HD) is challenging due to HD patient frailty, the complexity of HD clinical trials and practice variability among countries. Among the most recent HD innovations, medium cut-off (MCO) dialyzers present an optimized membrane geometry that provides enhanced clearances for middle and large molecular weight uremic toxins (UT). These toxins are poorly cleared by available HD techniques and largely contribute to patient morbidity and mortality. The aim of this paper is to assess the available clinical evidence about MCO membranes and to identify the next steps needed to generate conclusive data on their use in HD. Methods: With this purpose, we first reviewed and compared the current HD technologies aimed to improve the clearance of middle and large UT; subsequently, we used a Delphi questionnaire to identify and discuss the consensus about MCO efficacy within a large sample of the Italian Nephrology community. Results and Conclusions: Our investigation gathered a significant degree of consensus on the beneficial role of MCO membrane and expanded HD. Finally, we used our results to propose future trial designs and clinical investigations aimed to improve evidence quality about the use of these membranes in the present clinical scenario of dialysis units. [ABSTRACT FROM AUTHOR]

Background: The application of combination therapy for cancer treatment is limited due to poor tumor-specific drug delivery and the abscopal effect.Methods: Here, PD-L1- and CD44-responsive multifunctional nanoparticles were developed using a polymer complex of polyethyleneimine and oleic acid (PEI-OA) and loaded with two chemotherapeutic drugs (paclitaxel and chloroquine), an antigen (ovalbumin), an immunopotentiator (CpG), and an immune checkpoint inhibitor (anti-PD-L1 antibody).Results: PEI-OA greatly improved the drug loading capacity and encapsulation efficiency of the nanoplatform, while the anti-PD-L1 antibody significantly increased its cellular uptake compared to other treatment formulations. Pharmacodynamic experiments confirmed that the anti-PD-L1 antibody can strongly inhibit primary breast cancer and increase levels of CD4+ and CD8+ T cell at the tumor site. In addition, chloroquine reversed the "immune-cold" environment and improved the anti-tumor effect of both chemotherapeutics and immune checkpoint inhibitors, while it induced strong immune memory and prevented lung metastasis.Conclusions: Our strategy serves as a promising approach to the rational design of nanodelivery systems for simultaneous active targeting, autophagy inhibition, and chemotherapy that can be combined with immune-checkpoint inhibitors for enhanced breast cancer treatment. [ABSTRACT FROM AUTHOR]

Background: The prevalence of ear piercings is 8%-32%. Complications can be due to the factors such as the amount of tissue blood supply, the location of the piercing, the extent of hygiene techniques, and much more. Materials and Methods: A total of 586 females (age, 18-28 years) in Riyadh, Saudi Arabia, with at least one ear piercing were included in this analytical cross-sectional study by convenience sampling from September 2019 to April 2020. A link to an Arabic web-based questionnaire was distributed through social media (WhatsApp, Twitter, and Snapchat). It included questions related to both earlobe and ear cartilage piercings. Bivariate statistical tests were carried out. Results: The prevalence of a probable ear piercing-related infection for ear cartilage piercings was found to be significantly higher than for earlobe piercings (41.4% vs. 29.6%) (P = 0.0004) (confidence interval [CI] = 0.443-0.795). A significant association between piercing type (3.3% of earlobe piercings and 8.1% of ear cartilage piercings) and scar formation was observed (P = 0.0002) (CI = 0.209-0.722). The prevalence of ear piercing complications among participants who used piercing needles was lower for both earlobe piercings and ear cartilage piercings (3.65%, 8.75%) (P = 0.0015) than among those who used piercing guns (37.9%, 43.4%) (P = 0.114). Conclusion: Probable external ear infections were more common among those with cartilage ear piercings than those with earlobe piercings. Future studies should include participants of a broader age category and in different locations in Saudi Arabia. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the optimal activation of plastic aligner for the canine distal movement by combining the stress and strain of periodontal ligament. Computer-aided design models of the upper canine, periodontal ligament, alveolar bone, and plastic aligner were constructed. The stresses and strains of periodontal ligament were acquired by fitting plastic aligner on the canine, which will cause the canine distal-direction movement. The activation of plastic aligner was set into 12 groups, including 0.050, 0.100, 0.125, 0.150, 0.175, 0.200, 0.225, 0.250, 0.275, 0.300, 0.350, and 0.400 mm. Assuming the volume-averaged hydrostatic stress (VAHS) ranging from 4.7 to 16 kPa to be the optimal stress, and an average strain no less than 0.3 to be the optimal strain. The optimal activation of plastic aligner was acquired based on the optimal stress and average strain. As the activation increased, the stress and strain of periodontal ligament increased visibly. The degree of activation of plastic aligner was nonlinearly and positively related to VAHS and average strain. According to the fitted curves, the activation corresponding to the optimal stress was 0.07–0.24 mm and the activation was not less than 0.21 mm based on the optimal strain. The optimal activation of plastic aligner for the canine distal movement was 0.21–0.24 mm in this study. The degree of activation affects the force system of orthodontic tooth movement, and it should be taken into consideration to obtain healthy and efficient tooth movement. The activation with 0.21–0.24 mm seems optimal for orthodontic tooth movement in the plastic aligner system in this study. [ABSTRACT FROM AUTHOR]

Background and Objectives: This study was conducted to determine the effective method to torque the incisor with thermoplastic aligner using a three-dimensional (3D) finite element method. Materials and Methods: Three finite element models of maxilla and maxillary dentition were developed. In the first model, thermoplastic aligner without any auxiliaries was used. In the second and third models, thermoplastic aligner with horizontal ellipsoid composite attachment and power ridge were used, respectively. The software used for the study was ANSYS 14.5 FE. A force of 100 g was applied to torque the upper right central incisor. The resultant force transfer, stress distribution, and tooth displacement were evaluated. Results: The overall tooth displacement and stress distribution appeared high in the model with power ridge, whereas the root movement was more in the horizontal ellipsoid composite attachment model. The model without any auxillaries produced least root movement and stress distribution. Conclusion: Horizontal ellipsoid composite attachment achieved better torque of central incisor than the model with power ridge and model without any auxillaries. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate constants of the Karvonen (k) and heart rate reserve (HRR) (a) formulas that correspond to the anaerobic threshold (AT) to conveniently estimate the intensity of exercise therapy in nonbetablocked patients undergoing hemodialysis. Twenty-three patients undergoing hemodialysis performed cardiopulmonary exercise testing (CPX) and their HR at AT was measured. The predictor coefficients for a target HR corresponding to AT were calculated for each patient based on CPX. Interclass correlation coefficients (ICC) and Bland-Altman analysis were used to evaluate the reliability of the formulas. Mean values of coefficient k of the Karvonen formula and a of the HRR formula were 0.24 ± 0.11 and 17.4 ± 8, respectively. The target HR calculated with k = 0.24 and a = 17 had significant ICC between HR at AT (0.74 and 0.77, respectively; P < 0.05). Using the Karvonen and HRR formulas to determine a target HR corresponding to AT is a simple and easy method that can be used to develop exercise programs for hemodialysis patients. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular (CV) morbidity and mortality are higher in chronic kidney disease (CKD) than in the general population. Reduced heart rate recovery (HRR) is an independent risk factor for CV disease. The aim of the study was to determine the prognostic role of HRR in a homogenous group of CKD patients. Methods: One hundred and twenty-five IgA nephropathy patients (82 male, 43 female, age 54.7 ± 13 years) with CKD stage 1–4 were investigated and followed for average 70 months. We performed a graded exercise treadmill stress test. HRR was derived from the difference of the peak heart rate and the heart rate at 1 min after exercise. Patients were divided into two groups by the mean HRR value (22.9 beats/min). The composite (CV and renal) endpoints included all-cause mortality and any CV event such as stroke, myocardial infarction, revascularisation (CV) and end-stage renal disease, renal replacement therapy (renal). Results: Patients with reduced HRR (< 23 bpm) had significantly more end point events (22/62 patients vs. 9/53 patients, p = 0.013) compared to the higher HRR (≥23 bpm). Of the secondary the endpoints (CV or renal separately) rate of the renal endpoint was significantly higher in the lower HRR group (p = 0.029), while there was no significant difference in the CV endpoint between the two HRR groups (p = 0.285). Independent predictors of survival were eGFR and diabetes mellitus by using Cox regression analysis. Kaplan-Meier curves showed significant differences in metabolic syndrome and non-metabolic syndrome when examined at the combined endpoints (cardiovascular and renal) or at each endpoint separately. The primary endpoint rate was increased significantly with the increased number of metabolic syndrome component (Met.sy. comp. 0 vs. Met. sy. comp. 2+, primary endpoints, p = 0.012). Conclusion: Our results showed that reduced HRR measured by treadmill exercise test has a predictive value for the prognosis of IgA nephropathy. The presence of metabolic syndrome may worsen the prognosis of IgA nephropathy. [ABSTRACT FROM AUTHOR]

Background: Pathologic tooth migration (PTM) is a common complication of mild to severe periodontitis and proper orthodontic treatment is helpful to alleviate periodontal diseases. The goal of this study is to explore an optimal orthodontic displacement of clear aligner using a three-dimensional (3D) finite element model (FEM). Methods: The cone beam computed tomography (CBCT) data of a patient received invisible orthodontics without diabetes and other systemic diseases were collected. Based on the new classification scheme for periodontal diseases in 2017 (stage I: mild periodontitis, [M1]; stage II: moderate periodontitis, [M2]; stage III: severe periodontitis, [M3]), 3D-FEMs of mandible were established using MIMICS 10.0 and ABAQUS 6.5 softwares. The 3D stress distribution diagrams and stress value of the teeth (left lower incisor, left lower central incisor, right lower lateral incisor, and right lower central incisor) under three different periodontal conditions (M1, M2, and M3) with axial inclination 90° and 100° were obtained by ABAQUS 6.5. Results: The stress of anterior teeth was concentrated in the teeth neck, and became greater when the periodontal condition was worse. The stress value of anterior teeth and the strain at the top of the alveolar crest are greater as the displacement increasing. The stress value of anterior teeth and the strain at the top of the alveolar crest in axial inclination 100° are relatively great compared to those of axial inclination 90°. For patients with excessively inclined anterior teeth (such as 100°), the optimal orthodontic displacement is 0.18 mm. In order to ensure that alveolar ridge crest is not deformed, the displacement is less than 0.18 mm (strain for 0.165 mm), 0.15 mm (strain for 0.167 mm) and 0.10 mm (strain for 0.117 mm) respectively when alveolar bone is normal, resorption 1/3 or 1/3–1/2. Conclusions: The optimal orthodontic displacement for patients (M1, M2, and M3) with excessively inclined anterior teeth (axial inclination 100°) is 0.18 mm. To avoid the strain at the top of the alveolar crest, the optimal displacements for M1, M2 and M3 periodontal disease patients are less than 0.18 mm, 0.15 mm and 0.10 mm, respectively. [ABSTRACT FROM AUTHOR]

Background: We undertook a systematic review and meta-analysis to investigate the relationship between blood glucose levels and mortality in patients with sepsis. Methods: Medline and EMBASE were searched from inception to April 8, 2018. Cohort studies or case-control studies reported the association between blood glucose and mortality in patients with sepsis were selected. Study characteristics, baseline characteristics, definition of hyperglycemia, and outcomes of interest were extracted. We performed a dose-response meta-analysis to assess the effect of blood glucose level on mortality. We also conducted metaanalysis for patients with or without diabetes separately. Results: Ten cohort studies involving 26 429 patients were included, of which 5 were prospective studies and 5 retrospective studies. Dose-response analysis showed that the effect of blood glucose on mortality may differ in patients with versus without diabetes. There was a U-shaped relationship for patients with diabetes and a J-shaped relationship for patients without diabetes, with blood glucose at 145 to 155 mg/dL corresponding to lowest mortality both in patients with and without diabetes. Conclusions: Current evidence suggested U-shaped relationship between blood glucose and mortality in all patients irrespective of their diabetes status. Diabetic patients with blood glucose below 145 mg/dL may have poorer prognosis compared to patients without established diabetes. [ABSTRACT FROM AUTHOR]

Purpose: The aim was to evaluate the scope and potential ethical concerns related to the use of teledentistry in clinical orthodontics. Methods: Indexed databases were searched up to and including October 2020. The eligibility criteria were as follows: (a) original clinical studies, and (b) case reports/series. Historic reviews, commentaries, experimental studies, and letters to the editor, were excluded. The pattern of the present review was customized to summarize the relevant information. Results: A total of 4 clinical studies (out of 1016) were included in the present evidence‐based review. Three studies reported that teledentistry is useful in clinical orthodontics. In 1 study, a clear conclusion could not be derived regarding the benefits of teledentistry in clinical orthodontics. Two out of 4 studies did not obtain prior approval from an Institutional Review Board or Ethical Committee. Three studies did not report any measures that were undertaken to safeguard the electronic transfer of patient‐related health information. Conclusions: Teleorthodontics facilitates treatment planning/monitoring by sharing orthodontics‐based patient records among oral healthcare providers; however, the importance of direct patient supervision and routine follow‐ups during orthodontic therapy cannot be overlooked. Further studies are needed to establish ethical guidelines and a standard of care in this emerging field. [ABSTRACT FROM AUTHOR]

Myocardial fibrosis is recognized as a key pathological process in the development of cardiac disease and a target for future therapeutics. Despite this recognition, the assessment of fibrosis is not a part of routine clinical practice. This is primarily due to the difficulties in obtaining an accurate assessment of fibrosis non-invasively. Moreover, there is a clear discrepancy between the understandings of myocardial fibrosis clinically where fibrosis is predominately studied with comparatively low-resolution medical imaging technologies like MRI compared with the basic science laboratories where fibrosis can be visualized invasively with high resolution using molecularly specific fluorescence microscopes at the microscopic and nanoscopic scales. In this article, we will first review current medical imaging technologies for assessing fibrosis including echo and MRI. We will then highlight the need for greater microscopic and nanoscopic analysis of human tissue and how this can be addressed through greater utilization of human tissue available through endomyocardial biopsies and cardiac surgeries. We will then describe the relatively new field of molecular imaging that promises to translate research findings to the clinical practice by non-invasively monitoring the molecular signature of fibrosis in patients. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease is on the upraise in the industrialized and unindustrialized countries, which characterize at the present time one of the chief challenges for the health systems all the world. Depressed Ischemiac Heart disease patients may have a poorer outcome than non-depressed patients,so this study was performed with the aim of finding the link between depression and ischemic heart disease and its association with demographic factors in Iraqi patients. Patients and Method: The study was designed to be a case- control study involving 128 case of IHD patients and120 apparently healthy individuals serving as control group, with an age range from 20y-80y in Al-Diwaniyah Teaching Hospital in Al-Diwaniyah province/ Iraq. were examined for the presence of depressive disorder using ICD-10 diagnostic criteria and then assessing the severity of the depression in the depressed group by using Beck Depressive Inventory(BDI ). Results: The prevalence rate of depression was 48.3% in IHD patients while 22.5% in control groups . Conclusion: Because of high rate of depression among patients with different types of heart diseases, early detection and identification of as possible,to improve outcome . [ABSTRACT FROM AUTHOR]

Objective: The objective of this clinical study was to assess the predicted software models and clinical models and to compare the stage models of both the groups so as to evaluate the efficacy of tooth movement with clear aligner. Methods: The sample size included 10 cases with mild anterior crowding treated with aligner therapy. The predicted software models were superimposed on the clinical stereolithography (STL) models at various stages by using the MeshLab software. The predicted software models showing orthodontic tooth movement were compared with the actual movement achieved clinically. Results: The results of the present study have shown that when a comparison was made on the basis of irregularity scores in both the groups, it was seen that the irregularity score was higher at 2.55 at T4, 1.65 at T6, and 1.0 at T8 in the clinical STL group at each stage, whereas it was 2.0 at T4, 0.90 at T6, and 0.25 at T8 in the software model group. In addition, in comparing the mean accuracy of these three stages, the analysis of data showed that the mean accuracy is 62.5% at T4, 68.8% at T6, and 78.1% at T8. Conclusion: The predicted software models do not accurately reflect the patient's tooth position. There is an overestimation by predicted software as compared with actual clinically achieved tooth position. There is a need of overcorrection to be built in the treatment planning stage itself and execution of the anticipated end result. [ABSTRACT FROM AUTHOR]

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aimundo,3 Romeu Paulo Martins Silva,1 Vitor Engracia Valenti,6 Andrés Ricardo Pérez-Riera2,31Centro de Saúde e Desporto, Universidade Federal do Acre, Rio Branco, Acre, Brazil; 2Laboratório de Delineamento em Pesquisas e Escrita Científica, Centro Universitário Saúde ABC Santo André, São Paulo, Brazil; 3Laboratório de Delineamento em Pesquisas e Escrita Científica, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória, Vitória, Espirito Santo, Brazil; 4Graduate Entry Medical School, University of Limerick, Limerick V94 T9PX, Ireland; 5Escola Superior de Ciências da Santa Casa de Misericórdia, EMESCAM, Vitória, Brazil; 6Centro de Estudos do Sistema Nervoso Autônomo, State University of São Paulo, Marília, São Paulo, BrazilCorrespondence: Mauro José de Deus MoraisCentro de Saúde e Desporto, Universidade Federal do Acre, Rua Gumercindo, nº 292, Bairro: Universitário, Rio Branco 69.917.698, Acre, BrazilTel +55 6 899 971 6122Email maurodedeus@outlook.comItalla Maria Pinheiro BezerraEscola Superior de Ciências da Santa Casa de Misericórdia, EMESCAM, Bolsista Capes Brasil, Vitória, Rio Branco 69.915-900, BrazilTel +55 2 799 253 4941Email italla.bezerra@emescam.br Introduction: Physical exercises help in the rehabilitation and recovery of various diseases. Cardiovascular and hypertension problems are the main causes of people being affected by kidney problems, which as a consequence, affects the heart rate variability (HRV) of the individual. Physical activity developed in a well-planned and thorough way can be a component in the treatment of this problem. Objective: We aimed to evaluate the effects of aerobic exercise intervention during hemodialysis on autonomic heart rate regulation in individuals with chronic kidney disease (CKD). Methods: This was a longitudinal trial conducted in 19 CKD patients. The patients underwent three weekly sessions of aerobic exercise during hemodialysis for 30 mins for 12 weeks (three months). Results: HRV was analyzed before and after the protocol training. Linear indices of HRV were not different between before and after the protocol training. Nonlinear HRV analysis indicated reduced values of determinism (p=0008, Cohen's d=0.82) and entropy (p=003, Cohen's d=0.84) after the training protocol. Conclusion: In conclusion, aerobic exercise training during hemodialysis did not improve autonomic control of heart rate in CKD patients. [ABSTRACT FROM AUTHOR]

OBJECTIVE To estimate the prevalence of depression and to identify associated factors in patients hospitalized with heart failure (HF) using the Patient Health Questionnaire-9 (PHQ-9). METHOD The study sample consisted of 152 patients with HF who were hospitalized in the Department of Cardiology of a tertiary hospital in Athens, Greece over a period of one year. Data were collected using a questionnaire consisting of three parts; socio-demographic and clinical characteristics, results of laboratory and diagnostic work-up retrieved from the hospital records, and the PHQ-9 scale. RESULTS The prevalence of major depression (PHQ-9 score ≥10) was 34.2%. Among the factors examined, worse overall perceived health (OPH) (p<0.001) and New York Heart Association (NYHA) class (p<0.001) were strongly associated with major depression. Age (p=0.015) was also associated with major depression, with the younger (<60 years) and the older ≥80 years) patients being more depressed. Sleep duration (p=0.028) was associated with major depression, with those sleeping <6 hours and >8 hours being more depressed. After stepwise logistic regression, OPH, NYHA class and age remained statistically significantly associated with major depression. CONCLUSIONS Measures must be taken to identify, evaluate and manage depression in patients hospitalized with HF, the prevalence of which is particularly high in this population. [ABSTRACT FROM AUTHOR]

Sudden cardiac death (SCD) is an unpredictable and common mode of death in patients with heart failure (HF). Alterations in calcium handling may lead to malignant arrhythmias, resulting in SCD, and variants in calcium signaling-related genes have a significant association with SCD. Therefore, the aim of the present retrospective cohort study was to investigate the association of Ser96Ala [histidine-rich calcium-binding protein (HRC)], Ser49Gly [β1-adrenergic receptor (ADRB1)], Arg389Gly (ADRB1) and Gly1886Ser [ryanodine receptor 2 (RYR2)] polymorphisms with serious arrhythmic events and overall mortality in patients with HF with reduced left ventricular ejection fraction of non-ischemic etiology. In total, 136 patients with HF underwent physical examination, routine laboratory tests, non-invasive assessment of cardiac function and an invasive electrophysiological study. The primary outcome was the occurrence of serious arrhythmic events, set as either SCD or appropriate implantable cardioverter-defibrillator (ICD) therapy, and the secondary outcome was all-cause death. During a median follow-up of 37 months, arrhythmic events occurred in 26 patients (19%) and 41 patients (30%) died. Patients carrying the Ser allele of the Ser96Ala polymorphism in HRC had worse survival than those with the Ala/Ala genotype (log-rank P=0.043). Despite the difference in survival time, the Ala/Ala genotype was not associated with all-cause death in the regression analysis [unadjusted hazard ratio (HR)=0.17; 95% CI, 0.02-1.21]. Regarding the Ser49Gly and Arg389Gly polymorphisms in ADRB1, homozygosity for the major alleles at both sites (Ser49Ser and Arg389Arg) was associated with a two-fold increased risk of all-cause death compared with the other genotype combinations (unadjusted HR=1.98; 95% CI, 1.02-3.82). However, this association was lost after controlling for clinical covariates. No association was observed for the Gly1886Ser polymorphism in RYR2. Overall, the present findings are concurrent with the hypothesis that the Ser96Ala (HRC), Ser49Gly (ADRB1) and Arg389Gly (ADRB1) polymorphisms may be associated with HF prognosis. In particular, the Ser96Ala polymorphism might aid in risk stratification and patient selection for ICD implantation. [ABSTRACT FROM AUTHOR]