Translation, Validity and Internal Consistency of the Quality of Dying and Death Questionnaire for Brazilian families of patients that died from cancer: a cross-sectional and methodological study

ABSTRACT BACKGROUND: The Quality of Dying and Death Questionnaire (QoDD) may prove to be an important evaluation tool in the Brazilian context, and, therefore, can contribute to a more precise evaluation of the dying and death process, improving and guiding the end-of-life patient care. OBJECTIVE: To translate and cross-culturally adapt the QoDD into Brazilian Portuguese and measure its validity (convergent and known-groups) and internal consistency DESIGN AND SETTING: A cross-sectional, methodological study was conducted at the Hospital de Câncer de Barretos, Brazil METHODS: A total of 78 family caregivers participated in this study. Semantic, cultural, and conceptual equivalences were evaluated using the content validity index. The construct validity was assessed through convergent validation and known groups analysis [presence of family members at the place of death; feel at peace with dying; and place of death (hospital versus home; hospital versus Palliative Care)]. Internal consistency was evaluated using Cronbach's alpha. RESULTS: The questionnaire was translated into Brazilian Portuguese and presented evidence of a clear understanding of its content. Cronbach's alpha values were ≥ 0.70, except for the domains of treatment preference (α = 0.686) and general concerns (α = 0.599). The convergent validity confirmed a part of the previously hypothesized correlations between the Palliative Care Outcome Scale-Brazil (POS-Br) total scores and the QoDD domain scores. The QoDD-Br domains could distinguish the patients who died in palliative care and general wards. CONCLUSION: The QoDD-Br is a culturally adapted valid instrument, and may be used to assess the quality of death of cancer patients.

Burial or cremation? Factors associated with preferences among patients with cancer in Brazil: a cross-sectional study

ABSTRACT BACKGROUND: People living with life-limiting illnesses and their family caregivers consistently emphasize the importance of preparing for imminent death, with planned funerals being a common aspect of this preparation. Few studies have described the funeral rituals or post-mortem preferences of patients with cancer. OBJECTIVE: To evaluate the percentage of patients with cancer who wish to be cremated and to identify the factors associated with this preference. DESIGN AND SETTING: Cross-sectional study conducted at Barretos Cancer Hospital. METHODS: A total of 220 patients with cancer completed a Sociodemographic and Clinical Questionnaire, the Duke University Religiosity Index, and burial or cremation preferences. Binary Logistic Regression was performed to identify independent variables associated with cremation. RESULTS: Of the 220 patients, 25.0% preferred cremation and 71.4% preferred burial. Talks about death with family or close friends in their daily life (odds ratio, OR = 2.89; P = 0.021), patients that answered "other" (unsure, tends not be true and not true) for religious beliefs are what really lie behind my whole approach to life (OR = 20.34; P = 0.005), and education 9 to 11 years (OR = 3.15; P = 0.019) or ≥ 12 years (OR = 3.18; P = 0.024) were associated with cremation preference. CONCLUSION: Most patients with Cancer in Brazil prefer burial after death. Discussions about death, religious beliefs and involvement, and educational level seem to influence the preference for cremation. A deeper understanding of ritual funeral preferences and their associated factors may guide policies, services, and health teams in promoting the quality of dying and death.

Prevalence of burnout and predictive factors among oncology nursing professionals: a cross-sectional study

ABSTRACT BACKGROUND: Burnout is a syndrome that mostly affects professionals working in contact with patients and their caregivers. In oncology care, nursing professionals are constantly required to provide emotional support for patients and their caregivers, throughout the process of becoming ill, suffering and dying. OBJECTIVE: To evaluate the prevalence and factors associated with burnout in a sample of nursing professionals at a cancer hospital. DESIGN AND SETTING: Cross-sectional study conducted at Hospital de Câncer de Barretos. METHODS: The study population comprised 655 nursing professionals. Burnout syndrome was assessed using the Maslach Burnout Inventory Human Service Survey. Univariate analysis and binary logistic regression models were used to identify independent predictors associated with burnout. RESULTS: Among 304 nursing professionals included in the study, 27 (8.9%) were classified as presenting burnout according to the two-dimensional criteria, and four (1.3%) were classified based on the three-dimensional criteria. Workplace characteristics were not associated with burnout, while single marital status (odds ratio, OR = 2.695; P = 0.037), perceived workplace stressors, such as impatience with colleagues (OR = 3.996; P = 0.007) and melancholy (OR = 2.840; P = 0.021) were considered to be predictors of burnout. Nursing professionals who would choose the profession again (OR = 0.214; P = 0.001) were least likely to present burnout. CONCLUSION: Perceived workplace stressors are strongly associated with burnout. Strategies focusing on restructuring of daily work processes and on activities that stimulate positive relationships are important for professionals' health because motivation to continue working in oncology nursing has a protective effect against burnout.

Predictors of happiness and satisfaction with life in individuals from the Brazilian general population who use social networks: a cross-sectional study / Preditores de felicidade e satisfação com a vida em indivíduos da população geral brasileira que utilizam redes sociais: um estudo transversal / Predictores de felicidad y satisfacción con la vida en personas de la población brasileña general que usan redes sociales: un estudio transversal

Abstract: This study aimed to identify possible conditions associated with the perception of happiness and satisfaction with life in a sample of the Brazilian population who use social networks. This was a cross-sectional study with participants recruited online in five regions of Brazil via Facebook and WhatsApp. Data were collected from October 2015 to October 2016. The instruments used were the Pemberton Happiness Index, the Satisfaction with Life Scale, and a questionnaire regarding sociodemographic and clinical characteristics and issues potentially associated with the feeling of happiness. In total, 2,151 participants were included. A total of five variables exerted the greatest influence on higher levels of happiness and satisfaction with life in the multiple linear regression model, in the multiple logistic regression analysis, and in the decision tree model. Being satisfied with financial circumstances, having a positive self-evaluation of health, having frequent family gatherings, engaging in physical activity ≥ 3 times a week, and having no previous psychological/psychiatric diagnosis are variables that "seem" to positively influence Brazilians' perception of happiness and satisfaction with life. We identified some predictors of happiness and satisfaction with life, which were mainly related to the social activities and personal satisfaction of the participating individuals. Encouraging people to seek strategies for increasing levels of happiness and life satisfaction based on modifiable variables, such as those found, can be helpful in this context.

Resumo: O estudo teve como objetivo identificar possíveis condições associadas com a percepção de felicidade e satisfação de vida em uma amostra de indivíduos da população geral brasileira que usam redes sociais. O estudo transversal recrutou participantes via redes sociais nas cinco macrorregiões brasileiras, através do Facebook e do WhatsApp. Os dados foram coletados entre outubro de 2015 e outubro de 2016. Os instrumentos utilizados foram o Índice de Felicidade de Pemberton, Escala de Satisfação com a Vida e um questionário sobre características sociodemográficas e clínicas e questões potencialmente associadas com a sensação de felicidade. Foram incluídos 2.151 participantes. Cinco variáveis tiveram maior influência sob níveis mais altos de felicidade e de satisfação com a vida, de acordo com o modelo de regressão linear múltipla, análise de regressão logística multivariada e modelo de árvore de decisão. A satisfação com as circunstâncias financeiras, a autoavaliação da saúde positiva, reuniões familiares frequentes, atividade física ≥ 3 vezes por semana e ausência de diagnóstico psicológico ou psiquiátrico prévio são variáveis que "parecem" influenciar positivamente a percepção de felicidade e satisfação com a vida entre os brasileiros. Foram identificados alguns preditores de felicidade e satisfação com a vida, relacionados principalmente a atividades sociais e à satisfação pessoal. Uma medida útil nesse contexto é incentivar as pessoas a buscarem estratégias para elevar os níveis de felicidade e de satisfação com a vida baseadas nas variáveis modificáveis identificadas no estudo.

Resumen: El objetivo fue identificar posibles condiciones asociadas con la percepción de felicidad y satisfacción con la vida, en una muestra de individuos de la población general brasileña que utilizó redes sociales. Se trata de un estudio transversal, con participantes reclutados en línea en cinco regiones de Brasil, a través del Facebook y del WhatsApp. Los datos fueron recogidos entre octubre 2015 y octubre 2016. Los instrumentos usados fueron: el Índice de Felicidad de Pemberton, la Escala de Satisfacción con la Vida, y un cuestionario respecto a las características sociodemográficas y clínicas, así como asuntos potencialmente asociados con el sentimiento de felicidad. Se incluyeron a un total de 2.151 participantes. Cinco variables ejercieron la influencia más significativa en los mayores niveles de felicidad y satisfacción con la vida en el modelo de regresión múltiple, en los análisis de regresión logística múltiple y en el modelo de árbol de decisión. Estar satisfecho con las circunstancias financieras, tener una autoevaluación positiva de salud, reunirse frecuentemente con la familia, implicarse en actividades físicas ≥ 3 veces a la semana, y no contar diagnósticos previos psicológicos/psiquiátricos son variables que "parecen" influenciar positivamente la percepción de felicidad y satisfacción con la vida de los brasileños. Se identificaron algunos predictores de felicidad y satisfacción con la vida, lo que estaba principalmente relacionado con actividades sociales y satisfacción personal de los participantes brasileños. Fomentar que la gente busque estrategias para incrementar los niveles de felicidad y satisfacción con la vida, basados en variables modificables como las encontradas, puede ser útil en este contexto.

New criteria for breast symmetry evaluation after breast conserving surgery for cancer / Novos critérios para avaliação da simetria da mama após cirurgia conservadora de câncer

ABSTRACT Objective: to evaluate symmetry after breast-conserving surgery (BCS) for cancer. Methods: a prospective study of patients undergoing BCS. These patients were photographed using the same criteria of evaluation. The references points used were the nipple height difference (NH), the nipple-manubrium distances (NM), nipple-sternum distances (NS) and the angle between the intramammary fold and the nipple (nipple angle; NA). ImageJ software was used. Three breast symmetry models were evaluated: excellent/others (model 1), excellent-good/others (model 2) and others/poor (model 3). The ROC curve was used to select acceptable criteria for the evaluation of symmetry. Decision tree model analysis was performed. Results: a total of 274 women were evaluated. The BCCT.core result was excellent in 5.8% (16), good in 24.1% (66), fair in 46.4% (127) and poor in 23.7% (65). The difference in NH was associated with good breast area (0.837-0.846); acceptable differences were below 3.1 cm, while unacceptable values were greater than 6.4 cm. Differences in the NM were associated with average breast area (0.709-0.789); a difference in value of less than 4.5 cm was acceptable, while values greater than 6.3 cm were unacceptable. In the decision tree combined model, a good-excellent outcome for patients with differential (d) dNH = 1 (0 to 5.30 cm) and dNM ≠ 3 (<6.28 cm); and for a poor/poor result, values dNM = 3 (> 6.35). Conclusions: the results presented here are simple tools that can assist the surgeon for breast symmetry evaluation.

RESUMO Objetivo: avaliar simetria após a cirurgia conservadora da mama (CCM) para câncer. Métodos: estudo prospectivo de pacientes submetidos à CCM, as quais foram fotografadas segundo os mesmos critérios de avaliação. Os pontos de referência utilizados foram a diferença de altura do mamilo (AM), a distância mamilo-manúbrio (MM), a distância mamilo-esterno (ME) e o ângulo entre o sulco intramamário e o mamilo (ângulo mamilo; AnM). Foi usado o programa ImageJ. Avaliamos três modelos de simetria mamária: excelente/outros (modelo 1), excelente-bom/outros (modelo 2) e outros/ruim (modelo 3). Aplicamos a curva ROC para selecionar os critérios aceitáveis para a avaliação da simetria. Realizamos análise com o modelo de árvore de decisão. Resultados: foram avaliadas 274 mulheres. Os resultados do BCCT.core foram excelentes em 5,8% (16), bons em 24,1% (66), regulares em 46,4% (127) e ruins em 23,7% (65). A diferença de AM (dAM) foi associada a boa área mamária (0,837-0,846); diferenças aceitáveis foram inferiores a 3,1 cm, enquanto os valores inaceitáveis foram superiores a 6,4 cm. As diferenças MM (dMM) foram associadas à área regular das mamas (0,709-0,789); diferença de valor inferior a 4,5 cm foi aceitável, enquanto valores superiores a 6,3 cm foram inaceitáveis. O modelo combinado de árvore de decisão demonstrou resultado bom-excelente para pacientes com diferencial (d) dAM = 1 (0 a 5,30 cm) e dMM ≠ 3 (< 6,28 cm), e resultado ruim/ruim com dMM = 3 (> 6,35 cm). Conclusões: os resultados aqui apresentados são ferramentas simples que podem auxiliar o cirurgião na avaliação da simetria mamária.

Analysis of the quality of life in patients submitted to oncological treatment of the head and neck / Análise da qualidade de vida em pacientes submetidos a tratamento oncológico de cabeça e pescoço

To evaluate the quality of life and the influence of sociodemographic and clinical variables in patients undergoing treatment for head and neck cancer. Method: Quantitative, cross-sectional study. Two instruments were used: sociodemographic and clinical questionnaire and the Functional Assessment Cancer Therapy Head Neck (FACT-HN). Results: 170 respondents, 60.6% male, 51.2% married, with laryngeal cancer being the most found (34.7%) of the total sample, 78.8% underwent surgical procedures. In FACT-HN, the variables that showed significance were: educational level, professional activity and salary income. Only in the subscale additional head and neck cancer specific concerns (HNSC) were significant: type of cancer, staging, chemotherapy and surgical treatment. Conclusions: The research contributes by showing that predictive factors of quality of life are also socioeconomic issues and not just clinical issues related to the therapeutic approach. Assistance planning is essential to provide support for rehabilitation and reintegration into society.

Objetivo: Avaliar a qualidade de vida e a influência de variáveis sociodemográficas e clínicas, nos pacientes submetidos ao tratamento de câncer de cabeça e de pescoço. Método: Estudo quantitativo, transversal. Foram utilizados dois instrumentos: questionário sociodemográfico e clínico e o instrumento Functional Assessment Cancer Therapy Head Neck (FACT-HN). Resultados: 170 entrevistados, 60,6% do sexo masculino, 51,2% casados, sendo o câncer de laringe o mais encontrado (34,7%) do total da amostra, 78,8% realizaram procedimento cirúrgico. No FACT-HN, as variáveis que apresentaram significância foram: nível educacional, atividade profissional e renda salarial. Apenas na subescala preocupações adicionais específicas do câncer de cabeça e pescoço (PACP) foram significativos: tipo de câncer, estadiamento, tratamento quimioterápico e cirúrgico. Conclusões: A pesquisa contribui ao evidenciar que fatores preditores de qualidade de vida são também questões socioeconômicas e não apenas questões clínicas relacionadas a abordagem terapêutica. O planejamento da assistência é fundamental para fornecer um suporte com vistas a reabilitação e reinserção na sociedade.

Implante Percutâneo Transeptal de Bioprótese em Disfunção de Prótese Valvar Cirúrgica Mitral - Experiência Multicêntrica Brasileira / Percutaneous Transseptal Bioprosthetic Implantation in Failed Prosthetic Surgical Mitral Valve - Brazilian Multicenter Experience

Resumo Fundamento A intervenção percutânea em pacientes com disfunção de prótese biológica mitral apresenta-se como uma alternativa ao tratamento cirúrgico convencional. Objetivo Relatar a primeira experiência brasileira de implante transcateter de bioprótese valve-in-valve mitral via transeptal (TMVIV-via transeptal). Métodos Foram incluídos pacientes portadores de disfunção de bioprótese cirúrgica submetidos ao TMVIV-transeptal em 12 hospitais brasileiros. Foram considerados estatisticamente significativos valores de p<0,05. Resultados Entre junho/2016 e fevereiro/2019, 17 pacientes foram submetidos ao TMVIV-via transeptal. A mediana de idade foi 77 anos (IIQ,70-82), a mediana do escore STS-PROM foi 8,7% (IIQ,7,2-17,8). Todos os pacientes tinham sintomas limitantes de insuficiência cardíaca (CF≥III), tendo 5 (29,4%) sido submetidos a mais de uma toracotomia prévia. Obteve-se sucesso do TMVIV-via transeptal em todos os pacientes. A avaliação ecocardiográfica demonstrou redução significativa do gradiente médio (pré-intervenção, 12±3,8 mmHg; pós-intervenção, 5,3±2,6 mmHg; p<0,001), assim como aumento da área valvar mitral (pré-intervenção, 1,06±0,59 cm2; pós-intervenção, 2,18±0,36 cm2; p<0,001) sustentados em 30 dias. Houve redução significativa e imediata da pressão sistólica de artéria pulmonar, com redução adicional em 30 dias (pré-intervenção, 68,9±16,4 mmHg; pós-intervenção, 57,7±16,5 mmHg; 30 dias, 50,9±18,7 mmHg; p<0,001). Durante o seguimento, com mediana de 162 dias (IIQ, 102-411), observou-se marcada melhora clínica (CF≤II) em 87,5%. Um paciente (5,9%) apresentou obstrução de via de saída de ventrículo esquerdo (VSVE), evoluindo para óbito logo após o procedimento, e outro morreu aos 161 dias de seguimento.Conclusão: A primeira experiência brasileira de TMVIV-transeptal demonstra a segurança e a efetividade dessa nova técnica. A obstrução da VSVE é uma complicação potencialmente fatal, reforçando a importância da seleção dos pacientes e do planejamento do procedimento. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Abstract Background Percutaneous intervention in patients with bioprosthetic mitral valve dysfunction is an alternative to conventional surgical treatment. Objectives To report the first Brazilian experience with transseptal transcatheter bioprosthetic mitral valve-in-valve implantation (transseptal-TMVIV). Methods Patients with surgical bioprosthetic dysfunction submitted to transseptal-TMVIV in 12 Brazilian hospitals were included. The significance level adopted was p<0.05. Results From June/2016 to February/2019, 17 patients underwent transseptal-TMVIV. Their median age was 77 years (IQR,70-82) and median Society of Thoracic Surgeons predicted risk of mortality (STS-PROM) score was 8.7% (IQR,7.2-17.8). All patients had limiting symptoms of heart failure (FC≥III) and 5 (29.4%) had undergone more than one previous thoracotomy. Transseptal-TMVIV was successful in all patients. Echocardiographic assessment showed a significant reduction in mean mitral valve gradient (pre-intervention, 12±3.8 mmHg; post-intervention, 5.3±2.6 mmHg; p<0.001), in addition to an increase in mitral valve area (pre-intervention, 1.06±0.59 cm2; post-intervention, 2.18±0.36 cm2; p<0.001) sustained for 30 days. There was a significant and immediate reduction in the pulmonary artery systolic pressure, with an additional reduction in 30 days (pre-intervention, 68.9±16.4 mmHg; post-intervention, 57.7±16.5 mmHg; 30 days, 50.9±18.7 mmHg; p<0.001). During follow-up (median, 162 days; IQR, 102-411), significant clinical improvement (FC≤II) was observed in 87.5% of the patients. One patient (5.9%) had left ventricular outflow tract (LVOT) obstruction and died right after the procedure, and another died at 161 days of follow-up. Conclusion The first Brazilian experience with transseptal-TMVIV shows the safety and effectivity of the new technique. The LVOT obstruction is a potentially fatal complication, reinforcing the importance of patients' selection and of procedural planning. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Impacto Atual da Circulação Extracorpórea na Cirurgia de Revascularização Miocárdica no Estado de São Paulo / Current Impact of Cardiopulmonary Bypass in Coronary Artery Bypass Grafting in São Paulo State

Resumo Fundamento Resultados prévios com o uso de circulação extracorpórea (CEC) geram dificuldades na escolha do melhor tratamento para cada paciente na cirurgia de revascularização miocárdica (CRM) no contexto atual. Objetivo Avaliar o impacto da CEC no cenário atual da CRM no estado de São Paulo. Métodos Foram analisados 2.905 pacientes submetidos à CRM de forma consecutiva em 11 centros do estado de São Paulo pertencentes ao Registro Paulista de Cirurgia Cardiovascular (REPLICCAR) I. Dados perioperatórios e de seguimento foram colocados via on-line por especialistas treinados e capacitados em cada hospital. Foram analisadas as associações das variáveis perioperatórias com o tipo de procedimento (com ou sem CEC) e com os desfechos. A mortalidade esperada foi calculada por meio do EuroSCORE II (ESII). Os valores de p menores de 5% foram considerados significativos. Resultados Não houve diferença significativa em relação à idade dos pacientes entre os grupos (p=0,081). Dentre os pacientes, 72,9% eram de sexo masculino; 542 pacientes foram operados sem CEC (18,7%). Das características pré-operatórias, pacientes com infarto agudo do miocárdio (IAM) prévio (p=0,005) e disfunção ventricular (p=0,031) foram operados com CEC; no entanto, pacientes de emergência ou em classe funcional New York Heart Association (NYHA) IV foram operados sem CEC (p<0,001). O valor do ESII foi semelhante para ambos os grupos (p=0,427). Na CRM sem CEC, houve preferência pelo uso do enxerto radial (p<0,001) e com CEC pela artéria mamária direita (p<0,001). No pós-operatório, o uso de CEC esteve associado com reoperação por sangramento (p=0,012). Conclusão Atualmente, no REPLICCAR, reoperação por sangramento foi o único desfecho associado ao uso da CEC na CRM. (Arq Bras Cardiol. 2020; 115(4):595-601)

Abstract Background Previous results on the use of cardiopulmonary bypass (CPB) have generated difficulties in choosing the best treatment for each patient undergoing myocardial revascularization surgery (CABG) in the current context. Objective Evaluate the current impact of CPB in CABG in São Paulo State. Methods A total of 2905 patients who underwent CABG were consecutively analyzed in 11 São Paulo State centers belonging to the São Paulo Registry of Cardiovascular Surgery (REPLICCAR) I. Perioperative and follow-up data were included online by trained specialists in each hospital. Associations of the perioperative variables with the type of procedure and with the outcomes were analyzed. The study outcomes were morbidity and operative mortality. The expected mortality was calculated using EuroSCORE II (ESII). The values of p <5% were considered significant. Results There were no significant differences concerning the patients' age between the groups (p=0.081). 72.9% of the patients were males. Of the patients, 542 underwent surgery without CPB (18.7%). Of the preoperative characteristics, patients with previous myocardial infarction (p=0.005) and ventricular dysfunction (p=0.031) underwent surgery with CPB. However, emergency or New York Heart Association (NYHA) class IV patients underwent surgery without CPB (p<0.001). The ESII value was similar in both groups (p=0.427). In CABG without CPB, the radial graft was preferred (p<0.001), and in CABG with CPB the right mammary artery was the preferred one (p<0.001). In the postoperative period, CPB use was associated with reoperation for bleeding (p=0.012). Conclusion Currently in the REPLICCAR, reoperation for bleeding was the only outcome associated with the use of CPB in CABG. (Arq Bras Cardiol. 2020; 115(4):595-601)

Revascularização cirúrgica do miocárdio - análise crítica da evolução e estado atual / Surgical mocardial revascularization - critical analysis of its evolution and current state

O desenvolvimento da cinecoronariografia por Sones, no início da década de 1960, abriu caminho para a moderna cirurgia de revascularização do miocárdio. Em 1967, Favarolo realizou as primeiras pontes de veia safena e a técnica se expandiu mundialmente. Apesar de seu começo empolgante, no início da década de 1970, estudos angiográficos mostraram taxas de oclusão dos enxertos venosos, no primeiro ano, entre 10 a 15%. Em 1986, Loop e colaboradores mostraram o aumento da sobrevida dos pacientes em 10 anos, quando utilizava-se a artéria torácica interna esquerda anastomosada na artéria descendente anterior. Lytle, em 1999, indicou que esse benefício era melhorado quando utilizava-se ambas as artérias torácicas internas. Paralelamente, novas técnicas também foram surgindo, como a cirurgia sem o uso da circulação extracorpórea e, também, a partir de 1995, a utilização de mini acesso. Durante todos esses anos, inúmeros estudos foram realizados, dentre eles podemos destacar: o estudo SYNTAX e sua grande contribuição com o desenvolvimento do syntax score ; o estudo Freedom, mostrando que pacientes diabéticos apresentam maior benefício com a cirurgia de revascularização do miocárdio em comparação ao tratamento percutâneo. Em relação às lesões de tronco de coronária esquerda, dois grandes estudos (NOBLE e EXCEL) mostraram que o tratamento percutâneo, em pacientes com syntax score baixo, é uma boa opção terapêutica. Nas síndromes coronarianas agudas sem elevação do segmento ST no eletrocardiograma, a opinião do Heart Team é de extrema importância para decisão de qual tratamento realizar, seja ele clínico, percutâneo ou cirúrgico. Já nas SCA com elevação do segmento ST no eletrocardiograma, o tratamento por cateter, com a colocação de stent, é o preferencial, reservando o tratamento cirúrgico apenas para casos de falha no tratamento percutâneo ou quando há aparecimento de complicações mecânicas

The development of coronary angiography by Sones, in the early 1960s, opened the way for modern myocardial revascularization surgery. In 1967, Favarolo performed the first saphenous vein coronary artery bypass grafting (CABG) surgery, and the technique expanded worldwide. Despite its exciting start, at the beginning of the 1970s, angiographic studies showed vein graft occlusion rates, in the first year, of between 10% and 15%. In 1986, Loop and colleagues showed increased 10-year patient survival when the left anastomosed internal thoracic artery was used in the left anterior descending artery. Lytle, in 1999, indicated that this benefit was improved when both internal thoracic arteries were used. Meanwhile, new techniques were also emerging, such as off-pump CABG and since 1995, the use of minimally invasive surgery. During these years, numerous studies were carried out, including: the SYNTAX Trial, with its major contribution with the development of the syntax score; and the Freedom Trial, which showed that diabetic patients still benefit most from myocardial revascularization surgery compared to percutaneous treatment. In relation to lesions of the left coronary trunk, two large studies (NOBLE and EXCEL) showed that percutaneous treatment in patients with a low syntax score is a good therapeutic option. In acute coronary syndromes without ST segment elevation in the electrocardiogram, the opinion of the Heart Team is extremely important for deciding on the best treatment, be it clinical, percutaneous, or surgical. In ACS with ST segment elevation in the electrocardiogram, catheter treatment with stent placement is the preferred choice, reserving surgical treatment only for cases of percutaneous treatment failure, or where there are mechanical complications.

Off-pump versus on-pump coronary artery bypass grafting in frail patients: study protocol for the fragile multicenter randomized controlled trial

Abstract Introduction: Advances in modern medicine have led to people living longer and healthier lives. Frailty is an emerging concept in medicine yet to be explored as a risk factor in cardiac surgery. When it comes to CABG surgery, randomized controlled clinical trials have primarily focused on low-risk (ROOBY, CORONARY), elevated-risk (GOPCABE) or high-risk patients (BBS), but not on frail patients. Therefore, we believe that off-pump CABG could be an important technique in patients with limited functional capacity to respond to surgical stress. In this study, the authors introduce the new national, multicenter, randomized, controlled trial "FRAGILE", to be developed in the main cardiac surgery centers of Brazil, to clarify the potential benefit of off-pump CABG in frail patients. Methods: FRAGILE is a two-arm, parallel-group, multicentre, individually randomized (1:1) controlled trial which will enroll 630 patients with blinded outcome assessment (at 30 days, 6 months, 1 year, 2 years and 3 years), which aims to compare adverse cardiac and cerebrovascular events after off-pump versus on-pump CABG in pre-frail and frail patients. Primary outcomes will be all-cause mortality, acute myocardial infarction, cardiac arrest with successful resuscitation, low cardiac output syndrome/cardiogenic shock, stroke, and coronary reintervention. Secondary outcomes will be major adverse cardiac and cerebrovascular events, operative time, mechanical ventilation time, hyperdynamic shock, new onset of atrial fibrillation, renal replacement therapy, reoperation for bleeding, pneumonia, length of stay in intensive care unit, length of stay in hospital, number of units of blood transfused, graft patency, rate of complete revascularization, neurobehavioral outcomes after cardiac surgery, quality of life after cardiac surgery and costs. Discussion: FRAGILE trial will determine whether off-pump CABG is superior to conventional on-pump CABG in the surgical treatment of pre-frail and frail patients. Trial registration: ClinicalTrials.gov, ID: NCT02338947. Registered on August 29th 2014; last updated on March 21st 2016.

Pitfalls and artifacts in the interpretation of oncologic PET/CT of the chest / Armadilhas e artefatos na interpretação de PET/CT na oncologia torácica

Abstract PET/CT is widely used for the evaluation of patients with thoracic malignancies. Although the levels of 18F-fluorodeoxyglucose (FDG) uptake are usually high in neoplastic diseases, they can also be physiological, due to artifacts. In addition, FDG uptake can occur in benign conditions such as infectious, inflammatory, and iatrogenic lesions. Furthermore, some malignant tumors, such as adenocarcinoma in situ (formerly known as bronchoalveolar carcinoma) and carcinoid tumors, may not show FDG uptake. Here, we illustrate the main pitfalls and artifacts in the interpretation of the results of oncologic PET/CT of the chest, outlining strategies for avoiding misinterpretation.

Resumo PET/CT é amplamente utilizada para avaliação de pacientes com neoplasias torácicas. Altos níveis de captação de 18F-fluordesoxiglicose (FDG) são geralmente vistos em neoplasias, mas também podem ser fisiológicos, decorrentes de artefatos ou ocorrerem em condições benignas, como lesões infecciosas, inflamatórias e iatrogênicas. Por outro lado, alguns tumores malignos podem não captar FDG, como o adenocarcinoma in situ (anteriormente denominado de carcinoma bronquioloalveolar) e tumores carcinoides. Os autores ilustram as principais armadilhas e artefatos na interpretação dos exames torácicos de PET/CT oncológicos, com estratégias para evitar erros de interpretação.

Sexual castes of Trachymyrmex fuscus (Formicidae: Attini) performing worker tasks / Castas sexuadas de Trachymyrmex fuscus (Formicidae: Attini) executando tarefas de operárias

ABSTRACT: The main of this research was to report an atypical foraging behavior in a colony of Trachymyrmex fuscus, situated in "Cerrado" (savanna ecoregion of Goiás, Brazil). The colony foraging activity was performed only by sexual caste. Comparison of the foraging rhythm of this colony with another of the same specie where foraging was performed only by worker caste, showed that working time hours were very similar. After observations on the foraging behavior, both colonies were excavated in order to characterize them (nest size, population composition and estimating of the symbiotic fungus volume). Besides the foraging activity performed only by sexual females, other important observations were highlighted in that colony: low number of workers, presence of worker larvae and pupae (45 and 43 respectively) and apparently normal growth of the symbiotic fungus. Our hypothesis is that sexual females were in charge of the entire colony maintenance. This could be a strategy of colony survival when the worker caste is reduced.

RESUMO: Este trabalho objetivou registrar um comportamento atípico de forrageamento em uma colônia de Trachymyrmex fuscus, localizada em área de cerrado, em Ipameri, Goiás, Brasil. Nessa colônia, a atividade de forrageamento era executada somente por castas sexuadas. A comparação do ritmo diário de forrageamento dessa colônia com o de outra, da mesma espécie, em que tal atividade era executada por castas operárias, mostrou ritmos das jornadas de trabalho relativamente similares. Essas colônias foram escavadas para sua própria caracterização. Além da atividade forrageadora, executada somente por fêmeas, outras observações relevantes mereceram destaque na referida colônia: inexpressivo número de operárias (5), presença de larvas e pupas de operárias (45 e 43, respectivamente) e crescimento aparentemente normal de fungo simbionte. Nossa hipótese é a de que as fêmeas sexuadas faziam a manutenção de toda a colônia. Essa pode ser uma estratégia para a sobrevivência da colônia em um momento em que a casta operária encontra-se reduzida.

Myocardial blood flow assessment with 82rubidium-PET imaging in patients with left bundle branch block

OBJECTIVES: Perfusion abnormalities are frequently seen in Single Photon Emission Computed Tomography (SPECT) when a left bundle branch block is present. A few studies have shown decreased coronary flow reserve in the left anterior descending territory, regardless of the presence of coronary artery disease. OBJECTIVE: We sought to investigate rubidium-82 (82Rb) positron emission tomography imaging in the assessment of myocardial blood flow and coronary flow reserve in patients with left bundle branch block. METHODS: Thirty-eight patients with left bundle branch block (GI), median age 63.5 years, 22 (58%) female, 12 with coronary artery disease (≥70%; GI-A) and 26 with no evidence of significant coronary artery disease (GI-B), underwent rest-dipyridamole stress 82Rb-positron emission tomography with absolute quantitative flow measurements using Cedars-Sinai software (mL/min/g). The relative myocardial perfusion and left ventricular ejection fraction were assessed in 17 segments. These parameters were compared with those obtained from 30 patients with normal 82Rb-positron emission tomography studies and without left bundle branch block (GII). RESULTS: Stress myocardial blood flow and coronary flow reserve were significantly lower in GI than in GII (p<0.05). The comparison of coronary flow reserve between GI-A and GI-B showed that it was different from the global coronary flow reserve (p<0.05) and the stress flow was significantly lower in the anterior than in the septal wall for both groups. Perfusion abnormalities were more prevalent in GI-A (p=0.06) and the left ventricular ejection fraction was not different between GI-A and GI-B, whereas it was lower in GI than in GII (p<0.001). CONCLUSION: The data confirm that patients with left bundle branch block had decreased myocardial blood flow and coronary flow reserve and coronary flow reserve assessed by 82Rb-positron emission tomography imaging may be useful in identifying coronary artery disease in patients with left bundle branch block.

Seven decades of studies with Asopinae predators in Brazil (1933●-○2014) / Sete décadas de estudos com asopinae predadores no Brasil (1933●-○2014)

Studies of Asopinae predators in Brazil were initiated in the 1930's, focusing on the use of these insects in biological control programs. However, the beginning of a period of major contributions to the knowledge on Asopinae predators started in the year 1986, with the release of the first research results, in the Proceedings of the X Brazilian Congress of Entomology in Maceió, Alagoas, Brazil. In 1991 the first scientific paper was published on the predator Podisus connexivus Bergroth [= Podisus nigrispinus (Dallas)] (Hemiptera: Pentatomidae), with study of the biological parameters of this predator for alternative feeding of the caterpillars Bombyx mori Linnaeus (Lepidoptera: Bombycidae) and larvae Musca domestica (Linnaeus) (Diptera: Muscidae). The first master thesis studying Asopinae predators in Brazil was defended in 1990 at the Federal University of Lavras, which focused was on biology and predatory capacity of Podisus nigrolimbatus [= Brontocoris nigrolimbatus = Brontocoris tabidus] and Podisus connexivus [= Podisus nigrispinus] in the laboratory. Throughout all these years of research and investigations, advances with Asopinae predators occurred in several fields that resulted in a better understanding of these insects, making them an effective tool for controlling insect pests in the agriculture and forestry sectors.

Estudos dos predadores Asopinae no Brasil foram iniciados na década de 1930 focando o uso desses insetos em programas de controle biológico. Entretanto, o início de um período de grandes contribuições sobre o conhecimento de predadores Asopinae iniciou-se a partir do ano de 1986, com a divulgação do primeiro resultado de pesquisa, nos Anais do X Congresso Brasileiro de Entomologia em Maceió, Alagoas. Em 1991, foi publicado o primeiro artigo científico sobre o predador Podisus connexivus Bergroth, 1891 [= Podisus nigrispinus (Dallas, 1851)] (Hemiptera: Pentatomidae), com o estudo dos parâmetros biológicos desse predador em alimentação alternada de lagartas de Bombyx mori Linnaeus, 1758 (Lepidoptera: Bombycidae) e larvas de Musca domestica (Linnaeus, 1758) (Diptera: Muscidae). A primeira dissertação de mestrado com predadores Asopinae no Brasil, foi defendida em 1990, na Universidade Federal de Lavras, onde o foco foi a biologia e a capacidade predatória de Podisus nigrolimbatus [= Brontocoris nigrolimbatus = Brontocoris tabidus] e Podisus connexivus [= P. nigrispinus] em laboratório. Ao longo de todos esses anos de investigações, os avanços com predadores Asopinae ocorreram em vários ramos que resultaram em um melhor entendimento desses insetos, tornando-os uma eficiente ferramenta no controle de insetos pragas nos setores agrícola e florestal.

Effect of Global Postural Reeducation on cardiovascular system of healthy subjects / Efeito da Reeducação Postural Global sobre o sistema cardiovascular de indivíduos saudáveis

Objective To evaluate the effect of Global Postural Reeducation (GPR) on cardiovascular system by heart rate variability (HRV), blood pressure (BP) and heart rate (HR). Materials and methods Seventeen healthy men (22.47 ± 3.02 years) were submitted to the postures frog on the floor, frog on the air, sitting, standing against the wall and inclined standing, two postures per session. The systolic and diastolic blood pressure (SBP and DBP) and HR were recorded. The intervals between heartbeats were collected during the whole session (Polar S810i). The frequency domain was analyzed (Wavelet Transform), the low frequency (LF) and high frequency (HF) were obtained. The data were analyzed by ANOVA and Tukey (p < 0.05). Results Increased LF/HF ratio was observed in the frog on the floor (1 ± 0.1 vs. 2 ± 0.3 p < 0.05) and on the air postures (1 ± 0.1 vs. 2 ± 0.2 p < 0.01). There was an increase in SBP in the postures frog on the floor (123 ± 2 vs. 136 ± 4 p < 0.05), frog on the air (122 ± 2 vs. 133 ± 3 p < 0.05), standing against the wall (123 ± 2 vs. 136 ± 4 p < 0.05), inclined standing (124 ± 3 vs. 146 ± 5 p < 0.05). There was increase of DBP in the postures frog on the floor (69 ± 2 vs. 81 ± 2 p < 0.01), frog on the air (72 ± 2 vs. 83 ± 3 p < 0.05), sitting (85 ± 2 vs. 102 ± 3 p < 0.01). There was increase in HR in the postures frog on the air (67 ± 2 vs. 77 ± 3 p < 0.05) and inclined standing (88 ± 3.5 vs. 101 ± 3 p < 0.05). Conclusion The increase in LF/HF ratio and also the BP and HR indicates high sympathetic activity, possibly related to the work isometric developed during GPR method. [P] .

Objetivo Avaliar o efeito da Reeducação Postural Global (RPG) sobre o sistema cardiovascular por meio da variabilidade da frequência cardíaca (VFC), pressão arterial (PA) e frequência cardíaca (FC). Materiais e métodos Dezessete homens saudáveis (22,47± 3,02 anos) foram submetidos às posturas rã no chão, rã no ar, sentada, de pé contra a parede e de pé inclinada, sendo duas posturas por sessão. A pressão arterial sistólica e diastólica (PAS, PAD) e FC foram registradas. Os intervalos entre os batimentos cardíacos foram coletados durante toda a sessão (Polar S810i). O domínio da frequência foi analisado (transformada Wavelet), as bandas de baixa (LF) e a alta frequências (HF) foram obtidas. Os dados foram analisados por ANOVA e Tukey (p < 0,05). Resultados Houve aumento da relação LF/HF nas posturas rã no chão (1 ± 0,1 vs. 2 ± 0,3 p < 0,05); rã no ar (1 ± 0,1 vs. 2 ± 0,2 p < 0,01). Observou-se aumento da PAS nas posturas rã no chão (123 ± 2 vs. 136 ± 4 p < 0,05), rã no ar (122 ± 2 vs. 133 ± 3 p < 0,05), de pé na parede (123 ± 2 vs. 136 ± 4 p < 0,05), de pé inclinada (124 ± 3 vs. 146 ± 5 p < 0,05). Houve aumento da PAD nas posturas rã no chão (69 ± 2 vs. 81 ± 2 p < 0,01), rã no ar (72 ± 2 vs. 83 ± 3 p < 0,05), sentada (85 ± 2 vs. 102 ± 3 p < 0,01). Houve aumento da FC nas posturas rã no ar (67 ± 2 vs. 77 ± 3 p < 0,05) e de pé inclinada (88 ± 3,5 vs. 101 ± 3 p < 0,05). Conclusão O aumento da relação LF/HF e também da PA e da FC aponta para maior atividade simpática, possivelmente relacionada ao trabalho isométrico desenvolvido durante a realização ...

Culture of mouse peritoneal macrophages with mouse serum induces lipid bodies that associate with the parasitophorous vacuole and decrease their microbicidal capacity against Toxoplasma gondii

Lipid bodies [lipid droplets (LBs)] are lipid-rich organelles involved in lipid metabolism, signalling and inflammation. Recent findings suggest a role for LBs in host response to infection; however, the potential functions of this organelle in Toxoplasma gondii infection and how it alters macrophage microbicidal capacity during infection are not well understood. Here, we investigated the role of host LBs in T. gondii infection in mouse peritoneal macrophages in vitro. Macrophages cultured with mouse serum (MS) had higher numbers of LBs than those cultured in foetal bovine serum and can function as a model to study the role of LBs during intracellular pathogen infection. LBs were found in association with the parasitophorous vacuole, suggesting that T. gondii may benefit from this lipid source. Moreover, increased numbers of macrophage LBs correlated with high prostaglandin E2 (PGE2) production and decreased nitric oxide (NO) synthesis. Accordingly, LB-enriched macrophages cultured with MS were less efficient at controlling T. gondii growth. Treatment of macrophages cultured with MS with indomethacin, an inhibitor of PGE2 production, increased the microbicidal capacity against T. gondii. Collectively, these results suggest that culture with MS caused a decrease in microbicidal activity of macrophages against T. gondii by increasing PGE2 while lowering NO production.

Efeito da terapia LED (λ = 945 ± 20 nm) de baixa intensidade sobre tecido epitelial de ratos diabéticos em processo de reparo / Low level LED therapy (λ = 945 ± 20 nm) effect on epithelial tissue of diabetic rats during repairing process

INTRODUÇÃO: O diabetes mellitus é uma condição sistêmica que pode causar retardo da resposta tecidual frente a uma lesão. Diversos estudos têm apontado o laser como importante ferramenta terapêutica para o auxílio do processo de reparo tecidual. Contudo, poucos estudos foram realizados com o emprego de LED (Light Emitting Diode). Assim, o objetivo deste trabalho foi analisar o efeito da terapia com LED (λ = 945 ± 20nm) de baixa intensidade sobre tecido epitelial de ratos diabéticos em processo de reparo. MÉTODOS: Para tal, foi realizada a indução de diabetes experimental em 20 ratos machos (Wistar), com administração de 40mg/kg, por via endovenosa, de mono-hidrato de aloxana diluído em solução tampão. Após 14 dias, os animais foram submetidos à incisão tecidual na região dorsal, seguida de sutura e divididos em grupo-controle (GI e GIII, 3 e 7 dias pós-lesão, respectivamente), e grupo-tratado com LED (GII e GIV, 3 e 7 dias pós-lesão, respectivamente). Os animais do grupo tratado (n = 10) foram irradiados de forma transcutânea, em duas sessões (30 minutos e 48 horas pós-lesão). RESULTADOS: O número de fibroblastos foi significativamente maior no GIV em relação ao GIII. CONCLUSÃO: Considerando o aumento do número de fibroblastos (análise quantitativa) e o adequado fechamento da lesão (análise qualitativa), pode-se concluir que houve um efeito positivo da terapia LED na região do infravermelho próximo sobre o processo de reparo, após 7 dias de lesão tecidual em animais diabéticos (GIV).

INTRODUCTION: Diabetes mellitus is a systemic condition that can cause delayed tissue response to injury. Several studies have demonstrated laser therapy as an important tool to aid the process of tissue repair. However, few studies have been conducted with the use of LED (Light Emitting Diode). OBJECTIVE: The objective of this study was to analyze the low intensity LED (λ = 945 ± 20 nm) therapy effect on epithelial tissue of diabetic rats in the healing process. METHODS: The induction of experimental diabetes was performed in 20 male rats (Wistar) with the intravenous administration of 40mg/kg of alloxan monohydrate diluted in buffer solution. After 14 days the animals underwent tissue incision in the dorsal region, followed by suture, and divided into control groups (GI and GIII, 3 and 7 days post-injury, respectively) and groups treated with LED (GII and GIV, 3 and 7 days post-injury, respectively). The treated groups (n = 10) were irradiated transcutaneously, in two sessions (30 minutes, 48 hours post-injury). RESULTS: The number of fibroblasts was significantly higher in GIV compared to GIII. CONCLUSION: Considering the increase of fibroblasts (quantitative analysis) and appropriate closing of the lesion (qualitative analysis), we conclude that LED therapy in the near infrared region causes a positive effect on healing process after 7 days in tissue injury in diabetic animals (GIV).

Medicina nuclear: cintilografia de perfusão miocárdica e PET. O padrão ouro?N / Nuclear medicine: myocardial perfusion scintigraphy and PET. The gold standard?

Pacientes com insuficiência cardíaca podem ter grande benefício quando a presença de miocárdio ainda viável é identificada, com posterior revascularização. Por outro lado, sabe-se que tal procedimento não confere vantagem na ausência de viabilidade miocárdica. Vários métodos não invasivos de imagem disponíveis podem indicar presença ou ausência de músculo cardíaco passível de recuperação. Na área da medicina nuclear em cardiologia, tais informações podem ser obtidas pela cintilografia de perfusão miocárdica, técnica de gated_SPECT ou pela tomografia por emissão de pósitrons. A propriedade de redistribuição pode conferir uma vantagem ao tálio-201 na detecção de viabilidade. PET tem a vantagem de ser capaz de avaliar tanto a perfusão do miocárdio quanto a presença de atividade metabólica celular. Ao longo dos próximos anos, os avanços no campo da cardiologia nuclear incluirão maior acessibilidade da tomografia por emissão de pósitrons para estudos de perfusão e metabolismo, dando continuidade aos avanços na área de imagem molecular. Desta forma, as técnicas de cardiologia nuclear poderão cada vez mais responder questões fundamentais na decisao terapêutica de pacientes com insuficiência cardíaca de origem isquêmica.

Resultados imediatos e seguimento clínico dos pacientes submetidos a implante valvar aórtico transcateter / Immediate results and clinical follow-up of patients undergoing transcatheter aortic-valve implantation

INTRODUÇÃO: Um terço da população idosa portadora de estenose aórtica calcificada sintomática não apresenta condições cirúrgicas em decorrência do elevado risco operatório. O implante valvar aórtico transcateter (IVAT) surgiu como uma alternativa terapêutica para esses pacientes. MÉTODOS: Incluímos, no período de novembro de 2008 a abril de 2012, todos os pacientes submetidos a IVAT em nosso serviço. Relatamos as características clínicas basais, os dados dos procedimentos, os resultados hospitalares e o seguimento clínico dessa população. As definições utilizadas foram baseadas nos critérios do Valve Academic Research Consortium. RESULTADOS: O IVAT foi realizado em 23 pacientes, com 79 ± 6,7 anos de idade, 56% do sexo feminino. O EuroSCORE foi de 20,4 ± 11,1%. A prótese CoreValve® foi utilizada em 19 pacientes (82,6%) e a Edwards SAPIEN TM nos demais. A taxa de sucesso do procedimento foi de 96%. O tempo médio de seguimento clínico foi de 22 ± 12,8 meses, observando-se 6 óbitos (26,1%) nesse período, 3 dos quais ocorreram nos primeiros 30 dias (13%) e outros 2 (21,7%), até o final do primeiro ano. Um paciente apresentou ataque isquêmico transitório na fase hospitalar (4,3%), mas não ocorreram episódios de acidente vascular encefálico ou de infarto do miocárdio no período periprocedimento ou no acompanhamento tardio. O desfecho combinado de segurança aos 30 dias ocorreu em 5 pacientes (21,7%) e o desfecho combinado de eficácia aos 12 meses foi de 78,3%. CONCLUSÕES: Os resultados obtidos neste estudo demonstram o IVAT como procedimento atrativo para o tratamento de pacientes portadores de estenose aórtica calcificada de alto risco cirúrgico.

BACKGROUND: One third of the elderly population with symptomatic calcified aortic stenosis cannot undergo surgery due to their high operative risk. The transcatheter aortic-valve implantation (TAVI) has emerged as an alternative therapy for this group of patients. METHODS: All patients submitted to TAVI from November 2008 to April 2012 were included in our study. We report the baseline clinical characteristics, procedural data, hospital outcomes and clinical follow-up of this population. Definitions were based on the Valve Academic Research Consortium criteria. RESULTS: TAVI was performed in 23 patients, with 79 ± 6.7 years of age, and 56% were female. The EuroSCORE was 20.4 ± 11.1%. The CoreValve® prosthesis was used in 19 patients (82.6%) and the Edwards SAPIEN TM valve was used in the remaining ones. Procedure success rate was 96%. The mean follow-up was 22 ± 12.8 months, with 6 deaths (26.1%) in this period, 3 of which were observed in the first 30 days (13%) and other 2 (21.7%) by the end of the first year. One patient had a transient ischemic attack during hospitalization (4.3%), but there were no episodes of stroke or myocardial infarction in the periprocedural period or in the follow-up. The composite safety endpoint at 30 days was observed in 5 patients (21.7%) and the composite efficacy endpoint at 12 months was 78.3%. CONCLUSIONS: The results of this study demonstrate that TAVI is an attractive procedure for the treatment of patients with calcified aortic stenosis and high operative risk.