ConKeD: multiview contrastive descriptor learning for keypoint-based retinal image registration.

Retinal image registration is of utmost importance due to its wide applications in medical practice. In this context, we propose ConKeD, a novel deep learning approach to learn descriptors for retinal image registration. In contrast to current registration methods, our approach employs a novel multi-positive multi-negative contrastive learning strategy that enables the utilization of additional information from the available training samples. This makes it possible to learn high-quality descriptors from limited training data. To train and evaluate ConKeD, we combine these descriptors with domain-specific keypoints, particularly blood vessel bifurcations and crossovers, that are detected using a deep neural network. Our experimental results demonstrate the benefits of the novel multi-positive multi-negative strategy, as it outperforms the widely used triplet loss technique (single-positive and single-negative) as well as the single-positive multi-negative alternative. Additionally, the combination of ConKeD with the domain-specific keypoints produces comparable results to the state-of-the-art methods for retinal image registration, while offering important advantages such as avoiding pre-processing, utilizing fewer training samples, and requiring fewer detected keypoints, among others. Therefore, ConKeD shows a promising potential towards facilitating the development and application of deep learning-based methods for retinal image registration.

Toward Fully Multiferroic van der Waals SpinFETs: Basic Design and Quantum Calculations.

Manipulating spin transport enhances the functionality of electronic devices, allowing them to surpass physical constraints related to speed and power. For this reason, the use of van der Waals multiferroics at the interface of heterostructures offers promising prospects for developing high-performance devices, enabling the electrical control of spin information. Our work focuses primarily on a mechanism for multiferroicity in two-dimensional van der Waals materials that stems from an interplay between antiferromagnetism and the breaking of inversion symmetry in certain bilayers. We provide evidence for spin-electrical couplings that include manipulating van der Waals multiferroic edges via external voltages and the subsequent control of spin transport including for fully multiferroic spin field-effect transistors.

Local experience of laboratory activities in a BS physical therapy course: integrating sEMG and kinematics technology with active learning across six cohorts.

Introduction: Integrating technology and active learning methods into Laboratory activities would be a transformative educational experience to familiarize physical therapy (PT) students with STEM backgrounds and STEM-based new technologies. However, PT students struggle with technology and feel comfortable memorizing under expositive lectures. Thus, we described the difficulties, uncertainties, and advances observed by faculties on students and the perceptions about learning, satisfaction, and grades of students after implementing laboratory activities in a PT undergraduate course, which integrated surface-electromyography (sEMG) and kinematic technology combined with active learning methods. Methods: Six cohorts of PT students (n = 482) of a second-year PT course were included. The course had expositive lectures and seven laboratory activities. Students interpreted the evidence and addressed different motor control problems related to daily life movements. The difficulties, uncertainties, and advances observed by faculties on students, as well as the students' perceptions about learning, satisfaction with the course activities, and grades of students, were described. Results: The number of students indicating that the methodology was "always" or "almost always," promoting creative, analytical, or critical thinking was 70.5% [61.0-88.0%]. Satisfaction with the whole course was 97.0% [93.0-98.0%]. Laboratory grades were linearly associated to course grades with a regression coefficient of 0.53 and 0.43 R-squared (p < 0.001). Conclusion: Integrating sEMG and kinematics technology with active learning into laboratory activities enhances students' engagement and understanding of human movement. This approach holds promises to improve teaching-learning processes, which were observed consistently across the cohorts of students.

Extending the computational and experimental analysis of lipase active site selectivity.

Molecular docking is an important computational analysis widely used to predict the interaction of enzymes with several starting materials for developing new valuable products from several starting materials, including oils and fats. In the present study, molecular docking was used as an efficient in silico screening tool to select biocatalysts with the highest catalytic performance in butyl esters production in a solvent-free system, an eco-friendly approach, via direct esterification of free fatty acids from Licuri oil with butanol. For such purpose, three commercial lipase preparations were used to perform molecular docking studies such as Burkholderia cepacia (BCL), Porcine pancreatic (PPL), and Candida rugosa (CRL). Concurrently, the results obtained in BCL and CRL are the most efficient in the esterification process due to their higher preference for catalyzing the esterification of lauric acid, the main fatty acid found in the licuri oil composition. Meanwhile, PPL was the least efficient because it preferentially interacts with minor fatty acids. Molecular docking with the experimental results indicated the better performance in the synthesis of esters was BCL. In conclusion, experimental results analysis shows higher enzymatic productivity in esterification reactions of 1294.83 µmol/h.mg, while the CRL and PPL demonstrated the lowest performance (189.87 µmol / h.mg and 23.96 µmol / h.mg, respectively). Thus, molecular docking and experimental results indicate that BCL is a more efficient lipase to produce fatty acids and esters from licuri oil with a high content of lauric acid. In addition, this study also demonstrates the application of molecular docking as an important tool for lipase screening to achieve more sustainable production of butyl esters with a view synthesis of biolubricants.

Extraordinary variability in gene activation and repression programs during gonadal sex differentiation across vertebrates.

Genes involved in gonadal sex differentiation have been traditionally thought to be fairly conserved across vertebrates, but this has been lately questioned. Here, we performed the first comparative analysis of gonadal transcriptomes across vertebrates, from fish to mammals. Our results unambiguously show an extraordinary overall variability in gene activation and repression programs without a phylogenetic pattern. During sex differentiation, genes such as dmrt1, sox9, amh, cyp19a and foxl2 were consistently either male- or female-enriched across species while many genes with the greatest expression change within each sex were not. We also found that downregulation in the opposite sex, which had only been quantified in the mouse model, was also prominent in the rest of vertebrates. Finally, we report 16 novel conserved markers (e.g., fshr and dazl) and 11 signaling pathways. We propose viewing vertebrate gonadal sex differentiation as a hierarchical network, with conserved hub genes such as sox9 and amh alongside less connected and less conserved nodes. This proposed framework implies that evolutionary pressures may impact genes based on their level of connectivity.

Experimental and Computational Analysis of Synthesis Conditions of Hybrid Nanoflowers for Lipase Immobilization.

This work presents a framework for evaluating hybrid nanoflowers using Burkholderia cepacia lipase. It was expanded on previous findings by testing lipase hybrid nanoflowers (hNF-lipase) formation over a wide range of pH values (5-9) and buffer concentrations (10-100 mM). The free enzyme activity was compared with that of hNF-lipase. The analysis, performed by molecular docking, described the effect of lipase interaction with copper ions. The morphological characterization of hNF-lipase was performed using scanning electron microscopy. Fourier Transform Infrared Spectroscopy performed the physical-chemical characterization. The results show that all hNF-lipase activity presented values higher than that of the free enzyme. Activity is higher at pH 7.4 and has the highest buffer concentration of 100 mM. Molecular docking analysis has been used to understand the effect of enzyme protonation on hNF-lipase formation and identify the main the main binding sites of the enzyme with copper ions. The hNF-lipase nanostructures show the shape of flowers in their micrographs from pH 6 to 8. The spectra of the nanoflowers present peaks typical of the amide regions I and II, current in lipase, and areas with P-O vibrations, confirming the presence of the phosphate group. Therefore, hNF-lipase is an efficient biocatalyst with increased catalytic activity, good nanostructure formation, and improved stability.

Removal of enrofloxacin using Eichhornia crassipes in microcosm wetlands.

The global consumption of antibiotics leads to their possible occurrence in the environment. In this context, nature-based solutions (NBS) can be used to sustainably manage and restore natural and modified ecosystems. In this work, we studied the efficiency of the NBS free-water surface wetlands (FWSWs) using Eichhornia crassipes in microcosm for enrofloxacin removal. We also explored the behavior of enrofloxacin in the system, its accumulation and distribution in plant tissues, the detoxification mechanisms, and the possible effects on plant growth. Enrofloxacin was initially taken up by E. crassipes (first 100 h). Notably, it accumulated in the sediment at the end of the experimental time. Removal rates above 94% were obtained in systems with sediment and sediment + E. crassipes. In addition, enrofloxacin was found in leaves, petioles, and roots (8.8-23.6 µg, 11-78.3 µg, and 10.2-70.7 µg, respectively). Furthermore, enrofloxacin, the main degradation product (ciprofloxacin), and other degradation products were quantified in the tissues and chlorosis was observed on days 5 and 9. Finally, the degradation products of enrofloxacin were analyzed, and four possible metabolic pathways of enrofloxacin in E. crassipes were described.

Renal Transplant Artery Stenosis and Kinking: An Unusual Association.

Renal artery stenosis of the kidney allograft associated with kinking is not a frequent finding. As a correctable cause of graft dysfunction, it is important to diagnose it as soon as possible to avoid further graft damage and improve graft and patient survival. As pulsed wave Doppler ultrasound mapping of the graft's renal arteries is essential to diagnose possible alterations, point of care ultrasound (POCUS) is a highly useful tool for early diagnosis. We present a case in which nephrologists performed this examination promptly allowing a timely diagnosis and treatment plan.

Model for Nonrelativistic Topological Multiferroic Matter.

We provide a model capable of accounting for the multiferroicity in certain materials. The model's base is on free electrons and spin moments coupled within nonrelativistic quantum mechanics. The synergistic interplay between the magnetic and electric degrees of freedom that turns into the multiferroic phenomena occurs at a profound quantum mechanical level, conjured by Berry's phases and the quantum theory of polarization. Our results highlight the geometrical nature of the multiferroic order parameter that naturally leads to magnetoelectric domain walls, with promising technological potential.

Insulin use and clinical outcomes in patients undergoing coronary artery bypass graft surgery

Abstract Objective: To describe insulin use and postoperative glucose control in patients undergoing coronary artery bypass graft (CABG) surgery. Methods: We examined 2,390 patients with and without diabetes enrolled in the Contemporary Analysis of Perioperative Cardiovascular Surgical Care (CAPS-Care) Study who underwent CABG surgery (01/2004 - 06/2005) to describe postoperative insulin use, variation in insulin use across different hospitals, and associated in-hospital complications and clinical outcomes. Logistic regression was used to assess the adjusted relationship between insulin use and clinical outcomes. Results: Overall, insulin was used in 82% (n=1,959) of patients, including 95% (n=1,203) with diabetes (n=1,258) and 67% (n=756) without diabetes (n=1,132). Continuous insulin was used in 35.5% of patients in the operating room and in 56% in the intensive care unit. Continuous insulin use varied significantly among centers from 8-100% in patients with diabetes. When compared with all patients not receiving insulin, insulin use in patients without diabetes was associated with a higher rate of death or major complication (adjusted odds ratio [OR]=1.54; 95% confidence interval [CI] 1.15-2.04; P=0.003). In patients with diabetes, insulin use was not associated with a higher risk of adverse outcomes (adjusted OR=1.01; 95% CI 0.52-1.98; P=0.98). Conclusion: The postoperative use of insulin is high among CABG patients in the United States of America. Insulin use in patients without diabetes was associated with worse clinical outcomes compared to patients (both with and without diabetes) who did not receive insulin. Further investigation is needed to determine the optimal use of postoperative insulin after CABG.

A especialidade de Alergia e Imunologia Clínica nos diferentes níveis de atenção à saúde no Brasil / Allergy and Clinical Immunology specialty in the different levels of health care in Brazil

Objetivos: Avaliar a atuação de alergistas/imunologistas no serviço público e identificar prioridades, carências e demandas na assistência aos pacientes com doenças alérgicas e imunodeficiências. Métodos: Foi desenvolvido um questionário on-line autoaplicável por meio do Google Forms, composto por 17 questões de múltipla escolha sobre dados demográficos, área de atuação, local de desempenho das atividades profissionais e acesso a exames laboratoriais. Resultados: Responderam ao questionário on-line 367 associados. A média de idade foi de 45,3 anos (desvio padrão, DP = 11,7), e 255 dos participantes eram mulheres (69,5%). Atuavam também como pediatras 52,9% dos alergistas, e apenas 37,6% atendiam pacientes com imunodeficiências primárias no Sistema Único de Saúde (SUS). Os recursos para abordagem desses pacientes eram escassos e não distribuídos de maneira uniforme. Conclusões: Os especialistas em Alergia e Imunologia Clínica estão concentrados nos grandes centros, e os que atuam no serviço público não têm acesso a recursos adequados para o diagnóstico e tratamento das doenças alérgicas e imunodeficiências primárias. Ações estratégicas em várias instâncias do SUS são necessárias para melhorar a atenção aos pacientes com doenças imunoalérgicas no Brasil.

Objectives: To evaluate the performance of allergists/ immunologists in the public service and to identify priorities, needs and demands in the care of patients with allergic diseases and immunodeficiencies. Methods: A self-administered online questionnaire was developed through Google Forms, consisting of 17 multiple choice questions about demographic data, area of performance, place of professional performance and access to laboratory exams. Results: 367 patients answered the online questionnaire. The mean age was 45.3 years (standard deviation, SD = 11.7), and 255 participants were female (69.5%). A total of 52.9% of allergists also worked as pediatricians, and only 37.6% treated primary immunodeficiency patients through the Brazilian Unified Health System (SUS). Resources to manage these patients were scarce and unevenly distributed. Conclusions: Allergy and Clinical Immunology specialists are concentrated in large centers and those who work in the public service do not have access to adequate resources for diagnosis and treatment of allergic diseases and primary immunodeficiencies. Strategic actions in various levels of SUS are necessary to improve care for patients with immunologic and/or allergic diseases in Brazil.

Effects of plantar foot sensitivity manipulation on postural control of young adult and elderly / Efeitos da manipulação da sensibilidade plantar sobre o controle da postura ereta em adultos jovens e idosos

ABSTRACT Introduction: Subjects with sensorial losses present balance deficits. Although such condition is often observed among elderly, there is discussion concerning the dependence on sensorial information for body sway control in the elderly without sensorial losses. Purpose: We investigated the effects of foot sensitivity manipulation on postural control during upright standing in young adults and independent elderly (n = 19/group). Methods: Plantar sensitivity was evaluated by esthesiometry, and speed of center of pressure shift data during upright posture were evaluated for each foot using a baropodometer while the subjects were standing with eyes open or closed. The young adult group was evaluated for center of pressure in normal conditions and after plantar sensitivity disturbance, by immersing their feet in water and ice. Results: Young adults did not show alterations in their center of pressure after sensorial perturbation and presented, even under sensorial perturbation, better postural control than elderly subjects. The elderly showed lower foot sensitivity and greater center of pressure oscillation than young adults. Conclusion: Elderly subjects seem to rely more on foot sensitivity for control of body sway than young adults. In the elderly, a clinical intervention to improve foot sensitivity may help in upright posture maintenance.

RESUMO Introdução: Pessoas com perdas sensoriais apresentam déficits de equilíbrio. Embora esse quadro seja comum em idosos, ainda se discute o quanto idosos sem doenças que afetam as vias sensoriais dependem dessa informação para controlar oscilações corporais durante o controle da postura. Objetivo: Investigar os efeitos da perturbação da sensibilidade plantar sobre o controle da postura ereta em adultos jovens e idosos independentes (n = 19/grupo). Métodos: A sensibilidade plantar foi avaliada com estesiômetro e dados de velocidade e deslocamento do centro de pressão durante a postura de pé foram avaliados para cada pé com um baropodômetro, em condições de olhos abertos e fechados. O grupo de adultos jovens foi avaliado quanto ao centro de pressão nas condições normal e pós-perturbação da sensibilidade plantar, pela imersão dos pés em água e gelo. Resultados: Adultos não apresentaram alterações no centro de pressão em resposta à perturbação sensorial e tiveram, mesmo na condição de perturbação sensorial, melhor controle postural do que idosos. Idosos apresentaram menor sensibilidade plantar e maior oscilação do centro de pressão do que os adultos jovens. Conclusão: Idosos pareceram depender mais da sensibilidade plantar para manter o controle postural do que adultos jovens. Em idosos, intervenções clínicas que melhorem a sensibilidade plantar podem auxiliar na tarefa de manter a postura de pé.

Nuevos procedimientos broncoscópicos en Argentina: Reducción volumétrica pulmonar endoscópica con válvulas endobronquiales / Bronchoscopic lung volume reduction. New bronchoscopic procedures in Argentina

La Enfermedad Pulmonar Obstructiva Crónica (EPOC) es una enfermedad caracterizada por limitación del flujo aéreo espiratorio donde el atrapamiento aéreo y la hiperinsuflación dinámica conducen a la producción de disnea que muchas veces incapacita al paciente a pesar de un correcto tratamiento farmacológico y de rehabilitación. Los tratamientos quirúrgicos destinados a paliar esta situación como la cirugía de reducción de volumen pulmonar (CRVP) presentan una morbimortalidad que limita su uso. La búsqueda de formas menos invasivas para conseguir el mismo propósito dieron origen a una serie de procedimientos broncoscópicos para la reducción de volumen pulmonar dentro de los cuales, las válvulas endobronquiales (VEB), son las que acumulan mayor desarrollo y experiencia. Si bien los estudios con VEB son heterogéneos y en su conjunto, muestran modestos beneficios en los test de función pulmonar, ejercicio y calidad de vida relacionada con la salud, existe un grupo de pacientes con enfisema pulmonar heterogéneo, cisura interlobar intacta, atrapamiento aéreo severo y baja tolerancia al ejercicio que muestra beneficios estadística y clínicamente significativos. Nuevos estudios se encuentran en desarrollo para dar más peso de evidencia a la acumulada en la actualidad.

Chronic Obstructive Pulmonary Disease (COPD) is characterized by airflow limitation, air trapping and dynamic hyperinflation that lead to disabling dyspnea despite appropriate pharmacologic treatment and pulmonary rehabilitation. Though surgical treatments such as lung transplant surgery and lung volume reduction (LVRS) are available, their high morbidity and mortality limit their use. To avoid these complications multiple procedures for bronchoscopic lung volume reduction have been developed, among which endobronchial valves (EBV) have accumulated the largest amount of evidence. While studies with EBV are heterogeneous and show modest benefits in pulmonary function tests, exercise capacity and quality of life, there is a group of patients with heterogeneous emphysema, intact interlobar fissure, severe air trapping and low exercise tolerance that show a statistically and clinically significant benefits. New studies are under way to further support the growing evidence.

Isometric muscle force, rate of force development and knee extensor neuromuscular efficiency asymmetries at different age groups / Assimetrias na força muscular isométrica, taxa de desenvolvimento de força e na eficiência neuromuscular de extensores do joelho em diferentes faixas de idade

The aim of this study was to evaluate force, rate of force development and knee extensor neuromuscular efficiency asymmetries in children, adults and elderly. Each subject performed maximal isometric voluntary contractions (MIVC) and submaximal trials (15% and 30% MIVC). Maximal force, rate of force development (RFD) and neuromuscular efficiency were evaluated and compared between groups and between preferred and non-preferred lower limb. Children (mean age 8.4, SD 0.7 yrs), female adults (mean age 23.2, SD 3.5 yrs) and elderly (mean age 65.9 SD 7.0 yrs) were evaluated. RFD was higher in young adults, and similar between children and elderly. Neuromuscular efficiency decreased significantly with aging (P<0.05). Inter-limb asymmetries were observed for force and RFD in favor of the preferred lower limb in the elderly (P<0.05). Force and RFD asymmetries in the elderly are supported by the right hemisphere-aging model contributing to increased motor asymmetries. It was suggested that both physical assessment and training in the elderly should consider asymmetries that apparently are inherent to the aging process. A simple protocol for maximal and submaximal force assessment may be useful for delineating impairments in force and power in the elderly.

Neste estudo, avaliamos assimetrias na força, taxa de desenvolvimento de força (TDF) e eficiência neuromuscular de extensores de joelho em crianças, adultos e idosos. Cada sujeito realizou contrações isométricas voluntárias máximas e submáximas (15% e 30% da contração isométrica voluntária máxima). Força máxima, TDF e eficiência neuromuscular foram avaliadas e comparadas entre os grupos e entre perna preferida e não-preferida. Foram avaliadas crianças (média de idade de 8,4 ± 0,7 anos), adultos (média de idade de 23,2 ± 3,5 anos) e idosos (média de idade de 65,9 ± 7,0 anos), do sexo feminino. A TDF foi maior em adultos jovens, e similar entre crianças e idosos. A eficiência neuromuscular diminuiu significativamente com o envelhecimento (P<0,05). Foram observadas assimetrias em força e TDF em favor da perna preferida em idosos (P<0,05). Assimetrias em força e TDF em idosos podem ser justificadas por fatores neurais, como a mudança em favor do hemisfério cerebral direito, levando a assimetrias motoras. Este resultado sugere que tanto a avaliação física quanto o treinamento em idosos deve levar em consideração assimetrias, que parecem ser inerentes ao processo de envelhecimento. Assim, um protocolo simples para avaliar a força máxima e submáxima pode ser útil para quantificar déficits de força e potência em idosos.

Infarto agudo al miocardio con elevación del segmento ST: ¿todavía existe un rol para la terapia trombolítica? / Acute myocardial infarction with ST segment elevation: is there still a role for thrombolytic therapy?

Se estima que más de tres millones de personas sufrirán un infarto al agudo al miocardio con elevación de ST (IAMCEST) al año. Desde hace más de 15 años las guías de manejo publicadas y actualizadas por las sociedades de cardiología europeas y de los Estados Unidos han sido enfáticas en que la angioplastia es la opción de reperfusión preferida. Los beneficios de la terapia fibrinolítica en pacientes con IAMCEST están bien establecidos durante las primeras 12 horas del inicio de los síntomas.

It is estimated that over three million people suffer acute myocardial infarction with ST elevation (STEMI) annually. Since 15 years ago, management guidelines published and updated by the European cardiology societies and the United States have been emphatic that angioplasty is the preferred reperfusion option. Thebenefits of fibrinolytic therapy in STEMI patients are well established in the first 12 hours of onset of symptoms.

Racial differences in prostate cancer prevalence / Análise da prevalência de câncer de próstata entre as diversas etnias

Objetivo: Analisar descritivamente as diferenças etnicas na prevalência de câncer de próstata no Brasil. Materiais e métodos: Entre 1922 e 1997, 1773 homens foram submetidos a toque retal (TR), dosagem de PSA e questionário padrão (AUA-IPSS). Foram classificados etnicamente em amarelos (45 casos), brancos (1180 casos) e negróides (210 casos). Em 347 homens não foi possível definir a etnia. Os pacientes foram orientados a submeter-se a biópsia de próstata quando o PSA e/ou o TR estivessem alterados. Avaliou-se também o estádio clínico e escore de Gleason na ocasião do diagnóstico, sendo que as etnias foram comparadas quanto à prevalência de câncer. Resultados:Foram feitas 346 biópsias e diagnosticados 51 tumores (14,7 porcento de positividade nas biópsias). Dos tumores, 4 (7,8 porcento) apresentavam PSA normal, 16 (31,4 porcento) PSA entre 4,1 ng/ml e 10 ng/ml e 31 (60,8 porcento), PSA>10 ng/ml. A prevalência de câncer em brancos foi de 2,4 porcento e em negróides de 5,5 porcento (p<0,05). A média de idade para brancos foi de 62,3 ± 0,4 anos e para negróides 62,4 ± 0,7 anos (p>0,05). O PSA mediano para brancos foi 3 ng/ml e para negróides 3,3 ng/ml (p>0,05). Os negróides apresentaram maior prevalência de TR alterado (18,9 porcento versus 11,7 porcento, p<0,05). A instrução mediana de brancos foi 3 e a de negróides 2 (p<0,05). A prevalência de tumores clinicamente localizados foi de 61,3 porcento. Conclusões: A prevalência de câncer de próstata em negróides é maior do que em brancos (5,5 porcento versus 2,4 porcento). O PSA mediano foi similar em ambas etnias. Os negróides apresentaram maior prevalência de toque retal alterado (18,9 porcento versus 11,7 porcento).

Evaluation of the influence of protein p53 in penile carcinoma / Avaliaçäo da influência da proteína p53 no câncer de pênis

Introduçäo: A expressäo da proteína p53 e a sua influência no comportamento biológico do carcinoma epidermóide do pênis (CEP) foram estudadas em relaçäo aos seguintes parâmetros: grau histológico, estadio clinicopatológico, e fatores prognósticos, tais como curva de sobrevida e risco de morte pelo tumor. Material e métodos: De 1979 a 1995, 55 pacientes com CEP tratados cirurgicamente foram estudados retrospectivamente. A presença da proteína p53 foi verificada nos espécimes cirúrgicos do tumor primário e de suas metástases mais respresentativos pela análise imunohistoquímica. A intensidade da expressäo da p53 foi determinada pelo número de núcleos corados nas células tumorais, classificando-a em 4 grupos: grupo 1 - até 25 por cento; grupo 2 - de 26 a 50 por cento; grupo 3 - de 51 a 75 por cento; grupo 4 - mais de 75 por cento de núcleos corados. A relaçäo entre a expressäo da p53 nas células tumorais e os parâmetros estudados foi analisada. Resultados: Taxas elevadas de expressäo da p53 correlacionaram-se com graus menores de diferenciaçäo celular (p=0,053). Doze pacientes faleceram em decorrência do tumor durante este estudo. Nossos dados mostram que quanto maior a expressäo da p53 no tumor, pior é o prognóstico (p=0,025). Näo houve relaçäo significativa entre a presença da p53 e o estadio clinicopatológico do tumor. Conclusäo: Nossos dados mostram que existe expressäo significativa da p53 no CEP. Quanto maior a expressäo da p53, pior o prognóstico para o paciente e maior a agressividade biológica do tumor. O tumor se torna mais agressivo de acordo com a intensidade da proteína no núcleo das células tumorais.

Análise comparativa dos resultados da cirurgia do labirinto (Cox-maze) para fibrilação atrial crônica em pacientes com doença valvar mitral reumática ou degenerativa / Comparative results of maze procedure for chronic atrial fibrillation in rheumatic and degenerative mitral valve disease

OBJETIVO: Comparar resultados da correção de Fibrilação Atrial (FA) Crônica em Doença Mitral Reumática (R) ou Degenerativa (D) a curto e médio prazos. CASUÍSTICA E MÉTODOS: De 1994 a 1997, 57 pacientes foram submetidos à Cirurgia do Labirinto e correção mitral. Oito (20 por cento) reumáticos eram do sexo masculino; 32 (80 por cento) feminino. Dos degenerativos 8 (47 por cento) eram do sexo masculino; 9 (53 por cento) femininos, (NS). Idade 47 / 11 anos R; 54 / 17 D (0,05). Diâmetro do AE: 6,1 / 1,1 cm R e 5,9 / 1,2 D, (NS). RESULTADOS: Óbitos: 1 (2,5 por cento) imediato em R; 2 (12 por cento) hospitalares e 1 (7 por cento) tardio em D (NS). Implante de marcapasso (MP) em 4 (10 por cento) R e 2 (17 por cento) D (NS). Tempos de isquemia: 63 / 16 min R; 63 / 15 min D, (NS). Circulação extracorpórea: 92 / 19 min R e 96 / 23 min D, (NS). Na alta hospitalar: 3 (10 por cento) R e nenhum D recebiam medicação antiarrítmica, (NS); 9 (23 por cento) R e 3 (20 por cento) D recebiam anticoagulantes (NS). Conversão a ritmo sinusal (RS) em 31 (80 por cento) do grupo R e em 12 (80 por cento) do D, (NS). Ritmo de MP em 4 (10 por cento) R, NS. FA incidiu em 4 (10 por cento) R e em 2 (13 por cento) D, (NS). Ritmo juncional em 1 (7 por cento) D, (NS). Na última avaliação: RS em 27 (71 por cento) R e 9 (75 por cento) D (NS). Ritmo de MP em 4 (10 por cento) R e 2 (17 por cento) D, (NS). FA em 6 (16 por cento) R e nenhum D, (NS).Taquicardia atrial paroxística em 1 (3 por cento) R e 1 (8 por cento) do grupo D, (NS). À ergometria, realizada em média de 16,2 / 11,1 meses PO por 24 (60 por cento) pacientes R e a 16,4 / 10,0 meses PO para 10 (59 por cento) degenerativos, 6 (25 por cento) R e 1 (10 por cento) D apresentaram RC adequada (NS). Em 3 (12,5 por cento) R e 6 (60 por cento) D foi considerada intermediária (p = 0,009). RC inadequada foi detectada em 15 (62,5 por cento) pacientes R e 3 (30 por cento) D- (p = 0,09). CONCLUSÃO: A etiologia R ou D não afeta a morbimortalidade e os benefícios aos pacientes com valvopatia mitral submetidos à Cirurgia do Labirinto e correção valvar. A recuperação do RS e a presença de arritmias no PO foi semelhante nos grupos. A resposta cronotrópica ao exercício tende a ser menor no grupo degenerativo