Age-related white matter change disease predicts long-term cerebrovascular morbidity following carotid endarterectomy.

PURPOSE: Cerebrovascular diseases remain a critical focus of medical research due to their substantial impact on global health. Carotid stenosis, often associated with atherosclerosis and advancing age, profoundly affects cerebral blood supply and white matter integrity. This study aims to assess how age-related white matter changes (ARWMC) score, applied to cortex and Basal Ganglia, relates to cardiovascular and cerebrovascular events in patients who underwent carotid endarterectomy (CEA). METHODS: Ninety patients undergoing CEA with regional anesthesia were prospectively enrolled from January 2012 to January 2022, and a post hoc analysis of patients with preoperative cerebral CT scans were reviewed, stratified by ARWMC score. Survival analysis and multivariate Cox regression were employed to assess time-dependent variables and independent predictors. RESULTS: A median follow-up of 51 months (Inter-quartile range [IQR [ [38.8-63.2] months) revealed higher ARWMC grades in the basal ganglia independently associated with significantly increased stroke risk (HR=5.070, 95% CI: 1.509-17.031, P=0.009), acute heart failure (HR=19.066, 95% CI: 2.038-178.375, P=0.01), major adverse cardiovascular events (MACE) (HR=2.760, 95% CI: 1.268-6.009, P=0.011), and all-cause mortality (HR=2.497, 95% CI:1.009-6.180, P=0.048). Polyvascular disease and chronic kidney disease emerged as additional predictors of MACE. CONCLUSION: Higher grades of ARWMC score in the basal ganglia were related to a significant increase in the risk of adverse cardiovascular events, such as stroke, MACE, AHF and all-cause mortality. This study suggests that ARWMC may have potential as a possible predictor of long-term cardio- and cerebrovascular events in patients undergoing CEA.

The intermittent intrapulmonary deflation technique for airway clearance in patients with cystic fibrosis: A randomized trial.

BACKGROUND: Cystic fibrosis (CF) is a muco-obstructive lung disease characterized by thick sputum with abnormal rheological properties. The intermittent intrapulmonary deflation (IID) is a new instrumental airway clearance technique (ACT) that aims to decrease the sputum viscoelastic properties. This study assessed the benefits of adding the IID technique to a conventional ACT in patients with CF hospitalized for intravenous antibiotic therapy. METHODS: Participants with CF accustomed to autogenic drainage (AD) as their standard ACT received, in a randomized order, a 30-min session of either AD alone or AD combined with IID (AD+IID). Sputum was collected during each ACT regimens and for a 24-hour period following both sessions. Sputum wet weight, dry weight, solids content and rheological properties were analyzed. Cough events occurring during and over 2 h post ACT were compared between both regimens. RESULTS: Seventeen patients with CF (aged 29 ± 11 years; FEV1%: 57.1 ± 20.1) were analysed. The sputum wet weight collected during AD alone was significantly higher than during AD+IID (8.11 ± 6.93 vs 5.40 ± 4.11 respectively, p = 0.01). The sputum rheological properties did not significantly differ between group. There were more cough episodes during AD alone compared to AD+IID (median [IQR]: 8 [5-15.5] vs 5 [3.5-11.0] respectively, p = 0.02). CONCLUSIONS: In participants with CF accustomed to AD, adding the IID technique in combination to AD does not confer a clear benefit on airway clearance in the short term. Clinical Trials register: NCT04157972.

Ventral tegmental area dopamine projections to the hippocampus trigger long-term potentiation and contextual learning.

In most models of neuronal plasticity and memory, dopamine is thought to promote the long-term maintenance of Long-Term Potentiation (LTP) underlying memory processes, but not the initiation of plasticity or new information storage. Here, we used optogenetic manipulation of midbrain dopamine neurons in male DAT::Cre mice, and discovered that stimulating the Schaffer collaterals - the glutamatergic axons connecting CA3 and CA1 regions - of the dorsal hippocampus concomitantly with midbrain dopamine terminals within a 200 millisecond time-window triggers LTP at glutamatergic synapses. Moreover, we showed that the stimulation of this dopaminergic pathway facilitates contextual learning in awake behaving mice, while its inhibition hinders it. Thus, activation of midbrain dopamine can operate as a teaching signal that triggers NeoHebbian LTP and promotes supervised learning.

Is Incentive Spirometry Superior to Standard Care in Postoperative Cardiac Surgery on Clinical Outcomes and Length of Hospital and Intensive Care Unit Stay? A Systematic Review with Meta-Analysis.

INTRODUCTION: Cardiac surgery is a frequent surgical procedure and may present a high risk of complications. Among the prophylactic strategies studied to decrease the rates of negative outcomes, respiratory care seems to reduce pulmonary complications. Incentive spirometry (IS) is a low-cost, respiratory exercise technique, used for the prevention and treatment of postoperative pulmonary complications (PPC). The aim of this review was to evaluate whether IS is superior to respiratory care, mobilization exercises, and noninvasive ventilation on PPC, and clinical outcomes. METHODS: Systematic review. Medical Literature Analysis and Retrieval System Online (or MEDLINE®), Embase®, Cochrane Central Register of Controlled Trials (or CENTRAL), Physiotherapy Evidence Database (or PEDro), Cumulative Index of Nursing and Allied Health (or CINAHL®), Latin American and Caribbean Health Sciences Literature (or LILACS), Scientific Electronic Library Online (or SciELO), Allied, Scopus®, and OpenGrey databases, clinical trial registration sites, conferences, congresses, and symposiums were searched. RESULTS: Twenty-one randomized trials and one quasi-randomized trial (1,677 participants) were included. For partial pressure of oxygen (PaO2), IS was inferior to respiratory care (mean difference [MD] -4.48; 95% confidence interval [CI] -8.32 to -0.63). Flow-oriented IS was inferior to respiratory care on PaO2 (MD -4.53; 95% CI -8.88 to -0.18). However, compared to respiratory care, flow-oriented IS was superior on recovery vital capacity. CONCLUSIONS: This meta-analysis revealed that IS was not superior to standard respiratory care for PPCs and clinical outcomes, therefore its use should not be widely recommended until further studies with high quality be performed to ensure this clinical guidance.

The Impact of Positive Expiratory Pressure Therapy on Hyperinflation in Patients With COPD.

BACKGROUND: Lung hyperinflation is a typical clinical feature of patients with COPD. Given the association between breathing at elevated lung volumes and the manifestation of severe debilitating symptoms, therapeutic interventions such as positive expiratory pressure (PEP) therapy and its variations (temporary, oscillatory) have been devised to mitigate lung hyperinflation. However, the efficacy of these interventions remains to be conclusively demonstrated. METHODS: A systematic review with meta-analysis of randomized trials was conducted following the PRISMA guidelines. Seven databases were screened with no date or language restriction. Two authors independently applied eligibility criteria and assessed the risk of bias of included studies using the Cochrane risk-of-bias tool. Outcomes were lung hyperinflation measures detected through changes in inspiratory capacity (IC), functional residual capacity (FRC), total lung capacity (TLC), and residual volume (RV), as well as FEV1, FVC, dyspnea, and physical capacity. Pooled standardized mean differences (SMDs) or mean differences (MDs) and 95% CI were calculated using a random-effects model. RESULTS: Seven trials, all with a high risk of bias, were included. Compared to control group, RV significantly decreased (4 studies, n = 231; SMD -0.42 [95% CI -0.77 to -0.08], P = .02), dyspnea improved (n = 321, SMD -1.17 [95% CI -1.68 to -0.66], P < .001), and physical capacity increased (5 studies, n = 311; MD 30.1 [95% CI 19.2-41.0] m, P < .001) with PEP therapy. There was no significant difference between PEP therapy and the control group in TLC, FVC, or FEV1. Only one study reported changes in inspiratory capacity as well as FRC. CONCLUSIONS: In patients with COPD, the effect of PEP therapy on lung hyperinflation is unclear owing to the non-consistent change in lung hyperinflation outcomes, insufficient data, and lack of high-quality trials. Dyspnea and physical capacity might improve with PEP therapy.

Researching New Drug Combinations with Senolytic Activity Using Senescent Human Lung Fibroblasts MRC-5 Cell Line.

Therapeutically targeting senescent cells seems to be an interesting perspective in treating chronic lung diseases, which are often associated with human aging. The combination of the drug dasatinib and the polyphenol quercetin is used in clinical trials as a senolytic, and the first results point to the relief of physical dysfunction in patients with idiopathic pulmonary fibrosis. In this work, we tested new combinations of drugs and polyphenols, looking for senolytic activity using human lung fibroblasts (MRC-5 cell line) with induced senescence. We researched drugs, such as azithromycin, rapamycin, metformin, FK-506, aspirin, and dasatinib combined with nine natural polyphenols, namely caffeic acid, chlorogenic acid, ellagic acid, ferulic acid, gallic acid, epicatechin, hesperidin, quercetin, and resveratrol. We found new effective senolytic combinations with dasatinib and ellagic acid and dasatinib and resveratrol. Both drug combinations increased apoptosis, reduced BCL-2 expression, and increased caspase activity in senescent MRC-5 cells. Ellagic acid senolytic activity was more potent than quercetin, and resveratrol counteracted inflammatory cytokine release during senolysis in vitro. In conclusion, dasatinib and ellagic acid and dasatinib and resveratrol present in vitro senolytic potential like that observed for the combination in clinical trials of dasatinib and quercetin, and maybe they could be future alternatives in the senotherapeutic field.

Short-term outcomes after selective shunt during carotid endarterectomy: a propensity score matching analysis.

INTRODUCTION AND OBJECTIVES: Carotid cross-clamping during carotid endarterectomy might lead to intraoperative neurologic deficits, increasing stroke/death risk. If deficits are detected, carotid shunting has been recommended to reduce the risk of stroke. However, shunting may sustain a specific chance of embolic events and subsequently incurring harm. Current evidence is still questionable regarding its clear benefit. The aim is to determine whether a policy of selective shunt impacts the complication rate following an endarterectomy. MATERIAL AND METHODS: From January 2013 to May 2021, all patients undergoing carotid endarterectomy under regional anesthesia with intraoperative neurologic alteration were retrieved. Patients submitted to selective shunt were compared to a non-shunt group. A 1:1 propensity score matching (PSM) was performed. Differences between the groups and clinical outcomes were calculated, resorting to univariate analysis. RESULTS: Ninety-eight patients were selected, from which 23 were operated on using a shunt. After PSM, 22 non-shunt patients were compared to 22 matched shunted patients. Concerning demographics and comorbidities, both groups were comparable to pre and post-PSM, except for chronic heart failure, which was more prevalent in shunted patients (26.1%, P=0.036) in pre-PSM analysis. Regarding 30-day stroke and score Clavien-Dindo ≥2, no significant association was found (P=0.730, P=0.635 and P=0.942, P=0.472, correspondingly, for pre and post-PSM). CONCLUSIONS: In this cohort, resorting to shunting did not demonstrate an advantage regarding 30-day stroke or a Clavien-Dindo ≥ 2 rates. Nevertheless, additional more extensive studies are mandatory to achieve precise results concerning the accurate utility of carotid shunting in this subset of patients under regional anesthesia.

Hyperfunctioning papillary thyroid carcinoma - a case report and literature review.

BACKGROUND: Malignant hyperfunctioning thyroid nodules are rare and more likely to occur in follicular cancer types rather than papillary variants. The authors present a case of a papillary thyroid carcinoma associated with a hyperfunctioning nodule. METHODS: A single adult patient submitted to total thyroidectomy with the presence of thyroid carcinoma within hyperfunctioning nodules was selected. Additionally, brief literature was conducted. RESULTS: An asymptomatic 58-year-old male was subjected to routine blood analysis and a TSH level of <0.003 mIU/L was found. Ultrasonography revealed a 21 mm solid, hypoechoic, and heterogenous nodule with microcalcifications in the right lobe. A fine needle aspiration guided by ultrasound resulted in a follicular lesion of undetermined significance. A 99mTc thyroid scintigram was followed and identified a right-sided hyperfunctioning nodule. Another cytology was performed and a papillary thyroid carcinoma was derived as a result. The patient underwent a total thyroidectomy. Postoperative histology confirmed the diagnosis and a tumor-free margin with no vascular or capsular invasions. CONCLUSION: Hyperfunctioning malignant nodules are a rare association, although a careful approach should be led since major clinical implications arise. Selective fine needle aspiration in all suspicious ≥1 cm nodules should be considered.

Polyvascular Disease Influences Long-Term Cardiovascular Morbidity in Carotid Endarterectomy.

INTRODUCTION/OBJECTIVE: Carotid stenosis (CS) is an important cause of ischemic stroke. Secondary prevention lies in performing a carotid endarterectomy (CEA) procedure, the recommended treatment in most cases. When 2 or more vascular regions are simultaneously affected by atherosclerosis, mainly the carotid arteries, coronary arteries, or limb arteries, a multivessel disease polyvascular disease (PVD) is present. This study aims to assess the potential role of PVD as a long-term predictor of major adverse cardiovascular events (MACE) and all-cause mortality in patients submitted to CEA. METHODS: From January 2012 to December 2021, patients submitted to CEA for carotid stenosis in a tertiary care and referral center were eligible from a prospective database. A posthoc survival analysis was performed using the Kaplan-Meier survival curve method. The primary outcome was the incidence of long-term MACE and all-cause mortality. Secondary outcomes included acute myocardial infarction (AMI), major adverse limb events (MALE), stroke, and acute heart failure (AHF). RESULTS: A total of 207 patients were enrolled, with a median follow-up of 63 months. The mean age was 70.4 ± 8.9, and 163 (78.7%) were male. There were 65 (31.4%) patients that had 2 arterial vascular territories affected, and 29 (14.0%) patients had PVD in 3 arterial beds. On multivariable analysis, both MACE and all-cause mortality had as independent risk factors age (aHR 1.039, P = 0.003; aHR 1.041, P = 0.019), chronic kidney disease (aHR 2.524, P = 0.003; aHR 3.377, P < 0.001) and PVD2 (aHR 3.381, P < 0.001; aHR 2.665, P = 0.013). PVD1 was only associated with MACE as a statistically significant risk factor (aHR 2.531, 1.439-4.450, P < 0.001). CONCLUSIONS: PVD in patients with cerebrovascular disease (CVD) was revealed to carry a 2-fold increased risk for all-cause mortality and MACE during long-term follow-up. PVD may be a simple yet valuable tool in predicting all-cause mortality, MACE, AMI, and MALE after CEA.

Effects of the intermittent intrapulmonary deflation technique on expiratory flow limitation: an in vitro study.

INTRODUCTION: The intermittent intrapulmonary deflation (IID) technique is a recent airway clearance technique that intends to delay the onset of expiratory flow limitation (EFL) during exhalation. We showed in a previous study that IID increased the expiratory volume of COPD patients compared to quiet breathing and positive expiratory pressure (PEP) therapy. We hypothesized that it was due to the attenuation of the EFL. OBJECTIVES: To verify the physiologic effects of IID and PEP techniques on EFL with a mechanical lung model. METHODS: A mechanical lung model was created to assess the effects of IID and PEP techniques. The thorax was simulated by a plexiglas box in which an adult test lung was connected. A calibration syringe simulated the inspiratory phase. Later, with activation of the IID, the expiratory phase was driven by the deflation generated by the device. With PEP, the expiration occurred maintaining an expiratory pressure between 5 and 10 cmH2O. A pneumotachograph and a pressure transducer were placed in series for flow, volumes and pressure measurements. RESULTS: The model reproduced physiological characteristics of EFL. However, the deflation of the model was slowed by IID and PEP, and flow remained almost constant, so flow limitation was reduced. CONCLUSION: The IID and PEP attenuate EFL and increase exhaled volume in the in vitro model.

Incidence of myocardial injury in patients submitted to carotid endarterectomy.

Myocardial injury following noncardiac surgery (MINS) is associated with higher mortality and major adverse cardiovascular event rates in the short- and long-term in patients undergoing carotid endarterectomy (CEA). However, its incidence is still unclear in this subset of patients. Therefore, this systematic review with meta-analysis aims to determine the incidence of MINS in patients undergoing CEA. Three electronic databases MEDLINE, Scopus, and Web of Science were used to search for studies assessing the occurrence of MINS in the postoperative setting of patients undergoing CEA. The incidence of MINS was pooled by random-effects meta-analysis, with sources of heterogeneity being explored by meta-regression and subgroup analysis (general anesthesia vs. regional anesthesia). Assessment of studies' quality was performed using National Heart, Lung, and Blood Institute Study Quality Assessment Tool, and Risk of Bias 2 tools. Twenty studies were included, with a total of 117,933 participants. Four of them were RCTs, while the remaining were cohort studies. All observational cohorts had an overall high risk of bias, except for Pereira Macedo et al. Three of them had repeated population, thus only data from the most recent one was considered. On the other hand, all RCT had an overall low risk of bias. In patients under regional anesthesia, the incidence of MINS in primary studies ranged between 2% and 15.3%, compared to 0-42.5% for general anesthesia. The meta-analytical incidence of MINS after CEA was of 6.3% [95% CI 2.0-10.6%], but severe heterogeneity was observed (I2=99.1%). MINS appears to be relatively common among patients undergoing CEA. The observed severe heterogeneity points to the need for further larger studies adopting consistent definitions of MINS and equivalent cut-off values.

Fatores associados ao conhecimento de universitários no sul do Brasil sobre infecções sexualmente transmissíveis / Factores asociados al conocimiento de universitarios del sur del Brasil sobre enfermedades de transmisión sexual / Factors associated with the knowledge of southern Brazil undergraduate students about sexuallu transmitted diseases

Objetivo: compreender e mensurar os conhecimentos sobre Infecções Sexualmente Transmissíveis e seus fatores associados entre estudantes de uma universidade federal. Método:realizou-se uma pesquisa transversal, quantitativa, de amostragem não aleatória. Os critérios de seleção foram ser estudante da universidade e possuir maioridade. Coletou-se os dados entre outubro e dezembro de 2020, através de um questionário online. Na análise de dados realizou-se as frequências absolutas e relativas das variáveis e verificou-se associações pelo teste qui-quadrado. Resultados: dos 284estudantes universitários do sul do Brasil participantes,40,1% obtiveram sete acertos, 38,4%, seis acertos e 21,5%, cinco acertos ou menos. Observou-se que alguns fatores influenciam no conhecimento no assunto: renda; sexo; área do curso de graduação; e conhecer alguém com Infecções Sexualmente Transmissíveis. Conclusão:estudantes ainda carecem de conhecimentos no assunto, existindo necessidade de organizar políticas públicas dos serviços de saúde em direção a esse tema nas abordagens comportamental e biomédica.

Objective:to understand and measure knowledge about sexually transmitted diseases and their associated factors among students at a federal university. Method:a cross-sectional, quantitative, non-random sampling survey was made. The selection criteria were being an undergraduate student in adulthood. Data were collected between October and December 2020, through an online questionnaire. In the data analysis, the absolute and relative frequencies of the variables were executed and associations were verified using thechi-square test. Results:of the 284undergraduate students of southern Brazil, 40.1% had 7 points, 38.4% 6 points, and 21.5% 5 points or fewer. It was observed that some factors influence the knowledge on the subject: income; sex; undergraduate course area; and knowing someone with sexually transmitted diseases. Conclusion:students still lack knowledge on the subject, showing a need to organize public policies in health services toward this topic in behavioral and biomedical approaches.

Objetivo: comprender y medir el conocimiento sobre enfermedades de transmisión sexual y sus factores asociados entre estudiantes de una universidad federal. Método:encuesta transversal, de muestreo no aleatorio. Los criterios de selección eran ser estudiante y ser mayor de edad. Los datos se recogieron entre octubre y diciembre de 2020 por cuestionario online. Los análisis se realizaron con las frecuencias absolutasy relativas de las variables con prueba del cuádruple. Resultados:de los 284 estudiantes del sur de Brasil participantes, 40,1% obtuvo 7 aciertos, 38,4% con 6 aciertos y 21,5% 5 aciertos o menos. Se observó que algunos factores influyen en el conocimiento del tema: renda, sexo, área de la graduación y contacto con alguien sobre enfermedades sexualmente transmisible. Conclusión:los estudiantes aún carecen de conocimientos sobre el tema, habiendo la necesidad de organizar las políticas públicas de los servicios de salud en los enfoques comportamental y biomédico.

Effect of Enzymatic Biotransformation on the Hypotensive Potential of Red Grape Pomace Extract.

Hypertension is a widespread health risk, affecting over a billion people and causing 9 million deaths per year. The Renin-Angiotensin-Aldosterone System (RAAS) is a primary target for hypertension treatment, and it is primarily treated through drugs that inhibit the Angiotensin I-Converting Enzyme (ACE). In addition to pharmacological treatment, various plants are recommended in traditional medicine for blood pressure regulation. This study aimed to produce high-phenolic-content extracts with and without enzymatic assistance from red grape pomace and evaluate their antioxidant capacity and ACE inhibitory potential. The total phenolic content (TPC) was measured, and phenolic identification was performed using HPLC analysis. In addition, the antioxidant capacity and anti-hypertensive potential were determined via in vitro assays. There was no statistical difference in the TPC antioxidant capacity between the extraction methods. Otherwise, when considering the extraction yield, the enzymatic process recovered around 70% more phenolic compounds from the pomace, and the phenolic profile was changed. Enzymatic assistance also significantly increased the ACE inhibitory potential in the grape pomace extract. This study demonstrates the viability of upcycling grape pomace to obtain bioactive compounds and to reduce their environmental impact, and highlights the influence of the enzymatic extraction on the hypotensive potential of the extract.

Sustainable production of naturally colored extruded breakfast cereals from blends of broken rice and vegetable flours.

There is a growing demand for practical and healthy food products. Obtaining naturally colored breakfast cereals with the incorporation of functional ingredients is a promising alternative for consumers that are looking for healthiness. This study aimed to evaluate the feasibility of using vegetable flours, rich in pigments, to obtain naturally colored breakfast cereals through thermoplastic extrusion. Vegetables considered "unsuitable for the retail market", classified as "type B", were used to prepare different flours from carrot (CF), spinach (SF) and beetroot (BF). Extrudates were produced from a mixture of 90% broken rice (BR) and 10% vegetable flour (CF, SF or BF). Besides giving the extrudates a natural color, the use of vegetable flours also provided nutritional and functional enrichment due to increased mineral, protein, lipid, fiber and phenolic compound contents, and greater antioxidant capacity. However, some of these components, such as fibers, affect extrudate physical structure and technological characteristics, evidenced by reduced expansion, hardness, paste viscosity and greater interaction with water present in milk under consumption conditions. In general, the evaluated flours proved to be an alternative for imparting a natural color to extruded breakfast cereals, in addition to positively contributing to their nutritional and functional value.

Undifferentiated pleomorphic sarcoma in a white-eared opossum (Didelphisalbiventris).

We report a case of high-grade undifferentiated pleomorphic sarcoma in a free-living white-eared opossum (Didelphis albiventris) in Central Brazil. Grossly, it appeared as a soft yellow mass, approximately 8 cm in diameter, with an irregular, adherent and ulcerated surface, which extended from the proximal epiphysis of the femur to the proximal third of the tibia and fibula. The mass invaded the medullary cavity and had a necrotic centre. Multiple nodular metastases (0.5-1.5 cm) were present in the liver, lungs and spleen. Histologically, the neoplasm was characterized by pleomorphic cells with indistinct boundaries, many multinucleated cells, necrosis and tissue invasion. There was intense cytoplasmic immunolabelling of neoplastic cells for vimentin and moderate cytoplasmic and nuclear labelling for human muscle actin, human smooth muscle actin and lysozyme. Immunolabelling for Iba1, CD18, CD1A, cytokeratin AE1/AE3, glial fibrillary acidic protein and desmin was negative. To our knowledge, this is the first report of an undifferentiated pleomorphic sarcoma in this species.

R2CHA2DS2-VA Predictsthe Cardiovascular Risk after Carotid Endarterectomy.

BACKGROUND: R2CHA2DS2-VA score has been used to predict short and long-term outcomes in many cardiovascular diseases. This study aims to validate the R2CHA2DS2-VA score as a long-term major adverse cardiovascular events (MACE) predictor after carotid endarterectomy (CEA). Secondary outcomes were also assessed regarding the incidence of all-cause mortality, acute myocardial infarction (AMI), major adverse limb events (MALE), and acute heart failure (AHF). METHODS: From January 2012 to December 2021, patients (n = 205) from a Portuguese tertiary care and referral center that underwent CEA with regional anesthesia (RA) for carotid stenosis (CS) were selected from a previously collected prospective database, and a posthoc analysis was performed. Demographics and comorbidities were registered. Clinical adverse events were assessed 30 days after the procedure and in the subsequent long-term surveillance period. Statistical analysis was performed by the Kaplan-Meier method and Cox proportional hazards regression. RESULTS: Of the patients enrolled, 78.5% were males with a mean age of 70.44 ± 8.9 years. Higher scores of R2CHA2DS2-VA were associated with long-term MACE (adjusted hazard ratio (aHR) 1.390; 95% confidence interval (CI) 1.173-1.647); and mortality (aHR 1.295; 95% CI 1.08-1.545). CONCLUSIONS: This study demonstrated the potential of the R2CHA2DS2-VA score to predict long-term outcomes, such as AMI, AHF, MACE, and all-cause mortality, in a population of patients submitted to carotid endarterectomy.

Short-Term Effect of Intermittent Intrapulmonary Deflation on Air Trapping in Patients With COPD.

BACKGROUND: Intermittent intrapulmonary deflation is an airway clearance technique that generates negative pressure during expiratory phases. This technology is intended to reduce air trapping by delaying the onset of air-flow limitation during exhalation. The objective of this study was to compare the short-term effect of intermittent intrapulmonary deflation versus positive expiratory pressure (PEP) therapy on trapped gas volume and vital capacity (VC) in patients with COPD. METHODS: We designed a randomized crossover study in which the participants with COPD received a 20-min session of both intermittent intrapulmonary deflation and PEP therapy on separate days and in random order. Lung volumes were measured via body plethysmography and helium dilution techniques, and spirometric outcomes were reviewed before and after each therapy. The trapped gas volume was estimated via functional residual capacity (FRC), residual volume (RV), and by the difference between FRC obtained through body plethysmography and helium dilution. Each participant also performed 3 VC maneuvers, from total lung capacity to RV with both devices. RESULTS: Twenty participants with COPD (mean ± SD ages 67 ± 8 y; FEV1 48.1 ± 17.0%) were recruited. There was no difference between the devices in FRC or trapped gas volume. However, the RV decreased more during intermittent intrapulmonary deflation compared with PEP. The intermittent intrapulmonary deflation mobilized a larger expiratory volume than PEP during the VC maneuver (mean difference 389 mL, 95% CI 128-650 mL; P = .003). CONCLUSIONS: The RV decreased after intermittent intrapulmonary deflation compared with PEP, but this effect was not captured by other estimates of hyperinflation. Although the expiratory volume obtained during the VC maneuver with intermittent intrapulmonary deflation was greater than that obtained with PEP, the clinical importance as well as the long-term effects remain to be determined.(ClinicalTrials.gov registration NCT04157972.).

Influência da composição corporal durante a hospitalização sobre a função pulmonar e força da musculatura inspiratória em pacientes com COVID-19: estudo transversal / Influence of body composition during hospitalization on lung function and inspiratory muscle strength in patients with COVID19: cross-sectional study

Introdução: Cerca de 31% dos pacientes hospitalizados com COVID-19 perdem mais de 5% de seu peso inicial, levando a fraqueza muscular. Portanto, a composição corporal tornou-se foco de investigação, para estimar comprometimento pulmonar, força da musculatura inspiratória e mortalidade. Objetivos: Investigar se a perda de peso e a composição corporal de pacientes internados com COVID-19 influenciam na função pulmonar e na força muscular inspiratória após alta hospitalar. Métodos: Estudo transversal. Pacientes adultos foram avaliados após internação por COVID-19. Os desfechos avaliados foram função pulmonar, pressão inspiratória máxima (Pimáx), composição corporal e mortalidade. As correlações entre as variáveis foram estimadas pelo Coeficiente de Correlação de Pearson. Resultados: A capacidade Vital Forçada (CVF) foi correlacionada com perda de peso, massa muscular esquelética, massa magra, perna esquerda e massa livre de gordura; o volume expiratório forçado no primeiro segundo (VEF1) correlacionou-se apenas com a perda de peso; e a Pimáx foi correlacionada com massa muscular esquelética, massa magra, perna esquerda, perna direita e massa livre de gordura. Conclusão: Observou-se correlação moderada entre CVF e as variáveis de composição corporal analisadas, exceto massa magra da perna esquerda; entre VEF1 e perda de peso; e entre Pimáx e as variáveis de composição corporal analisadas, exceto perda de peso.

Efeito da reabilitação cardiopulmonar e metabólica em pacientes que apresentaram dessaturação da oxihemoglobina induzida pelo exercício após alta hospitalar pela COVID-19: série de casos / Effect of cardiopulmonary and metabolic rehabilitation in patients with exercise-induced oxyhemoglobin desaturation after hospital discharge from COVID-19: case series

INTRODUÇÃO: A dessaturação da oxihemoglobina induzida pelo exercício em pacientes pós-COVID-19 parece estar associada à redução da difusão e dos volumes pulmonares, à maior dispneia e baixa capacidade funcional, sendo relacionada à maior mortalidade e pior prognóstico. A reabilitação cardiopulmonar e metabólica (RCPM) é relevante, pois visa restaurar a funcionalidade, tolerância ao esforço e a qualidade de vida (QV). OBJETIVO: Verificar os efeitos da RCPM em pacientes que apresentaram dessaturação da oxihemoglobina induzida pelo exercício após alta hospitalar pela COVID-19 e ainda observar a diferença entre os treinamentos contínuo de moderada intensidade (TCMI) e o intervalado de alta intensidade (TIAI) na tolerância ao esforço, nos sintomas e na QV. MÉTODOS: Trata-se do relato de uma série de 4 casos que foram hospitalizados por COVID-19 e que após alta hospitalar apresentaram dessaturação da oxihemoglobina induzida pelo esforço durante o teste do degrau de 6 minutos (TD6). Os pacientes foram avaliados por meio de espirometria de repouso, mensuração da força da musculatura inspiratória, TD6, teste da caminhada de 6 minutos (TC6), teste de repetições máximas do quadríceps e bíceps braquial e responderam ao questionário SF-36 de QV. Submetidos a um protocolo de treinamento contendo treino da musculatura inspiratória e treino resistido para grandes grupos musculares, adicionalmente, 2 pacientes fizeram TCMI (com 60-80% da frequência cárdica de reserva (FCR)) e 2 TIAI (com 40% da FCR na fase off, durante 4 minutos e 80 a 100%, na fase on, durante 2 minutos) em esteira por 30 minutos e, por fim, após 3 meses foram reavaliados. RESULTADOS: Observouse aumento da tolerância ao esforço, da força muscular inspiratória e periférica, além da melhora da QV e redução dos sintomas em todos os pacientes após a RCPM, porém houve incrementos maiores nos pacientes submetidos ao TIAI comparados ao TCMI na distância percorrida em metros (caso 1- 156 (23% de incremento); caso 3 - 168 (40%)) versus (caso 2 e 4 - 60 metros, com incrementos de 9% e 14%, respectivamente) e maior número de degraus (caso 1- 28 (23% de aumento); caso 3- 37 (34%)) versus (caso 2 ­ 2 (2% incremento); caso 4 - 15 (21%)). CONCLUSÃO: A RCPM apresentou efeitos positivos, com incremento da capacidade funcional e melhora da QV, além da redução dos sintomas durante o esforço, particularmente nos pacientes submetidos ao TIAI.

INTRODUCTION: Exercise-induced oxyhemoglobin desaturation in post-COVID-19 patients appears to be associated with reduced diffusion and lung volumes, greater dyspnea and low functional capacity, being related to higher mortality and worse prognosis. Cardiopulmonary and metabolic rehabilitation (CPMR) is relevant, as it aims to restore functionality, exercise tolerance and quality of life (QoL). OBJECTIVE: To verify the effects of CPMR in patients who presented exercise-induced oxyhemoglobin desaturation after hospital discharge due to COVID-19 and also to observe the difference between moderate-intensity continuous training (MICT) and high intensity interval training (HIIT) on effort tolerance, symptoms and QoL. METHODS: This is the report of a series of 4 cases who were hospitalized for COVID-19 and who, after hospital discharge, presented exertion-induced oxyhemoglobin desaturation during the 6-minute step test (6MST). Patients were assessed using spirometry at rest, measurement of inspiratory muscle strength, 6MST, 6-minute walk test (6MWT), quadriceps and biceps brachii maximum repetitions test, and answered the SF-36 QoL questionnaire. Submitted to a training protocol containing training of the inspiratory muscles and resistance training for large muscle groups, additionally, 2 patients underwent CMIT (with 60-80% of heart rate reserve) and 2 HIIT (with 40% of HR reserve in the off, for 4 minutes and 80 to 100%, in the on phase, for 2 minutes) on a treadmill for 30 minutes, finally, after 3 months, they were reassessed. RESULTS: There was an increase in effort tolerance, inspiratory and peripheral muscle strength, in addition to an improvement in QoL and a reduction in symptoms in all patients after CPMR, but there were greater increments in patients submitted to HIIT compared to CMIT in the distance covered in meters (case 1 - 156 (23% increment); case 3 - 168 (40%)) versus (case 2 and 4 - 60 meters, with increments of 9% and 14%, respectively) and greater number of steps (case 1 - 28 (23% increase); case 3- 37 (34%)) versus (case 2 ­ 2 (2% increment); case 4 - 15 (21%)). CONCLUSION: CPMR had positive effects, with an increase in functional capacity and improvement in QoL, in addition to a reduction in symptoms during exertion, particularly in patients undergoing HIIT.