Effects of minimally invasive surgical and miniscrew-assisted rapid palatal expansion (MISMARPE) on the nasal cavity and upper airway: a comparative cohort study.

This study was performed to evaluate the impact on the upper airway and nasal cavity of a new minimally invasive surgical and miniscrew-assisted rapid palatal expansion (MISMARPE) technique for the treatment of adult patients with transverse maxillary deficiency, in comparison to surgically assisted rapid palatal expansion (SARPE). Computed tomography scans of 21 MISMARPE and 16 SARPE patients were obtained preoperatively (T0) and at the end of the activation period (T1) and analysed. Linear and volumetric measurements were performed in the dental, alveolar, nasal cavity, and oropharynx regions. Generalised estimating equations were used to consider the intervention time and surgery type, and their interaction. In both groups, measurements were increased at T1 (P < 0.001), except for oropharynx volume (P > 0.05). A greater expansion in nasal cavity floor and median palatal suture was shown for MISMARPE when compared to SARPE (P < 0.001), with the same degree of expander activation (P = 0.094). A trapezoidal (coronal plane) and 'V' shape (axial plane) expansion pattern, was observed after MISMARPE. Both surgical techniques were effective for maxillary expansion in adults. However, MISMARPE was performed without osteotomy of the pterygomaxillary suture, in an outpatient setting and with local anaesthesia.

Adipose perforator flaps without skin donor site: "in between" single scar approach for reconstruction of small peripheral breast defects after lumpectomy.

In breast conserving surgery, the reconstruction of defects in small breasts where volume displacement techniques are not feasible can be challenging. In contrast, patients with bigger breasts may not wish to undergo major breast remodeling surgery or breast symmetrization procedures. In such cases, volume replacement techniques can be beneficial, but these leave additional scars and are time consuming. The authors propose an "in between" single scar approach to perform both lumpectomy and reconstruction of small peripheral breast tumors. This approach reduces morbidity and operating time compared with standard volume replacement techniques. The tumors are resected from below, guided by wire, using an incision in the lateral breast crease or inframammary fold, depending on their location. The same incision is used to raise an adipose or adipofascial flap based on perimammary perforators, lateral thoracic artery perforator flap (LTAP), lateral intercostal artery perforator flap (LICAP), or anterior intercostal artery perforator flaps (AICAP) flaps, without skin donor site. Between March and November 2022, eight patients underwent this procedure. In four cases LICAP flap was used; in three-AICAP flap was chosen; and in one-LTAP perforator flap was used. Clear surgical margins were achieved in all cases. The average follow-up time was 9.9 months, during which no local recurrences were detected. All flaps survived. Two patients experienced seromas at the donor site, and an organized hematoma was also reported. This approach represents a viable alternative to volume displacement techniques or no reconstruction for small peripheral lumpectomy defects.

Treatment of painful temporomandibular joint disc displacement without reduction: network meta-analysis of randomized clinical trials.

There is currently no consensus on the best treatment for painful temporomandibular disc displacement without reduction (DDwoR), and no network meta-analysis (NMA) of randomized clinical trials (RCTs) comparing all types of treatments for this condition has been conducted. The objective of this study was to compare and rank all treatments for DDwoR, including conservative treatments, occlusal splints, low-level laser therapy (LLLT), arthrocentesis (Arthro) alone, Arthro plus intra-articular injection (IAI) of platelet-rich plasma (PRP), Arthro plus IAI of hyaluronic acid (HA), Arthro with exercises, Arthro plus occlusal splints, and manipulative therapy. Outcome variables were pain intensity on a visual analogue scale (VAS) and maximum mouth opening (MMO, mm). The mean difference with 95% confidence interval was estimated using Stata software. The GRADE system was used to assess the certainty of the evidence. A total of 742 patients from 16 RCTs were included in the NMA. Both direct meta-analysis and NMA showed that Arthro with IAI of co-adjuvants provided better pain reduction in the short term (≤3 months) than Arthro alone. However, the quality of the evidence was very low. In the intermediate term, Arthro alone or combined with co-adjuvants provided better pain reduction than conservative treatment, but with low-quality evidence. Conservative treatment significantly increased MMO in the short term compared to other treatments. In conclusion, the results of this NMA suggest that arthrocentesis with intra-articular injection of adjuvant medications may be superior to conservative treatments in reducing pain intensity at long-term follow-up, while no significant differences were found for the MMO outcome. However, the quality of evidence was generally low to very low, and further RCTs are needed to confirm these findings.

Effects of different doses of estradiol benzoate used in a cervical relaxation protocol on the success of non-surgical embryo recovery and luteal function in superovulated ewes.

This study investigated the effectiveness of different doses of estradiol benzoate (EB) to promote cervical relaxation and their effects on luteal function and outcomes of non-surgical embryo recovery (NSER) in sheep. Multiparous (MULT) and nulliparous (NULL) crossbred Lacaune X Santa Inês ewes were superovulated and naturally bred. Seven days after progesterone withdrawal, females were randomly assigned to one of three distinct cervical relaxation protocols, consisting of i.m. treatment with 37.5 µg d-cloprostenol and different doses of EB: 0.0 mg (0.0EB group; n = 3 NULL and 14 MULT); 0.5 mg (0.5EB group; n = 4 NULL and 12 MULT) or 1.0 mg (1.0EB group, n = 6 NULL and 11 MULT) 16 h before NSER. All ewes received 50 IU of oxytocin 20 min before NSER (D17). Blood samples were collected and ultrasound exams (B-mode and color Doppler) were performed at two timepoints: immediately before d-cloprostenol and EB treatments and prior to NSER. Estrous behavior, corpora lutea count and NSER success outcomes were not affected by EB treatments nor parity (P > 0.05). Embryo recovery rate was greater for ewes in the 0.5EB group and in the NULL ewes (P < 0.05). Ovarian biometrics differed between the two evaluation timepoints in all groups (P < 0.05). Plasma estradiol increased over time, reaching a significant greater level in 1.0EB ewes compared to controls on D17 (P < 0.05), whereas progesterone concentrations decreased over time in all groups (P > 0.05). In conclusion, treatments did not affect NSER success but they did affect luteal function by altering P4 and E2 concentrations. Therefore, the NSER technique can be successfully performed in ewes with or without prior treatment with EB.

Single dose of 300 IU hCG in the early luteal phase in superovulated ewes: Effects on corpora lutea, progesterone profile, and embryo recovery.

This study aimed to evaluate the effects of hCG treatment during the early luteal phase on ovarian function, progesterone profile, and embryo yield in superovulated ewes. Superovulated sheep were randomly assigned to receive 300 IU hCG i.m. (GhCG, n = 24) or not (GControl, n = 25) at 96 h after the removal of the progesterone (P4) device (D13). Non-surgical embryo recovery (NSER) was performed eight days after P4 withdrawal. Ultrasound evaluations were performed on D13, D14, D16, and D17. Blood samples were collected on D14, D16, and D17. Superovulation scores were recorded based on the number of corpora lutea (CL) as follows: 1 (≤ 2), 2 (3-5), 3 (6-8), and 4 (≥ 9). NSER efficiency, superovulation response, and luteal tissue area were similar in both groups (P > 0.05). Structural luteolysis tended to be higher in GControl (P = 0.07; 47.0 %) while functional luteolysis was similar in both groups (P > 0.05; 0.0 % and 5.9 %). The recovery rate was greater (P < 0.05) in GhCG (89.8 %) compared with GControl (71.0 %), with similar overall ova/embryo numbers observed for both groups (P > 0.05). GhCG showed a higher concentration of animals with a superovulatory response score of 4 (54.5 %; P < 0.05) compared with the lowest scores. Plasma progesterone on D16 was higher (P < 0.05) in GhCG ewes (11.1 ± 1.5 vs 6.9 ± 1.5 ng/mL). In conclusion, the hCG treatment improved circulating P4 and embryo recovery rate, tended to maintain luteal functionality, and thus constitutes an additional tool for improving embryo yield in superovulated ewes.

Electronic spectrum of Kekulé patterned graphene considering second neighbor-interactions.

The effects of second-neighbor interactions in Kekulé-Y patterned graphene electronic properties are studied starting from a tight-binding Hamiltonian. Thereafter, a low-energy effective Hamiltonian is obtained by projecting the high energy bands at the Γ point into the subspace defined by the Kekulé wave vector. The spectrum of the low energy Hamiltonian is in excellent agreement with the one obtained from a numerical diagonalization of the full tight-binding Hamiltonian. The main effect of the second-neighbour interaction is that a set of bands gains an effective mass and a shift in energy, thus lifting the degeneracy of the conduction bands at the Dirac point. This band structure is akin to a 'pseudo spin-one Dirac cone', a result expected for honeycomb lattices with a distinction between one third of the atoms in one sublattice. Finally, we present a study of Kekulé patterned graphene nanoribbons. This shows that the previous effects are enhanced as the width decreases. Moreover, edge states become dispersive, as expected due to second neighbors interaction, but here the Kek-Y bond texture results in an hybridization of both edge states. The present study shows the importance of second neighbors in realistic models of Kekulé patterned graphene, specially at surfaces.

Diversity of Secondary Metabolism in Aspergillus nidulans Clinical Isolates.

The filamentous fungus Aspergillus nidulans has been a primary workhorse used to understand fungal genetics. Much of this work has focused on elucidating the genetics of biosynthetic gene clusters (BGCs) and the secondary metabolites (SMs) they produce. SMs are both niche defining in fungi and of great economic importance to humans. Despite the focus on A. nidulans, very little is known about the natural diversity in secondary metabolism within this species. We determined the BGC content and looked for evolutionary patterns in BGCs from whole-genome sequences of two clinical isolates and the A4 reference genome of A. nidulans Differences in BGC content were used to explain SM profiles determined using liquid chromatography-high-resolution mass spectrometry. We found that in addition to genetic variation of BGCs contained by all isolates, nine BGCs varied by presence/absence. We discovered the viridicatumtoxin BGC in A. nidulans and suggest that this BGC has undergone a horizontal gene transfer from the Aspergillus section Nigri lineage into Penicillium sometime after the sections Nigri and Nidulantes diverged. We identified the production of viridicatumtoxin and several other compounds previously not known to be produced by A. nidulans One isolate showed a lack of sterigmatocystin production even though it contained an apparently intact sterigmatocystin BGC, raising questions about other genes and processes known to regulate this BGC. Altogether, our work uncovers a large degree of intraspecies diversity in BGC and SM production in this genetic model species and offers new avenues to understand the evolution and regulation of secondary metabolism.IMPORTANCE Much of what we know about the genetics underlying secondary metabolite (SM) production and the function of SMs in the model fungus Aspergillus nidulans comes from a single reference genome. A growing body of research indicates the importance of biosynthetic gene cluster (BGC) and SM diversity within a species. However, there is no information about the natural diversity of secondary metabolism in A. nidulans We discovered six novel clusters that contribute to the considerable variation in both BGC content and SM production within A. nidulans We characterize a diverse set of mutations and emphasize how findings of single nucleotide polymorphisms (SNPs), deletions, and differences in evolutionary history encompass much of the variation observed in nonmodel systems. Our results emphasize that A. nidulans may also be a strong model to use within-species diversity to elucidate regulatory cross talk, fungal ecology, and drug discovery systems.

Randomized clinical trial of class II restoration in permanent teeth comparing ART with composite resin after 12 months.

OBJECTIVE: This study evaluated the effectiveness of class II restorations, in permanent teeth, through the ART technique in comparison to composite resin. MATERIALS AND METHODS: Participants (154), aged 8 to 19 years, with good general health, with class II cavities in permanent teeth, and without pulp involvement and tooth pain were included in this parallel and randomized clinical trial. The Ethics Committee approval number was CAAE: 24012913.0.1001.5417. Seventy-seven restorations were made with each restorative material (Equia Fil-GC Corporation and Z350-3M). Evaluations occurred at 6 and 12 months by the criteria of ART and the USPHS modified. Data were analyzed by Mann-Whitney, chi-square, Fisher's exact, chi-square tests with linear trend and logistic regression by enter method (p < 0.050). The Kaplan-Meier test evaluated the survival rates of the restorations. The log-rank test compared the survival curves. RESULTS: Regardless of the evaluation criteria used, the success rates of ART restorations were 98.7% (6 months) and 95.8% (12 months) and for composite resins were 100% (6 months) and 98.7% (12 months), with no statistical difference of restoration groups (p > 0.050). Survival rates for restorations, regardless of the evaluation criteria used, are the same as the success rates, with the exception of ART restorations at 12 months of follow-up (94.8%). CONCLUSION: No differences in the success rates of class II restorations of ART compared to resin composite, in permanent teeth, were observed after 12 months. CLINIC SIGNIFICANT: HVGIC can safely be used to restore proximal cavities in permanent teeth up to 12 months.

The Role of Lignocellulosic Composition and Residual Lipids in Empty Fruit Bunches on the Production of Humic Acids in Submerged Fermentations.

The aim of this research was to study the production of humic acids (HA) by Trichoderma reesei from empty fruit bunches (EFBs) of palm oil processing, with a focus on the effects of lignocellulosic content and residual lipids. EFBs from two different soils and palm oil producers were previously characterized about their lignocellulosic composition. Submerged fermentations were inoculated with T. reesei spores and set up with or without residual lipids. The results showed that the soil and the processing for removal of the palm fresh fruits were crucial to EFB quality. Thus, EFBs were classified as type 1 (higher lignocellulosic and fatty acids composition similar to the palm oil and palm kernel oil) and type 2 (lower lignocellulosic content and fatty acids composition similar to palm oil). Despite the different profiles, the fungal growth was similar for both EFB types. HA production was associated with fungal growth, and it was higher without lipids for both EFBs. The highest HA productivity was obtained from type 1 EFB (approximately 90 mg L-1 at 48 h). Therefore, the lignocellulosic composition and the nature of the residual lipids in EFBs play an important role in HA production by submerged fermentation.

Tilapia rearing with high rate algal pond effluent: ammonia surface loading rates and stocking densities effects.

In two pilot-scale experiments, fingerlings and juvenile of tilapia were reared in high rate algal pond (HRAP) effluent. The combination of three different total ammonia nitrogen (TAN) surface loading rates (SLR1 = 0.6, SLR2 = 1.2; SLR3 = 2.4 kg TAN·ha-1·d-1) and two fish stocking densities (D1 = 4 and D2 = 8 fish per tank) was evaluated during two 12-week experiments. Fingerlings total weight gain varied from 4.9 to 18.9 g, with the highest value (equivalent to 0.225 g·d-1) being recorded in SLR2-D1 treatment; however, high mortality (up to 67%) was recorded, probably due to sensitivity to ammonia and wide daily temperature variations. At lower water temperatures, juvenile tilapia showed no mortality, but very low weight gain. The fish rearing tanks worked as wastewater polishing units, adding the following approximate average removal figures on top of those achieved at the HRAP: 63% of total Kjeldahl nitrogen; 54% of ammonia nitrogen; 42% of total phosphorus; 37% of chemical oxygen demand; 1.1 log units of Escherichia coli.

Further contributions to the understanding of nitrogen removal in waste stabilization ponds.

A set of experiments were conducted in Brazil in a pilot-scale waste stabilization pond (WSP) system (a four-maturation-pond series) treating an upflow anaerobic sludge blanket (UASB) reactor effluent. Over a year and a half the pond series was monitored under two flow rate conditions, hence also different hydraulic retention times and surface loading rates. On-site and laboratory trials were carried out to assess: (i) ammonia losses by volatilization using acrylic capture chambers placed at the surface of the ponds; (ii) organic nitrogen sedimentation rates using metal buckets placed at the bottom of the ponds for collecting settled particulate matter; (iii) nitrogen removal by algal uptake based on the nitrogen content of the suspended particulate matter in samples from the ponds' water column. In addition, nitrification and denitrification rates were measured in laboratory-based experiments using pond water and sediment samples. The pond system achieved high nitrogen removal (69% total nitrogen and 92% ammonia removal). The average total nitrogen removal rates varied from 10,098 to 3,849 g N/ha·d in the first and the last ponds, respectively, with the following fractions associated with the various removal pathways: (i) 23.5-45.6% sedimentation of organic nitrogen; (ii) 13.1-27.8% algal uptake; (iii) 1.2-3.1% ammonia volatilization; and (iv) 0.15-0.34% nitrification-denitrification.

Milk fermented by Lactobacillus species from Brazilian artisanal cheese protect germ-free-mice against Salmonella Typhimurium infection.

Ingestion of milks fermented by Lactobacillus strains showing probiotic properties is an important tool to maintain gastrointestinal health. In this study, Lactobacillus rhamnosus D1 and Lactobacillus plantarum B7, isolated from Brazilian artisanal cheese, were used as starters for the functional fermented milks to assess their probiotic properties in a gnotobiotic animal model. Male germ-free Swiss mice received a single oral dose of milk fermented by each sample, and were challenged with Salmonella Typhimurium five days afterwards. Milk fermented by both Lactobacillus strains maintained counts above 108 cfu/ml during cold storage. Lactobacillus strains colonised the gut of the germ-free-mice, maintaining their antagonistic effect. This colonisation led to a protective effect against Salmonella challenge, as demonstrated by reduced pathogen translocation and histological lesions, when compared to control group, especially for Lactobacillus rhamnosus D1. Additionally, mRNA expression of inflammatory (interferon gamma, interleukin (IL)-6, tumour necrosis factor alpha) and anti-inflammatory (transforming growth factor ß1) cytokines was augmented in animals previously colonised and then challenged, when compared to other experimental groups. Lactobacillus plantarum B7 colonisation also promoted higher expression of IL-17, showing a proper maturation of colonised germ-free-mice immune system. IL-5 was stimulated by both strains' colonisation and not by S. Typhimurium challenge.

Evaluation of colonisation resistance in stool of human donors using ex vivo, in vitro and in vivo assays.

The indigenous microbiota is the population of microorganisms normally present on the surface and mucosa of an individual, where it performs essential health functions, including the colonisation resistance (CR) against pathogens. To identify the bacteria responsible and the mechanisms involved in the CR, the germ-free (GF) animal model has been used, because in vitro studies cannot always be extrapolated to what occurs in vivo. In this study, ex vivo antagonism assays against seven enteropathogenic bacteria using stools from 15 healthy human donors confirmed that the CR showed individual variation. Using in vitro antagonism assays, 14 strains isolated from dominant faecal microbiota of donors with elevated CR were selected for mono-association in GF mice to test the in vivo antagonism against Salmonella enterica ser. Typhimurium. Mice mono-associated with Enterococcus hirae strain 8.2, Bacteroides thetaiotaomicron strain 16.2 and Lactobacillus ruminis strain 18.1 had significant reductions in faecal counts of the pathogen during the challenge. After five days of infection, the group associated with E. hirae 8.2 showed a reduction in the translocation of S. Typhimurium to the spleen, while the group associated with L. ruminis 18.1 presented an increased translocation to the liver. The histological data confirmed these results and revealed that the mice associated with E. hirae 8.2 showed fewer lesions on ileum and liver, compared to the damage caused by S. Typhimurium alone, while in mice associated with L. ruminis 18.1 there was significantly worse lesions. Concluding, from the dominant faecal microbiota from healthy human with high CR, through ex vivo, in vitro and in vivo assays, a bacterium was characterised for its high CR potential, being a candidate for probiotic use.

Saccharomyces cerevisiae UFMG A-905 treatment reduces intestinal damage in a murine model of irinotecan-induced mucositis.

Indigenous microbiota plays a crucial role in the development of several intestinal diseases, including mucositis. Gastrointestinal mucositis is a major and serious side effect of cancer therapy, and there is no effective therapy for this clinical condition. However, some probiotics have been shown to attenuate such conditions. To evaluate the effects of Saccharomyces cerevisiae UFMG A-905 (Sc-905), a potential probiotic yeast, we investigated whether pre- or post-treatment with viable or inactivated Sc-905 could prevent weight loss and intestinal lesions, and maintain integrity of the mucosal barrier in a mucositis model induced by irinotecan in mice. Only post-treatment with viable Sc-905 was able to protect mice against the damage caused by chemotherapy, reducing the weight loss, increase of intestinal permeability and jejunal lesions (villous shortening). Besides, this treatment reduced oxidative stress, prevented the decrease of goblet cells and stimulated the replication of cells in the intestinal crypts of mice with experimental mucositis. In conclusion, Sc-905 protects animals against irinotecan-induced mucositis when administered as a post-treatment with viable cells, and this effect seems to be related with the reduction of oxidative stress and preservation of intestinal mucosa.

Oral health-related quality of life before hematopoietic stem cell transplantation.

OBJECTIVES: This study was planned to evaluate the impact of oral health on the quality of life (QoL) of patients undergoing hematopoietic stem cell transplantation (HSCT). MATERIAL AND METHODS: We assessed 200 patients divided into two paired groups: 100 patients prior to HSCT (SG) and 100 healthy volunteers (CG). We applied the Oral Health Impact Profile instrument, which is based on the biopsychosocial problem gradation of World Health Organization (WHO) and relates oral health problems with QoL according to seven dimensions. RESULTS: Fourteen patients in SG were referred for extraction of one to eight teeth, mostly due to deep caries with risk of pulpal infection and possible spread of infection via blood (r = 0.59, p = 0.000). The presence of severely compromised teeth by extensive decay correlated with Oral Health Impact Profile (OHIP-14). The Mann-Whitney test showed a significant difference between SG and CG in the following dimensions: functional limitation (p < 0.001), physical pain (p = 0.025), physical disability (p = 0.016), and social disability (p = 0.01). CONCLUSIONS: The impact of oral health on QoL of onco-hematologic patients is weak but is greater as compared to healthy ones. Nevertheless, a significant impact is seen in patients with severely compromised teeth. CLINICAL RELEVANCE: The negligence of oral care, proper hygiene, and the search for dental care may increase the risk for local and systemic infections.

Fano resonances in hexagonal zigzag graphene rings under external magnetic flux.

We study transport properties of hexagonal zigzag graphene quantum rings connected to semi-infinite nanoribbons. Open two-fold symmetric structures support localized states that can be traced back to those existing in the isolated six-fold symmetric rings. Using a tight-binding Hamiltonian within the Green's function formalism, we show that an external magnetic field promotes these localized states to Fano resonances with robust signatures in transport. Local density of states and current distributions of the resonant states are calculated as a function of the magnetic flux intensity. For structures on corrugated substrates we analyze the effect of strain by including an out-of-plane centro-symmetric deformation in the model. We show that small strains shift the resonance positions without further modifications, while high strains introduce new ones.

Detecting genomic damages in the frog Dendropsophus minutus: preserved versus perturbed areas.

The aim of the study was to use the comet assay (single-cell gel electrophoresis) and micronucleus test to assess the extent of genomic damage in the whole blood of Dendropsophus minutus from agroecosystems with great use of agrochemicals and to compare the results to those obtained from animals living in unpolluted areas. Our results indicated that specimens of D. minutus collected in perturbed areas exhibited higher amounts of DNA damage in blood cells in comparison to animals from areas free of agricultural activities. The average and standard deviation of all comet assay parameters (tail length, percentage of DNA in the tail, and olive tail moment) and micronuclei frequency were significantly higher in specimens collected in perturbed areas than in the animals from preserved areas. Our study showed that animals from perturbed areas, such as agroecosystems, tend to have higher amounts of DNA damage than animals from reference areas. Moreover, we can conclude that D. minutus tadpoles could be included as a model organism in biomonitoring studies.

Further contributions to nitrogen removal modelling in waste stabilization ponds.

A large database from an experimental maturation pond system in Brazil was used to verify the agreement of field results with values predicted by some of the most widely accepted models to describe ammonium and total nitrogen (TN) removal in facultative and maturation ponds. The same database was used to derive a pH-independent linear model to predict ammonium removal in ponds, which was proved to be, essentially, a function of ammonium surface loading rate. In general, all these models made reasonable predictions of ammonium or TN removal but tended to overestimate low ammonium effluent concentrations while underestimating higher values of field data.

Sensor de variabilidade da frequência cardíaca como preditor de descompensação da insuficiência cardíaca e terapia de ressincronização cardíaca / Heart rate variability sensor as a predictor of heart failure decompensation and cardiac resynchronization therapy

A insuficiência cardíaca é a via final comum à maioria das doenças cardiovasculares, sendo um dosmais importantes desafios clínicos atuais na área da saúde. Em 2007 foi a causa mais frequente de internaçõespor doenças cardiovasculares no Sistema Único de Saúde. Em pacientes com insuficiência cardíaca, a atividadeneuro-hormonal previne o resultado cardiovascular. A variabilidade da frequência cardíaca é uma medida indireta do tônus autonômico e serve como forma de predizer a possibilidade de morte súbita cardíaca e não súbita. Avariabilidade da frequência cardíaca tem sido proposta não só para prever a falência cardíaca grave, mas tambémpara conduzir o tratamento e talvez antecipar o diagnóstico da insuficiência cardíaca agudamente descompensada.A melhora clínica do paciente com insuficiência cardíaca após terapia de ressincronização cardíaca demanda algum tempo, independentemente da melhora rápida dos parâmetros ecocardiográficos, sugerindo ser o remodelamento cardíaco reverso um processo dinâmico e que deve ser aguardado após a terapia de ressincronização cardíaca. Nestetrabalho é feita revisão bibliográfica complementada com a análise do prontuário de uma paciente com insuficiência cardíaca submetida a terapia de ressincronização cardíaca, demonstrando que há melhora ecocardiográfica rápida mas que a melhora clínica se dá após algum tempo do implante do ressincronizador cardíaco. Conclui-se que oremodelamento reverso necessita, em alguns casos, de maior espaço de tempo após o implante do ressincronizadorcardíaco para que haja resultados clínicos, os quais podem não ocorrer ainda que haja melhora da fração de ejeção ao ecocardiograma...

Heart failure is the final common pathway for most cardiovascular diseases, being one of the mostimportant current clinical challenges in healthcare. In 2007 it was the most frequent cause of hospital admissionsfor cardiovascular diseases in the Brazilian Public Healthcare System. In patients with heart failure, neuro-hormonal activity prevents cardiovascular outcome. Heart rate variability is an indirect measure of autonomic tone and serves as a way to predict the possibility of sudden and non-sudden cardiac death. Heart rate variability has been proposed not only as a predictor of severe heart failure, but also to conduct treatment and eventually anticipate the diagnosis of acute decompensated heart failure. The clinical improvement of patients with heart failure after cardiacresynchronization therapy takes some time regardless of the rapid improvement in echocardiographic parameters suggesting that reverse cardiac remodeling is a dynamic process that takes time after cardiac resynchronization therapy. This study reviewed the literature and evaluated the records of a patient with heart failure undergoing cardiac resynchronization therapy demonstrating that there is rapid echocardiographic improvement but thatclinical improvement occurs sometime after the implantation of a cardiac resynchronizer. In conclusion, in somecases a longer time is required after cardiac resynchronization for the clinical outcomes of reverse remodelling tobe observed, which is not always the case, despite ejection fraction improvements at the echocardiogram...