Hybrid ablation for persistent/long-standing persistent atrial fibrillation: a meta-analysis and trial sequential analysis of randomized controlled trials.

The efficacy and safety of hybrid ablation (HA) for patients with non-paroxysmal atrial fibrillation (AF) remain unclear. PubMed, Embase, Cochrane, and ClinicalTrials.gov were searched for randomized controlled trials (RCTs) comparing HA (endo-epicardial ablation) versus endocardial ablation (EA) for patients with persistent/long-standing persistent AF. Risk ratios (RRs) and 95% confidence intervals (CIs) were pooled. Our meta-analysis included 3 RCTs comprising 358 patients, of whom 233 (65.1%) were randomized to HA. Compared with EA, HA reduced the recurrence of atrial tachyarrhythmias (RR 0.53; 95% CI 0.41-0.69; p < 0.01) but had no subgroup interaction according to AF type (p = 0.90). There was no significant difference in major adverse events (RR 1.22; 95% CI 0.46-3.25; p = 0.68). Trial sequential analysis indicates that the observed effects can be deemed conclusive. In conclusion, in patients with persistent/long-standing persistent AF, HA substantially reduced the recurrence of atrial tachyarrhythmias. Notably, patients with long-standing persistent AF may benefit more from this ablation strategy.

Chronic Anticoagulation in Patients with Atrial Fibrillation and COVID-19: A Systematic Review and Meta-Analysis. / Anticoagulação Crônica em Pacientes com Fibrilação Atrial e COVID-19: Uma Revisão Sistemática e Metanálise.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is associated with hypercoagulability. It remains uncertain whether ongoing anticoagulation for atrial fibrillation (AF) in patients who later contract COVID-19 improves clinical outcomes. OBJECTIVES: To compare chronic oral anticoagulation with no previous anticoagulation in patients with AF who contracted a COVID-19 infection concerning the outcomes of all-cause mortality, COVID-19 mortality, intensive care unit (ICU) admission, and hospitalization. METHODS: We systematically searched PubMed, Embase, and Cochrane Library for eligible studies from inception to December 2022. We included studies comparing COVID-19 outcomes in patients with versus without prior chronic anticoagulation for AF. Risk ratios (RR) with 95% confidence intervals (CI) were pooled with a random-effects model. The level of significance was set at p < 0.05. Quality assessment and risk of bias were performed according to Cochrane recommendations. RESULTS: Ten studies comprising 1,177,858 patients with COVID-19 and AF were identified, of whom 893,772 (75.9%) were on prior chronic anticoagulation for AF. In patients with COVID-19, being on chronic anticoagulation for AF significantly reduced all-cause mortality (RR 0.75; 95% CI 0.57 to 0.99; p = 0.048; I2 = 89%) and COVID-19-related mortality (RR 0.76; 95% CI 0.72 to 0.79; p < 0.001; I2 = 0%) when compared with no prior anticoagulation. In contrast, there was no difference between groups regarding hospitalization (RR 1.08; 95% CI 0.82 to 1.41; p = 0.587; I2 = 95%) or ICU admission (RR 0.86; 95% CI 0.68 to 1.09; p = 0.216; I2 = 69%). CONCLUSIONS: In this meta-analysis, chronic anticoagulation for patients with AF who contracted COVID-19 was associated with significantly lower rates of all-cause mortality and COVID-19-related mortality as compared with no previous anticoagulation.

FUNDAMENTO: A doença por coronavírus 2019 (COVID-19) está associada à hipercoagulabilidade. Permanece incerto se a anticoagulação contínua para fibrilação atrial (FA) em pacientes que posteriormente contraem COVID-19 melhora os desfechos clínicos. OBJETIVOS: Comparar a anticoagulação oral crônica com ausência de anticoagulação prévia em pacientes com FA que contraíram uma infecção por COVID-19 em relação aos desfechos de mortalidade por todas as causas, mortalidade por COVID-19, admissão em unidade de terapia intensiva (UTI) e hospitalização. MÉTODOS: Buscamos sistematicamente no PubMed, Embase e Cochrane Library estudos elegíveis desde o início até dezembro de 2022. Incluímos estudos que compararam desfechos de COVID-19 em pacientes com e sem anticoagulação crônica prévia para FA. Foram agrupadas razões de risco (RR) com intervalos de confiança (IC) de 95% por meio de um modelo de efeitos aleatórios. O nível de significância foi estabelecido em p < 0,05. As avaliações da qualidade e do risco de viés foram realizadas de acordo com as recomendações da Cochrane. RESULTADOS: Foram identificados 10 estudos abrangendo 1.177.858 pacientes com COVID-19 e FA, dos quais 893.772 (75,9%) estavam em anticoagulação crônica prévia para FA. Em pacientes com COVID-19, a anticoagulação crônica para FA reduziu significativamente a mortalidade por todas as causas (RR 0,75; IC 95% 0,57 a 0,99; p = 0,048; I2 = 89%) e a mortalidade relacionada à COVID-19 (RR 0,76; IC 95% 0,72 a 0,79; p < 0,001; I2 = 0%) quando comparada com a ausência de anticoagulação prévia. Em contrapartida, não houve diferença entre os grupos em relação à hospitalização (RR 1,08; IC 95% 0,82 a 1,41; p = 0,587; I2 = 95%) ou internação em UTI (RR 0,86; IC 95% 0,68 a 1,09; p = 0,216; I2 = 69%). CONCLUSÕES: Nesta metanálise, a anticoagulação crônica para pacientes com FA que contraíram COVID-19 foi associada a taxas significativamente mais baixas de mortalidade por todas as causas e mortalidade relacionada à COVID-19 em comparação com a ausência de anticoagulação anterior.

Primary Retroperitoneal Lymph Node Dissection for Clinical Stage II A/B Seminomas: A Systematic Review and Meta-Analysis.

INTRODUCTION: Chemotherapy and radiation therapy are considered standard treatments for stage II seminoma patients; however, these therapies are associated with long-term toxicities. Recently, retroperitoneal lymph node dissection has emerged as an alternative strategy, and the first three phase II trials were published in 2023 with promising results. The present study conducted a systematic review and meta-analysis to evaluate this surgery as an alternative treatment for stage IIA/B seminoma patients. PURPOSE: Seminomas are the most common testicular tumors, often affecting young adult males. Standard treatments for stage II seminomas include chemotherapy and radiation therapy, but these therapies are associated with long-term toxicities. Thus, identifying alternative strategies is paramount. Herein, we conducted a systematic review and meta-analysis to appraise the efficacy and safety of retroperitoneal lymph node dissection (RPLND) for treating this condition. METHODS: We systematically searched the PubMed, Embase, and Cochrane databases for studies evaluating RPLND as a primary treatment for stage II A/B seminomas. Using a random-effects model, single proportion and means and pooled 2-year recurrence-free survival rates with hazard rates and 95% CI were calculated. RESULTS: Seven studies were included, comprising 331 males with stage II seminomas. In the pooled analysis, the recurrence rate was 17.69% (95% CI 12.31-24.75), and the 2-year RFS rate was 81% (95% CI 0.77-0.86). The complication rate was 9.16% (95% CI 6.16-13.42), the Clavien-Dindo > 2 complication rate was 8.83% (95% CI 5.76-13.31), and the retrograde ejaculation rate was 7.01% (95% CI 3.54-13.40). The median operative time was 174.68 min (95% CI 122.17-249.76 min), median blood loss was 105.91 mL (95% CI 46.89-239.22 mL), and patients with no evidence of lymph node involvement ranged from 0-16%. CONCLUSIONS: Primary RPLNDs for treating stage IIA/B seminomas have favorable RFS rates, with low complication and recurrence rates. These findings provide evidence that this surgery is a viable alternative therapy for these patients.

CORRELATION OF BLOOD AND SALIVARY TROPONIN IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION: PRELIMINARY STUDY / CORRELAÇÃO DA TROPONINA SANGUÍNEA E SALIVAR EM PACIENTES COM INFARTO AGUDO DO MIOCÁRDIO: ESTUDO PRELIMINAR

Introduction: In the event of myocardial injury, the identification of biomarkers that constitute the cardiac muscle cell, especially troponins, can be observed from blood and saliva samples. The preference for using saliva as a diagnostic fluid is supported by the ease of obtaining it using a non-invasive and potentially pre-hospital method. Objective: To verify the expression of troponin I in salivary fluid in acute myocardial infarction in emergency and pre-hospital screenings and correlate it with plasma troponin I levels. Method: Cross-sectional analytical study of diagnostic testing in 27 patients, 9 women and 18 men, with diagnostic confirmation of acute myocardial infarction. Blood and saliva samples were collected and stored and transported over a period of up to 24 hours for troponina I quantification. Results: The study demonstrated that 44.4% of patients were positive for troponin I in both analyses, with equal dichotomous results in 48.1% of cases. Thus, the salivary troponin test achieved 48% sensitivity and 50% specificity. Conclusion: It was possible to identify troponin in the saliva fluid of patients suffering from acute myocardial infarction, but the probability of a false positive result was 50% and a false negative result was 52%.

Introdução: Na ocorrência da lesão miocárdica, a identificação de biomarcadores constituintes da célula muscular cardíaca, em especial as troponinas, pode ser observada a partir de amostras de sangue e saliva. A preferência pela utilização da saliva como fluído diagnóstico é sustentada pela facilidade de obtenção a partir de método não invasivo e potencialmente pré-hospitalar. Objetivo: Verificar a expressão de troponina I do fluído salivar no infarto agudo do miocárdio em triagens de emergências e pré-hospitalares e correlacioná-la com os níveis plasmáticos da troponina I. Método: Estudo analítico transversal de teste diagnóstico em 27 pacientes, 9 mulheres e 18 homens, com confirmação diagnóstica de infarto agudo do miocárdio. Foram coletadas amostras de sangue e saliva armazenadas e transportadas em período de até 24 h para quantificação da troponina I. Resultados: O estudo demonstrou que 44,4% dos pacientes apresentaram positivação de troponina I em ambas as análises, com igualdade de resultados dicotômicos em 48,1% dos casos. Assim, o teste de troponina salivar obteve 48% de sensibilidade e 50% de especificidade. Conclusão: Foi possível identificar troponina I no fluido da saliva de pacientes em vigência de infarte agudo do miocárdio, mas a probabilidade de ela ter resultado falso positivo foi de 50% e de falso negativo de 52%.

Anticoagulação Crônica em Pacientes com Fibrilação Atrial e COVID-19: Uma Revisão Sistemática e Metanálise / Chronic Anticoagulation in Patients with Atrial Fibrillation and COVID-19: A Systematic Review and Meta-Analysis

Resumo Fundamento: A doença por coronavírus 2019 (COVID-19) está associada à hipercoagulabilidade. Permanece incerto se a anticoagulação contínua para fibrilação atrial (FA) em pacientes que posteriormente contraem COVID-19 melhora os desfechos clínicos. Objetivos: Comparar a anticoagulação oral crônica com ausência de anticoagulação prévia em pacientes com FA que contraíram uma infecção por COVID-19 em relação aos desfechos de mortalidade por todas as causas, mortalidade por COVID-19, admissão em unidade de terapia intensiva (UTI) e hospitalização. Métodos: Buscamos sistematicamente no PubMed, Embase e Cochrane Library estudos elegíveis desde o início até dezembro de 2022. Incluímos estudos que compararam desfechos de COVID-19 em pacientes com e sem anticoagulação crônica prévia para FA. Foram agrupadas razões de risco (RR) com intervalos de confiança (IC) de 95% por meio de um modelo de efeitos aleatórios. O nível de significância foi estabelecido em p < 0,05. As avaliações da qualidade e do risco de viés foram realizadas de acordo com as recomendações da Cochrane. Resultados: Foram identificados 10 estudos abrangendo 1.177.858 pacientes com COVID-19 e FA, dos quais 893.772 (75,9%) estavam em anticoagulação crônica prévia para FA. Em pacientes com COVID-19, a anticoagulação crônica para FA reduziu significativamente a mortalidade por todas as causas (RR 0,75; IC 95% 0,57 a 0,99; p = 0,048; I2 = 89%) e a mortalidade relacionada à COVID-19 (RR 0,76; IC 95% 0,72 a 0,79; p < 0,001; I2 = 0%) quando comparada com a ausência de anticoagulação prévia. Em contrapartida, não houve diferença entre os grupos em relação à hospitalização (RR 1,08; IC 95% 0,82 a 1,41; p = 0,587; I2 = 95%) ou internação em UTI (RR 0,86; IC 95% 0,68 a 1,09; p = 0,216; I2 = 69%). Conclusões: Nesta metanálise, a anticoagulação crônica para pacientes com FA que contraíram COVID-19 foi associada a taxas significativamente mais baixas de mortalidade por todas as causas e mortalidade relacionada à COVID-19 em comparação com a ausência de anticoagulação anterior.

Abstract Background: Coronavirus disease 2019 (COVID-19) is associated with hypercoagulability. It remains uncertain whether ongoing anticoagulation for atrial fibrillation (AF) in patients who later contract COVID-19 improves clinical outcomes. Objectives: To compare chronic oral anticoagulation with no previous anticoagulation in patients with AF who contracted a COVID-19 infection concerning the outcomes of all-cause mortality, COVID-19 mortality, intensive care unit (ICU) admission, and hospitalization. Methods: We systematically searched PubMed, Embase, and Cochrane Library for eligible studies from inception to December 2022. We included studies comparing COVID-19 outcomes in patients with versus without prior chronic anticoagulation for AF. Risk ratios (RR) with 95% confidence intervals (CI) were pooled with a random-effects model. The level of significance was set at p < 0.05. Quality assessment and risk of bias were performed according to Cochrane recommendations. Results: Ten studies comprising 1,177,858 patients with COVID-19 and AF were identified, of whom 893,772 (75.9%) were on prior chronic anticoagulation for AF. In patients with COVID-19, being on chronic anticoagulation for AF significantly reduced all-cause mortality (RR 0.75; 95% CI 0.57 to 0.99; p = 0.048; I2 = 89%) and COVID-19-related mortality (RR 0.76; 95% CI 0.72 to 0.79; p < 0.001; I2 = 0%) when compared with no prior anticoagulation. In contrast, there was no difference between groups regarding hospitalization (RR 1.08; 95% CI 0.82 to 1.41; p = 0.587; I2 = 95%) or ICU admission (RR 0.86; 95% CI 0.68 to 1.09; p = 0.216; I2 = 69%). Conclusions: In this meta-analysis, chronic anticoagulation for patients with AF who contracted COVID-19 was associated with significantly lower rates of all-cause mortality and COVID-19-related mortality as compared with no previous anticoagulation.

Preoperative Levosimendan in Patients With Severe Left Ventricular Dysfunction Undergoing Isolated Coronary Artery Bypass Grafting: A Meta-Analysis of Randomized Controlled Trials.

OBJECTIVE: To verify the impact of preoperative levosimendan on patients with severe left ventricular dysfunction (ejection fraction <35%) undergoing isolated coronary artery bypass grafting. DESIGN: A meta-analysis. SETTING: Hospitals. PARTICIPANTS: The authors included 1,225 patients from 6 randomized controlled trials. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The authors performed a meta-analysis of trials that compared preoperative levosimendan with placebo or no therapy, reporting efficacy and safety endpoints. Statistical analyses used mean differences and risk ratios (RR), with a random effects model. Six studies were included, comprising 1,225 patients, of whom 615 (50.2%) received preoperative levosimendan, and 610 (49.8%) received placebo/no therapy. Preoperative levosimendan showed a lower risk of all-cause mortality (RR 0.31; 95% CI 0.16-0.60; p < 0.01; I2 = 0%), postoperative acute kidney injury (RR 0.44; 95% CI 0.25-0.77; p < 0.01; I2 = 0%), low-cardiac-output syndrome (RR 0.45; 95% CI 0.30-0.66; p < 0.001; I2 = 0%), and postoperative atrial fibrillation (RR 0.49; 95% CI 0.25-0.98; p = 0.04; I2 = 85%) compared to control. Moreover, levosimendan significantly reduced the need for postoperative inotropes and increased the cardiac index at 24 hours postoperatively. There were no differences between groups for perioperative myocardial infarction, hypotension, or any adverse events. CONCLUSION: Preoperative levosimendan in patients with severe left ventricular dysfunction undergoing isolated coronary artery bypass grafting was associated with reduced all-cause mortality, low-cardiac-output syndrome, acute kidney injury, postoperative atrial fibrillation, and the need for circulatory support without compromising safety.

Long-Term Remote vs. Conventional Monitoring of Pacemakers: Systematic Review and Meta-Analysis of Randomized Controlled Trials.

PURPOSE OF REVIEW: Remote monitoring (RM) is the standard of care for patients with cardiac implantable electronic devices (CIEDs), particularly pacemakers. However, the long-term outcomes of RM versus conventional monitoring (CM) of pacemakers and its effectiveness in reducing in-office (IO) visits for device reprogramming require elucidation. This systematic review and meta-analysis aimed to compare the RM and CM of pacemakers over a long-term follow-up. RECENT FINDINGS: We systematically searched the PubMed/MEDLINE, Embase, Cochrane, and ClinicalTrials.gov databases for randomized controlled trials (RCTs) comparing RM and CM of pacemakers with at least 12 months of follow-up. Binary endpoints were pooled with risk ratios (RRs), whereas continuous outcomes were computed using mean differences (MDs) or standardized MDs (SMDs). Heterogeneity was assessed using I2 statistics. Among the eight included RCTs, 2159 (48.9%) of 4063 patients underwent RM. Follow-up periods ranged from 12 to 24 months. There were no significant between-group differences in all-cause mortality (RR = 1.19; 95% confidence interval [CI], 0.90-1.57; p = 0.22; I2 = 0%), stroke (RR = 0.90; 95% CI, 0.43-1.91; p = 0.79; I2 = 23%), hospitalizations for cardiovascular and/or device-related adverse events (RR = 0.95; 95% CI, 0.75-1.21; p = 0.70; I2 = 0%), and quality of life (SMD = - 0.06; 95% CI, - 0.22 to 0.10; p = 0.473; I2 = 0%). RM was associated with fewer IO visits/patient/year (MD = 0.98; 95% CI, - 1.64 to - 0.33; p = 0.08; I2 = 98%) and higher rates of atrial tachyarrhythmia (ATA) detection (RR = 1.22; 95% CI, 1.01-1.48; p = 0.04; I2 = 0%) than was CM. This meta-analysis suggests that RM of pacemakers leads to higher rates of ATA detection and fewer IO visits/patient/year, without compromising patient safety.

Angiotensin Receptor-Neprilysin Inhibitor Effects on Atherosclerotic Cardiovascular Disease Events: A Meta-Analysis of Randomized Controlled Trials.

Sacubitril-valsartan is an angiotensin receptor-neprilysin inhibitor (ARNI) associated with a decreased risk of death and hospitalization for selected patients with heart failure (HF). However, its association with improved atherosclerotic cardiovascular disease (ASCVD) events remains unclear. We performed a meta-analysis to evaluate the association of ARNI with ASCVD events in patients with HF. We systematically searched PubMed, Embase, Cochrane, and ClinicalTrials.gov for studies comparing ARNIs with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) in terms of myocardial infarction, stroke, angina pectoris, peripheral artery disease, and the composite end point in patients with HF. A total of 8 randomized controlled trials were included, with 17,541 patients assigned to either the ARNI (8,764 patients) or ACEi/ARB (8,777 patients) groups. The incidence of composite end point (risk ratio [RR] 1.03, 95% confidence interval [CI] 0.93 to 1.13, p = 0.63), myocardial infarction (RR 1.02, 95% CI 0.81 to 1.30, p = 0.85), angina pectoris (RR 0.96, 95% CI 0.80 to 1.17, p = 0.70), and stroke (RR 0.99, 95% CI 0.85 to 1.16, p = 0.93) were not statistically different between the ARNI and ACEi/ARB groups. However, ARNI was associated with a higher incidence of peripheral artery disease (RR 1.63, 95% CI 1.05 to 2.52, p = 0.03). In conclusion, this meta-analysis found no association between ARNI therapy and improved ASCVD events in patients with HF.

Pretreatment with P2Y12 inhibitors in ST-elevation myocardial infarction: A systematic review and meta-analysis.

BACKGROUND: Pretreatment with oral P2Y12 inhibitors is a standard practice for ST-elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI). However, the efficacy and safety of P2Y12 inhibitors pretreatment remain unclear. OBJECTIVES: We conducted a meta-analysis to investigate the impact of P2Y12 inhibitor pretreatment on thrombotic and hemorrhagic endpoints in STEMI patients. METHODS: We searched multiple databases for studies that compared P2Y12 inhibitor pretreatment with no pretreatment in STEMI patients and reported endpoints of interest. Random effects model was used for the meta-analysis. RESULTS: Our meta-analysis included 3 randomized controlled trials and 14 observational studies, comprising 70,465 patients assigned to either P2Y12 inhibitor pretreatment (50,328 patients) or no pretreatment (20,137 patients). Compared to no pretreatment, P2Y12 inhibitor pretreatment did not result in significant reductions in all-cause mortality (risk ratio [RR] 0.73; 95% confidence interval [CI]: 0.52-1.03; p = 0.07), myocardial infarction (RR 0.75; 95% CI: 0.53-1.07; p = 0.11), or major bleeding (RR 0.80; 95% CI: 0.56-1.16; p = 0.22) at 30 days. However, our subgroup analysis revealed that P2Y12 inhibitor pretreatment administered in the pre-hospital setting was associated with a significant reduction in the incidence of myocardial infarction compared to no pretreatment (RR 0.73; 95% CI: 0.56-0.91; p < 0.01). CONCLUSION: Our analysis suggests that pretreatment with oral P2Y12 inhibitors before PCI in patients with STEMI was not associated with reduced all-cause mortality, myocardial infarction, or major bleeding. However, pretreatment with P2Y12 inhibitors in the pre-hospital setting appears to be beneficial in reducing reinfarction.

Efficacy and safety of bexagliflozin in patients with type 2 diabetes mellitus: A systematic review and meta-analysis.

AIM: To assess the efficacy of bexagliflozin in reducing glycated haemoglobin (HbA1c) and the occurrence of side effects in patients with type 2 diabetes (T2DM). METHODS: We searched the PubMed, Embase, Cochrane and ClinicalTrials.gov databases for placebo-controlled, randomized clinical trials published up until 15 February 2023. The primary outcome was change in HbA1c. We computed weighted mean differences (WMDs) for continuous outcomes and odds ratios (ORs) for binary endpoints, with 95% confidence intervals (CIs). RESULTS: A total of six studies and 3111 patients were included, of whom 1951 were prescribed bexagliflozin. Compared with placebo, bexagliflozin significantly reduced HbA1c levels (WMD -0.53%; 95% CI -0.75, -0.31), fasting plasma glucose levels (WMD -1.45 mmol/L; 95% CI -2.32, -0.57), systolic blood pressure (WMD -4.66 mmHg; 95% CI -6.41, -2.92), diastolic blood pressure (WMD -2.12 mmHg; 95% CI -3.94, -0.30), body weight overall (WMD -1.61 kg; 95% CI -2.14, -1.07), and body weight in patients with a body mass index >25 kg/m2 (WMD -2.05 kg; 95% CI -2.78, -1.31). The proportion of patients who achieved HbA1c < 7% was higher in patients who received bexagliflozin as compared with placebo (OR 1.94; 95% CI 1.36-2.78). There were no significant differences between groups regarding side effects such as hypoglycaemia, genital mycotic infection, urinary tract infection, diarrhoea, headache, nausea, polyuria, diabetic ketoacidosis, or all-cause mortality. CONCLUSIONS: In this meta-analysis, the use of bexagliflozin was associated with improved clinical and laboratory measures in patients with T2DM compared with placebo, with a similar profile of side effects. These findings support the efficacy of bexagliflozin in the treatment of T2DM.

EVALUATION OF THE OMENTUM AS A STEM CELL DONOR ISCHEMIC MYOCARDIAL THROUGH CD34 IMMUNOHISTOCHEMICAL ANALYSIS / AVALIAÇÃO DO OMENTO COMO DOADOR DE CÉLULAS TRONCO NO MIOCÁRDIO ISQUÊMICO ATRAVÉS DA ANÁLISE IMUNOHISTOQUÍMICA DO CD34

Background: Cardiovascular diseases are the leading cause of death in the world. The use of hematopoietic precursor cells and recent advances made in heart graft bioengineering offer a new therapeutic modality for post-myocardial infarction (MI)  and cardiac tissue regeneration. CD34 is a marker expressed on all hematopoietic and endothelial precursor cells, and functions as a cell adhesion factor. The antibody corresponding to this marker is used in immunohistochemistry to assess the formation of new vessels and the presence of stem cells. Aim: To evaluate the efficacy of omentopexy as stem cell donor, on previously infarcted myocardium, using immunohistochemically analysis of CD34. Method: Myocardial infarction was generated in four pigs, by ligature of the 1st and 2nd marginal branches of the circumflex artery. In three animals, abrasion of the infarcted epicardium was performed followed by multiple myocardial perforations and the mobilization of the omentum from the abdominal cavity to the mediastinum, sutured on the infarcted area. In the fourth animal, omentopexy was not performed and only the abrasion and perforation of the infarcted area were performed. All hearts were removed for CD34 immunohistochemically evaluation. Results:  In the samples from the group submitted to omentopexy, there was a 60% increase in angiogenesis, and in the samples from the control animal there was minimal staining.  Four samples from different sites of each animal, totaling 16 histopathological samples were evaluated. All samples were immunolabelled for CD34. Conclusions: Omentopexy proved to be effective in seeding previously infarcted myocardium with stem angiogenic cells, seen through immunohistochemistry, using CD34 marker.

Racional: As doenças cardiovasculares são a principal causa de morte no mundo. O uso de células precursoras hematopoiéticas e os recentes progressos feitos na bioengenharia de enxertos cardíacos oferecem uma nova modalidade terapêutica para a regeneração do tecido cardíaco pós-infarto do miocárdio (IM). O CD34 é um marcador expresso em todas as células precursoras hematopoiéticas e endoteliais, e funciona como fator de adesão celular. O anticorpo que correspondente a este marcador é utilizado na imunohistoquímica para avaliar a formação de novos vasos e a presença de células-tronco. Objetivo: O estudo teve por objetivo avaliar a eficácia da omentopexia na neovascularização e na doação de células tronco de corações suínos previamente infartados, a partir da análise imunohistoquímica do CD34. Método: O infarto do miocárdio foi gerado em 4 suínos, por ligadura do 1°e 2° ramos marginais da artéria circunflexa. Em 3 animais realizou-se abrasão cuidadosa do epicárdio infartado seguido de múltiplas perfurações miocárdicas e a mobilização do omento da cavidade abdominal para o mediastino, envolvendo a área infartada e as perfurações. No quarto animal não foi realizado a omentopexia sendo realizado apenas a abrasão e perfuração da área infartada. Todos os animais foram eutanasiados ao 30º dia pós operatório e os corações retirados para avaliação macroscópica, microscópica e Imunohistoquímica do CD34. Resultados: Nas amostras do grupo submetido a omentopexia, ocorreu um aumento de 60% da angiogênese, sendo que nas amostras do animal controle houve marcação mínima. Foram avaliadas quatro amostras de diferentes sítios de cada coração dos animais, totalizando 16 amostras histopatológicas. Todas as amostras foram imunomarcadas para CD-34. Conclusões: O omento mostrou-se eficiente na indução de neovascularização pela presença de células tronco, vista através da marcação do CD34, demonstrando grande potencial como futura terapêutica para restaurar áreas de miocárdio isquêmico.

Fast growth rate of a right atrial myxoma.

Primary cardiac tumors are rare, with an incidence between 0.0017 and 0.19%, and are asymptomatic in up to 72% of cases. Approximately 75% of tumors are benign, and nearly 50% of these are myxomas. Concerning location, 75% of myxomas are in the left atrium, 15 to 20% in the right atrium, and more rarely in the ventricles. The finding of cardiac myxomas usually implies immediate surgical excision to prevent embolic events and sudden cardiac death. Reports with documented growth rate are rare, and the actual growth rate remains a controversial issue. We report the rapid growth rate of a right atrial myxoma in an oligosymptomatic 69-year-old patient, with negative previous echocardiographic history in the last two years, who refused surgery upon diagnosis, enabling monitoring of myxoma growth.

Fast growth rate of a right atrial myxoma

ABSTRACT Primary cardiac tumors are rare, with an incidence between 0.0017 and 0.19%, and are asymptomatic in up to 72% of cases. Approximately 75% of tumors are benign, and nearly 50% of these are myxomas. Concerning location, 75% of myxomas are in the left atrium, 15 to 20% in the right atrium, and more rarely in the ventricles. The finding of cardiac myxomas usually implies immediate surgical excision to prevent embolic events and sudden cardiac death. Reports with documented growth rate are rare, and the actual growth rate remains a controversial issue. We report the rapid growth rate of a right atrial myxoma in an oligosymptomatic 69-year-old patient, with negative previous echocardiographic history in the last two years, who refused surgery upon diagnosis, enabling monitoring of myxoma growth.

Congestive Hepatopathy Secondary to Right Ventricular Hypertrophy Related to Monocrotaline-Induced Pulmonary Arterial Hypertension.

Heart dysfunction and liver disease often coexist. Among the types of cardiohepatic syndrome, Type 2 is characterized by the chronic impairment of cardiac function, leading to chronic liver injury, referred to as congestive hepatopathy (CH). In this study, we aimed to establish a rat model of CH secondary to right ventricular hypertrophy (RVH) related to monocrotaline (MCT)-induced pulmonary arterial hypertension (PAH). Fifty male Wistar rats were divided into four groups and randomly assigned to control and experimental groups. Three experimental groups were submitted to intraperitoneal MCT inoculation (60 mg/kg) and were under its effect for 15, 30 and 37 days. The animals were then sacrificed, obtaining cardiac and hepatic tissues for anatomopathological and morphometric analysis. At macroscopic examination, the livers in the MCT groups presented a nutmeg-like appearance. PAH produced marked RVH and dilatation in the MCT groups, characterized by a significant increase in right ventricular free wall thickness (RVFWT) and chamber area. At histological evaluation, centrilobular congestion was the earliest manifestation, with preservation of the hepatocytes. Centrilobular hemorrhagic necrosis was observed in the groups exposed to prolonged MCT. Sinusoidal dilatation was markedly increased in the MCT groups, quantified by the Sinusoidal Lumen Ratio (SLR). The Congestive Hepatic Fibrosis Score and the Centrilobular Fibrosis Ratio (CFR) were also significantly increased in the MCT30 group. Hepatic atrophy, steatosis, apoptotic bodies and, rarely, hydropic swelling were also observed. SLR correlated strongly with CFR and RVFWT, and CFR correlated moderately with RVFWT. Our rat model was able to cause CH, related to monocrotaline-induced PAH and RVH; it was feasible, reproducible, and safe.

SOFTWARE-ASSISTED IMAGE ANALYSIS FOR IDENTIFICATION AND QUANTIFICATION OF HEPATIC SINUSOIDAL DILATATION AND CENTRILOBULAR FIBROSIS.

BACKGROUND: Heart dysfunction and liver disease often coexist because of systemic disorders. Any cause of right ventricular failure may precipitate hepatic congestion and fibrosis. Digital image technologies have been introduced to pathology diagnosis, allowing an objective quantitative assessment. The quantification of fibrous tissue in liver biopsy sections is extremely important in the classification, diagnosis and grading of chronic liver disease. AIM: To create a semi-automatic computerized protocol to quantify any amount of centrilobular fibrosis and sinusoidal dilatation in liver Masson's Trichrome-stained specimen. METHOD: Once fibrosis had been established, liver samples were collected, histologically processed, stained with Masson's trichrome, and whole-slide images were captured with an appropriated digital pathology slide scanner. After, a random selection of the regions of interest (ROI's) was conducted. The data were subjected to software-assisted image analysis (ImageJ®). RESULTS: The analysis of 250 ROI's allowed to empirically obtain the best application settings to identify the centrilobular fibrosis (CF) and sinusoidal lumen (SL). After the establishment of the colour threshold application settings, an in-house Macro was recorded to set the measurements (fraction area and total area) and calculate the CF and SL ratios by an automatic batch processing. CONCLUSION: Was possible to create a more detailed method that identifies and quantifies the area occupied by fibrous tissue and sinusoidal lumen in Masson's trichrome-stained livers specimens.

Software-assisted image analysis for identification and quantification of hepatic sinusoidal dilatation and centrilobular fibrosis / Análise da imagem histológica assistida por software para identificação e quantificação de dilatação sinusoidal e fibrose hepática centrolubular

ABSTRACT Background: Heart dysfunction and liver disease often coexist because of systemic disorders. Any cause of right ventricular failure may precipitate hepatic congestion and fibrosis. Digital image technologies have been introduced to pathology diagnosis, allowing an objective quantitative assessment. The quantification of fibrous tissue in liver biopsy sections is extremely important in the classification, diagnosis and grading of chronic liver disease. Aim: To create a semi-automatic computerized protocol to quantify any amount of centrilobular fibrosis and sinusoidal dilatation in liver Masson's Trichrome-stained specimen. Method: Once fibrosis had been established, liver samples were collected, histologically processed, stained with Masson's trichrome, and whole-slide images were captured with an appropriated digital pathology slide scanner. After, a random selection of the regions of interest (ROI's) was conducted. The data were subjected to software-assisted image analysis (ImageJ®). Results: The analysis of 250 ROI's allowed to empirically obtain the best application settings to identify the centrilobular fibrosis (CF) and sinusoidal lumen (SL). After the establishment of the colour threshold application settings, an in-house Macro was recorded to set the measurements (fraction area and total area) and calculate the CF and SL ratios by an automatic batch processing. Conclusion: Was possible to create a more detailed method that identifies and quantifies the area occupied by fibrous tissue and sinusoidal lumen in Masson's trichrome-stained livers specimens.

Resumo Racional: Tecnologias de imagem digital têm sido introduzidas ao diagnóstico patológico, permitindo avaliações quantitativas objetivas. A quantificação de tecido fibroso em biópsias de fígado é extremamente importante para a classificação, diagnóstico e graduação de doenças crônicas hepáticas. Objetivo: Criar um protocolo computadorizado semi-automático para quantificação de fibrose centrolobular e dilatação sinusoidal em amostras de fígado coradas por Tricrômico de Masson. Método: Uma vez instaurada a fibrose, amostras de fígado foram coletadas, processadas histologicamente, coradas por Tricrômico de Masson e WSI (Whole Slide Images) foram capturadas por scanner digital patológico apropriado. Uma seleção aleatória das regiões de interesse (ROI) foi realizada. Os dados foram submetidos a uma análise de imagem assistida por software (ImageJ®). Resultados: A análise de 250 ROIs permitiu obter-se empiricamente as melhores configurações capazes de identificar fibrose centrolobular (FC) e lúmen sinusoidal (LS). Após o estabelecimento das configurações de padrão de cor, uma Macro de autoria própria foi gravada para definir as medidas (área da fração e área total) e calcular as razões de FC e LS por processamento em grupo/lote (batch mode). Conclusão: Foi possível criar um método detalhado capaz de identificar e quantificar a área ocupada por tecido fibroso e lúmen sinusoidal em espécimes de fígado coradas por Tricrômico de Masson.

Infarto do miocárdio durante a pandemia de Covid-19: Análise comparativa em cinco capitais brasileiras / Myocardial infarction during the Covid-19 pandemic: Comparative analysis in five brazilian capitals

Na tentativa de controle de transmissão da COVID-19, os órgãos de saúde recomendaram isolamento domiciliar, distanciamento social e suspensão de serviços hospitalares não urgentes. Grande parte da população relutou em buscar atendimento médico. A hipótese levantada é que houve redução na incidência de internamentos e aumento na mortalidade por infarto agudo do miocárdio durante a pandemia. Este estudo procurou comparar e analisar a incidência dos internamentos e mortalidade por infarto agudo do miocárdio em cinco cidades brasileiras durante a pandemia (2020/2021) com um mesmo período (2019/2020) sem pandemia. É estudo ecológico no qual foram analisados registros comparativos da incidência de internamentos e mortalidade por infarto nas cinco capitais brasileiras. Em conclusão, houve decréscimo na incidência de internamentos durante a pandemia em todas as capitais analisadas, exceto Campo Grande, e redução na mortalidade por infarto agudo do miocárdio em todas as capitais.

In an attempt to control the transmission of COVID-19, health state agency recommended home isolation, social distancing and suspension of non-urgent hospital services. Much of the population was reluctant to seek medical attention. The hypothesis raised is that there was a reduction in the incidence of hospitalizations and an increase in mortality from acute myocardial infarction during the pandemic. This study sought to compare and analyze the incidence of hospitalizations and mortality from acute myocardial infarction in five Brazilian cities during the pandemic (2020/2021) with the same period (2019/2020) without. It is an ecological study in which comparative records of the incidence of hospitalizations and mortality from infarction in the five Brazilian capitals were analyzed. In conclusion, there was a decrease in the incidence of hospitalizations during the pandemic in all capitals analyzed, except Campo Grande, and a reduction in mortality from acute myocardial infarction in all capitals.

Desenvolvimento e análise experimental de técnicas de descelularização em artéria de coelho como enxerto biológico: estudo piloto / Development and experimental analysis of decelullarization techniques in rabbit artery as a biological graft: pilot study

Doenças cardiovasculares são as causas mais comuns de óbitos no mundo. Técnicas de revascularização são utilizadas em casos avançados, porém frequentemente mostram complicações. Enxertos sintéticos, autólogos e heterólogos tradicionais, muitas vezes, não atendem às necessidades do paciente. O processo de descelularização representa uma via alternativa para enxertos heterólogos, sendo visado na engenharia de tecidos, devido à possibilidade de manter uma matriz orgânica bioativa e versátil, retirando apenas os agentes antigênicos. Este estudo teve o objetivo de desenvolver e validar, experimentalmente, protocolos de descelularização em vasos sanguíneos de animais e, posteriormente, avaliar o seu potencial de biocompatibilidade e recelularização in vivo. Foram extraídos segmentos arteriais da aorta torácica, aorta abdominal e carótidas comuns de coelho que foram submetidos a dois protocolos de descelularização: descelularização por método enzimático com tripsina 0,1% e pelo detergente aniônico Triton X-100 0,25%. Em conclusão, a descelularização permite a remoção de células antigênicas em enxertos vasculares, com capacidade de manter a integridade da estrutura do vaso.

Cardiovascular diseases are the most common causes of death in the world. Revascularization techniques are used in advanced cases, but they often show complications. Synthetic, autologous and traditional heterologous grafts often do not meet the patient's needs. The decellularization process represents an alternative route for heterologous grafts, being targeted in tissue engineering, due to the possibility of maintaining a bioactive and versatile organic matrix, removing only the antigenic agents. This study aimed to, experimentally, develop and validate decellularization protocols in animal blood vessels and, subsequently, evaluate their potential for biocompatibility and recellularization in vivo. Arterial segments were extracted from the thoracic aorta, abdominal aorta and common carotid arteries of rabbits that were submitted to two decellularization protocols: decellularization by enzymatic method with 0.1% trypsin and by the anionic detergent Triton X-100 0.25%. In conclusion, decellularization allows the removal of antigenic cells in vascular grafts, with the ability to maintain the integrity of the vessel structure.

Dano histológico renal em modelo experimental de hipertrofia ventricular direita induzida por monocrotalina / Renal histological damage in an experimental model of monocrotalin-induced right ventricular hypertrophy

Monocrotalina, alcalóide tóxico obtido de plantas do gênero crotalaria, pode ter potencial efeito tóxico em órgãos do corpo humano, como rins, pulmões, coração, fígado e outros efeitos. O objetivo deste estudo foi avaliar o dano renal causado pela exposição à monocrotalina. Trata-se de estudo experimental em ratos divididos em 4 grupos, um dos quais recebeu injeção de soro fisiológico e os outros três inoculação de monocrotalina, com tempos diferentes para sacrifício; subsequentemente, estudo histológico foi feito a fim de evidenciar as lesões renais. Em conclusão, constatou-se que houve lesão renal. Contudo, não foi possível afirmar o mecanismo exato responsável por elas, ou seja, se foram decorrentes da ação tóxica direta da monocrotalina, ou se, também, esteve relacionado a outros fatores sistêmicos.

Monocrotaline, a toxic alkaloid obtained from plants of the Crotalaria genus, may have a potential toxic effect on human body organs, such as kidneys, lungs, heart, liver and other effects. The aim of this study was to evaluate the kidney damage caused by exposure to monocrotaline. This is an experimental study in rats divided into 4 groups, one of which received saline injection and the other three received monocrotaline inoculation, with different times for sacrifice; subsequently, a histological study was performed in order to evidence renal lesions. In conclusion, it was found that there was kidney damage. However, it was not possible to state the exact mechanism responsible for them, that is, if they were due to the direct toxic action of monocrotaline, or if it was also related to other systemic factors.

Análise dos fatores de risco para déficit neurológico em fraturas da coluna vertebral torácica e lombar / Analysis of risk factors for neurological deficit in fractures of the thoracic and lumbar vertebral spine

Responsáveis por 89% de lesões neurológicas, as fraturas de coluna vertebral torácica e lombar, quando analisadas perante os fatores de risco para déficit neurológico, apresentam associação controversa. Apesar da relação contestável, estudos apontam que as características morfológicas dessas lesões estão associadas ao grau de déficit neurológico e funcionam como guia para a estratégia terapêutica. O objetivo deste estudo foi identificar quais os fatores de risco para déficit neurológico nas fraturas da coluna vertebral torácica e lombar. É estudo transversal, observacional e individuado, no qual foram analisados 150 pacientes. Em conclusão, demonstrou-se que os subtipos de fratura A são fatores de risco para déficit neurológico e determinantes da conduta terapêutica aplicada. Além disso, indicou relação entre a classificação do déficit neurológico e energia do trauma com a necessidade de tratamento invasivo.

Responsible for 89% of neurological injuries, fractures of the thoracic and lumbar spine, when analyzed in terms of risk factors for neurological deficit, present a controversial association. Despite the debatable relationship, studies indicate that the morphological characteristics of these lesions are associated with the degree of neurological deficit and function as a guide for the therapeutic strategy. The aim of this study was to identify the risk factors for neurological deficit in thoracic and lumbar spine fractures. It is a cross-sectional, observational and individualized study, in which 150 patients were analyzed. In conclusion, it was demonstrated that fracture subtypes A are risk factors for neurological deficit and determinants of the therapeutic approach applied. In addition, it indicated a relationship between the classification of neurological deficit and trauma energy with the need for invasive treatment.