Evaluation of Minimally Invasive Preparation of Curved Mesial Canals of Mandibular Molars - An In Vitro Study.

INTRODUCTION: Curved mesial roots can be challenging for different stages of endodontic treatment. Preparation aims to enlarge, clean, and shape the root canal system, and hundreds of systems are available to carry it out. Aiming to maintain pericervical dentin, minimally invasive preparation was proposed, and with it, instruments with lower tapers emerged. This study aimed to evaluate the increase in canal volume, the centering ability of the instruments, and root canal transportation of two different rotary systems with lower tapers. METHODS: Eighteen curved mesial roots of extracted mandibular molars were scanned by micro-CT at 3 moments: initial and after the 2 stages of endodontic preparation. The canals were prepared using TruNatomy (TN) and ProDesign Logic 2 (PDL2) instruments up to sizes 25.04 and 26.04, respectively, and after 36.03 and 35.05, respectively. The data were analyzed using parametric and nonparametric tests with a significance level of 5%. RESULTS: TN and PDL2 systems showed no difference regarding the increase in the volume of the canals with the first instruments, but after preparation with a diameter size of 35 or 36, there was a difference (P < .01) between the systems in the cervical and middle thirds. CONCLUSION: Both systems shaped the mesial canals of mandibular molars while keeping low transportation and good centering ability in enlargements up to diameter size 35 or 36 with tapers of 3 or 5%.

How does nano-focus computed tomography impact the quantification of debris within the root canal system?

The aim of this study was to compare the quantification of hard-tissue debris by using micro-computed tomography (micro-CT) and nano-focus computed tomography (nano-CT) after root canal instrumentation. Ten mandibular molars containing an isthmus in the mesial root were scanned in a SkyScan 1172 micro-CT device with a voxel size of 12.8 µm and in a NanoTom nano-CT device with 5.5 µm. The mesial root canals were irrigated with 5 mL of saline solution at the orifice level, instrumented with Reciproc R25 files and a second scanning was performed by micro-CT and nano-CT devices for post-instrumentation images. DataViewer software was used for registering the pre- and post-operative micro-CT and nano-CT images. The root canal and the debris were segmented for quantitative analysis of the volume of the canal and volume of debris using CTAn software. Statistical analysis was performed using the T test for comparison between volume of the canal after instrumentation and volume of debris in both image modalities. The level of significance was set at p < 0.05. Nano-CT images showed higher values of debris when compared with micro-CT (p < 0.05) after root canal instrumentation. No difference was observed between the volume of the root canal after instrumentation in the two imaging methods used (p > 0.05). Nano-CT technology can be recommended as a more precise method for quantitative analysis of hard-tissue debris. Moreover, in Endodontic research it is a promising method, as it is capable of providing higher spatial and contrast resolution, faster scanning and higher image quality.

The Influence of Parental Sleep and Experiences Related to COVID-19 on Sleep in Children and Adolescents between 2020 and 2021 in Brazil.

The study aimed to evaluate the influence of parental sleep and experiences related to COVID-19 on sleep changes in children and adolescents in the period between 2020 and 2021 in Brazil and further compare the sleep of adults with and without children. This is a longitudinal web-survey study. Participants were invited to respond to a questionnaire regarding sleep characteristics, mental health issues, and work/lifestyle modifications in two waves of the pandemic (April-July 2020 and 2021). A total of 1172 adults answered both questionnaires, and 281 were dyads (parent-child/adolescent). Parent and non-parent adult responders had similar sociodemographic data, with a predominance of the female sex and self-declared white skin color prevailing along with higher levels of education in both groups. The prevalence of sleep problems in adults varied from 20.6% to 30.2% in the parent group and from 16.9% to 30.1% in non-parents. The prevalence of sleep problems in children and adolescents raised from 2020 to 2021 (respectively, 48% and 49.5%) but differences were not statistically significant. The multivariate logistic model showed in both years that changes in children's/adolescents' sleep was related to parents working at home, infected family/friends, time of exposure to COVID-19, and daytime sleep dysfunction. Our data showed that parental sleep and experiences related to COVID-19 influenced sleep changes in children and adolescents. Parents had a significant difference in daytime sleepiness compared to the group without children.

Effects of the COVID-19 pandemic on sleep quality in children and adolescents: A systematic review and meta-analysis.

We synthesise the literature on the potential influence of the COVID-19 pandemic on sleep quality in children and adolescents. The search identified studies that examined the relationship between sleep quality and disorders during the COVID-19 pandemic. It began in May 2021 and has had two updates with the last in January 2022. The databases used were LILACS, PubMed, and EMBASE. Random effects models were performed to explore heterogeneity between studies. Data were presented as continuous variables (mean value and standard deviation) to perform a meta-analysis. Twenty-nine studies from 16 countries were identified: Nine had children and eight had adolescents. The overall quality of the studies ranged from high (27.6%) to medium (65.5%) and low (6.9%). Eight studies were eligible for meta-analysis. There was an increase in sleep duration during the pandemic when compared with the previous period 0.33 (95%CI -0.07; 0.60) (p < 0.001) and late bedtime 0.78 (95%CI -0.33; 1.22) (p < 0.001). A trend toward reduced sleep efficiency was also detected 0.54 (95%CI -0.75; -0.33) p = 0.20. Parents' reports of increased use of screen media/electronic devices were associated with worse sleep quality. The results suggest an influence of the pandemic on sleep characteristics such as increased sleep duration, late bedtimes, and poor sleep quality. These alterations were related to changes in family routines during this period.

How does nano-focus computed tomography impact the quantification of debris within the root canal system?

Abstract The aim of this study was to compare the quantification of hard-tissue debris by using micro-computed tomography (micro-CT) and nano-focus computed tomography (nano-CT) after root canal instrumentation. Ten mandibular molars containing an isthmus in the mesial root were scanned in a SkyScan 1172 micro-CT device with a voxel size of 12.8 µm and in a NanoTom nano-CT device with 5.5 µm. The mesial root canals were irrigated with 5 mL of saline solution at the orifice level, instrumented with Reciproc R25 files and a second scanning was performed by micro-CT and nano-CT devices for post-instrumentation images. DataViewer software was used for registering the pre- and post-operative micro-CT and nano-CT images. The root canal and the debris were segmented for quantitative analysis of the volume of the canal and volume of debris using CTAn software. Statistical analysis was performed using the T test for comparison between volume of the canal after instrumentation and volume of debris in both image modalities. The level of significance was set at p < 0.05. Nano-CT images showed higher values of debris when compared with micro-CT (p < 0.05) after root canal instrumentation. No difference was observed between the volume of the root canal after instrumentation in the two imaging methods used (p > 0.05). Nano-CT technology can be recommended as a more precise method for quantitative analysis of hard-tissue debris. Moreover, in Endodontic research it is a promising method, as it is capable of providing higher spatial and contrast resolution, faster scanning and higher image quality.

Oral healthcare management practices in Brazil: systematic review and metasummary

Universal health coverage is a global target included in the United Nations Sustainable Development Goals agenda for 2030. Healthcare in Brazil has universal coverage through the Unified Health System (SUS), which guarantees health as basic right to the Brazilian population. Considering the principles of SUS, public oral healthcare management is a huge challenge. Aim: To identify good management practices for quality care adopted by local public oral healthcare managers and teams around Brazil. Methods: This study was registered with PROSPERO (CRD42017051639). Five databases (PubMed, Embase, Web of Science, Scopus and Lilacs) as well as the reference lists and citations of the included publications were searched according to PRISMA guidelines. Results:A total of 30,895 references were initially found, which were evaluated according to the defined eligibility criteria. Twenty qualitative studies, eight surveys and two mixed-model studies were selected. The practices (codes) were organized into three main groups (families), and the Frequency of the Effect Size (FES) of each code was calculated. Among the 20 codes identified, the most relevant ones were: Diagnosis and Health Planning (FES=80%) and Family Health Strategy(FES=66,7). The Intensity of the Effect Size of each study was also calculated to demonstrate the individual contribution of each study to the conclusions. Conclusion: The evidence emerging from this review showed that healthcare diagnosis, planning, and performance based on the family health strategy principles were the most relevant practices adopted by public oral healthcare managers in Brazil. The widespread adoption of these practices could lead to improved oral healthcare provision and management in Brazil

Comparison of hemodynamic instability among continuous, intermittent and hybrid renal replacement therapy in acute kidney injury: A systematic review of randomized clinical trials.

PURPOSE: To compare hemodynamic instability during continuous, intermittent and hybrid renal replacement therapy (RRT) in critically ill patients, and its association with renal recovery and mortality. MATERIALS AND METHODS: The search was conducted in accordance with the PRISMA guidelines which was registered at the PROSPERO Database (CRD42018086504). Randomized clinical trials (RCTs) involving critically ill patients with acute kidney injury (AKI) treated with continuous, intermittent or hybrid RRT were included. The search was performed using PubMed, Embase and Cochrane databases. RESULTS: Out of 3442 citations retrieved, 12 RCTs were included in the systematic analysis, representing 1419 patients. Most studies (n = 8) did not report differences in hemodynamic parameters across different RTT modalities. The incidence of hypotensive episodes varied from 5 to 60% among the studies. Punctual differences on heart rate and blood pressure were observed among studies. However, studies presented high heterogeneity in terms of outcome definitions and measurement, thus making the conduction of meta-analysis impossible. CONCLUSIONS: There is very few information available regarding hemodynamic tolerance of renal replacement therapy methods. A better standardization of hemodynamic tolerance and further reports are needed before conclusions can be drawn.

A network meta-analysis of direct factor Xa inhibitors for the treatment of cancer-associated venous thromboembolism.

INTRODUCTION: Treatment of cancer-associated venous thromboembolism (CAVTE) remains challenging. The aim of this study was to assess the outcomes of direct acting oral anticoagulants (DOAs) for the treatment of CAVTE. MATERIALS AND METHODS: A network meta-analysis of randomized clinical trials comparing DOAs (Apixaban, Rivaroxaban, and Edoxaban) versus Dalteparin for the treatment of CAVTE was performed. Outcomes of interest included, VTE recurrence, all-cause mortality, event-free survival, major bleeding, and clinically relevant non-major bleeding (CRNMB). Analysis was based on a random effects model and Bayesian Markov-chain Monte Carlo method was used for indirect comparisons. RESULTS: Four RCTs involving 2894 patients were included. Overall certainty of evidence was moderate regarding all outcomes. DOAs exhibited lower risk of VTE (RR 0.62; 95% CI 0.44, 0.87; P = 0.007), similar risk of major bleeding (RR 1.33; 95% CI 0.84, 2.11; P = 0.23), and higher risk of CRNMB (RR 1.66, 95% CI 1.08, 2.56; P = 0.02), compared with Dalteparin. Risk of all-cause mortality and event-free survival were similar between groups with RR 0.99 (95% CI 0.84, 1.16) and RR 1.03 (95% CI 0.94, 1.13), respectively. Apixaban ranked first for recurrent VTE (42.4%) and major bleeding (62.3%) and Dalteparin ranked first for CRNMB (54.7%). Rivaroxaban ranked best considering all-cause mortality (58.7%); Apixaban ranked best for event-free survival (83.6%). CONCLUSIONS: DOAs presented a reduced risk of recurrent VTE with similar risk of major bleeding compared to Dalteparin. However, a higher risk of CRNMB is expected when this cohort of patients are treated with DOAs instead of Dalteparin.

Uso do instrumento Reciproc Blue associado à terapia fotodinâmica: relato de caso / Use of the Reciproc Blue instrument associated with photodynamic therapy: case report

Introdução: A presença de microrganismos é considerada a principal causa de insucesso da terapia endodôntica. Além disso, a anatomia interna dos dentes também representa um grande desafio para os endodontistas. Desse modo, lançar mão da tecnologia reduz tempo clínico e aumenta a chance de sucesso da terapia endodôntica. Objetivo: O objetivo do presente estudo foi relatar um caso clínico com a utilização de instrumentação mecanizada e o sistema Reci- proc Blue associados à terapia fotodinâmica. Descrição: Paciente do sexo feminino, melanoderma, compareceu à clínica escola de uma faculdade de Odontologia apresentando duas fístulas intrabucais ativas na região de fundo de vestíbulo próxima aos ápices dos dentes #12 e #22. Após os exames clínicos, radiográficos, testes de sensibilidade e rastreamento de fístulas, estabeleceu-se o diagnóstico de necrose pulpar, sugestível de abscesso apical crônico dos incisivos laterais superiores. Resultados: O tratamento endodôntico dos dois elementos dentários foi realizado em sessão única, utilizando o instrumento Reciproc Blue em movimento reciprocante associado à terapia fotodinâmica. Após 30 dias da conclusão dos tratamentos endodônticos e restauradores, os dentes apresentavam-se assintomáticos e com cicatrização das fístulas intrabucais. Conclusão: O uso do sistema Reciproc Blue associado à terapia fotodinâmica foi eficaz. Constatou-se o sucesso clínico e radiográfico da terapêutica aplicada, verificando-se o restabelecimento da região periapical, com regressão da lesão radiograficamente e ausência de sinais clínicos e sintomas de infecção do canal radicular. O acompanhamento por tempo prolongado é necessário para se avaliar o total reparo da lesão periapical (AU).

Introduction: The presence of microorganisms is considered the main cause of endodontic therapy failure. In addition, an internal anatomy also poses a major challenge for endodontists. In this way, avail a series of quick techniques and increase the chance of success. The reason of this study was to relate clinical cases, root canal treatment, using mechanized instrumentation with the system Reciproc Blue instrument, associated with photodynamic therapy. Case report: A female genetic patient, brown skin, presented at the school clinic of a dental school, with a major complaint of "blistering on the gum." At the clinical examination, the target dates are inside the mouth active in the selection bottom region near the apexes of the elements 12 and 22. Through clinical, radiographic, sensitivity and screening tests of fistulae, diagnosis and diagnosis of pulp necrosis, suggestive of chronic apex abscess of the incisors. Results: Endodontic treatment of the two dental elements was performed in a single session using the Reciproc Blue instrument in a reciprocating motion associated with photodynamic therapy. After 30 days of completion of endodontic and restorative treatments, one patient returned for evaluation and clinical follow-up. The new asymptomatic presentation and with a healing of the intrabucal fistulas. Conclusion: The system Reciproc Blue associated with photo-dynamic therapy was effective. It was verified the clinical and radiographic success of apicality, confirming the reestablishment of the apex region with regression of the radiographic lesion and the absence of clinical signs and signs of infection of the root canal. The patient is with the clinician and radiographic studies (AU).

Cleaning efficacy and uncontrolled removal of dentin of two methods of irrigant activation in curved canals connected by an isthmus.

The aim of this study was to compare the efficacy of UAI with ESI, sonic activation with Eddy® and syringe irrigation in removing debris, and dentin removal during canal irrigation. Twenty-four mandibular molars containing isthmus type V and with a mean curvature of 32.5° were instrumented and divided into three groups for final irrigation: UAI with ESI, sonic activation with Eddy and syringe irrigation. The samples were scanned in a SkyScan 1172 micro-CT device for pre-, post-instrumentation and post-irrigation images and analysis of dentin removal. Statistical analysis was performed using Wilcoxon, Kruskal-Wallis and Dunn tests. UAI and sonic activation significantly improved debris removal (P < 0.05). No significant difference was observed regarding dentin removal between the groups (P > 0.05), although higher values were found for UAI. Sonic activation with Eddy® showed to be an effective and safe device since it was able to remove debris without causing damage to the canal walls.

Root canal shaping of curved canals by Reciproc Blue system and Pro Taper Gold: A micro-computed tomographic study.

BACKGROUND: This study aimed to evaluate the centralization and transportation of ProTaper Gold (PTG) rotary system and Reciproc Blue (RB) reciprocating system in curved canals, by using micro-CT. MATERIAL AND METHODS: Twenty extracted mandibular molars were previously scanned by using the SkyScan 1174 microtomograph to select the Vertucci IV anatomic type. The specimens were divided into two groups (n=10) according to the mechanized system used to prepare the root canals. The teeth were scanned by micro-CT to calculate the increase volume, percentage of dentin removed, remaining dentin thickness, structure model index (SMI), degree of transportation and centering ability of root canals. The Student's t test was used to evaluate differences between PTG and RB in each measurement evaluated. RESULTS: No significant differences were found between the groups in the increase of the total root canal and apical volume; percentage of dentin removed after preparation; SMI of the mesiolingual canal; degree of transportation of the canal and centering ability of the cervical and middle thirds (P>0.05). There were significant differences in the mesiobuccal canal in SMI and in the centering ability of the apical third (P<0.05). Concerning the remaining dentin thickness, there was also no significant diferences between the groups, except for some regions were RB was observed to have a superior cutting capacity (P<0.05). CONCLUSIONS: Both systems were efficient and safe for performing preparation of the moderately curved root canals of mandibular molars. RB instruments produced more circular and better centralized canals in the apical third of the mesiobuccal canal, with superior cutting action when compared with PTG instruments. Key words:Nickel-titanium instrument, heat treatment, micro-computed tomography, canal transportation.

Influence of CBCT-based volumetric distortion and beam hardening artefacts on the assessment of root canal filling quality in isthmus-containing molars.

OBJECTIVES: To evaluate the influence of artefacts in cone beam CT (CBCT) images of filled root canals in isthmus-containing molars. METHODS: 10 teeth presenting canals with an isthmus were instrumented and filled with a thermoplasticised obturation technique. The teeth were scanned using a micro-CT device and two CBCT devices: 3D Accuitomo 170 (ACC) and NewTom VGi evo (NT), with different acquisition protocols: larger and smaller voxel size. Three examiners assessed the CBCT images for: (1) detection of filling voids; (2) assessment of under- or overestimation of the filling material and (3) resemblance of CBCT images to the reference standard. Analyses of Task 1 yielded accuracy, sensitivity and specificity for detection of filling voids. For tasks 2 and 3, statistical analysis was performed using Wilcoxon test. The level of significance was set at p < .05. RESULTS: For Task 1, ACC showed higher sensitivity, whereas NT presented higher specificity. No significant difference was found between the protocols in ACC, however, for NT, differences between protocols were significant for all diagnostic values. In Task 2, visualisation of the filling was overestimated for NT, while for ACC, underestimation was observed. For Task 3, images with smaller voxel size were more similar to the reference image, for both CBCT devices. CONCLUSIONS: Different artefacts compromise the detection of filling voids on CBCT images of canals in mandibular molars with isthmus. ACC and NT present rather similar diagnostic accuracy, even though artefact expression remains device-specific.

Analysis of the physicochemical properties, cytotoxicity and volumetric changes of AH Plus, MTA Fillapex and TotalFill BC Sealer.

BACKGROUND: To evaluate the physicochemical properties and cytotoxicity of AH Plus, MTA Fillapex and TotalFill BC Sealer. Volumetric changes were also evaluating using micro-computed tomography (micro-CT). MATERIAL AND METHODS: Radiopacity and flow were evaluated in accordance with the ISO 6876, while setting time was evaluated in accordance with the ASTM- C266-08 specifications. The release of Ca2+ ions and pH were measured with spectrophotometer and pH meter, respectively, after different time intervals (1h, 3h, 24h, 72h, 168h, and 360h). Cytotoxicity was evaluated by MTT reduction assay to check 3T3 cells viability at 24, 48 and 72 hours. Volumetric change was evaluated by micro-CT, by using 30 acrylic teeth, filled with gutta-percha cones and the tested root canal sealer. The samples were evaluated after 168h, 360h and 720h of immersion in distilled water. Data were statistically analyzed by one-way ANOVA and Tukey test or by Kruskal-Wallis and Dunn tests (P<0.05). RESULTS: MTA Fillapex and TotalFill BC Sealer showed lower radiopacity than AH Plus (P<0.05). The MTA Fillapex showed the highest flow, while AH Plus showed the lowest flow (P<0.05). The initial and final setting time of AH Plus were lower than MTA Fillapex and TotalFill BC Sealer (P<0.05). In general, TotalFill BC Sealer presented higher Ca2+ ion release and pH than the other tested sealers. TotalFill BC Sealer also showed overall lower cytotoxicity when compared to the other sealers. Volumetric change of AH Plus and TotalFill BC Sealer was lower than MTA Fillapex (P<0.05). CONCLUSIONS: AH Plus, MTA Fillapex and TotalFill BC Sealer showed slight differences in the physicochemical properties and cytotoxicity, but all suitable for an endodontic sealer. However, AH Plus and TotalFill BC Sealer showed low volumetric changes when compared to MTA Fillapex. Key words:Calcium silicate, cytotoxicity, physicochemical properties, micro computed tomography.

Nursing Guidelines on Cardiac Surgery and Parents' Anxiety: Randomized Clinical Trial.

OBJECTIVE: The preparation of parents of children who should undergo cardiac surgery requires special treatment such as the explanations about the event. This study aims to compare the effects of standardized nursing guidelines with routine institutional orientation on the anxiety of parents of children undergoing cardiac surgery. METHODS: Randomized clinical trial. The sample consisted of parents of children who underwent cardiac surgery from December 2010 to April 2011. Twenty-two parents were randomized to the intervention group (IG) and received the standard nursing guidelines and 22 participated in the control group (CG) and received the routine guidelines from the institution. Anxiety was assessed by the State-Trait Anxiety Inventory (STAI) applied in the preoperative period, between 12 and 20 hours before surgery and before receiving standard or institutional guidelines and 48 hours after surgery. The analysis of variance (ANOVA) for repeated measures was performed to evaluate the differences between the variations in STAI scores between the groups during the studied period. The level of significance was 0.05. RESULTS: There were no significant differences in baseline anxiety scores between groups with regard to trait anxiety as well as state anxiety: STAI-trait (CG 42.6±4.9 vs. IG 41.4±6.0, P=0.48); STAI-state (CG 42.3±5.7 vs. IG 45.6±8.3, P=0.18). Likewise, the variation in score after 48 hours was similar between groups (STAI-trait P=0.77; STAI-state P=0.61). CONCLUSION: There were no significant differences in the parents' anxiety levels when comparing the two types of guidelines: the standard nursing and the institutional orientation.

Nursing guidelines on cardiac surgery and parents anxiety: randomized clinical trial

Abstract Objective: The preparation of parents of children who should undergo cardiac surgery requires special treatment such as the explanations about the event. This study aims to compare the effects of standardized nursing guidelines with routine institutional orientation on the anxiety of parents of children undergoing cardiac surgery. Methods: Randomized clinical trial. The sample consisted of parents of children who underwent cardiac surgery from December 2010 to April 2011. Twenty-two parents were randomized to the intervention group (IG) and received the standard nursing guidelines and 22 participated in the control group (CG) and received the routine guidelines from the institution. Anxiety was assessed by the State-Trait Anxiety Inventory (STAI) applied in the preoperative period, between 12 and 20 hours before surgery and before receiving standard or institutional guidelines and 48 hours after surgery. The analysis of variance (ANOVA) for repeated measures was performed to evaluate the differences between the variations in STAI scores between the groups during the studied period. The level of significance was 0.05. Results: There were no significant differences in baseline anxiety scores between groups with regard to trait anxiety as well as state anxiety: STAI-trait (CG 42.6±4.9 vs. IG 41.4±6.0, P=0.48); STAI-state (CG 42.3±5.7 vs. IG 45.6±8.3, P=0.18). Likewise, the variation in score after 48 hours was similar between groups (STAI-trait P=0.77; STAI-state P=0.61). Conclusion: There were no significant differences in the parents' anxiety levels when comparing the two types of guidelines: the standard nursing and the institutional orientation.

Creation and Implementation of a Prospective and Multicentric Database of Patients with Acute Myocardial Infarction: RIAM. / Criação e Implementação de um Banco de Dados Prospectivo e Multicêntrico de Pacientes com Infarto Agudo do Miocárdio: RIAM.

BACKGROUND: Multicenter registries representing the real world can be a significant source of information, but few studies exist describing the methodology to implement these tools. OBJECTIVE: To describe the process of implementing a database of ST-segment elevation acute myocardial infarction (STEMI) at a reference hospital, and the application of this process to other centers by means of an online platform. METHODS: In 2009, our institution implemented an Registry of Acute Myocardial Infarction (RIAM), with the prospective and consecutive inclusion of every patient admitted to the institution who received a diagnosis of STEMI. From March 2014 to April 2016, the registries were uploaded to a web-based system using the REDCap software and the registry was expanded to other centers. Upon subscription, the REDCap platform is a noncommercial software made available by Vanderbilt University to institutions interested in research. RESULTS: The following steps were taken to improve and expand the registry: 1. Standardization of variables; 2. Implementation of institutional REDCap (Research Electronic Data Capture); 3. Development of data collection forms (Case Report Form - CRF); 4. Expansion of registry to other reference centers using the REDCap software; 5. Training of teams and participating centers following an SOP (Standard Operating Procedure). CONCLUSION: The description of the methodology used to implement and expand the RIAM may help other centers and researchers to conduct similar studies, share information between institutions, develop new health technologies, and assist public policies regarding cardiovascular diseases. (Arq Bras Cardiol. 2020; 114(3):446-455).

FUNDAMENTO: Registros multicêntricos representativos do mundo real podem fornecer informações importantes, mas existem poucos estudos descrevendo como implementar estas ferramentas. OBJETIVO: Descrever o processo de implementação de um banco de dados em infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCST) em um hospital de referência e sua aplicação para outros centros com uma plataforma online . MÉTODOS: Nossa instituição implementou em 2009 um Registro de Infarto Agudo do Miocárdio (RIAM), com a inclusão prospectiva e consecutiva de todos os pacientes com diagnóstico de IAMCST que internaram na instituição. No período de março de 2014 a abril de 2016 foi realizada a migração para o sistema online com o software REDCap e expansão do registro para outros centros. A plataforma REDCap é um software de uso gratuito disponibilizado pela Universidade Vanderbilt a instituições interessadas em pesquisa, mediante cadastramento prévio. RESULTADOS: Foram realizadas as seguintes etapas do aprimoramento e expansão do registro: 1. Padronização das variáveis; 2. Implementação do software REDCap ( Research Electronic Data Capture ) institucional; 3. Desenvolvimento de formulários de coleta de dados ( Case Report Form - CRF); 4. Expansão do registro para outros centros de referência utilizando o software REDCap; 5. Treinamento da equipe e dos centros participantes pelo POP (Procedimento Operacional Padrão). CONCLUSÕES: A descrição da metodologia utilizada para implementar e expandir o RIAM pode auxiliar outros centros e pesquisadores a realizar estudos semelhantes, compartilhar informações entre instituições, o desenvolvimento de novas tecnologias em saúde e auxiliar nas políticas públicas em doenças cardiovasculares. (Arq Bras Cardiol. 2020; 114(3):446-455).

Stress-delta B-type Natriuretic Peptide Levels as a Test for Inducible Myocardial Ischemia: A Systematic Review and Meta-Analysis.

Background Cardiac ischemia induces myocardial dysfunction and ventricular wall stretch, which causes the release of B-type natriuretic peptide (BNP) into the bloodstream. However, it is unclear whether inducible ischemia produces a significant change in BNP levels ("stress delta-BNP"). The objective of this study was to determine the utility of stress-delta BNP levels and its precursor NT-proBNP for detecting inducible myocardial ischemia during cardiac stress testing. Methods We conducted a systematic review and meta-analysis. We searched PubMed, EMBASE, Web of Science, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Ovid. Studies examining the changes in levels of BNP and its precursor, N-terminal pro-B-type natriuretic peptide (NT-proBNP), after an exercise cardiac stress test were included. Two reviewers independently analyzed titles and abstracts. Abstracts that did not provide enough information regarding eligibility criteria were kept for full-text evaluation. The same two reviewers also performed data extraction for analyses. Any disagreement was resolved by a consensus and, if it persisted, by a third reviewer adjudication. We report the median and mean values in studies in the order of sample size. Results A total of 15 studies met the inclusion criteria. Nine studies reported results in medians and six studies reported results in means. Of the nine studies, five assessed BNP alone, three assessed NT-proBNP, and one assessed both. Due to the non-normal distribution of results in these studies, they could not be meta-analyzed. Of the six studies that reported results in means, three assessed BNP and three assessed NT-proBNP. The standardized difference between normal and ischemic patients' stress-delta BNP values was -0.39 (95% confidence interval (CI): -0.61; -0.17) in a fixed-effects model and -0.73 (95% CI: -1.72; 0.28) in the random-effects model with high heterogeneity (I^2 = 94%, Q test P = 0.001). For NT-proBNP, the meta-analysis model showed no significant difference between the stress-delta test for ischemic and normal patients (standardized mean difference (SMD): -0.02, 95% CI: -0.31; 0.28). Patients without inducible ischemia appeared to have a lower baseline BNP and NT-proBNP compared to patients with inducible ischemia by stress testing. Although some studies report higher stress-delta BNP in the ischemic group, this pattern was not seen consistently across studies. There was high heterogeneity across studies which was not robust to sensitivity analysis. A random-effects model failed to find statistically significant differences in stress-delta BNP or NT-proBNP. Conclusions We failed to find a relationship between stress-delta BNP or NT-proBNP and the presence or absence of ischemia. This may be due to high heterogeneity in the underlying studies.

Criação e Implementação de um Banco de Dados Prospectivo e Multicêntrico de Pacientes com Infarto Agudo do Miocárdio: RIAM / Creation and Implementation of a Prospective and Multicentric Database of Patients with Acute Myocardial Infarction: RIAM

Resumo Fundamento Registros multicêntricos representativos do mundo real podem fornecer informações importantes, mas existem poucos estudos descrevendo como implementar estas ferramentas. Objetivo Descrever o processo de implementação de um banco de dados em infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCST) em um hospital de referência e sua aplicação para outros centros com uma plataforma online . Métodos Nossa instituição implementou em 2009 um Registro de Infarto Agudo do Miocárdio (RIAM), com a inclusão prospectiva e consecutiva de todos os pacientes com diagnóstico de IAMCST que internaram na instituição. No período de março de 2014 a abril de 2016 foi realizada a migração para o sistema online com o software REDCap e expansão do registro para outros centros. A plataforma REDCap é um software de uso gratuito disponibilizado pela Universidade Vanderbilt a instituições interessadas em pesquisa, mediante cadastramento prévio. Resultados Foram realizadas as seguintes etapas do aprimoramento e expansão do registro: 1. Padronização das variáveis; 2. Implementação do software REDCap ( Research Electronic Data Capture ) institucional; 3. Desenvolvimento de formulários de coleta de dados ( Case Report Form - CRF); 4. Expansão do registro para outros centros de referência utilizando o software REDCap; 5. Treinamento da equipe e dos centros participantes pelo POP (Procedimento Operacional Padrão). Conclusões A descrição da metodologia utilizada para implementar e expandir o RIAM pode auxiliar outros centros e pesquisadores a realizar estudos semelhantes, compartilhar informações entre instituições, o desenvolvimento de novas tecnologias em saúde e auxiliar nas políticas públicas em doenças cardiovasculares. (Arq Bras Cardiol. 2020; 114(3):446-455)

Abstract Background Multicenter registries representing the real world can be a significant source of information, but few studies exist describing the methodology to implement these tools. Objective To describe the process of implementing a database of ST-segment elevation acute myocardial infarction (STEMI) at a reference hospital, and the application of this process to other centers by means of an online platform. Methods In 2009, our institution implemented an Registry of Acute Myocardial Infarction (RIAM), with the prospective and consecutive inclusion of every patient admitted to the institution who received a diagnosis of STEMI. From March 2014 to April 2016, the registries were uploaded to a web-based system using the REDCap software and the registry was expanded to other centers. Upon subscription, the REDCap platform is a noncommercial software made available by Vanderbilt University to institutions interested in research. Results The following steps were taken to improve and expand the registry: 1. Standardization of variables; 2. Implementation of institutional REDCap (Research Electronic Data Capture); 3. Development of data collection forms (Case Report Form - CRF); 4. Expansion of registry to other reference centers using the REDCap software; 5. Training of teams and participating centers following an SOP (Standard Operating Procedure). Conclusion The description of the methodology used to implement and expand the RIAM may help other centers and researchers to conduct similar studies, share information between institutions, develop new health technologies, and assist public policies regarding cardiovascular diseases. (Arq Bras Cardiol. 2020; 114(3):446-455)

Safety and efficacy of baroreflex activation therapy for heart failure with reduced ejection fraction: a rapid systematic review.

To retrieve and assess the available data in the literature about the safety and efficacy of baroreflex activation therapy (BAT) in heart failure with reduced ejection fraction (HFrEF) patients, through a rapid systematic review of clinical studies. Rapid systematic review of literature. Searched electronic databases included PubMed, EMBASE, CENTRAL, Scopus, and Web of Science using Mesh and free terms for heart failure and BAT. No language restriction was used for the searches. We included full peer reviewed publications of clinical studies (randomized or not), including patients with HFrEF undergoing BAT, with or without control group, assessing safety and efficacy outcomes. One reviewer conducted the analysis of the selected abstracts and the full-text articles, performed data extraction, and evaluated the methodological quality of the selected articles. The methodological quality was assessed according to the Cochrane Collaboration instruments. A descriptive summary of the results is provided. Of the 441 citations screened, 10 publications were included (three were only conference abstracts), reporting data from three studies. Only one study was a randomized clinical trial. Two studies reported a 6 month following, and the other study analysed outcomes up to 41 months. The procedure seems to be safe when performed by a well-trained multi-professional team. An 86% rate of system and procedure-related complication-free was reported, with no cranial nerve injuries. Improvements in New York Heart Association class of heart failure, quality of life, 6 min walk test, and hospitalization rates, as well as in muscle sympathetic nerve activity. No meta-analysis was conducted because of the lack of homogeneity across studies; the results from each study are reported individually. BAT procedure seems to be safe if appropriate training is provided. Improvements in clinical outcomes were described in all included studies. However, several limitations do not allow us to make conclusive statements on the efficacy of BAT for HFrEF. New well-designed trials are still needed.

Gene therapy for refractory angina and cell therapy for heart failure: experience of a Brazilian research group.

Cell therapy has shown impressive effects in experimental cardiomyopathy models. To a lesser extent, gene therapy has also been studied. In both cases, translation to clinical therapy has been disappointing. This paper is intended to describe the experience and achievements of a multicenter working group located in Porto Alegre, southern Brazil, in experimental and translational research projects for cell-based and gene therapy methods in the treatment of dilated and ischemic cardiomyopathies. The results of preclinical and clinical studies showed that bone marrow mononuclear stem cells indeed have an effect in improving myocardial perfusion and contractile function, but the overall results are poorly translated to the clinical level. Gene therapy studies with direct myocardial injections of naked VEGF 165 plasmid showed improvement in myocardial perfusion and function in animal models. A randomized clinical trial found that this method is safe and improved myocardial perfusion, but the benefits disappeared after 1 year. An animal experiment associating VEGF 165 with angiopoietin was undertaken in mini pigs to extend the durability of that therapy. In conclusion, our efforts to better understand the mechanisms and functions of gene and cell-based therapies in cardiology resulted in significant findings and propose a future look at cell-free therapeutic approaches.