Overexploitation assessment in an urban karst aquifer: The case of Sete Lagoas (MG), Brazil.

Overexploitation of groundwater in urban karst aquifers can lead to negative consequences such as land subsidence, depletion of springs and lakes, and water pollution. It can also have indirect effects such as environmental, socio-economic, and political instability. In the municipality of Sete Lagoas, Brazil, the long-term effects of extensive groundwater extraction have been observed and studied over the years. This paper analyzes the response of the karst aquifer to urban, industrial, and climatological changes that may have contributed to changes in the aquifer over the last four decades. The results show that groundwater extraction has exceeded the average aquifer recharge since the year 2000. From the 1980s, the number of wells has steadily increased due to unplanned urban development, resulting in higher demand for groundwater. In the 2010s, pumping from tubular wells (7.39 × 107 m3/yr) exceeded the maximum recharge capacity of the aquifer (7.33 × 107 m3/yr). These wells are mainly concentrated in two areas: the central urban zone and the industrial sector. As a result, kilometer-long cones of depression have formed, changing the aquifer from confined to unconfined within these regions. According to the census data, about 67% of the wells remain unidentified. The average annual recharge to the aquifer is estimated to be 5.68 × 107 m3/yr, which accounts for 12% of the average annual rainfall in the region. Climatological trends indicate an incipient decrease in precipitation and an increase in temperature, suggesting a potential decrease in future aquifer recharge. In addition, only 17% of the area has high infiltration rates ranging from 35% to 75%. The current situation in Sete Lagoas is one of overexploitation of groundwater resources, which could be mitigated by localized reduction of groundwater consumption and implementation of effective management strategies to increase aquifer recharge.

Coping religioso-espiritual de pacientes no período pré-operatório de cirurgia cardíaca / Coping religioso-espiritual de pacientes en el período preoperatorio de cirugía cardíaca / Religious-spiritual coping of patients in the preoperative period of cardiac surgery

Objetivo: avaliar o coping religioso-espiritual em pacientes no período pré-operatório de cirurgia cardíaca. Método: estudo transversal, analítico, no qual foram avaliados 62 pacientes internados no período pré-operatório de cirurgia cardíaca, entre os meses setembro e dezembro de 2020, em dois hospitais de referência em cirurgia cardíaca no Nordeste do Brasil. Resultados: os pacientes apresentaram um alto uso do coping religioso-espiritual total, com predominância para o positivo. Os principais fatores utilizados para o coping religioso-espiritual positivo foram Posição positiva frente a Deus e Afastamento através Deus/Religião/Espiritualidade. Conclusão: os enfermeiros podem considerar e investir em intervenções que favoreçam o coping positivo, visando repercutir melhor experiência do paciente diante de estressores importantes, como a cirurgia cardíaca.

Objetivo: evaluar el coping religioso-espiritual en pacientes en el período preoperatorio de cirugía cardíaca. Método: estudio transversal, analítico, en el cual fueron evaluados 62 pacientes internados en el período preoperatorio de cirugía cardíaca, entre los meses septiembre y diciembre de 2020, en dos hospitales de referencia en cirugía cardíaca en el nordeste de Brasil. Resultados: los pacientes presentaron un alto uso del coping religioso-espiritual total, con predominio para el positivo. Los principales factores utilizados para el coping religioso-espiritual positivo fueron Posición positiva frente a Dios y Alejamiento a través de Dios/Religión/Espiritualidad. Conclusión: los enfermeros pueden considerar e invertir en intervenciones que favorezcan el afrontamiento positivo, buscando repercutir mejor experiencia del paciente ante estresantes importantes, como la cirugía cardíaca.

Objective: to evaluate the religious-spiritual coping in patients in the preoperative period of cardiac surgery. Method: cross-sectional, analytical study, in which 62 patients hospitalized in the preoperative period of cardiac surgery, between September and December 2020, in two reference hospitals in cardiac surgery in northeastern Brazil, were evaluated. Results: the patients showed a high use of religious-spiritual coping, with predominance for the positive. The main factors used for positive religious-spiritual coping were Positive position towards God and Distancing through God/Religion/Spirituality. Conclusion: nurses can consider and invest in interventions that favor positive coping, aiming to reflect better patient experience in the face of important stressors, such as cardiac surgery.

Goldilocks at the dawn of complex life: mountains might have damaged Ediacaran-Cambrian ecosystems and prompted an early Cambrian greenhouse world.

We combine U-Pb in-situ carbonate dating, elemental and isotope constraints to calibrate the synergy of integrated mountain-basin evolution in western Gondwana. We show that deposition of the Bambuí Group coincides with closure of the Goiás-Pharusian (630-600 Ma) and Adamastor (585-530 Ma) oceans. Metazoans thrived for a brief moment of balanced redox and nutrient conditions. This was followed, however, by closure of the Clymene ocean (540-500 Ma), eventually landlocking the basin. This hindered seawater renewal and led to uncontrolled nutrient input, shallowing of the redoxcline and anoxic incursions, fueling positive productivity feedbacks and preventing the development of typical Ediacaran-Cambrian ecosystems. Thus, mountains provide the conditions, such as oxygen and nutrients, but may also preclude life development if basins become too restricted, characterizing a Goldilocks or optimal level effect. During the late Neoproterozoic-Cambrian fan-like transition from Rodinia to Gondwana, the newborn marginal basins of Laurentia, Baltica and Siberia remained open to the global sea, while intracontinental basins of Gondwana became progressively landlocked. The extent to which basin restriction might have affected the global carbon cycle and climate, e.g. through the input of gases such as methane that could eventually have collaborated to an early Cambrian greenhouse world, needs to be further considered.

Groundwater governance: The illegality of exploitation and ways to minimize the problem.

In Brazil, there are about 2.5 million tubular wells in which 88% of them are illegal, extracting more than 17,580 Mm3/yr. This irregular use may cause sustainability issues that may be economic, social, or environmental (overexploitation, well losses and associated increases of water conflicts; aquifer contamination; and land subsidence). This paper aims to address the illegal wells in Brazil and discuss measures to minimize it. Conclusions indicate that users do not understand the aquifer dynamic and, therefore, do not have a proper understanding of problems such as loss of water quality and quantity caused by the excess of groundwater exploitation. This creates a false idea that there are no water conflicts among users, which causes a lack of engagement by society. Without groundwater users and stakeholder pressure, the government does not aim to control or close illegal wells, and the "vicious cycle" persists. The one way to break this "vicious cycle" would be programs of social communication and users' participation, coupled with improvements to the control apparatus and inspection from State institutions, making sure that there is correct management and not only legislations that are not applied.

Cadmium behavior in a karst environment hydrological cycle.

Karst regions are important water providers, supplying approximately 25% of the world population. These areas present higher vulnerability to contamination due to hydrodynamics, which hampers the natural depuration of these waters until reaching the underground environment. High concentrations of cadmium (Cd) are observed in the São Miguel watershed, state of Minas Gerais, Brazil. This toxic element is generally and predominantly released into the atmosphere by burning materials that have Cd in their composition, potentially contaminating surface and groundwater. Therefore, the objective of the study is to map Cd concentrations in the hydrological cycle of the São Miguel karst watershed and, through natural background level values (NBL 90%) of rainwater, surface water and groundwater, to understand the seasonal behavior of this element, and to identify the most vulnerable areas to contamination. To achieve this goal, rainwater, surface, and groundwater seasonal monitoring were conducted in 87 sampling stations. A total of 335 samples were collected, distributed over a watershed area of 520 km2. Concentrations of cadmium above 1 µg/L were found in 21.49% of samples during the rainy season. The origin and distribution of Cd were related to rainfall. For rainwater samples, 90% presented Cd concentration of 3.06 µg/L. When these waters precipitate, they contaminate surface waters (NBL 90% = 1.50 µg/L) and groundwater (NBL 90% = 2.81 µg/L). This study presented a hydrochemical cycle map and proposed NBL values of Cd for surface water and groundwater, helping to understand how the environment is contaminated by this element.

Continuous Renal Replacement Therapy Might Mask Immobilization-Induced Hypercalcemia in Critically Ill Patients.

Immobilization and prolonged bed rest are harmful to the skeleton, which suffers increased resorption, and contribute to reducing survival rates among patients in critical care units. We report a patient who presented hypercalcemia 10 days after continuous venovenous hemofiltration has ended. Investigative tests showed an increase of serum C-terminal telopeptide of type I collagen (CTx), with suppressed parathormone and calcitriol. Denosumab was administered with a significant response, decreasing ionized calcium and CTx levels. The calcium infusion rate during dialysis procedures, used for citrate anticoagulation compensation, has progressively decreased, suggesting that endogenous calcium was taking part in the citrate chelation. In this report, we highlight the challenges in early diagnosis of immobilization-induced hypercalcemia among patients who are on continuous renal replacement therapy undergoing citrate anticoagulation.

Factores de riesgo para ansiedad y depresión en el periodo preoperatorio de cirugía cardiaca / Fatores de risco para ansiedade e depressão no período pré-operatório de cirurgia cardíaca / Risk factors for anxiety and depression in the preoperative period of cardiac surgery

Objetivo: Evaluar los factores de riesgo de ansiedad y depresión en el período preoperatorio de la cirugía cardíaca.Método: Se trata de un estudio seccional, realizado entre enero y junio de 2017, en un hospital universitario de referencia en cardiología en el nordeste de Brasil. Se evaluaron 174 pacientes utilizando un cuestionario propio y la Escala Hospitalaria de Ansiedad y Depresión (HADS) y calculadas las Odds Ratios para evaluar el riesgo.Resultados: En la evaluación de la ansiedad, fueron factores de riesgo significativos: sexo femenino, años de estudio, ausencia de acompañante, experiencia previa de cirugía cardiaca y la cancelación de la cirugía durante el internamiento. En cuanto a la depresión, se revelaron factores de riesgo: sexo femenino y tiempo de internamiento mayor de 15 días.Conclusión: El enfermero tiene instrumentos disponibles para reconocer la ansiedad y la depresión, incluyendo los diagnósticos de enfermería y las escalas validadas, así como tiene un papel preponderante en la actuación en estos casos. Debe ser un desafío institucional dinamizar el servicio para evitar prolongaciones de la internación y cancelaciones de cirugía por cuestiones estructurales

Objetivo: avaliar os fatores de risco de ansiedade e depressão no período pré-operatório de cirurgia cardíaca. Método: Trata-se de um estudo seccional, realizado entre janeiro e junho de 2017, em um hospital universitário de referência em cardiologia no nordeste do Brasil. Foram avaliados 174 pacientes utilizando-se um questionário próprio e a Escala Hospitalar de Ansiedade e Depressão (HADS) e calculadas as Odds Ratios para avaliar o risco. Resultados: Na avaliação da ansiedade, foram fatores de risco significativos: sexo feminino, anos de estudo, ausência de acompanhante, experiência prévia de cirurgia cardíaca e o cancelamento da cirurgia durante o internamento. Quanto à depressão, revelaram-se fatores de risco: sexo feminino e tempo de internamento maior de 15 dias. Conclusão: O enfermeiro tem instrumentos disponíveis para reconhecer a ansiedade e a depressão, incluindo os diagnósticos de enfermagem e as escalas validadas, assim como tem papel preponderante na atuação nestes casos. Deve ser um desafio institucional dinamizar o serviço de forma a evitar prolongamentos do internamento e cancelamentos de cirurgia por questões estruturais

Objective: To evaluate the risk factors of anxiety and depression in the preoperative period of cardiac surgery.Method: This is a sectional study, conducted between January and June 2017, in a university hospital of reference in cardiology in northeastern Brazil. A total of 174 patients were evaluated using their own questionnaire and the Hospital Anxiety and Depression Scale (HADS) and Odds Ratios were calculated to assess the risk.Results: In the assessment of anxiety, significant risk factors were: female gender, years of study, absence of companion, previous experience of cardiac surgery and cancellation of surgery during hospitalization. As for depression, risk factors were revealed: female sex and hospitalization time greater than 15 days.Conclusion: The nurse has instruments available to recognize anxiety and depression, including nursing diagnoses and validated scales, as well as having a preponderant role in these cases. It should be an institutional challenge to streamline the service in order to avoid prolongation of hospitalization and cancellations of surgery for structural reasons

Spiritual well-being and hope in the preoperative period of cardiac surgery / El bienestar espiritual y la esperanza en el período preoperatorio de cirugía cardíaca / Bem-estar espiritual e esperança no período pré-operatório de cirurgia cardíaca

ABSTRACT Objective: To characterize relations between spiritual well-being and hope of patients in the preoperative period of cardiac surgery. Method: Exploratory cross-sectional study with quantitative approach, performed in the infirmaries of a reference hospital in cardiology. We evaluated 69 patients hospitalized in preoperative period of myocardial revascularization, valve repair or replacement. Results: We verified that patients hold relevant scores of hope and welfare in all areas, being the existential well-being significantly lower than the religious one. The average of the spiritual well-being score was below the required to be considered high. There was no significant correlation between welfare and hope. Conclusion: Nurses should develop a watchful eye to these issues, be trained in specific protocols of spiritual anamnese and use the real moments of care to strengthen the patients.

RESUMEN Objetivo: Caracterizar las relaciones entre el bienestar espiritual y la esperanza de los pacientes en el preoperatorio de cirugía cardíaca. Método: Estudio transversal, exploratorio, con abordaje cuantitativo, realizado en las enfermerías de un hospital de referencia en cardiología. Fueron evaluados a 69 pacientes internados en el período preoperatorio de cirugía de revascularización miocárdica, cambio o plastia de válvula. Resultados: Se certificó que los pacientes mantenían relevantes puntajes de esperanza y bienestar en todos los dominios, siendo que el bienestar existencial fue significativamente más pequeño que el bienestar religioso. El promedio del puntaje de bienestar espiritual quedó abajo del corte para ser considerado elevado. No hubo correlación significativa entre el bienestar y la esperanza. Conclusión: Los enfermeros deben desarrollar una atenta mirada para esas cuestiones, ser entrenados en protocolos específicos de anamnesis espiritual y aprovechar los momentos reales de cuidado para fortalecer a los pacientes.

RESUMO Objetivo: Caracterizar as relações entre o bem-estar espiritual e a esperança dos pacientes em pré-operatório de cirurgia cardíaca. Método: Estudo transversal, exploratório, com abordagem quantitativa, realizado nas enfermarias de um hospital de referência em cardiologia. Foram avaliados 69 pacientes internados no período pré-operatório de cirurgia de revascularização miocárdica, troca ou plastia valvar. Resultados: Verificou-se que os pacientes mantinham relevantes escores de esperança e bem-estar em todos os domínios, sendo que o bem-estar existencial foi significativamente menor que o bem-estar religioso. A média do escore de bem-estar espiritual ficou abaixo do corte para ser considerada elevada. Não houve correlação significativa entre bem-estar e esperança. Conclusão: Os enfermeiros devem desenvolver um olhar atento para essas questões, ser treinados em protocolos específicos de anamnese espiritual e aproveitar os momentos reais de cuidado para fortalecer os pacientes.

Spiritual well-being and hope in the preoperative period of cardiac surgery.

OBJECTIVE: To characterize relations between spiritual well-being and hope of patients in the preoperative period of cardiac surgery. METHOD: Exploratory cross-sectional study with quantitative approach, performed in the infirmaries of a reference hospital in cardiology. We evaluated 69 patients hospitalized in preoperative period of myocardial revascularization, valve repair or replacement. RESULTS: We verified that patients hold relevant scores of hope and welfare in all areas, being the existential well-being significantly lower than the religious one. The average of the spiritual well-being score was below the required to be considered high. There was no significant correlation between welfare and hope. CONCLUSION: Nurses should develop a watchful eye to these issues, be trained in specific protocols of spiritual anamnese and use the real moments of care to strengthen the patients.

Transmissivity of Aquifer by Capture Zone Method: An Application in the Sete Lagoas Karst Aquifer, MG, Brazil.

Transmissivity is an important hydraulic parameter to determine the amount of water passed horizontally across a given saturated thickness of an aquifer. The techniques to quantify this parameter, such as grain size analyses or pumping tests, can have limitations of time/spatial scale, viability, or economically. One technique that can be used, but little adopted, is the capture zone analysis. In this paper, capture zone analytical equations were used to estimate transmissivity values in order to verify the effectiveness of this methodology as alternative in situations where other traditional methods present implementation difficulties. The results were compared with field data estimated by aquifer tests conducted in the same region. A sensitivity analysis was also performed to identify possible discrepancies between the analytical and field data results. The aquifer studied was the Sete Lagoas Karst Aquifer in the urban region of the municipality of Sete Lagoas, Brazil. The method proved to be a viable and economical tool, where the analytical values compared to the aquifer tests showed similarities, being confirmed by a sensitivity analysis. However, a reliable potentiometric surface map, which enables the identification of the parameters for analytical capture zone equations, is needed.

Transmissivity of Aquifer by Capture Zone Method: An Application in the Sete Lagoas Karst Aquifer, MG, Brazil

ABSTRACT Transmissivity is an important hydraulic parameter to determine the amount of water passed horizontally across a given saturated thickness of an aquifer. The techniques to quantify this parameter, such as grain size analyses or pumping tests, can have limitations of time/spatial scale, viability, or economically. One technique that can be used, but little adopted, is the capture zone analysis. In this paper, capture zone analytical equations were used to estimate transmissivity values in order to verify the effectiveness of this methodology as alternative in situations where other traditional methods present implementation difficulties. The results were compared with field data estimated by aquifer tests conducted in the same region. A sensitivity analysis was also performed to identify possible discrepancies between the analytical and field data results. The aquifer studied was the Sete Lagoas Karst Aquifer in the urban region of the municipality of Sete Lagoas, Brazil. The method proved to be a viable and economical tool, where the analytical values compared to the aquifer tests showed similarities, being confirmed by a sensitivity analysis. However, a reliable potentiometric surface map, which enables the identification of the parameters for analytical capture zone equations, is needed.

Diagnósticos de enfermagem aplicados a pacientes com insuficiência cardíaca descompensada / Nursing diagnosis applied to patients with decompensated heart failure / Diagnósticos de enfermería aplicados a pacientes con insuficiencia cardíaca descompensada

The present study aimed to identify the priority nursing diagnoses for patients with decompensated heart failure. Quantitative study conducted in a cardiac emergency service of a university of Pernambuco, between October 2014 and February 2015. The study sample was composed of 62 patients admitted for the treatment of acute decompensated heart failure, emergency inpatients and patients from any functional class. The main nursing diagnoses were Decreased Cardiac Output (87.3%), Activity Intolerance (79.4%) and Ineffective Breathing Pattern (38.1%). The signs and symptoms of decompensation caused by systemic or pulmonary congestion provided the basis for the recognition of defining characteristics that made it possible to formulate priority nursing diagnoses for these patients (AU).

Objetivou-se identificar os diagnósticos de enfermagem prioritários para pacientes com insuficiência cardíaca descompensada. Trata-se de uma com abordagem quantitativa, realizada em pronto-socorro cardiológico de uma universidade de Pernambuco, entre outubro de 2014 e fevereiro de 2015. A amostra do estudo foi composta de 62 pacientes admitidos por insuficiência cardíaca descompensada, internados de emergência e de qualquer classe funcional. Os principais diagnósticos de enfermagem foram: Débito Cardíaco Diminuído (87,3%), Intolerância à Atividade (79,4%) e Padrão Respiratório Ineficaz (38,1%). Os sinais e sintomas da descompensação, oriundos da congestão sistêmica ou pulmonar, serviram como base para o reconhecimento das características definidoras que permitiram a elaboração dos diagnósticos de enfermagem prioritários para esses pacientes (AU).

Fue objetivo del estudio identificar los diagnósticos de enfermería prioritarios para pacientes con insuficiencia cardíaca descompensada. El abordaje fue cuantitativo y se realizó en la emergencia cardiológica de una universidad de Pernambuco, entre octubre de 2014 y febrero de 2015. La muestra del estudio fue compuesta de 62 pacientes admitidos por insuficiencia cardíaca descompensada, internados en emergencia y de cualquier clase funcional. Los principales diagnósticos de enfermería fueron: Débito Cardíaco Disminuido (87,3%), Intolerancia a la Actividad (79,4%) y Patrón Respiratorio Ineficaz (38,1%). Las señales y síntomas de la descompensación, que vienen de la congestión sistémica o pulmonar, fueron utilizadas como base para el reconocimiento de las características determinantes, las cuales posibilitaron la elaboración de los diagnósticos de enfermería prioritarios para eses pacientes (AU)

Geologic conceptual model of the municipality of Sete Lagoas (MG, Brazil) and the surroundings.

The study area is located in the state of Minas Gerais, Brazil, among the municipalities of Pedro Leopoldo, Matozinhos, and Sete Lagoas, with Velhas River as the eastern boundary. It is located in the São Francisco Craton, where carbonated argillo-arenaceous sediments are emplaced giving origin to the Bambuí Group, in the São Francisco Basin. Despite the geological knowledge previously developed, the region needs work on integration and detailing of such information. For this reason, the main objective was to contribute to the quality of the geologic cartography, the spatial distribution, and the structural framework geometry. Thus, geologic mapping, aerial photography interpretation, and evaluation of 270 lithologic well profiles were carried out. It was possible to establish a new geologic perspective of the region by obtaining the detailed geologic map of the municipality of Sete Lagoas, 14 geologic cross sections, and a geologic conceptual model. The study showed that the area is within a basin border, presenting a geometry conditioned by horst and graben system controlled by faulting. This structural feature displaced stratigraphic sequences positioning them side by side with lithologic sequences with different ages.

Impact of body mass index in spinal surgery for degenerative lumbar spine disease.

BACKGROUND: Obesity is a factor for degenerative lumbar spine disease (DLSD), with increasing prevalence worldwide. Consequently, patients who are overweight or obese have benefited from surgical treatment for DLSD, despite their anatomical and clinical differences. OBJECTIVES: To analyse the effect of body mass index (BMI) in spinal surgery for degenerative lumbar spine disease (DLSD). PATIENTS AND METHODS: A retrospective analysis of 100 patients who underwent surgery for DLSD was performed. The study time was 13 months (January 2013-January 2014). The patients were first evaluated with regard to their BMI and were subsequently divided into four groups of patients: BMI <25, BMI between 25 and 30, BMI between 30 and 35, and BMI above 35. The same patients were assessed for their results regarding the extent of surgery in four groups: patients undergoing surgery for treatment of one segment, two segments, three segments, and four or more segments of DLS. The aspects evaluated were surgical time, bleeding, surgical complications, surgical site infection (SSI), and re-operation due to failure of the first procedure. RESULTS: A total of 118 surgeries were performed on 100 patients (52 male/48 female), mean age 52.77 years old (52.77 ± 14.45), range between 26 and 85 years old, and a mean BMI of 29.43 kg/m(2) (29.43 ± 5.54). The surgical time averaged 258.1 min (258.1 ± 82.79); the bleeding was 660 millilitres (ml) (660 ± 509.1); complications that were related to the surgical procedure occurred in 38% of cases; SSI occurred in 5% of cases, and re-operations or SSI due to complications occurred in 12% of cases. After analysis of all variables, it was observed that the groups were homogeneous without statistical variation when divided by the BMI; however, it was also observed that the extent of surgery was the factor responsible for the increased rate of SSI (p=0.05) and increased potential of re-operation due to complications (p=0.003). CONCLUSION: BMI is not a complicating factor for the outcome of patients undergoing surgery for DLSD in terms of SSI, surgical complications, and re-operation rates. Furthermore, the extent of surgery was associated with increased postoperative SSI and the need for a second surgery due to the failure of the first procedure.

Autologous Transplantation of Bone Marrow Adult Stem Cells for the Treatment of Idiopathic Dilated Cardiomyopathy / Transplante Autólogo de Células-Tronco Adultas para Tratamento da Cardiomiopatia Dilatada Idiopática

Background: Morbimortality in patients with dilated idiopathic cardiomyopathy is high, even under optimal medical treatment. Autologous infusion of bone marrow adult stem cells has shown promising preliminary results in these patients. Objective: Determine the effectiveness of autologous transplantation of bone marrow adult stem cells on systolic and diastolic left ventricular function, and on the degree of mitral regurgitation in patients with dilated idiopathic cardiomyopathy in functional classes NYHA II and III. Methods: We administered 4,54 x 108 ± 0,89 x 108 bone marrow adult stem cells into the coronary arteries of 24 patients with dilated idiopathic cardiomyopathy in functional classes NYHA II and III. Changes in functional class, systolic and diastolic left ventricular function and degree of mitral regurgitation were assessed after 3 months, 6 months and 1 year. Results: During follow-up, six patients (25%) improved functional class and eight (33.3%) kept stable. Left ventricular ejection fraction improved 8.9%, 9.7% e 13.6%, after 3, 6 and 12 months (p = 0.024; 0.017 and 0.018), respectively. There were no significant changes neither in diastolic left ventricular function nor in mitral regurgitation degree. A combined cardiac resynchronization and implantable cardioversion defibrillation was implanted in two patients (8.3%). Four patients (16.6%) had sudden death and four patients died due to terminal cardiac failure. Average survival of these eight patients was 2.6 years. Conclusion: Intracoronary infusion of bone marrow adult stem cells was associated with an improvement or stabilization of functional class and an improvement in left ventricular ejection fraction, suggesting the efficacy of this intervention. There were no significant changes neither in left ventricular diastolic function nor in the degree of mitral regurgitation. .

Fundamento: Pacientes portadores de cardiomiopatia dilatada idiopática apresentam alta morbimortalidade, mesmo em tratamento clínico otimizado. A infusão autóloga de células-tronco adultas da medula óssea mostrou resultados clínicos preliminares promissores nesses pacientes. Objetivo: Determinar a eficácia do transplante autólogo de células-tronco adultas da medula óssea sobre as funções sistólica e diastólica, e o grau de insuficiência mitral em pacientes portadores de cardiomiopatia dilatada idiopática em classes funcionais NYHA II e III. Métodos: Infundiram-se 4,54 x 108 ± 0,89 x 108 células-tronco adultas da medula óssea nas artérias coronárias de 24 pacientes com cardiomiopatia dilatada idiopática em classes funcionais NYHA II e III. Após 3 meses, 6 meses e 1 ano, avaliaram-se as mudanças de classe funcional, das funções ventricular esquerda sistólica e diastólica, e do grau da insuficiência mitral. Resultados: No seguimento, seis (25%) pacientes melhoraram sua classe funcional e oito (33,3%) mantiveram sua classe funcional inicial. A fração de ejeção ventricular esquerda aumentou 8,9%, 9,7% e 13,6%, após 3 e 6 meses e 1 ano (p = 0,024; p = 0,017 e p = 0,018), respectivamente. A função diastólica ventricular esquerda e o grau de insuficiência mitral não demonstraram mudanças significativas. Dois pacientes (8,3%) receberam cardioversor e ressincronizador implantável. Ocorreram quatro (16,6%) mortes súbitas e quatro (16,6%) mortes por insuficiência cardíaca terminal. A sobrevida média desses oitos pacientes foi de 2,6 anos. Conclusão: A infusão intracoronariana de células-tronco adultas da medula óssea em pacientes com cardiomiopatia dilatada idiopática promoveu melhora ...

Autologous transplantation of bone marrow adult stem cells for the treatment of idiopathic dilated cardiomyopathy.

BACKGROUND: Morbimortality in patients with dilated idiopathic cardiomyopathy is high, even under optimal medical treatment. Autologous infusion of bone marrow adult stem cells has shown promising preliminary results in these patients. OBJECTIVE: Determine the effectiveness of autologous transplantation of bone marrow adult stem cells on systolic and diastolic left ventricular function, and on the degree of mitral regurgitation in patients with dilated idiopathic cardiomyopathy in functional classes NYHA II and III. METHODS: We administered 4,54 x 10(8) ± 0,89 x 10(8) bone marrow adult stem cells into the coronary arteries of 24 patients with dilated idiopathic cardiomyopathy in functional classes NYHA II and III. Changes in functional class, systolic and diastolic left ventricular function and degree of mitral regurgitation were assessed after 3 months, 6 months and 1 year. RESULTS: During follow-up, six patients (25%) improved functional class and eight (33.3%) kept stable. Left ventricular ejection fraction improved 8.9%, 9.7% e 13.6%, after 3, 6 and 12 months (p = 0.024; 0.017 and 0.018), respectively. There were no significant changes neither in diastolic left ventricular function nor in mitral regurgitation degree. A combined cardiac resynchronization and implantable cardioversion defibrillation was implanted in two patients (8.3%). Four patients (16.6%) had sudden death and four patients died due to terminal cardiac failure. Average survival of these eight patients was 2.6 years. CONCLUSION: Intracoronary infusion of bone marrow adult stem cells was associated with an improvement or stabilization of functional class and an improvement in left ventricular ejection fraction, suggesting the efficacy of this intervention. There were no significant changes neither in left ventricular diastolic function nor in the degree of mitral regurgitation.

Avaliação funcional e histológica da oxigenoterapia hiperbárica em ratos com lesão medular / Functional and histologic evaluation of hyperbaric oxygen therapy in rats with spinal cord injury

OBJETIVOS: Avaliar a eficácia da aplicação da oxigenoterapia hiperbárica em ratos Wistar, com lesão medular contusa produzida por equipamento computadorizado para impacto por queda de peso, NYU Impactor. MÉTODOS: Avaliaram-se 17 ratos machos com peso variando de 265 a 426 g; realizaram-se impactos com peso de 10 g de uma altura pré-determinada de 12,5 mm ao nível da décima vértebra torácica, após realização de laminectomia prévia. Os ratos foram divididos aleatoriamente em grupo controle e grupo oxigênio hiperbárico. Este último, submetido à tratamento com oxigenoterapia em câmara hiperbárica, durante uma hora diária por um período de 30 dias. A avaliação da recuperação locomotora foi realizada no 2º, 9º, 16º, 23º e 30º dia pós-operatório, avaliados através de escala funcional e o sítio de lesão submetido à exame anatomopatológico. RESULTADOS: Demonstrou-se melhora da recuperação locomotora nos ratos tratados com oxigênio hiperbárico nas fases iniciais de avaliação mas no final da avaliação não havia diferença estatisticamente significante entre ambos grupos. O exame anatomopatológico comprovou as alterações estruturais da medula espinal nos dois grupos. CONCLUSÃO: A lesão medular leve provocada nos ratos evoluiu de maneira diferente no grupo da oxigenoterapia hiperbárica comparativamente ao grupo controle, na fase inicial.

OBJECTIVE: To evaluate the effectiveness of the application of hyperbaric oxygen therapy in Wistar rats with spinal cord contusion produced using computerized equipment to create impact by a falling weight, NYU Impactor. METHODS: We evaluated 17 male rats with weights ranging from 265 to 426 g; impacts were performed with a weight of 10 g from a pre-determined height of 12.5 mm, at the tenth thoracic vertebra, after completion of prior laminectomy. The rats were randomly divided into a control group and a group treated with hyperbaric oxygen. The latter, was treated with oxygen therapy in a hyperbaric chamber for one hour daily for a period of 30 days. The assessment of locomotor recovery was conducted on the 2nd, 9th, 16th, 23rd and 30th postoperative days, measured by the functional scale and the site of injury submitted to anatomopathological examination. RESULTS: Improved locomotor recovery was demonstrated in the rats treated with hyperbaric oxygen in the initial stages of the evaluation, but at the end of the evaluation there was no statistically significant difference between the two groups. The anatomopathological examination showed structural changes of the spinal cord in both groups. CONCLUSION: Spinal cord injury in rats evolved differently in the hyperbaric oxygen therapy group compared with the control group, in the initial phase.