The Use of Cognitive Tests in the Assessment of Dyslexia.

In this literature review, we address the use of cognitive tests, including intelligence tests, in the assessment and diagnosis of dyslexia, from both historic and present-day perspectives. We discuss the role of cognitive tests in the operationalization of the concepts of specificity and unexpectedness, two constructs considered essential to the characterization of dyslexia since the publication of early case reports in the late nineteenth century. We review the advantages and disadvantages of several approaches to specific learning disabilities' identification that are used in schools. We also discuss contemporary debates around the use of standardized cognitive testing in dyslexia evaluations, in particular, the arguments of those who favor an approach to diagnosis based on prior history and the results of a comprehensive evaluation and those who favor an approach based on an individual's response to intervention. We attempt to explain both perspectives by examining clinical observations and research findings. We then provide an argument for how cognitive tests can contribute to an accurate and informed diagnosis of dyslexia.

Brain imaging studies of emotional well-being: a scoping review.

This scoping review provides an overview of previous empirical studies that used brain imaging techniques to investigate the neural correlates of emotional well-being (EWB). We compiled evidence on this topic into one accessible and usable document as a foundation for future research into the relationship between EWB and the brain. PRISMA 2020 guidelines were followed. We located relevant articles by searching five electronic databases with 95 studies meeting our inclusion criteria. We explored EWB measures, brain imaging modalities, research designs, populations studied, and approaches that are currently in use to characterize and understand EWB across the literature. Of the key concepts related to EWB, the vast majority of studies investigated positive affect and life satisfaction, followed by sense of meaning, goal pursuit, and quality of life. The majority of studies used functional MRI, followed by EEG and event-related potential-based EEG to study the neural basis of EWB (predominantly experienced affect, affective perception, reward, and emotion regulation). It is notable that positive affect and life satisfaction have been studied significantly more often than the other three aspects of EWB (i.e., sense of meaning, goal pursuit, and quality of life). Our findings suggest that future studies should investigate EWB in more diverse samples, especially in children, individuals with clinical disorders, and individuals from various geographic locations. Future directions and theoretical implications are discussed, including the need for more longitudinal studies with ecologically valid measures that incorporate multi-level approaches allowing researchers to better investigate and evaluate the relationships among behavioral, environmental, and neural factors. Systematic review registration: https://osf.io/t9cf6/.

The E3 ubiquitin ligase RNF40 suppresses apoptosis in colorectal cancer cells.

BACKGROUND: Colorectal cancer (CRC) is the fourth leading cause of cancer-related deaths worldwide, and deciphering underlying molecular mechanism is essential. The loss of monoubiquitinated histone H2B (H2Bub1) was correlated with poor prognosis of CRC patients and, accordingly, H2Bub1 was suggested as a tumor-suppressive mark. Surprisingly, our previous work revealed that the H2B ubiquitin ligase RING finger protein 40 (RNF40) might exert tumor-promoting functions. Here, we investigated the effect of RNF40 loss on tumorigenic features of CRC cells and their survival in vitro. METHODS: We evaluated the effects of RNF40 depletion in several human CRC cell lines in vitro. To evaluate cell cycle progression, cells were stained with propidium iodide and analyzed by flow cytometry. In addition, to assess apoptosis rates, caspase 3/7 activity was assessed in a Celigo® S-based measurement and, additionally, an Annexin V assay was performed. Genomic occupancy of H2Bub1, H3K79me3, and H3K27ac was determined by chromatin immunoprecipitation. Transcriptome-wide effects of RNF40 loss were evaluated based on mRNA-seq results, qRT-PCR, and Western blot. To rescue apoptosis-related effects, cells were treated with Z-VAD-FMK. RESULTS: Human CRC cell lines displayed decreased cell numbers in vitro after RNF40 depletion. While the differences in confluence were not mediated by changes in cell cycle progression, we discovered highly increased apoptosis rates after RNF40 knockdown due to elevated caspase 3/7 activity. This effect can be explained by reduced mRNA levels of anti-apoptotic and upregulation of pro-apoptotic BCL2 family members. Moreover, the direct occupancy of the RNF40-mediated H2B monoubiquitination was observed in the transcribed region of anti-apoptotic genes. Caspase inhibition by Z-VAD-FMK treatment rescued apoptosis in RNF40-depleted cells. However, knockdown cells still displayed decreased tumorigenic features despite the absence of apoptosis. CONCLUSIONS: Our findings reveal that RNF40 is essential for maintaining tumorigenic features of CRC cells in vitro by controlling the expression of genes encoding central apoptotic regulators.

Effect of Definition on Incidence and Prognosis of Type 2 Myocardial Infarction.

BACKGROUND: Uncertainties regarding the most appropriate definition and treatment of type 2 myocardial infarction (T2MI) due to supply-demand mismatch have contributed to inconsistent adoption in clinical practice. OBJECTIVES: This study sought a better understanding of the effect of the definition of T2MI on its incidence, treatment, and event-related mortality, thereby addressing an important unmet clinical need. METHODS: The final diagnosis was adjudicated in patients presenting with symptoms suggestive of myocardial infarction by 2 independent cardiologists by 2 methods: 1 method required the presence of coronary artery disease, a common interpretation of the 2007 universal definition (T2MI2007); and 1 method did not require coronary artery disease, the 2012 universal definition (T2MI2012). RESULTS: Overall, 4,015 consecutive patients were adjudicated. The incidence of T2MI based on the T2MI2007 definition was 2.8% (n = 112). The application of the more liberal T2MI2012 definition resulted in an increase of T2MI incidence of 6% (n = 240), a relative increase of 114% (128 reclassified patients, defined as T2MI2012reclassified). Among T2MI2007, 6.3% of patients received coronary revascularization, 22% dual-antiplatelet therapy, and 71% high-dose statin therapy versus 0.8%, 1.6%, and 31% among T2MI2012reclassified patients, respectively (all p < 0.01). Cardiovascular mortality at 90 days was 0% among T2MI2012reclassified, which was similar to patients with noncardiac causes of chest discomfort (0.2%), and lower than T2MI2007 (3.6%) and type 1 myocardial infarction (T1MI) (4.8%) (T2MI2012reclassified vs. T2MI2007 and T1MI: p = 0.03 and 0.01, respectively). CONCLUSIONS: T2MI2012reclassified has a substantially lower event-related mortality rate compared with T2MI2007 and T1MI. (Advantageous Predictors of Acute Coronary Syndromes Evaluation [APACE] Study; NCT00470587).

A prospective pilot study on the incidence of post-operative lymphedema in women with endometrial cancer.

To determine the incidence of lower-extremity lymphedema after surgical therapy including lymphadenectomy in endometrial cancer patients using standardized leg measurements. Also, to determine additional risk factors for the development of lymphedema and to study the effect of lymphedema on one's quality of life. In this prospective cohort study, patients with the diagnosis of endometrial cancer who were to undergo definitive surgical management were evaluated pre-operatively and followed post-operatively over the course of two years. Standardized leg measurements were performed by the same individuals at six time-points. Subjects also completed a standardized quality-of-life survey at each time-point. The incidence of lymphedema in 39 women with endometrial cancer using a standardized leg measurement protocol was 12.8% with lymphedema defined as a 20% increase in post-operative leg measurements. There was no significant association between the development of lymphedema and the number of pelvic or para-aortic lymph nodes removed, medical comorbidities, or surgical approach (p > 0.05). Of the five patients who met criteria for lymphedema, only one had worsening quality-of-life concerns post-operatively on the FACT-En, version 4, survey. This is the first prospective study using standardized leg measurements to calculate the incidence of post-operative lymphedema in endometrial cancer. Medical comorbidities, surgical approach, number of lymph nodes removed, and location of lymph nodes removed did not appear to affect the development of lymphedema in this cohort. A prospective, multicenter trial is needed to confirm these findings and to further assess the impact of lymphedema on one's quality of life.

Momentum spectrometer for electron-electron coincidence studies on superconductors.

We present a new experimental setup to study electron-electron coincidences from superconducting surfaces. In our approach, electrons emitted from a surface are projected onto a time- and position-sensitive microchannel plate detector with delayline position readout. Electrons that are emitted within 2 π solid angle with respect to the surface are detected in coincidence. The detector used is a hexagonal delayline detector with enhanced multiple hit capabilities. It is read out with a Flash analog-to-digital converter. The three-dimensional momentum vector is obtained for each electron. The intrinsic dead time of the detector has been greatly reduced by implementing a new algorithm for pulse analysis. The sample holder has been matched to fit the spectrometer while being capable of cooling down the sample to 4.5 K during the measurement and heating it up to 420 K for the cleaning procedure.

Qualidade de vida de pacientes com migrânea relacionada ao período menstrual submetidos à terapia auricular / Life quality of patients with migraine related to menstrual period undergoing auricular therapy

A migrânea é uma doença crônica caracterizada por crises intermitentes de cefaléia e sintomas associados, e constitui uma afecção que acomete em torno de 12 a 15 % da população em geral, em sua maioria mulheres. A qualidade de vida desses indivíduos fica comprometida, gerando um grande impacto físico, mental e social para os migranosos. Um dos métodos de tratamento que se mostra eficaz para aliviar os sintomas da migrânea menstrual é a terapia auricular ou auriculoterapia. O objetivo dessa pesquisa foi avaliar a qualidade de vida de pacientes com migrânea relacionada ao período menstrual que foram submetidos à terapia auricular. Para tanto, foram realizadas sessões de auriculoterapia em pacientes previamente selecionados e aplicado o questionário de qualidade de vida SF-36, em três momentos, antes da primeira sessão, sessenta dias após o início do tratamento e uma terceira avaliação noventa dias após o início do tratamento. Os resultados demonstraram que dos oitos indivíduos estudados, sete tiveram uma melhora geral da sua qualidade de vida. Conclui-se, assim, que o tratamento com a terapia auricular foi eficaz para a melhora da qualidade de vida de mulheres com migrânea relacionada ao período menstrual.

Migraine is a chronic disease characterized by intermittent attacks of headache and associated symptoms. It is a disease that affects around 12 to 15% of the general population, most of them being women. The quality of life of these individuals is compromised, causing a major impact on physical, mental and social for those who suffer from migraine. One method of treatment that seems to be effective in relieving the symptoms of menstrual migraine is auricular therapy. The purpose of this study was to evaluate the quality of life of patients with migraine related to the menstrual period who underwent auricular therapy. To this end, sessions were held in patients previously selected and implemented the survey of quality of life SF-36 on three different occasions. Before the first session, sixty days after the start of treatment and a third evaluation, ninety days after the beginning of treatment. The results showed that from eight individuals, seven had a general improvement in their quality of life. It follows that the treatment with auricular therapy was effective for improving quality of life of women with migraine related to menstruation.

Frequency of potential interactions between drugs in medical prescriptions in a city in southern Brazil.

CONTEXT AND OBJECTIVE: Drug interactions form part of current clinical practice and they affect between 3 and 5% of polypharmacy patients. The aim of this study was to identify the frequency of potential drug-drug interactions in prescriptions for adult and elderly patients. TYPE OF STUDY AND SETTING: Cross-sectional pharmacoepidemiological survey in the Parque Verde housing project, municipality of Cascavel, Paraná, Brazil, between December 2006 and February 2007. METHODS: Stratified cluster sampling, proportional to the total number of homes in the housing project, was used. The sample consisted of 95 homes and 96 male or female patients aged 19 or over, with medical prescriptions for at least two pharmaceutical drugs. Interactions were identified using DrugDigest, Medscape and Micromedex softwares. RESULTS: Most of the patients were female (69.8%), married (59.4%) and in the age group of 60 years or over (56.3%), with an income less than or equal to three minimum monthly salaries (81.3%) and less than eight years of schooling (69.8%); 90.6% of the patients were living with another person. The total number of pharmaceutical drugs was 406 (average of 4.2 medications per patient). The drugs most prescribed were antihypertensives (47.5%). The frequency of drug interactions was 66.6%. Among the 154 potential drug interactions, 4.6% were classified as major, 65.6% as moderate and 20.1% as minor. CONCLUSION: The high frequency of drug prescriptions with a potential for differentiated interactions indicates a situation that has so far been little explored, albeit a reality in household surveys.

Frequency of potential interactions between drugs in medical prescriptions in a city in southern Brazil / Frequência de potenciais interações entre drogas nas prescrições médicas em uma cidade do Sul do Brasil

CONTEXT AND OBJECTIVE: Drug interactions form part of current clinical practice and they affect between 3 and 5 percent of polypharmacy patients. The aim of this study was to identify the frequency of potential drug-drug interactions in prescriptions for adult and elderly patients. TYPE OF STUDY AND SETTING: Cross-sectional pharmacoepidemiological survey in the Parque Verde housing project, municipality of Cascavel, Paraná, Brazil, between December 2006 and February 2007. METHODS: Stratified cluster sampling, proportional to the total number of homes in the housing project, was used. The sample consisted of 95 homes and 96 male or female patients aged 19 or over, with medical prescriptions for at least two pharmaceutical drugs. Interactions were identified using DrugDigest, Medscape and Micromedex softwares. RESULTS: Most of the patients were female (69.8 percent), married (59.4 percent) and in the age group of 60 years or over (56.3 percent), with an income less than or equal to three minimum monthly salaries (81.3 percent) and less than eight years of schooling (69.8 percent); 90.6 percent of the patients were living with another person. The total number of pharmaceutical drugs was 406 (average of 4.2 medications per patient). The drugs most prescribed were antihypertensives (47.5 percent). The frequency of drug interactions was 66.6 percent. Among the 154 potential drug interactions, 4.6 percent were classified as major, 65.6 percent as moderate and 20.1 percent as minor. CONCLUSION: The high frequency of drug prescriptions with a potential for differentiated interactions indicates a situation that has so far been little explored, albeit a reality in household surveys.

CONTEXTO E OBJETIVO: As interações medicamentosas fazem parte da prática corrente na clínica médica e a sua incidência oscila entre 3 por cento e 5 por cento nos pacientes fazendo uso da polifarmácia. O objetivo do estudo foi identificar a frequência de interações droga-droga potenciais em prescrições de pacientes adultos e idosos. TIPO DE ESTUDO E LOCAL: Inquérito farmacoepidemiológico de corte transversal, realizado de 12/2006 a 02/2007 no conjunto habitacional Parque Verde, Cascavel, Paraná, Brasil. MÉTODO: A amostra foi por conglomerado e estratificada, proporcional ao total de residências no conjunto habitacional, constituída de 95 residências, com 96 pacientes de 19 anos ou mais, sexo feminino e masculino, com prescrição de no mínimo duas especialidades farmacêuticas. As interações foram identificadas de acordo com os softwares DrugDigest, Medscape, Micromedex. RESULTADOS: A maioria dos pacientes pertencia ao gênero feminino (69,8 por cento), em situação conjugal casada (59,4 por cento), com renda menor ou igual a três salários mínimos (81,3 por cento), faixa etária 60 anos ou mais (56,3 por cento) e 8 anos ou menos de estudo (69,8 por cento) com 90,6 por cento dos pacientes moravam com mais outra pessoa. O total de especialidades farmacêuticas foi de 406, correspondendo a uma média de 4,2 medicamentos por paciente. Os fármacos mais prescritos foram os anti-hipertensivos (47,5 por cento). A frequência de interações medicamentosas foi de 66,6 por cento. Dentre as 154 interações medicamentosas potenciais, 4,6 por cento foram classificadas como maior e 65,6 por cento como moderada e 20,1 por cento como menor. CONCLUSÃO: A alta frequência de prescrições de drogas com potencial de interações diferenciado indica uma situação ainda pouco explorada, mas real em pesquisa domiciliar.

Inquérito farmacoepidemiológico de pacientes de meia idade e idosos em três comunidades de Cascavel, PR - Brasil: verificação evolutiva do conhecimento terapêutico / Pharmacoepidemiological survey of middle-age and elderly patients in three communities of Cascavel, PR - Brazil: progressive verification of their therapeutic knowledge

O objetivo da pesquisa foi identificar variáveis relacionadas ao conhecimento da terapêutica nos períodos pré e pós-intervenção e características sócio-demográficas de 80 pacientes de meia idade e idosos (45 anos ou mais) em três comunidades paroquiais de Cascavel-PR. Desenvolveu-se um inquérito farmacoepidemiológico, seguido de estudo prospectivo no período de novembro de 2003 a dezembro de 2004, e os dados foram coletados em formulário semi-estruturado. Houve predominância para o sexo feminino (82,5 por cento), idade média de 67,3 anos, escolaridade de menos de oito anos de estudo (75,0 por cento), maioria casado (57,5 por cento), morando apenas o casal (63,7 por cento), renda de 1 a 3 salários (80 por cento), número médio de medicamentos prescritos na fase pré (4,3) e na pós-intervenção (3,5). A classe de fármacos mais prescrita foi para o sistema cardiovascular (48,2 por cento). As variáveis, leitura da bula e freqüência, conhecimento sobre o medicamento, esquecimento da dose prescrita, satisfação com o medicamento e importância das informações, embora apresentassem diferenças na freqüência relativa do período pré-intervenção para o pós-intervenção, não sustentaram diferença estatisticamente significativa. Apesar desse resultado, é preciso considerar que a diferença quanto ao grau de evolução dos resultados apresentam relevância clinica, pendendo favoravelmente a relação benefício/risco.

Variables on therapeutic knowledge in pre- and post-intervention periods and the social and demographic characteristics of 80 middle-aged and elderly (45 years or more) patients in three parish communities in Cascavel, PR - Brazil are provided. A pharmacoepidemiological survey was developed; a prospective study between November 2003 and December 2004 was undertaken; data were collected in a semi-structured form. Females (82.5 percent) were predominant; average age 67.3 years old; schooling less than 8 years; most of them married (57.5 percent); only the couple inhabits the house (63.7 percent); income 1 to 3 salaries (80 percent); mean numbers of prescribed medicines pre- and post-intervention were 4.3 and 3.5, respectively. Medicine for the cardiovascular system (48.2 percent) was the most described (48.2 percent). Variables - reading information on drug and its frequency, knowledge on the medicine used and importance of information - were statistically non-significant, although difference in relative frequency from the pre- to the post-intervention period existed. Nevertheless, difference with regard to degree of progress in results shows clinical relevance with a favorable trend towards the benefit/risk ratio.

Estudo retrospectivo das complicações intra-operatórias na cirurgia de revascularização do miocárdio / Retrospective study of intra-operative complications in the surgery of revascularization of the myocardium

As complicações intra-operatórias na cirurgia de revascularização miocárdica (CRM) quando reconhecidas previamente podem guiar os cuidados prestados na sala operatória, dando continuidade na Unidade de Terapia Intensiva e durante toda internação. Quando a equipe conhece essas complicações sofridas pelo indivíduo poderá prever e prover cuidados mais específicos na seqüência de sua evolução cirúrgica. O objetivo desse estudo foi investigar a freqüência e tipos de complicações observadas no intra-operatório da CRM. Trata-se de um estudo retrospectivo, descritivo, transversal, baseado em dados secundários, com amostra intencional de 123 sujeitos. A coleta de dados realizou-se por meio do acesso ao banco de dados do Instituto de Moléstias Cardiovasculares do Oeste do Paraná, em Cascavel. Os dados foram analisados no programa computadorizado Statistic, versão 6,0. Os tipos de complicações observadas nesse período foram: cardiovasculares, pulmonares, alteração nos vasos do enxerto e sangramento. Dentre essas, a que obteve maior freqüência foi alteração nos vasos do enxerto, em 33 (26,8%) casos. As complicações no intra-operatório podem não ser passíveis de prevenção quando consideradas as características individuais de cada sujeito, entretanto, todos os esforços precisam ser direcionados para que o evento, quando ocorrer, seja bem atendido, evitando dessa forma, complicações adicionais maiores.

The intra-operative complications in the myocardium revascularization (MRC) when previously known can lead the care applied in the operating theater, supporting the Intensive Therapy Unit continuation and so during the hospitalization. When the crew is aware of these complications suffered by the inpatient will be able to foresee and provide more specific care in the sequence of the surgery evolution. The aim of this study was to investigate the frequency and complication types observed in the intra-operative myocardial revascularization surgery. It is a retrospective, descriptive, transversal study, based upon secondary data, with an intentional 123-patient-sample. The data collection took place through the access of the West of Parana Cardiovascular Diseases Institute database, in Cascavel. The data was analyzed in the Statistic 6,0 program. The complication types observed in that period were: cardiovascular, pulmonary, alteration in the vases of the graft and bleeding. Among these, the one that had the largest frequency was the alteration in the vases of the graft in 33 cases, equivalent to 26,8% of the cases. The importance of identifying these complications in this group is taken into account as a way of preventing from them.

Las complicaciones intra-operatorias en la Cirugía de Revascularización Miocárdica (CRM) cuando reconocidas previamente pueden guiar los cuidados prestados en la sala de operaciones, ofreciendo continuaidad en la Unidad de Terapia Intensiva y durante toda la internación. Cuando el equipo conoce las complicaciones sufridas por el individuo, podrá prevenir y proveer cuidados más especificos en la secuencia de la evolución de la cirugía. El objetivo de este estudio fue averiguar la frecuencia y las clases de complicaciones observadas en el intraoperatorio de la CRM. Es un estudio retrospectivo, descriptivo, transversal, basado en datos secundarios, con muestra intencional de 123 sujetos. El recogimiento de datos se realizo por medio del acceso al banco de datos del Instituto de Molestias Cardiovasculares del Oeste de Paraná, en Cascavel. Los datos fueron analizados en el programa Statistic 6,0. Las clases de complicaciones observadas en ese periodo fueron: cardiovasculares, pulmonares, alteración en los vasos del enjerto y sangramiento. De entre esos, la que obtuvo mayor frecuencia fue la alteración en los vasos del enjerto, en 33, equivalientes a 26,8% de los casos. Se considera la importancia de identificar estas complicaciones en ese grupo, para que se las puedan prevenir.

Complicações no pós-operatório de revascularização miocárdica / Types of complications in the postoperative period of miocardic revascularization

A cirurgia de revascularização miocárdica (RM) é uma das principais opções para tratar a insuficiência coronariana. Este estudo, de abordagem quantitativa, teve como objetivo investigar os tipos de complicações ocorridas no período pós-operatório de RM em 119 indivíduos. Os dados foram coletados no Banco de Dados de um Serviço de Cirurgia Cardíaca e analisados com o auxílio do Programa Statistica 6,0. Dentre as alterações presentes no pós-operatório, as cardiovasculares foram responsáveis por 14 (11,8 por cento) casos, as pulmonares por 12 (10,1 por cento), as neurológicas por 6 (5 por cento), as gastrintestinais por 4 (3,4 por cento), as renais por 2 (1,7 por cento). As relacionadas a sangramento ou a problemas no sistema músculo-esquelético apareceram 1 (0,8 por cento) vez, respectivamente. Ocorreram também 3 (2,5 por cento) óbitos nesse grupo. O conhecimento dos tipos de problemas no pós-operatório de RM é de suma importância, principalmente para a enfermagem, visto que favorece a implementação de ações pró-ativas ao paciente, no sentido de prevenir danos e/ou seqüela

Efeitos da crioterapia e laser 904nm na redução de edema traumático em patas de ratas / Effect of the cryotherapy and laser 904nm in reduction of traumatic edema in rat´s paws

O edema inflamatório agudo é considerado um problema para a reabilitação, porque contribui para a dor, diminuição de movimento e futura formação de fibrose tecidual. Sendo, portanto, importante a sua diminuição, após processos traumáticos. Este trabalho objetivou comparar a analisar os efeitos da crioterapia e do laser em edema traumático agudo em patas de ratas wistar. O experimento incluiu o estudo de 15 ratas wistar com 176,25+-19,74g, divididas aleatoriamente em três grupos. Inicialmente o volume da pata posterior esquerda foi avaliado por hidropletismografia, e, depois foram submetidas à lesão traumática. Após cinco minutos da lesão foi novamente medido o volume da pata, evidenciando-se a formação de edema. Para G1 a pata esquerda foi posicionada durante dez minutos em crioterapia, num recipiente com água e gelo a 5 grau C. No G2 realizou-se aplicação a laser 904nm,3J/cm2 sobrea a lesão. O G3 foi o grupo controle. Houve reavaliações em 15 e 20 minutos depois da lesão Durante todo o experimento as ratas permaneceram sedadas. Para o G1, o volume deslocado inicialmente foi de 1,18+-0,11ml; após cinco minutos 1,34+-0,11; após 15 minutos 1,22+-0,13; e, após 20 min 1,30+-0,24. Para o G2 foi 1,3+-0,08; após 5 minutos 1,45+-0,17; depois de 10 minutos 1,40+-0,14; e, após 15 minutos 1,40+-0,14. Para o G3 os valores foram 1,3+-0,16; 1,52+-0,04; 1,58+-0,08; e 1,70+-0,007. Apesar da inexistência de diferença estatística, observou-se tendência de diminuição e estabilização do edema depois das aplicações nos dois grupos, sendo mais acentuado em G1.

Can particulate extraction from the ascending aorta reduce neurologic injury in cardiac surgery?

OBJECTIVE: This study examined whether extraction of particulate emboli using intra-aortic filtration could decrease neurologic outcomes. METHODS: Patients (N = 582) were enrolled in a prospective, controlled study and alternately assigned to the therapy arm (n = 304; intra-aortic filtration) or control arm (n = 278). Preoperative, procedural, and postoperative data were collected. Neurologic examinations included the National Institutes of Health Stroke Scale, Glasgow Coma Scale, and memory tests. Investigators administering neurologic tests were blinded to the study arm. By the use of logistic regression and propensity matching, composite neurologic outcomes (transient ischemic attack, stroke, delirium, coma, and memory deficit) were evaluated. RESULTS: Patients in the filter group experienced a lower incidence of adverse neurologic outcomes than patients in the control group (4.3% vs 11.9%) (P <.001). There were significantly less transient ischemic attacks (0% vs 1.4%), delirium (3.0% vs 6.5%), and memory deficit (1.3% vs 6.2%). There were fewer strokes in the filter group compared with the control group (0.7% vs 2.2%), although the sample size was too small for a significant finding. Both groups experienced 1 coma outcome. The use of a filter was associated with an adjusted odds ratio of 0.375, implying that a patient who does not receive a filter is 2.7 times more likely to experience an adverse neurologic event. Logistic modeling also demonstrated that there are increasing chances of poor neurologic outcome with increasing age. The model indicates that there may be an increasing protective benefit from the filter with increasing age, although the interaction was not significant. CONCLUSIONS: The extraction of particulate emboli using intra-aortic filtration resulted in decreased neurologic outcomes.