The role of miRNAs in the diagnosis of stable atherosclerosis of different arterial territories: A critical review.

Atherosclerotic disease is a major cause of morbidity and mortality worldwide. Atherosclerosis may be present in different arterial territories and as a single- or multi-territorial disease. The different phenotypes of atherosclerosis are attributable only in part to acquired cardiovascular risk factors and genetic Mendelian inheritance. miRNAs, which regulate the gene expression at the post-transcriptional level, may also contribute to such heterogeneity. Numerous miRNAs participate in the pathophysiology of atherosclerosis by modulating endothelial function, smooth vascular cell function, vascular inflammation, and cholesterol homeostasis in the vessel, among other biological processes. Moreover, miRNAs are present in peripheral blood with high stability and have the potential to be used as non-invasive biomarkers for the diagnosis of atherosclerosis. However, the circulating miRNA profile may vary according to the involved arterial territory, considering that atherosclerosis expression, including the associated molecular phenotype, varies according to the affected arterial territory. In this review, we discuss the specific circulating miRNA profiles associated with atherosclerosis of different arterial territories, the common circulating miRNA profile of stable atherosclerosis irrespective of the involved arterial territory, and the circulating miRNA signature of multi-territorial atherosclerosis. miRNAs may consist of a simple non-invasive method for discriminating atherosclerosis of different arterial sites. The limitations of miRNA profiling for such clinical application are also discussed.

Dapagliflozin Impact on the Exercise Capacity of Non-Diabetic Heart Failure with Reduced Ejection Fraction Patients.

Background: Dapagliflozin has been shown to reduce morbidity and mortality in Heart Failure with reduced Ejection Fraction (HFrEF), but its impact on exercise capacity of non-diabetic HF outpatients is unknown. Methods: Adult non-diabetic HF patients with a left ventricular ejection fraction (LVEF) <50% were randomized 1:1 to receive dapagliflozin 10 mg or to continue with HF medication. Patients underwent an initial evaluation which was repeated after 6 months. The variation of several clinical parameters was compared, with the primary endpoint being the 6 month peak oxygen uptake (pVO2) variation. Results: A total of 40 patients were included (mean age 61 ± 13 years, 82.5% male, mean LVEF 34 ± 5%), half being randomized to dapagliflozin, with no significant baseline differences between groups. The reported drug compliance was 100%, with no major safety events. No statistically significant difference in HF events was found (p = 0.609). There was a 24% reduction in the number of patients in New York Heart Association (NYHA) class III in the treatment group as opposed to a 15.8% increase in the control group (p = 0.004). Patients under dapagliflozin had a greater improvement in pVO2 (3.1 vs. 0.1 mL/kg/min, p = 0.030) and a greater reduction in NT-proBNP levels (−217.6 vs. 650.3 pg/mL, p = 0.007). Conclusion: Dapagliflozin was associated with a significant improvement in cardiopulmonary fitness at 6 months follow-up in non-diabetic HFrEF patients.

Impacto de um protocolo de desmame ventilatório na pessoa adulta na UCI / Impact of a ventilatory weaning protocol on adults in the ICU

A ventilação mecânica invasiva (VMI) é uma medida de suporte vital utilizada em cuidados intensivos, associada a custos elevados e a múltiplas complicações. O desmame ventilatório consiste no processo de transição entre a VMI e a ventilação espontânea (VE). Neste sentido vários autores defendem o recurso a protocolos de desmame ventilatório. O objetivo geral deste trabalho centrou-se em avaliar o impacto de um protocolo de desmame ventilatório com associado a intervenções de enfermagem de reabilitação na qualidade do desmame e nos outcomes dos doentes. Métodos: Recorrendo a um estudo de natureza quantitativa, com características de um estudo comparativo retrospetivo. O grupo 1 (G1) foi constituído pelos doentes admitidos e ventilados por um periodo superior a 24 horas, na unidade de cuidados intensivos (UCI) do Hospital Sousa Martins (HSM), Unidade de Saúde Local da Guarda (ULSG), entre um de dezembro de 2019 e 31 de janeiro de 2020. O grupo 2 (G2) correspondeu aos doentes admitidos na mesma UCI em igual período do ano anterior, previamente à aplicação do protocolo de desmame. O referencial de colheita de dados inclui, além de uma ficha sociodemográfica e clinica, uma grelha de observação realizada com base na pesquisa bibliográfica e adaptado à prática do serviço em questão. Dados esses que foram colhidos no G1 e consultados nos processos dos doentes que constituem o G2 para posterior comparação. Resultados: A maioria da amostra é masculina (56,7% no G1 e 58,1% no G2), com idade média global de 71,62 anos. Prevalência de melhores índices de qualidade de desmame e outcomes no G1 uma vez que este grupo apresentou menos dias de internamento (M=7,1), menos dias de VMI (M= 4,07), menor número de PREs (M=1,27), menor timing de desmame (M= 3,80 dias) e o desmame demorou em média 1,37 dias. O G2 apresentou valores de ordenação média maiores (10,32; 7,81; 2,87; 6,23; 2,77, respetivamente) no que respeita a estes indicadores, pelo que apresentou piores resultados relativos à qualidade geral do desmame e aos outcomes. Conclusões: A evidência dos resultados obtidos dá corpo à importância de uma abordagem multidisciplinar ao doente crítico, realçando a necessidade da associação de programas de enfermagem reabilitação ao desmame ventilatório.

Invasive mechanical ventilation (IMV) is a vital support measure used in intensive care, associated with high costs and multiple complications. Ventilatory weaning consists of the transition process between IMV and spontaneous ventilation (LV). In this sense, several authors defend the use of ventilatory weaning protocols. The general objective of this work was to assess the impact of a ventilatory weaning protocol associated with rehabilitation nursing interventions on the quality of weaning and the outcomes of patients. Methods: Using a quantitative study, with characteristics of a retrospective comparative study. Group 1 (G1) consisted of patients admitted and ventilated for more than 24 hours, in the intensive care unit (ICU) of Hospital Sousa Martins (HSM), Local Health Unit of Guarda (ULSG), among the 1st of December 2019 and the 31st of January, 2020. Group 2 (G2) corresponded to patients admitted to the same ICU in the same period of the previous year, prior to the application of the weaning protocol. The data collection framework includes, in addition to a sociodemographic and clinical form, an observation grid based on bibliographic research and adapted to the practice of the service in question. These data were collected in G1 and consulted in the patient files that constitute G2 for later comparison. Results: The majority of the sample is male (56.7% in G1 and 58.1% in G2), with an average age of 71.62 years. Prevalence of better weaning quality indexes and outcomes in G1 since this group had fewer days of hospitalization (M = 7.1), fewer days of IMV (M = 4.07), fewer PREs (M = 1 , 27), less weaning timing (M = 3.80 days) and weaning took an average of 1.37 days. G2 presented higher average ordination values (10.32; 7.81; 2.87; 6.23; 2.77, respectively) with regard to these indicators, which resulted in worse results regarding the overall quality of weaning and outcomes. Conclusions: The evidence of the obtained results embodies the importance of a multidisciplinary approach to critically ill patients, highlighting the need for the association of rehabilitation nursing programs with ventilatory weaning.

The Role of Extraversion, IQ and Contact in the Own-Ethnicity Face Recognition Bias.

While IQ is weakly related to the overall face recognition (Shakeshaft & Plomin, 2015), it plays a larger role in the processing of misaligned faces in the composite face task (Zhu et al., 2010). This type of stimuli are relatively novel and may reflect the involvement of intelligence in the processing of infrequently encountered faces, such as those of other-ethnicities. Extraversion is associated with increased eye contact which signifies less viewing of diagnostic features for Black faces. Using an old/new recognition paradigm, we found that IQ negatively correlated with the magnitude of the own-ethnicity bias (OEB) and that this relationship was moderated by contact with people from another ethnicity. We interpret these results in terms of IQ enhancing the ability to process novel stimuli by utilising multiple forms of coding. Extraversion was positively correlated with the OEB in White participants and negatively correlated with the OEB in Black participants suggesting that extraverts have lower attention to diagnostic facial features of Black faces, leading to poorer recognition of Black faces in both White and Black participants, thereby contributing to the relative OEB in these participants. The OEB is dependent on participant variables such as intelligence and extraversion.