Esophageal ph monitoring study of eight hours in pediatric patients with suspected gastroesophageal reflux

PURPOSE: To study the pH monitoring over eight hours, analyzing variables such symptomatology and esophagogastroduodenoscopy, as well as the following pH monitoring parameters: number of reflux episodes, number of episodes longer than five minutes, length of reflux time during the eight hours, and the episode of longest duration, for the diagnosis of gastroesophageal reflux. METHODS: A prospective study. Continuous measurement of esophageal pH was performed over eight hours on 35 patients whose ages ranged from four months to 11 years. The DPS-100 Diagnosis pH meter System was utilized, programmed in accordance with the methodology suggested by Vandenplas. The pH monitoring results were divided into positive and negative and compared with all the variables and parameters of the examination. RESULTS: We obtained statistically significant differences in all the pH monitoring parameters analyzed, with the reflux index being the most effective for identifying the pathological reflux, independent of age. None of the qualitative variables of age, symptomatology and esophagogastroduodenoscopy showed statistically significant differences when compared to the pH monitoring results. CONCLUSION: The esophageal pH monitoring of eight hours has its pH monitoring parameters validated for the diagnosis of gastroesophageal reflux.OBJETIVO: Estudar a pHmetria em oito horas, analisando variáveis como a idade, sintomatologia e esôfago-estômago-duodenografia, além dos seguintes parâmetros pHmétricos: número de episódios de refluxo, número de episódios maiores de cinco minutos, tempo de refluxo nas oito horas e episódio de maior duração, para o diagnóstico do refluxo gastroesofágico. MÉTODO: Estudo prospectivo realizado com a medição contínua do pH esofágico em oito horas em 35 pacientes, de quatro meses a 11 anos de idade. Foi utilizado aparelho de pHmetria DPS-100 Diagnosis pHmeter System com programa de acordo com a metodologia sugerida por Vandenplas e comparados com todas as variáveis e parâmetros do exame. RESULTADOS: Obtivemos diferença estatisticamente significante em todos os parâmetros pHmétricos analisados, com o índice de refluxo sendo o mais efetivo para identificar o refluxo patológico, independente da idade. Todas as variáveis qualitativas, idade, sintomatologia e esôfago-estômago-duodenografia, não mostraram diferenças estatisticamente significantes quando relacionados aos resultados da pHmetria. CONCLUSÃO: Concluímos que a pHmetria esofágica de oito horas tem seus parâmetros pHmétricos válidos para o diagnóstico do refluxo gastroesofágico.Universidade Federal de São Paulo (UNIFESP) EPM Departamento de CirurgiaUNIFESP, EPM, Depto. de CirurgiaSciEL

Efecto de la leche bovina fluorada sobre la cariogenicidad de biofilms de Streptococcus mutans y la desmineralización de esmalte y dentina radicular

64 p.Efecto de la leche bovina fluorada sobre la cariogenicidad de biofilms de streptococcus mutans y la desmineralización de esmalte y dentina radicular. OBJETIVO: Pese a que la leche fluorada ha probado ser una medida efectiva en la prevención de caries, sus efectos sobre la flora cariogénica son menos conocidos, particularmente en dentina. El propósito de este estudio, por lo tanto, fue determinar el efecto de leche bovina fluorada, sobre un biofilm oral de Streptoccocus mutans (S. mutans) y sobre la desmineralización de esmalte y dentina radicular, in vitro. METODOLOGIA: Biofilms de S. mutans UA159 fueron cultivados sobre bloques de esmalte y dentina bovinos y desafiados con sacarosa 10% 8 veces al día para promover la desmineralización y estimular al biofilm. Al segundo día, los bloques fueron divididos en 4 grupos: Grupo 1: NaCl 0.9% dos veces al día, Grupo 2: Leche bovina dos veces al día, Grupo 3: Leche bovina fluorada (5 ppm) dos veces al dia y Grupo 4: NaF 0.05% dos veces al día. El pH fue medido periódicamente y luego de 5 días de desafíos y tratamientos para esmalte y 4 para dentina, el biofilm fue colectado obteniéndose: el peso seco, microorganismos viables, proteínas solubles totales, polisacáridos extracelulares solubles, insolubles e intracelulares. Los bloques se recuperaron y se midió el % de pérdida de dureza superficial (%PDS) mediante un microindentador, para extrapolar la desmineralización sufrida. La diferencia entre los grupos de tratamiento fue medido con ANOVA seguido por Tukey. RESULTADOS: En esmalte, los cambios de pH en el medio de cultivo no muestran diferencias significativas entre los grupos. Las variaciones de pH son similares tanto para los grupos control (1 y 4) como para los grupos experimentales. Los valores de biomasa, microorganismos viables, y polisacáridos , no mostraron diferencias significativas entre los grupos. En el caso de las proteínas solubles totales hubo diferencias estadísticamente significativas (p<0.05) donde en el grupo en estudio leche bovina fluorada 5ppm y leche bovina, se encontró mayor cantidad de proteínas que el grupo control (NaF 0.05%). En dentina, las variaciones de pH del medio de cultivo se comportaron de manera similar en todos los grupos, sin diferencias significativas. Los valores de biomasa, microorganismos viables, proteínas solubles totales, y polisacáridos no mostraron diferencias significativas entre los grupos. El %PDS en esmalte fue menor para la leche con flúor que para la leche sin flúor (p<0,05). Pese a que en dentina el %PDS de la leche con flúor fue menor que en el grupo expuesto sólo a leche, la diferencia no resulto estadísticamente significativa. CONCLUSION: La leche bovina fluorada evita la desmineralización de esmalte provocada por la sacarosa. El mecanismo de acción del flúor en la leche no parece afectar la proliferación y crecimiento del biofilm./ ABSTRACTS: Fluoridated milk and Cariogenicity of Streptococcus mutans biofilms. OBJECTIVE: Although fluoridated milk has proven to be an effective measure in preventing caries, its effects on cariogenic flora are less clear, especially in dentin. The purpose of this study, therefore, was to determine the effect of fluoridated bovine milk, on an oral biofilm of Streptoccocus mutans (S. mutans) and over demineralization of enamel and root dentin, in vitro. METHODS: S. mutans UA159 biofilms were grown on bovine enamel and dentin slabs (n=27) of previously measured surface hardness (SH) and challenged with 10% sucrose 8 times a day to cause demineralization. On the second day, slabs were divided into four groups: Group 1: NaCl 0.9%, Group 2: bovine milk, Group 3: fluoridated bovine milk (5 ppm) and Group 4: NaF 0.05%. Treatments were delivered twice a day. Acidogenicity (pH) was periodically monitored and after 5 days, biofilms were collected to obtain: biofilm dry weight, viable microorganisms, total protein content, soluble and insoluble extracellular and intracellular polysaccharides. The slabs were recovered and SH was again determined by a microindenter to obtain the percentage SH change (%SHC), which allows to assess demineralization. Results were compared by ANOVA followed by Tukey test. RESULTS: pH, viable microorganisms, dry weight, total soluble proteins and polysaccharides, failed to show statistically significant differences either between enamel and dentin, or between treatment groups. When SHC was compared, tissue slabs of Groups 3 and 4 resulted in significantly lower %SHC than Groups 1 and 2 (p<0.05). CONCLUSION: Bovine milk fluoridation prevents demineralization of enamel caused by sucrose. The mechanism by which fluoridated milk does not seem to affect the proliferation and growth of the biofilm remains elusive and needs further research

Patient's reactions to digital rectal examination of the prostate

OBJECTIVE: In recent years, there has been a rise in the incidence of prostate cancer (PCa), and routine screening for the disease has become a well accepted clinical practice. Even with the recognized benefit of this approach, some men are still reluctant to undergo digital rectal examination (DRE). For this reason, we designed the present study in order to better understand men's reactions about this method of screening. The aim was to identify possible drawbacks that could be overcome to increase DRE. MATERIALS AND METHODS: We randomly selected 269 patients that were enrolled in an institutional PCa screening program. They were first asked to answer a question regarding their preferred position to undergo the examination. Following this step, they answered a questionnaire in which physical and psychological reactions regarding the DRE were presented. Finally, we used a visual analogical scale (VAS) to analyze the perception of pain during DRE. RESULTS: The supine position was preferred for most patients (53.9%). Before DRE, about 59.4% of patients felt that the exam would be acceptable. After DRE, this figure increased to 91.5% (p < 0.001). Mean VAS score during DRE was 1.69 on a scale with a range between 0 and 10 (0 = no pain; 10 = extreme pain). CONCLUSION: Patient expectations about DRE were negative before examination and changed significantly following the exam. Pain during examination was negligible, contrary to the prevalent belief. These two findings must be clearly presented to patients in order to improve PCa screening acceptance

Maternity “blues”: prevalence and risk factors

Objectives: estimate the prevalence and track the risk factors associated with, Maternity blues (MB). Methods: a transversal study was performed with 113 women, on the tenth day of puerperium. The following instruments were used: Pitt Scale (1968), Stein (1980), Inventory for stressful life events by Holmes & Rahe (1967), and a questionnaire with sociodemographic and obstetric data. Results: the prevalence of MB was 32.7% according to the Stein scale. In the univariated analysis, civil status and tobacco use were associated with MB. Legally married women and nonsmokers showed a risk approximately 4 times lower of experiencing the problem. Conclusions: MB was very prevalent in this sample. Obstetricians must be aware of this condition which may be associated with postpartum depression.Objetivos: estimar la prevalencia y rastrear los factores de riesgo asociados con la tristeza postparto (TP). Método: se realizó un estudio transversal con 113 mujeres, en el décimo día del puerperio. Se utilizaron los siguientes instrumentos: Pitt Scale (1968), Stein (1980), Inventory for Stressful Life Events de Holmes & Rahe (1967) y un cuestionario de datos sociodemográficos y obstétricos. Resultados: la prevalencia de la TP fue de un 32.7% de acuerdo con la escala Stein. En el análisis univariado, el estado civil y el consumo de tabaco se asociaron a la TP. Las mujeres casadas y las no fumadoras mostraron un riesgo aproximadamente 4 veces más bajo de sufrir el problema. Conclusiones: se encontró una alta prevalencia de la TP en la muestra. Los obstetras deberían estar alerta ante este estado, que puede asociarse con la depresión postparto

Environmental pH influences Candida albicans biofilms regarding its structure, virulence and susceptibility to fluconazole

Candida albicans colonizes sites with different environmental pH. However, it is unclear how these conditions can interfere on biofilms. This study aimed to evaluate the influence of environmental pH on behavior of C. albicans regarding its structure, virulence and susceptibility to fluconazole (FLZ). Minimal inhibitory concentration, minimal fungicidal concentration and time kill were used to evaluate the susceptibility to FLZ in planktonic cells under three pH values (4.0, 5.5, 7.0). These pH values were used for biofilms analysis. C. albicans ATCC 90028 was developed on poly(-methlymethacrylate) resin for 48 h. Then, 2.56 mu g/mL of FLZ was added to experimental groups for 24 h, and biofilms were analyzed by cell quantification, bioactivity, secretion of proteinases and phospholipases and structure. All data were analyzed by two-way ANOVA, followed by Tukey's test (alpha = 0.05). For planktonic cells, changes in environmental pH decreased the susceptibility to FLZ. C. albicans biofilms developed at pH 5.5 showed higher cell counts, bioactivity, bio-volume, average thickness and roughness coefficient (p 0.05), but increased secretion of proteinase and phospholipase (p < 0.05). Within the conditions studied, it was shown that environmental pH modulates the structure, virulence and susceptibility of C albicans to FLZ69-703944CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQ132399/2012-1; 2006-7/30814

The use of immunohistochemistry for diagnosis of prostate cancer

PURPOSE: Atypical glands (ASAP) are diagnosed in 5.0% of prostate biopsies, and cancer identification in a rebiopsy is higher than 40.0%. The use of antibodies to mark basal cells is currently a common practice, in order to avoid rebiopsies. There has been no reported study that has reviewed characteristics of radical prostatectomies (RPs) when immunohistochemistry (IHC) was necessary for definitive diagnosis. MATERIALS AND METHODS: Out of 4127 biopsies examined from 2004 to 2008, 144 (3.5%) were diagnosed with ASAP. IHC was performed using antibody anti-34ßE12 and p63. The results of surgical specimens of 27 patients treated by RP after the diagnosis of prostate cancer (PC) was made using IHC (Group 1) were compared with 1040 patients where IHC was not necessary (Group 2). RESULTS: IHC helped to diagnose PC in 103 patients (71.5%). Twenty-seven (26.2%) underwent RP. In Group 1, two (7.4%) adenocarcinomas were insignificant versus 29 (2.9%) for Group 2. Patients from Group 1 were younger (p = 0.039), had lower Gleason scores (GS) (p < 0.001), lower percentage of Gleason pattern 4 (p < 0.001), and smaller tumors (p < 0.001). CONCLUSION: The use of IHC did not lead to diagnosis of insignificant tumors as illustrated by absence of differences in pathological stage or positive surgical margins in men submitted to RP. Therefore, our results suggest that this modality should be routinely used for a borderline biopsy and ASAP cases

Contributions to the debate on the revision of the concept of cultural landscape: ICOMOS BRAZIL’s National Scientific Committee

The concept of landscape is polysemic and transdisciplinary, a basic condition for the recognition, planning and management of cultural landscapes, with a view to their integrated, shared and sustainable preservation. The recent extensions of the concept of cultural heritage have brought with them a breadth, diversity and complexity that prove to be counter-hegemonic, demanding greater participation and socio-cultural integration. The construction of the concept of cultural landscape has had in Brazil important thinkers, Charters and Regulations such as the Chancela del Landscape Cultural , the Portaria 375 or the Federal Constitution itself, in addition to various local initiatives and the declaration as World Heritage Sites of places like Rio, Pampulha or Paraty. The Constitution in its article 216 establishes as Brazilian cultural heritage tangible and intangible assets , highlighting that they must be taken not only individually but as a whole. Considering the conceptual revision in debate, the Brazilian committee reaffirms PRINCIPLES for a new approach and application of the concept of Cultural Landscape. The EPISTEMOLOGICAL ADVANCE makes us consider the systemic and complex character and its relationships, interactions, meanings, and interpretations. MAN - NATURE INTERACTION must be expressed through society. The DIVERSITY OF OBJECTIVES AND THEMES, built by groups associated with cultural practices and places, are considered true palimpsests. TERRITORIES AND TERRITORIAL SYSTEMS characterize the locus, sharing ecological or cultural functions and processes. SUSTAINABLE DEVELOPMENT integrates conservation, requalification, and protection actions, considering an INTEGRAL AND INTEGRATED APPROACH to the landscape in its MATERIAL, INTANGIBLE AND NATURAL DIMENSIONS. The DYNAMICITY and evolutionary character of cultural landscapes implies the recognition of their TRANSFORMATIONS and their PUBLIC INTEREST, harmonizing public-private interactions, and the need for INTEGRATED, SHARED AND PARTICIPATORY MANAGEMENT. The Landscape is a fundamental piece to incorporate the Cultural Heritage in the policies of development and protection of the territory. Français: Le concept de paysage est polysémique et transdisciplinaire, condition de base pour la reconnaissance, l\u27aménagement et la gestion des paysages culturels, en vue de leur préservation intégrée, partagée et durable. Les extensions récentes du concept de patrimoine culturel ont apporté avec elles une ampleur, une diversité et une complexité qui s\u27avèrent contre-hégémoniques, exigeant une plus grande participation et une intégration socioculturelle. La construction du concept de paysage culturel a eu au Brésil d\u27importants penseurs, Lettres et Règlements tels que la Chancela del Landscape Cultural , la Portaria 375 ou la Constitution fédérale elle-même, en plus de diverses initiatives locales et de la déclaration, PatrimoineMundial, de lieux comme Rio, Pampulha ou Paraty. L\u27article 216 de la Constitution établit comme patrimoine culturel brésilien les « biens corporels et immatériels », soulignant qu\u27ils doivent être pris non seulement individuellement mais « dans son ensemble ». Face à cette révision conceptuelle, le comité brésilien réaffirme les PRINCIPES d\u27une nouvelle approche et application du concept de paysage culturel. L\u27AVANCE ÉPISTEMOLOGIQUE nous fait considérer le caractère systémique et complexe et ses relations, interactions, significations et interprétations. L\u27INTERACTION HOMME - NATURE doit s\u27exprimer à travers la société dans son ensemble. La DIVERSITÉ DES OBJECTIFS ET DES THÈMES, construits par des groupes associés à des pratiques et des lieux culturels, sont considérés comme de véritables palimpsestes. TERRITOIRES ET SYSTÈMES TERRITORIAUX caractérisent le locus, partageant des fonctions et des processus écologiques ou culturels. LE DÉVELOPPEMENT DURABLE intègre des actions de conservation, de requalification et de protection, en considérant une APPROCHE INTÉGRÉE ET INTÉGRÉE du paysage dans ses DIMENSIONS MATÉRIELLES, IMMATÉRIELLES ET NATURELLES. La DYNAMICITÉ et le caractère évolutif des paysages culturels impliquent la reconnaissance de leurs TRANSFORMATIONS et de leur INTÉRÊT PUBLIC, harmonisant les interactions public-privé, et la nécessité d\u27une GESTION INTÉGRÉE, PARTAGÉE ET PARTICIPATIVE. Le Paysage est une pièce fondamentale pour intégrer le Patrimoine Culturel dans les politiques de développement et de protection du territoire. Español: El concepto de paisaje es polisémico y transdisciplinario, condición básica para el reconocimiento, planificación y gestión de los paisajes culturales, con miras a su preservación integrada, compartida y sostenible. Las recientes ampliaciones del concepto de patrimonio cultural han traído consigo una amplitud, diversidad y complejidad que demuestran ser contrahegemónicas, exigiendo una mayor participación e integración sociocultural. La construcción del concepto de paisaje cultural ha tenido en Brasil importantes pensadores, Cartas y Reglamentos como la “Chancela del Paisaje Cultural”, la “Portaria 375” o la propia Constitución Federal, además de diversas iniciativas locales y la declaración, Patrimonio Mundial, de sitios como Rio, Pampulha o Paraty. El artículo 216 de la Constitución establece como patrimonio cultural brasileño “los bienes de carácter material e inmaterial”, destacando que deben ser tomados no solo individualmente sino “en conjunto”. Frente a esta revisión conceptual, el comité brasileño reafirma PRINCIPIOS para un nuevo abordaje y aplicación del concepto de Paisaje Cultural. El AVANCE EPISTEMOLÓGICO nos hace considerar el carácter sistémico y complejo y sus relaciones, interacciones, significados e interpretaciones. La INTERACIÓN HOMBRE- NATURALEZA debe expresarse a través de la sociedad en conjunto. La DIVERSIDAD DE OBJETIVOS Y TEMAS, construidos por grupos asociados a prácticas culturales y lugares, se consideran verdaderos palimpsestos. TERRITORIOS Y SISTEMAS TERRITORIALES caracterizan el locus, compartiendo funciones y procesos, ecológicos o culturales. El DESARROLLO SOSTENIBLE integra conservación, acciones de recualificación y protección, considerando un ENFOQUE INTEGRAL E INTEGRADO del paisaje en sus DIMENSIONES MATERIAL, INTANGIBLE Y NATURAL. La DINAMICIDAD y el carácter evolutivo de los paisajes culturales implica el reconocimiento de sus TRANSFORMACIONES y de su INTERÉS PÚBLICO, armonizando las interacciones público–privado, y la necesidad de una GESTIÓN INTEGRADA, COMPARTIDA Y PARTICIPATIVA. El Paisaje se constituye en pieza fundamental para incorporar el Patrimonio Cultural en las políticas de desarrollo y protección del territorio

Inflammation and Cancer: Role of Annexin A1 and FPR2/ALX in Proliferation and Metastasis in Human Laryngeal Squamous Cell Carcinoma

The anti-inflammatory protein annexin A1 (ANXA1) has been associated with cancer progression and metastasis, suggesting its role in regulating tumor cell proliferation. We investigated the mechanism of ANXA1 interaction with formylated peptide receptor 2 (FPR2/ALX) in control, peritumoral and tumor larynx tissue samples from 20 patients, to quantitate the neutrophils and mast cells, and to evaluate the protein expression and co-localization of ANXA1/FPR2 in these inflammatory cells and laryngeal squamous cells by immunocytochemistry. in addition, we performed in vitro experiments to further investigate the functional role of ANXA1/FPR2 in the proliferation and metastasis of Hep-2 cells, a cell line from larynx epidermoid carcinoma, after treatment with ANXA1(2-26) (annexin A1 N-terminal-derived peptide), Boc2 (antagonist of FPR) and/or dexamethasone. Under these treatments, the level of Hep-2 cell proliferation, pro-inflammatory cytokines, ANXA1/FPR2 co-localization, and the prostaglandin signalling were analyzed using ELISA, immunocytochemistry and real-time PCR. An influx of neutrophils and degranulated mast cells was detected in tumor samples. in these inflammatory cells of peritumoral and tumor samples, ANXA1/FPR2 expression was markedly exacerbated, however, in laryngeal carcinoma cells, this expression was downregulated. ANXA1(2-26) treatment reduced the proliferation of the Hep-2 cells, an effect that was blocked by Boc2, and up-regulated ANXA1/FPR2 expression. ANXA1(2-26) treatment also reduced the levels of pro-inflammatory cytokines and affected the expression of metalloproteinases and EP receptors, which are involved in the prostaglandin signalling. Overall, this study identified potential roles for the molecular mechanism of the ANXA1/FPR2 interaction in laryngeal cancer, including its relationship with the prostaglandin pathway, providing promising starting points for future research. ANXA1 may contribute to the regulation of tumor growth and metastasis through paracrine mechanisms that are mediated by FPR2/ALX. These data may lead to new biological targets for therapeutic intervention in human laryngeal cancer.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fed Univ São Paulo UNIFESP, Paulista Sch Med EPM, São Paulo, BrazilFac Med FAMERP, Dept Mol Biol, Sao Jose Do Rio Preto, SP, BrazilFac Med FAMERP, Dept Otorhinolaringol, Sao Jose Do Rio Preto, SP, BrazilFac Med FAMERP, Dept Pathol, Sao Jose Do Rio Preto, SP, BrazilSão Paulo State Univ UNESP, Dept Biol & Zoot, Ilha Solteira, SP, BrazilUniv São Paulo, Inst Biosci, Dept Genet & Evolutionary Biol, São Paulo, BrazilSão Paulo State Univ UNESP, Dept Biol, Inst Biociencias Letras & Ciencias Exatas IBILCE, Saa Jose Do Rio Preto, SP, BrazilFed Univ São Paulo UNIFESP, Paulista Sch Med EPM, São Paulo, BrazilFAPESP: 2008/08187-4FAPESP: 2008/01655-2CNPq: 302768/2010-6Web of Scienc

Ultrasound-Promoted Synthesis of 3-(Thiophen-2-yl)-4,5-dihydro-1H-pyrazole-1carboximidamides and Anticancer Activity Evaluation in Leukemia Cell Lines

3-(Thiophen-2-yl)-4,5-dihydro-1H-pyrazole-1-carboximidamides were efficiently prepared through a cyclocondensation of thiophenylchalcones with aminoguanidine hydrochloride under ultrasonic conditions in the presence of KOH and ethanol as a green solvent in short reaction times (15-35 min) and good yields (62-95%). All compounds produced were evaluated against the human Jurkat and RS411 acute lymphoblastic leukemia cell lines of T- and B-cell origin, respectively, and the K562 myelogenous leukemia cell line. Six compounds presented half maximal inhibitory concentration (IC50) values around 15 mu mol L-1 and five compounds presented IC50 values around 40 mu mol L-1 for at least one of the three cell lines analyzed. One compound was not significantly cytotoxic, presenting IC50 value > 100 mu mol L- 1.Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq)Fundacao de Apoio ao Desenvolvimento do Ensino, Ciencia e Tecnologia do Estado de Mato Grosso do Sul (FUNDECT)Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP)Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES)FAPESPCNPqFundacao Univ Fed Grande Dourados, Grp Pesquisa Sintese & Caracterizacao Mol MS, Rua Joao Rosa Goes 1761, BR-79825070 Dourados, MS, BrazilUniv Estadual Campinas, Inst Biol, Dept Genet & Biol Mol, Rua Monteiro Lobato 255, BR-13083970 Campinas, SP, BrazilCtr Infantil Boldrini, Mol Biol Lab, Rua Dr Gabriel Porto 1270, BR-13083210 Campinas, SP, BrazilUniv Fed Sao Paulo, Dept Ciencias Exatas & Terra, Rua Prof Artur Riedel 275, BR-09972270 Diadema, SP, BrazilUniv Fed Pelotas, Ctr Ciencias Quim Farmaceut & Alimentos, Lab Lipid & Bioorgan, Campus Univ, BR-96001900 Pelotas, RS, BrazilUniv Estadual Mato Grosso do Sul, Rua Emilio Mascolli 275, BR-79950000 Navirai, MS, BrazilUniv Fed Sao Paulo, Dept Ciencias Exatas & Terra, Rua Prof Artur Riedel 275, BR-09972270 Diadema, SP, BrazilCNPq: 483021/2013-0FUNDECT: 0180/12FAPESP: 12/12802-1Web of Scienc

Surgical and percutaneous revascularization outcomes based on SYNTAX I, II, and residual scores: A long-term follow-up study

BACKGROUND: The objective of this study was to evaluate the association of SYNTAX scores I, II, and residual with cardiovascular outcomes of patients undergoing coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) and compare both procedures in a long-term follow-up. METHODS: This is a retrospective single-center study from the MASS registry at the Heart Institute of the University of São Paulo, Brazil in which 969 patients with stable coronary artery disease undergoing CABG (559) or PCI (410) were included. We assessed the SYNTAX scores I, II and residual in both interventions. Clinical endpoints were the first occurrence of a composite of overall death, myocardial infarction, stroke, or repeat revascularization (MACCE) and the total occurrence of each component of MACCE. RESULTS: In the CABG sample, SSI had a median of 23 (IQR 17-29.5), median SSII of 25.4 (IQR 19.2-32.8), and median rSS of 2 (IQR 0-6.5); in PCI SSI had a median of 14 (IQR 10-19.1), median SSII of 28.7 (IQR 23-34.2), and median rSS of 4.7 (IQR 0-9). Total of 174 events were documented and CABG patients had a lower rate of MACCE (15.6% vs. 21.2%; adjusted HR 1.98; 95% CI 1.13-3.47; P = 0.016) and repeat revascularization (3.8% vs. 11.5%; adjusted HR 4.35; CI 95% 1.74-10.85; P = 0.002) compared with PCI. No SYNTAX score tertile found a difference in death rate between procedures. In a multivariate analysis, the rSS was an independent predictor for MACCE (HR 1.04; 95% CI 1.01-1.06; P = 0.001). Regarding death, the only independent predictors were ejection fraction and renal function. CONCLUSION: Surgical revascularization resulted in a more complete revascularization and lower rates of major cardiac or cerebrovascular events in a long-term follow-up. Also, grading the incompleteness of revascularization through the residual SYNTAX score identified a higher event rate, suggesting that complete revascularization is associated with a better prognosis