TCT-44 Independent Mitral Valve Restenosis Predictors After Percutaneous Mitral Balloon Valvuloplasty In A Large, Consecutive Cohort Followed For More Than Two Decades

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Physical soil properties after seven years of composted tannery-sludge application

This study was performed to investigate the effects of composted tannery sludge (CTS) on the physical properties of tropical sandy soil after seven years of CTS application. CTS was applied to a Fluvisol at five rates (0.0, 2.5, 5.0, 10.0, and 20.0 Mg ha-1) in experimental plots (sized 20 m2) with four replications. Water infiltration into the soil was determined in the field with the concentric-ring infiltrometer method. Bulk density, total porosity, macroporosity, and microporosity were determined in the soil samples. The permanent CTS application altered the physical properties of the soil and led to a decrease in bulk density. The total porosity, microporosity and macroporosity values in the CTS-applied soil ranged from 44.1–51.7, 34.6–39.4, and 9.1–12.8%, respectively. Water-infiltration rates were significantly influenced by CTS. The cumulative infiltrated water in the soil varied from 21.3–34.7 cm. The basic infiltration rate was lower in the unamended soil and increased with an increase in the rate of CTS application. This study confirmed that the physical soil parameters improved after the permanent CTS application. Therefore, this application may be a suitable strategy for improving physical soil properties over time

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Ensino de análise do comportamento com o uso de questões sociocientíficas: um caso sobre a medicalização da vida

A educação científica sob um viés tecnicista e de mera transmissão de conhecimentos acumulados, desde uma perspectiva descontextualizada em termos históricos, filosóficos e sociais tem enfrentado diversas críticas. Neste contexto, as questões sociocientíficas surgiram como uma estratégia didática alternativa, no sentido, sobretudo, de contextualizar socialmente o conteúdo científico, nas aulas de ciências e nos cursos de formação de cientistas. Este artigo tem por objetivo analisar e discutir a utilização de uma questão sociocientífica no ensino de Análise do Comportamento, no que concerne à mobilização de conteúdos conceituais, procedimentais e atitudinais. O estudo focalizou uma turma em um curso de graduação em Psicologia, em Salvador (Bahia, Brasil). Tratando-se de um estudo exploratório inicial, a Questão Sociocientífica consistiu na utilização de um caso acerca da medicalização da vida, bem como de perguntas acerca do mesmo, com a função de organização dos conteúdos atitudinais, procedimentais e conceituais abordados na disciplina. A interpretação dos dados gerados fundamentou-se na análise de conteúdo, avaliando-se também o quanto os alunos alcançaram os objetivos de aprendizagem dos conteúdos propostos. A análise dos dados indica que a utilização de uma Questão Sociocientífica possibilitou uma mobilização significativa e contextualizada dos conteúdos conceituais, procedimentais e atitudinais, permitindo aos alunos um entendimento crítico e autônomo do significado dos conteúdos trabalhados na disciplina para a inserção social do psicólogo em contextos profissional, acadêmico e cotidiano

Incidence, Clinical Characteristics, and Impact of Acute Coronary Syndrome Following Transcatheter Aortic Valve Replacement.

The authors sought to assess the incidence, predictors, management, and prognosis of acute coronary syndrome (ACS) following TAVR. About one-half of the patients undergoing transcatheter aortic valve replacement (TAVR) have concurrent coronary artery disease (CAD). However, the occurrence and clinical impact of coronary events following TAVR remain largely unknown. Consecutive patients undergoing TAVR in our institution between May 2007 and November 2017 were included. Patients were followed at 1, 6, and 12 months, and yearly thereafter. ACS was diagnosed and classified according to the Third Universal Definition of Myocardial Infarction. A total of 779 patients (mean age 79 ± 9 years, 52% male, mean STS: 6.8 ± 5.1%) were included, 68% of which had a history of CAD. At a median follow-up of 25 (interquartile range: 10 to 44) months, 78 patients (10%) presented at least 1 episode of ACS, with one-half of the events occurring within the year following TAVR. Clinical presentation was type 2 non-ST-segment elevation myocardial infarction (35.9%), unstable angina (34.6%), type 1 non-ST-segment elevation myocardial infarction (28.2%), and ST-segment elevation myocardial infarction (1.3%). Male sex (hazard ratio [HR]: 2.19; 95% confidence interval [CI]: 1.36 to 3.54; p = 0.001), prior CAD (HR: 2.78; 95% CI: 1.50 to 5.18; p = 0.001), and nontransfemoral approach (HR: 1.71; 95% CI: 1.04 to 2.75; p = 0.035) were independently associated with ACS. Coronary angiography was performed in 53 (67.9%) patients with ACS, and 30 of them (56.6%) underwent percutaneous coronary intervention. In-hospital death rate at the time of the ACS episode was 3.8%. At a median follow-up of 21 (interquartile range: 8 to 34) months post-ACS, all-cause and cardiovascular death rates were 37.3% and 25.3%, respectively. Approximately one-tenth of patients undergoing TAVR were readmitted for an ACS after a median follow-up of 25 months. Male sex, prior CAD, and nontransfemoral approach were independent predictors of ACS. ACS was associated with high midterm mortality

Late Cerebrovascular Events Following Transcatheter Aortic Valve Replacement.

This study sought to determine the incidence, clinical characteristics, associated factors, and outcomes of late cerebrovascular events (LCVEs) (>30 days post-procedure) following transcatheter aortic valve replacement (TAVR). Scarce data exist on LCVEs following TAVR. This was a multicenter study including 3,750 consecutive patients (mean age, 80 ± 8 years; 50.5% of women) who underwent TAVR and survived beyond 30 days. LCVEs were defined according to the Valve Academic Research Consortium 2 (VARC 2) criteria. LCVEs occurred in 192 (5.1%) patients (stroke, 80.2%; transient ischemic attack, 19.8%) after a median follow-up of 2 (1 to 4) years. Late stroke was of ischemic, hemorrhagic, and undetermined origin in 80.5%, 18.8%, and 0.7% of patients, respectively. Older age, previous cerebrovascular disease, higher mean aortic gradient at baseline, the occurrence of stroke during the periprocedural TAVR period, and the lack of anticoagulation (novel oral anticoagulants or vitamin K antagonists) post-TAVR were independent factors associated with late ischemic stroke/transient ischemic attack (p  LCVEs occurred in 5.1% of TAVR recipients after a median follow-up of 2 years. LCVEs were ischemic in most cases, with older age, previous cerebrovascular events, higher mean aortic gradient at baseline, the occurrence during the periprocedural TAVR period, and lack of anticoagulation (but not valve thrombosis/degeneration) determining an increased risk. Late stroke was disabling in most cases and associated with dreadful early and midterm outcomes