Plantio em faixas: uma nova técnica sob a análise multicriterial da funcionalidade ecológica

We evaluated band planting (BP) to assess its efficiency in the early restoring of ecological processes using a multi-criteria protocol known as Framework for the Evaluation of Natural Resource Management Systems Incorporating Sustainability Indicators (MESMIS) to obtain the ecological functionality consolidation index (EFCI). We sampled a 4.3 ha-1 plantation, aged 3 years, with BP, 1.5-m space between bands, 2-m space between seedlings, and a 3.5-m band of natural regeneration, ten areas with conventional planting (CP), aged 5 years, in the coverage and diversity models, and ten areas restored by natural regeneration (NR), aged 4 years. Sampling was carried out in 36 10 m x 10 m blocks, totaling 144 plots, 15 blocks for BP, 11 blocks for CP, and 10 blocks for NR. Species richness was similar between the areas; however, there was a significant difference between BP and the other areas (CP and NR) by the Dunn’s test (p < 0.05). The NR area had the highest diversity (H’ = 3.03; J’ = 0.76), followed by BP (H’ = 2.56; J’ = 0.62), and CP (H’ = 2.0; J’ = 0.48), whereas the BP area (4.348 ind.ha-1) had the highest density. The BP had the highest EFCI for diversity (0.100), control, and management (0.067) compared to NR, for diversity (0.022), and similar to CP in soil protection and nutrient cycling (0.047). BP was efficient in recovering early ecological processes under conditions similar to fragments in the initial stage of succession.Avaliamos o plantio em faixas (PF) em relação a sua eficiência na restauração precoce de processos ecológicos utilizando o protocolo multicriterial, para obter o índice de consolidação da funcionalidade ecológica (ICFE). Amostramos um plantio de 4,3 ha-1, com três anos de idade, no modelo de PF com 1,5 m de espaçamento entre faixas, 2 m entre mudas e uma faixa de 3,5 m de condução de regeneração natural, dez áreas com plantio convencional (PC), com cinco anos de idade, no modelo de preenchimento e diversidade e dez áreas restauradas por regeneração natural (RN), com três anos de idade. A amostragem foi realizada em 36 blocos com dimens es de 10 m x 10 m, totalizando 144 parcelas, sendo 15 blocos para PF, 11 blocos para PC e 10 blocos para RN. A riqueza de esp cies foi semelhante entre as  reas, mas houve diferen a significativa entre o PF e as demais  reas (PC e RN) pelo teste de Dunn (p < 0,05). A diversidade foi maior na  rea RN (H’ = 3,03; J’ = 0,76), seguida por PF (H’ = 2,56; J’ = 0,62 e PC (H’ = 2,0; J’ = 0,48), mas a maior densidade foi registrada para PF (4.348 ind.ha-1). PF apresentou o maior ICFE para diversidade (0,100), controle e manejo (0,067) em comparação com RN (0,022) e semelhante ao PC na proteção do solo e ciclagem de nutrientes (0,047). O PF foi eficiente na recuperação de processos ecológicos precoces em condições semelhantes a fragmentos em estágio inicial de sucessão

Pericardial Stentless Valve for Aortic Valve Replacement: Long-Term Results

The Freedom Solo (FS) bovine pericardial valve (Sorin Group, Milan, Italy) is a stentless bioprosthesis that was introduced in 2004 and approved by the United States Food and Drug Administration in 2014. No long-term follow-up series are available to date. We report the multicenter experience of 4 European institutions that began implanting FS extensively from its introduction, providing the largest series with long-term follow-up

Stentless sutureless and transcatheter valves: A comparison of the hemodynamic performance of different prostheses concept

Stentless aortic valves have been developed to overcome obstructive limitations associated with stented bioprostheses. A new concept of surgical sutureless (SU) bioprosthesis has been developed in the last decade. In this multi-institutional study we sought to compare hemodynamics of different bioprosthesis concept as transcatheter (TAVR), Livanova Perceval S sutureless valve and Freedom Solo Stentless (FS) valve in patients undergoing aortic valve replacement (sAVR)

Early hemodynamics and clinical outcomes of isolated aortic valve replacement with stentless or transcatheter valve in intermediate-risk patients

Objective Stentless aortic valves have been developed to overcome obstructive limitations associated with stented bioprostheses. The aim of the current multi-institutional study was to compare hemodynamics of transcatheter (TAVR) and the Freedom SOLO Stentless (FS) valve in an intermediate risk population undergoing surgical aortic valve replacement. Methods From 2010 to 2014, 420 consecutive patients underwent isolated surgical aortic valve replacement with FS and 375 patients underwent TAVR. Only patients with intermediate operative risk (Society of Thoracic Surgeons score 4-10) and small aortic annulus (\ue2\u89\ua423\uc2\ua0mm) were included. After a propensity matched analysis 142 patients in each group were selected. Thirty-day postoperative clinical and echocardiographic parameters were evaluated. Results Mean prosthesis diameter was 22.2\uc2\ua0\uc2\ub1\uc2\ua00.9\uc2\ua0mm for FS and 22.4\uc2\ua0\uc2\ub1\uc2\ua01.0\uc2\ua0mm for TAVR. In-hospital mortality was 2.1% for FS and 6.3% for TAVR (P\uc2\ua0=\uc2\ua0.02). Postoperative FS peak gradients were 19.1\uc2\ua0\uc2\ub1\uc2\ua09.6\uc2\ua0mm Hg (mean 10.8\uc2\ua0\uc2\ub1\uc2\ua05.9\uc2\ua0mm Hg); TAVR peak gradients were 20.2\uc2\ua0\uc2\ub1\uc2\ua09.5\uc2\ua0mm Hg (mean 10.7\uc2\ua0\uc2\ub1\uc2\ua06.9\uc2\ua0mm Hg) P\uc2\ua0=\uc2\ua0.57 (P\uc2\ua0=\uc2\ua0.88). Postoperative effective orifice area was 1.93\uc2\ua0\uc2\ub1\uc2\ua00.52\uc2\ua0cm2for FS and 1.83\uc2\ua0\uc2\ub1\uc2\ua00.3\uc2\ua0cm2for TAVR (P\uc2\ua0=\uc2\ua0.65). There was no prostheses-patient mismatch in either group. Postoperative grade 2-3 paravalvular leak was present in 3.5% for TAVR and 0.7% for FS. Postoperative permanent pacemaker implant rate was 12% for TAVR and only 1 case (0.7%) in the FS group (P\uc2\ua0<\uc2\ua0.001). Conclusions In patients with small aortic annulus and intermediate risk, both FS and TAVR demonstrated similar excellent hemodynamic performance. TAVR demonstrated greater mortality and rates of pacemaker insertion. Further studies are warranted to validate TAVR indications in this subset of patients

Poliprotect vs Omeprazole in the Relief of Heartburn, Epigastric Pain, and Burning in Patients Without Erosive Esophagitis and Gastroduodenal Lesions: A Randomized, Controlled Trial

Introduction: In the treatment of upper GI endoscopy-negative patients with heartburn and epigastric pain or burning, antacids, antireflux agents, and mucosal protective agents are widely used, alone or as add-on treatment, to increase response to proton-pump inhibitors, which are not indicated in infancy and pregnancy and account for significant cost expenditure. Methods: In this randomized, controlled, double-blind, double-dummy, multicenter trial assessing the efficacy and safety of mucosal protective agent Poliprotect (neoBianacid, Sansepolcro, Italy) vs omeprazole in the relief of heartburn and epigastric pain/burning, 275 endoscopy-negative outpatients were given a 4-week treatment with omeprazole (20 mg q.d.) or Poliprotect (5 times a day for the initial 2 weeks and on demand thereafter), followed by an open-label 4-week treatment period with Poliprotect on-demand. Gut microbiota change was assessed. Results: A 2-week treatment with Poliprotect proved noninferior to omeprazole for symptom relief (between-group difference in the change in visual analog scale symptom score: [mean, 95% confidence interval] -5.4, -9.9 to -0.1; -6.2, -10.8 to -1.6; intention-to-treat and per-protocol populations, respectively). Poliprotect's benefit remained unaltered after shifting to on-demand intake, with no gut microbiota variation. The initial benefit of omeprazole was maintained against significantly higher use of rescue medicine sachets (mean, 95% confidence interval: Poliprotect 3.9, 2.8-5.0; omeprazole 8.2, 4.8-11.6) and associated with an increased abundance of oral cavity genera in the intestinal microbiota. No relevant adverse events were reported in either treatment arm. Discussion: Poliprotect proved noninferior to standard-dose omeprazole in symptomatic patients with heartburn/epigastric burning without erosive esophagitis and gastroduodenal lesions. Gut microbiota was not affected by Poliprotect treatment. The study is registered in Clinicaltrial.gov (NCT03238534) and the EudraCT database (2015-005216-15)

Rabeprazole is equivalent to omeprazole in the treatment of erosive gastro-oesophageal reflux disease. A randomised, double-blind, comparative study of rabeprazole and omeprazole 20 mg in acute treatment of reflux oesophagitis, followed by a maintenance open-label, low-dose therapy with rabeprazole

Background.: Previous studies have shown similar effects of rabeprazole and omeprazole, when used at the same dose in the treatment of reflux oesophagitis. However, such studies have been conducted as superiority studies but interpreted as equivalence ones. Aim.: To properly assess the comparative efficacy of rabeprazole and omeprazole in inducing complete endoscopic healing and symptom relief in patients with reflux oesophagitis. Methods.: Patients (n = 560) with Savary-Miller grade I-III reflux oesophagitis were randomised in a double-blind, double-dummy fashion to rabeprazole or omeprazole 20 mg once daily for 4-8 weeks. Then, patients endoscopically healed and symptomatically relieved were openly maintained with rabeprazole 10 mg or 2 × 10 mg once daily (in the event of clinical and/or endoscopic relapse) for a maximum of 48 weeks. Results.: After 4-8 weeks of treatment, healing (primary end-point) was observed in 228/233 (97.9%) patients in the rabeprazole group and in 231/237 (97.5%) in the omeprazole one (equivalence effect demonstrated by p < 0.0001 at Blackwelder test and an upper confidence limit at 97.5% of 0.023). However, rabeprazole was faster in inducing heartburn relief than omeprazole (2.8 ± 0.2 versus 4.7 ± 0.5 days of therapy to reach the first day with satisfactory heartburn relief, p = 0.0045 at log-rank test). In the maintenance phase, 15.2% of patients had an endoscopic and/or clinical relapse. Conclusion.: Rabeprazole is equivalent to omeprazole in healing reflux oesophagitis, but shows a faster activity on reflux symptoms in the early treatment phase. © 2005 Editrice Gastroenterologica Italiana S.r.l