Coronary-artery bypass surgery in patients with ischemic cardiomyopathy

BACKGROUND The survival benefit of a strategy of coronary-artery bypass grafting (CABG) added to guideline-directed medical therapy, as compared with medical therapy alone, in patients with coronary artery disease, heart failure, and severe left ventricular systolic dysfunction remains unclear. METHODS From July 2002 to May 2007, a total of 1212 patients with an ejection fraction of 35% or less and coronary artery disease amenable to CABG were randomly assigned to undergo CABG plus medical therapy (CABG group, 610 patients) or medical therapy alone (medical-therapy group, 602 patients). The primary outcome was death from any cause. Major secondary outcomes included death from cardiovascular causes and death from any cause or hospitalization for cardiovascular causes. The median duration of follow-up, including the current extended-follow-up study, was 9.8 years. RESULTS A primary outcome event occurred in 359 patients (58.9%) in the CABG group and in 398 patients (66.1%) in the medical-therapy group (hazard ratio with CABG vs. medical therapy, 0.84; 95% confidence interval [CI], 0.73 to 0.97; P=0.02 by log-rank test). A total of 247 patients (40.5%) in the CABG group and 297 patients (49.3%) in the medical-therapy group died from cardiovascular causes (hazard ratio, 0.79; 95% CI, 0.66 to 0.93; P=0.006 by log-rank test). Death from any cause or hospitalization for cardiovascular causes occurred in 467 patients (76.6%) in the CABG group and in 524 patients (87.0%) in the medical-therapy group (hazard ratio, 0.72; 95% CI, 0.64 to 0.82; P<0.001 by log-rank test). CONCLUSIONS In a cohort of patients with ischemic cardiomyopathy, the rates of death from any cause, death from cardiovascular causes, and death from any cause or hospitalization for cardiovascular causes were significantly lower over 10 years among patients who underwent CABG in addition to receiving medical therapy than among those who received medical therapy alone. (Funded by the National Institutes of Health; STICH [and STICHES] ClinicalTrials.gov number, NCT00023595.

Avaliação de seleções de morangueiro do programa de melhoramento genético da Embrapa na região de Atibaia/SP.

Resumo: A carência de genótipos de morangueiro desenvolvidos nas condições brasileiras gera dependência de cultivares estrangeiras e consequente vulnerabilidade do setor produtivo. O objetivo do presente trabalho foi avaliar o desempenho produtivo e a qualidade das frutas de três seleções avançadas (31-09, 35-06, 35-22) e da cultivar recém registrada BRS DC 25 (BRS Fênix), do Programa de Melhoramento Genético de Morangueiro da Embrapa, e de duas tradicionais cultivares comerciais de dias curtos, Camarosa e Camino Real, em Atibaia/SP, Capital Nacional do Morango. O experimento foi desenvolvido em campo aberto sob sistema de produção integrada, utilizando delineamento experimental inteiramente casualizado com quatro repetições de dez plantas, totalizando 240 plantas. A seleção 31-09 se destacou na produção de frutas comerciais, massa média de frutas e produção por planta. A cultivar BRS Fênix se destacou pela massa média de frutas e pelo alto percentual de frutas comerciais produzidas. A seleção 35-22 mostrou desempenho similar ao da cultivar Camino Real, assim como a 35-06 foi semelhante à Camarosa, não diferindo estatisticamente entre si em nenhum quesito avaliado. Todos os materiais apresentaram teor de sólidos solúveis adequados para comercialização, sem diferença estatística entre si e, em geral, se mostraram muito promissores em comparação às cultivares comerciais. -- Abstract: The lack of strawberry genotypes developed under Brazilian conditions leads to dependence on foreign cultivars and consequent vulnerability in the production sector. The objective of this study was to evaluate the productive performance and fruit quality of three advanced selections of strawberry (31-09, 35-06, 35-22) and of the newly registered cultivar BRS DC 25 (BRS Fênix) developed by Embrapa Strawberry Breeding Program, along with two traditional commercial short- day cultivars, Camarosa and Camino Real, in Atibaia/SP, the National Strawberry Capital. The experiment was conducted in an open field using integrated production system, employing a completely randomized experimental design with four replications of ten plants, totaling 240 plants. Selection 31-09 stood out in terms of commercial fruit production, average fruit weight, and yield per plant. BRS Fênix cultivar stood out for its average fruit weight and high percentage of commercial fruits produced. Selection 35-22 performed similarly to the Camino Real cultivar, while 35-06 showed similarities to the Camarosa cultivar, with no statistical differences observed among them in any evaluated aspect. All materials presented a suitable content of soluble solid for commercialization, with no statistical difference among them, and, in general, were very promising compared to commercial cultivars.CIIC 2023. Nº 23410

Bioprosthetic mitral valve thrombosis less than one year after replacement and an ablative MAZE procedure: a case report

Occurrence of bioprosthetic valve thrombosis less than a year after replacement is very uncommon. Here, we describe a case of a 57 year old male, who presented 10 months after receiving a bioprosthetic mitral valve replacement with a two week history of dyspnea on exertion, worsening orthopnea and decreased exercise tolerance. Echocardiography revealed severe mitral regurgitation (MR), thrombosis of the posterior mitral leaflet, left atrial (LA) mural thrombus and a depressed left ventricular ejection fraction of twenty-five percent. Given severe clot burden and decompensated heart failure (New York Heart Association - NYHA class III) repeat sternotomy was done to replace the bioprosthetic mitral valve and remove LA mural thrombus. MR was resolved postoperatively. This brief report further reviews promoting factors, established guidelines and management strategies of bioprosthetic valve thrombosis

Paisagens e práticas que favorecem polinizadores e a biodiversidade.

O desaparecimento, ou redução, dos polinizadores nas últimas décadas está gerando preocupação social e econômica no mundo

Avaliação do procedimento de intubação traqueal em unidades de referência de terapia intensiva pediátricas e neonatais

OBJETIVO: Descrever a taxa de sucesso e os fenômenos associados ao procedimento de intubação traqueal em duas unidades de terapia intensiva neonatais e duas pediátricas de Porto Alegre. MÉTODOS: Estudo transversal, com etapas retrospectiva e prospectiva, em que foram avaliadas todas as intubações ocorridas durante 6 meses em quatro unidades selecionadas. Realizou-se revisão padronizada de prontuários e entrevista com os médicos responsáveis, para caracterizar o procedimento de intubação. Utilizou-se o teste t para variáveis contínuas com distribuição normal, Mann-Whitney para distribuição assimétrica e o qui-quadrado para variáveis categóricas, com p OBJECTIVE: To describe intubation procedures in two pediatric and two neonatal intensive care units in the city of Porto Alegre. METHODS: Cross-sectional study divided into a retrospective and a prospective phase. All intubations performed in these units during a 6-month period were considered. Data were collected by interviewing the physician responsible for the procedure and reviewing the patients' charts, including drugs administered, sedation status, number of attempts, difficulties and complications during the procedure. Data were analyzed using the t test and the Mann-Whitney test for continuous variables and chi-square test for categorical variables, considering a p < 0.05. RESULTS: Sedatives were administered in 89.5% of the 134 pediatric procedures and 24% of the 116 neonatal procedures (p < 0.001). Muscle relaxants were prescribed for 3% of the children and 0.9% of the neonates. Only 53.7% of the children and 31.9% of the neonates were considered as adequately relaxed. The children who were inadequately relaxed had more intubations attempts (2.4&plusmn;1.3 vs 1.7&plusmn;1.2 p = 0.001), became more hypoxemic (20.9 vs 5.5% p = 0.015) and were more difficult to intubate (54.8 vs 25% p < 0.001). There were more urgent cases and more intubations attempts (2&plusmn;1.2 vs 1.5&plusmn;0.9 p = 0.036) among the inadequately relaxed neonates. Difficulties and complications occurred in 38.8 and 28.3% of the pediatric cases and 29 and 12% of the neonatal cases, respectively. CONCLUSIONS: There was no established routine for intubation procedures in the units studied, and the use of muscle relaxants was not usual. The absence of adequate muscle relaxation is associated with more intubation attempts, difficulties and hypoxemia during the intubation procedure