Guideline-directed medical therapy in severe heart failure with reduced ejection fraction: an analysis from the HELP-HF registry.

AIM: Persistent symptoms despite guideline-directed medical therapy (GDMT) and poor tolerance of GDMT are hallmarks of patients with advanced heart failure (HF) with reduced ejection fraction (HFrEF). However, real-world data on GDMT use, dose, and prognostic implications are lacking. METHODS AND RESULTS: We included 699 consecutive patients with HFrEF and at least one 'I NEED HELP' marker for advanced HF enrolled in a multicentre registry. Beta-blockers (BB) were administered to 574 (82%) patients, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers or angiotensin receptor-neprilysin inhibitors (ACEi/ARB/ARNI) were administered to 381 (55%) patients and 416 (60%) received mineralocorticoid receptor antagonists (MRA). Overall, ≥50% of target doses were reached in 41%, 22%, and 56% of the patients on BB, ACEi/ARB/ARNI and MRA, respectively. Hypotension, bradycardia, kidney dysfunction and hyperkalaemia were the main causes of underprescription and/or underdosing, but up to a half of the patients did not receive target doses for unknown causes (51%, 41%, and 55% for BB, ACEi/ARB/ARNI and MRA, respectively). The proportions of patients receiving BB and ACEi/ARB/ARNI were lower among those fulfilling the 2018 HFA-ESC criteria for advanced HF. Treatment with BB and ACEi/ARB/ARNI were associated with a lower risk of death or HF hospitalizations (adjusted hazard ratio [HR] 0.63, 95% confidence interval [CI] 0.48-0.84, and HR 0.74, 95% CI 0.58-0.95, respectively). CONCLUSIONS: In a large, real-world, contemporary cohort of patients with severe HFrEF, with at least one marker for advanced HF, prescription and uptitration of GDMT remained limited. A significant proportion of patients were undertreated due to unknown reasons suggesting a potential role of clinical inertia either by the prescribing healthcare professional or by the patient. Treatment with BB and ACEi/ARB/ARNI was associated with lower mortality/morbidity

EXPLORANDO As Potencialidades do BIM na Arquitetura de Interiores: Estudo de Caso

Em meio à era da tecnologia e informação digital, os principais meios de expressão gráfica tradicionalmente utilizados hoje na arquitetura são os modelos 2D, dentre os quais mais se destaca o AutoCAD. Esse tipo de modelo cada vez mais se mostra insuficiente para atender às demandas da indústria da construção, mais especificamente em arquitetura de interiores. A atual busca constante para suprir a demanda exigida pelo mercado que, inclui novas soluções para reduzir custos, rentabilizar negócios, melhorar a qualidade e produtividade dos projetos, além da discussão e aplicação cada vez mais presente da sustentabilidade fizeram as áreas encontrarem na tecnologia BIM (Building Information Modeling), um forte aliado nessa expansão. O BIM ou Modelagem da Informação da Construção se trata de um processo que possui grande potencial para utilização na arquitetura, incluindo projetos de interiores, uma vez que permite a representação da edificação com dados e informações que geram um modelo virtual 3D onde são inseridas as especificações, características dos materiais, etc. Apesar das potencialidades da aplicação do BIM para o uso em projetos de interiores, sua adoção na área ainda não é difundida e existem poucos estudos que abordam como essa tecnologia auxilia nesse processo. O objetivo geral deste trabalho é explorar as potencialidades do uso da tecnologia BIM em projetos de interiores por meio de um estudo de caso do projeto de reforma de um apartamento utilizando softwares BIM. A partir disso foram analisados os resultados encontrados, a fim de destacar as potencialidades para o uso dessa tecnologia em projetos de arquitetura de interiores e, dessa forma, contribuir para a disseminação do conhecimento e aplicação do BIM, incentivando seu uso e o interesse de novos pesquisadores para a área

Autoradiographic and ultrastructural studies on the human fibro-atheromatous plaque

Foam cells, either myogenic or macrophagic, are commonly detected in experimental and human fibro-atheromatous plaques. Their role in human atherosclerosis is not yet understood. This paper reports on a preliminary autoradiographic study combined with ultrastructural observations in the human fibro-atheromatous plaque. Most of the autoradiographic silver grains appeared on foam cells and monocyte-like cells, thus suggesting a local proliferation of these cells

Large-vessel endothelium switches to a microvascular phenotype during angiogenesis in collagen gel culture of rat aorta.

The purpose of this study was to investigate the vasoformative behavior in vitro of the native intimal endothelium of the rat aorta. To visualize the intimal surface directly, thoracic aortas were everted using a procedure that sequestered adventitial cells and possible remnant microvessels of periaortic soft tissues inside the aortic tube. Everted aortas embedded in collagen gel and cultured under serum-free conditions generated branching microvessels by a process of sprouting from the aortic intima. The newly formed microvessels originated from patches of activated intimal endothelial cells, which had survived the mechanical damage of the eversion procedure. Activated endothelial cells crawled over each other and engaged in lumen formation forming bilayers or multilayers of cells which became the source of sprouting histotypic microvessels. The endothelium of the newly formed microvessels was positive for factor VIII-related antigen and was partially surrounded by periendothelial cells which expressed alpha-smooth muscle actin. The results of this study indicate that the intimal endothelium of the rat aorta has considerable functional plasticity and can switch to a vasoformative phenotype in response to changes in the surrounding extracellular matrix environment

Large-vessel endothelium switches to a microvascular phenotype during angiogenesis in collagen gel culture of rat aorta.

The purpose of this study was to investigate the vasoformative behavior in vitro of the native intimal endothelium of the rat aorta. To visualize the intimal surface directly, thoracic aortas were everted using a procedure that sequestered adventitial cells and possible remnant microvessels of periaortic soft tissues inside the aortic tube. Everted aortas embedded in collagen gel and cultured under serum-free conditions generated branching microvessels by a process of sprouting from the aortic intima. The newly formed microvessels originated from patches of activated intimal endothelial cells, which had survived the mechanical damage of the eversion procedure. Activated endothelial cells crawled over each other and engaged in lumen formation forming bilayers or multilayers of cells which became the source of sprouting histotypic microvessels. The endothelium of the newly formed microvessels was positive for factor VIII-related antigen and was partially surrounded by periendothelial cells which expressed alpha-smooth muscle actin. The results of this study indicate that the intimal endothelium of the rat aorta has considerable functional plasticity and can switch to a vasoformative phenotype in response to changes in the surrounding extracellular matrix environment