Artigos e Materiais de Revistas Científicas - FM/MCP

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A coleção de Artigos e Materiais de Revistas Científicas engloba artigos originais, artigos de revisão, artigos de atualização, artigos técnicos, relatos de experiências, resenhas, ensaios, editoriais, cartas ao editor, debates, notas científicas e técnicas, depoimentos, entrevistas e pontos de vista. Consideram-se como artigos científicos originais os trabalhos redigidos para divulgação de informações e resultados sobre determinada pesquisa científica, publicados em periódico científico após avaliação por outros pesquisadores.


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  • article 0 Citação(ões) na Scopus
    Post-COVID-19 respiratory sequelae two years after hospitalization: an ambidirectional study
    (2024) CARVALHO, Carlos Roberto Ribeiro; LAMAS, Celina de Almeida; LUNA, Luis Augusto Visani de; CHATE, Rodrigo Caruso; SALGE, Joao Marcos; SAWAMURA, Marcio Valente Yamada; TOUFEN, Carlos; GARCIA, Michelle Louvaes; SCUDELLER, Paula Gobi; NOMURA, Cesar Higa; GUTIERREZ, Marco Antonio; BALDI, Bruno Guedes
    Background COVID-19 lung sequelae can impact the course of patient lives. We investigated the evolution of pulmonary abnormalities in post-COVID-19 patients 18-24 months after hospital discharge. Methods A cohort of COVID-19 patients admitted to the Hospital das Cl & iacute;nicas da Faculdade de Medicina da USP in S & atilde;o Paulo, Brazil, between March and August of 2020, were followed-up 6-12 months after hospital discharge. A subset of patients with pulmonary involvement and chest computed tomography (CT) scans were eligible to participate in this second follow-up (18-24 months). Data was analyzed in an ambidirectional manner, including retrospective data from the hospitalization, and from the first follow-up (6-12 months after discharge), and compared with the prospective data collected in this new follow-up. Findings From 348 patients eligible, 237 (68%) participated in this follow-up. Among participants, 139 (58%) patients presented ground-glass opacities and reticulations, and 80 (33%) presented fibrotic-like lesions (traction bronchiectasis and architectural distortion). Five (2%) patients improved compared to the 6-12-month assessment, but 20 (25%) of 80 presented worsening of lung abnormalities. For those with relevant assessments on both occasions, comparing the CT findings between this follow-up with the previous assessment, there was an increase in patients with architectural distortion (43 [21%] of 204 vs 57 [28%] of 204, p = 0.0093), as well as in traction bronchiectasis (55 [27%] of 204 vs 69 [34%] of 204, p = 0.0043). Patients presented a persistent functional impairment with demonstrated restrictive pattern in both follow-ups (87 [42%] of 207 vs 91 [44%] of 207, p = 0.76), as well as for the reduced diffusion capacity (88 [42%] of 208 vs 87 [42%] of 208, p = 1.0). Length of hospitalization (OR 1.04 [1.01-1.07], p = 0.0040), invasive mechanical ventilation (OR 3.11 [1.3-7.5] p = 0.011), patient's age (OR 1.03 [1.01-1.06] p = 0.0074 were consistent predictors for development of fibrotic-like lung lesions in post-COVID-19 patients. Interpretation Post-COVID-19 lung sequelae can persist and progress after hospital discharge, suggesting airways involvement and formation of new fibrotic-like lesions, mainly in patients who were in intensive care unit (ICU). Funding S & atilde;o Paulo Research Foundation (22/01769-5) and Instituto Todos pela Sa & uacute;de (C1721).
  • article 0 Citação(ões) na Scopus
    Sternal cleft: new options for reconstruction
    (2024) MACEDO, Joao Paulo Cassiano de; ARAUJO, Pedro Henrique Xavier Nabuco de; CAMPOS, Jose Ribas Milanez de; PEGO-FERNANDES, Paulo Manuel
    Sternal cleft (SC) is a rare congenital affection caused by the absence of sternal bar union. Diagnosis is generally made after birth due to paradoxical midline movement, although it can be made prenatally by ultrasonography. A computerized tomography scan (CT scan) after birth is generally used to confirm the diagnosis, assess other intrathoracic conditions, classify the SC, and plan for surgery. SC can be classified as complete or incomplete. A complete SC has a full gap between sternal bars. An incomplete SC is subdivided into superior or inferior, related to the point of bone fusion between the sternal bars. The goal of surgical treatment is to protect mediastinal structures. Many authors advocate the repair in newborn patients, although it can be performed in older patients. The main argument in its favor is the chest's flexibility, with a reduced risk of compression of the mediastinal structures. There are several cases of series and distinct surgical techniques in the literature. Some authors have suggested the use of autologous tissue, prosthetic material such as mesh, or titanium plates and screws. Although difficulties are often encountered in surgical access, they have not been discussed. Therefore, we are promoting modifications to the technique in response to this. The purpose is to show innovations, and how to deal with adversity during the procedure.
  • article 1 Citação(ões) na Scopus
    Changing trends in clinical characteristics and in-hospital mortality of patients with infective endocarditis over four decades
    (2024) SANTOS, Diego Augusto Medeiros; SICILIANO, Rinaldo Focaccia; BESEN, Bruno Adler Maccagnan Pinheiro; STRABELLI, Tania Mara Varejao; SAMBO, Caio Trevelin; MILCZWSKI, Vitor de Medeiros; GOLDEMBERG, Flora; TARASOUTCHI, Flavio; VIEIRA, Marcelo Luiz Campos; PAIXAO, Milena Ribeiro; GUALANDRO, Danielle Menosi; ACCORSI, Tarso Augusto Duenhas; POMERANTZEFF, Pablo Maria Alberto; MANSUR, Alfredo Jose
    Background: Infective endocarditis continues to be a significant concern and may be undergoing an epidemiological transition. Methods: Were studied 1804 consecutive episodes of infective endocarditis between 1978 and 2022. The mean age was 48 ( +/- 19), and 1162 (64%) patients were male. Temporal trends in demographic data, comorbidities, predisposing conditions, microorganisms, complications and in-hospital death have been studied over the decades (1978-1988, 1989-1999, 2000-2010 and 2011-2022). The outcomes and clinical characteristics were modeled using nonlinear cubic spline functions. Findings: Valve surgery was performed in 50% of the patients and overall in-hospital mortality was 30%. From the first to the fourth decade studied, the average age of patients increased from 29 to 57 years (p < 0.001), with significant declines in the occurrence of rheumatic valvular heart disease (15% to 6%; p < 0.001) and streptococcal infections (46% to 33%; p < 0.001). Healthcare-associated infections have increased (9% to 21%; p < 0.001), as have prosthetic valve endocarditis (26% to 53%; p < 0.001), coagulasenegative staphylococcal infections (4% to 11%; p < 0.001), and related-complications (heart failure, embolic events, and perivalvular abscess; p < 0.001). These changes were associated with a decline in adjusted inhospital mortality from 34% to 25% (p = 0.019). Interpretation: In the 44 years studied, there was an increase in the mean age of patients, healthcarerelated, prosthetic valve, coagulase-negative staphylococci/MRSA infections, and related complications. Notably, these epidemiological changes were associated with a decline in the adjusted in-hospital mortality.
  • article 1 Citação(ões) na Scopus
    Sex Differences in Prognosis of Heart Failure Due to Ischemic and Nonischemic Cardiomyopathy
    (2023) MANSUR, Antonio de Padua; PEREIRA-BARRETTO, Antonio Carlos; CARLO, Carlos Henrique del; AVAKIAN, Solange Desiree; NAKAGAWA, Naomi Kondo; CESAR, Luiz Antonio Machado; BOCCHI, Edimar Alcides
    Background: Limited research has explored sex-specific differences in death predictors of HF patients with ischemic (iCMP) and nonischemic (niCMP) cardiomyopathy. This study assessed sex differences in niCMP and iCMP prognosis. Methods: We studied 7487 patients with HF between February 2017 and September 2020. Clinical features and echocardiographic findings were collected. We used Kaplan-Meier, Cox proportional hazard models, and chi-square scores of Cox regression to determine death predictors in women and men. Results: The mean age was 64.3 +/- 14.2 years, with 4417 (59%) males. Women with iCMP and niCMP exhibited a significantly higher mean age, higher mean left ventricular ejection fraction, and smaller left ventricular diastolic diameter than men. Over 2.26 years of follow-up, 325 (14.7%) women and 420 (15.7%) men, and 211 women (24.5%) and 519 men (29.8%) with niCMP (p = NS) and iCMP (p = 0.004), respectively, died. The cumulative incidence of death was higher in men with iCMP (log-rank p < 0.0001) but similar with niCMP. Cox regression showed chronic kidney disease, diabetes, stroke, atrial fibrillation, age, and myocardial infarction as the main predictors of death for iCMP in women and men. Conclusions: Women exhibited a better prognosis than men with iCMP, but similar for niCMP. Nevertheless, sex was not an independent predictor of death for both CMP.
  • article 0 Citação(ões) na Scopus
    17β-estradiol and methylprednisolone association as a therapeutic option to modulate lung inflammation in brain-dead female rats
    (2024) VIDAL-DOS-SANTOS, Marina; ANUNCIACAO, Lucas F.; ARMSTRONG-JR, Roberto; RICARDO-DA-SILVA, Fernanda Y.; RAMOS, Isabella Yumi Taira; CORREIA, Cristiano J.; MOREIRA, Luiz F. P.; LEUVENINK, Henri G. D.; BREITHAUPT-FALOPPA, Ana C.
    Introduction: Brain death (BD) is known to compromise graft quality by causing hemodynamic, metabolic, and hormonal changes. The abrupt reduction of female sex hormones after BD was associated with increased lung inflammation. The use of both corticoids and estradiol independently has presented positive results in modulating BD-induced inflammatory response. However, studies have shown that for females the presence of both estrogen and corticoids is necessary to ensure adequate immune response. In that sense, this study aims to investigate how the association of methylprednisolone (MP) and estradiol (E2) could modulate the lung inflammation triggered by BD in female rats. Methods: Female Wistar rats (8 weeks) were divided into four groups: sham (animals submitted to the surgical process, without induction of BD), BD (animals submitted to BD), MP/E2 (animals submitted to BD that received MP and E2 treatment 3h after BD induction) and MP (animals submitted to BD that received MP treatment 3h after BD induction). Results: Hemodynamics, systemic and local quantification of IL-6, IL-1 beta, VEGF, and TNF-alpha, leukocyte infiltration to the lung parenchyma and airways, and adhesion molecule expression were analyzed. After treatment, MP/E2 association was able to reinstate mean arterial pressure to levels close to Sham animals (p<0.05). BD increased leukocyte infiltration to the airways and MP/E2 was able to reduce the number of cells (p=0.0139). Also, the associated treatment modulated the vasculature by reducing the expression of VEGF (p=0.0616) and maintaining eNOS levels (p=0.004) in lung tissue. Discussion: Data presented in this study show that the association between corticoids and estradiol could represent a better treatment strategy for lung inflammation in the female BD donor by presenting a positive effect in the hemodynamic management of the donor, as well as by reducing infiltrated leukocyte to the airways and release of inflammatory markers in the short and long term.
  • article 0 Citação(ões) na Scopus
    Hypertrophic cardiomyopathy as a high-risk feature on perioperative care: How to deal with this self-fulfilling prophecy?
    (2024) BICHUETTE, Luciana Dornfeld; LOTTENBERG, Marcos Pita; CARAMELLI, Bruno
  • article 4 Citação(ões) na Scopus
    Electrical Impedance Tomography Identifies Evolution of Regional Perfusion in a Porcine Model of Acute Respiratory Distress Syndrome
    (2023) MARTIN, Kevin T.; XIN, Yi; GAULTON, Timothy G.; VICTOR, Marcus; SANTIAGO, Roberta R.; KIM, Taehwan; MORAIS, Caio C. A.; KAZIMI, Aubrey A.; CONNELL, Marc; GERARD, Sarah E.; HERRMANN, Jacob; MUELLER, Ariel L.; LENART, Austin; SHEN, Jiacheng; KHAN, Sherbano S.; PETROV, Mihail; REUTLINGER, Kristan; ROZENBERG, Karina; AMATO, Marcelo; BERRA, Lorenzo; CEREDA, Maurizio
    Background: Bedside electrical impedance tomography could be useful to visualize evolving pulmonary perfusion distributions when acute respiratory distress syndrome worsens or in response to ventilatory and positional therapies. In experimental acute respiratory distress syndrome, this study evaluated the agreement of electrical impedance tomography and dynamic contrast-enhanced computed tomography perfusion distributions at two injury time points and in response to increased positive end-expiratory pressure (PEEP) and prone position.Methods: Eleven mechanically ventilated (VT 8 ml kg(-1)) Yorkshire pigs (five male, six female) received bronchial hydrochloric acid (3.5 ml kg(-1)) to invoke lung injury. Electrical impedance tomography and computed tomography perfusion images were obtained at 2 h (early injury) and 24 h (late injury) after injury in supine position with PEEP 5 and 10 cm H2O. In eight animals, electrical impedance tomography and computed tomography perfusion imaging were also conducted in the prone position. Electrical impedance tomography perfusion (Q(EIT)) and computed tomography perfusion (Q(CT)) values (as percentages of image total) were compared in eight vertical regions across injury stages, levels of PEEP, and body positions using mixed-effects linear regression. The primary outcome was agreement between Q(EIT) and Q(CT,) defined using limits of agreement and Pearson correlation coefficient.Results: Pao(2)/Fio(2 )decreased over the course of the experiment (healthy to early injury, -253 [95% CI, -317 to -189]; early to late injury, -88 [95% CI, -151 to -24]). The limits of agreement between Q(EIT) and Q(CT) were -4.66% and 4.73% for the middle 50% quantile of average regional perfusion, and the correlation coefficient was 0.88 (95% CI, 0.86 to 0.90]; P < 0.001). Electrical impedance tomography and computed tomography showed similar perfusion redistributions over injury stages and in response to increased PEEP. Q(EIT) redistributions after positional therapy underestimated Q(CT) in ventral regions and overestimated Q(CT) in dorsal regions.Conclusions: Electrical impedance tomography closely approximated computed tomography perfusion measures in experimental acute respiratory distress syndrome, in the supine position, over injury progression and with increased PEEP. Further validation is needed to determine the accuracy of electrical impedance tomography in measuring perfusion redistributions after positional changes.
  • article 0 Citação(ões) na Scopus
    Electrical Impedance Tomography to Monitor Hypoxemic Respiratory Failure
    (2024) FRANCHINEAU, Guillaume; JONKMAN, Annemijn H.; PIQUILLOUD, Lise; YOSHIDA, Takeshi; COSTA, Eduardo; ROZE, Hadrien; CAMPOROTA, Luigi; PIRAINO, Thomas; SPINELLI, Elena; COMBES, Alain; ALCALA, Glasiele C.; AMATO, Marcelo; MAURI, Tommaso; FRERICHS, Inez; BROCHARD, Laurent J.; SCHMIDT, Matthieu
    Hypoxemic respiratory failure is one of the leading causes of mortality in intensive care. Frequent assessment of individual physiological characteristics and delivery of personalized mechanical ventilation (MV) settings is a constant challenge for clinicians caring for these patients. Electrical impedance tomography (EIT) is a radiation-free bedside monitoring device that is able to assess regional lung ventilation and changes in aeration. With real-time tomographic functional images of the lungs obtained through a thoracic belt, clinicians can visualize and estimate the distribution of ventilation at different ventilation settings or following procedures such as prone positioning. Several studies have evaluated the performance of EIT to monitor the effects of different MV settings in patients with acute respiratory distress syndrome, allowing more personalized MV. For instance, EIT could help clinicians find the positive end-expiratory pressure that represents a compromise between recruitment and overdistension and assess the effect of prone positioning on ventilation distribution. The clinical impact of the personalization of MV remains to be explored. Despite inherent limitations such as limited spatial resolution, EIT also offers a unique noninvasive bedside assessment of regional ventilation changes in the ICU. This technology offers the possibility of a continuous, operator-free diagnosis and real-time detection of common problems during MV. This review provides an overview of the functioning of EIT, its main indices, and its performance in monitoring patients with acute respiratory failure. Future perspectives for use in intensive care are also addressed.
  • article 0 Citação(ões) na Scopus
    Coronary Artery Disease Assessment and Cardiovascular Events in Middle-Aged Patients on Hemodialysis
    (2024) GOWDAK, Luis Henrique Wolff; LIMA, Jose Jayme Galvao De; ADAM, Eduardo Leal; MANTA, Isabela Cristina Kirnew Abud; REUSING, Jose Otto; DAVID-NETO, Elias; CESAR, Luiz Antonio Machado; BORTOLOTTO, Luiz Aparecido
    Objective: To explore whether, in younger patients on dialysis with longer life expectancy, assessment of coronary artery disease (CAD) could identify individuals at higher risk of events and revascularization might improve outcomes in selected patients contrary to what had been observed in elderly patients. Methods: From August 1997 to January 2019, 2265 patients with stage 5 chronic kidney disease were prospectively referred for cardiovascular assessment. For this study, we selected 1374 asymptomatic patients aged between 18 and 64 years. After clinical risk stratification and cardiac scintigraphy by single -photon emission computed tomography, 866 patients underwent coronary angiography. The primary end point was the composite incidence of nonfatal/fatal major adverse cardiovascular events during a follow-up period of 0.1 to 189.7 months (median, 26 months). The secondary end point was all -cause mortality. Results: The primary end point occurred in 327 (23.8%) patients. Clinically stratified high -risk patients had a 3 -fold increased risk of the primary end point. The prevalence of abnormal findings on perfusion scans was 29.2% (n=375), and significant CAD was found in 449 (51.8%) of 866 patients who underwent coronary angiography. An abnormal finding on myocardial perfusion scan and the presence of CAD were significantly associated with a 74% and 22% increased risk of cardiovascular events, respectively. In patients undergoing percutaneous coronary intervention or coronary artery bypass grafting (n=99), there was an 18% reduction in the risk of all -cause death relative to patients receiving medical treatment (P=.03). Conclusion: In this cohort of middle-aged, asymptomatic patients on dialysis, assessment of CAD identified individuals at higher risk of events, and coronary intervention was associated with reducing the risk of death in selected patients.
  • article 0 Citação(ões) na Scopus
    Challenges of Congenital Heart Surgery in Brazil: It is Time to Designate Pediatric Congenital Heart Surgery Subspecialty
    (2024) PINTO JUNIOR, Valdester Cavalcante Pinto; MIANA, Leonardo Augusto; NAVARRO, Fabio Binhara; ROCHA, Bruno da Costa; ASSAD, Renato Samy; OLIVEIRA, Marcos Aurelio Barboza de; CROTI, Ulisses Alexandre; SALUM, Fabio Said; FURLANETTO, Beatriz Helena Sanches; JATENE, Marcelo Biscegli; CANEO, Luiz Fernando; MONTEIRO, Andrey Jose de Oliveira; NETO, Fernando Ribeiro de Moraes; ANTONIALI, Fernando; SALERNO, Pedro Rafael; NINA, Vinicius Jose da Silva
    Congenital heart disease (CHD) affects eight to ten out of every 1,000 births, resulting in approximately 23,057 new cases in Brazil in 2022. About one in four children with CHD requires surgery or other procedures in the first year of life, and it is expected that approximately 81% of these children with CHD will survive until at least 35 years of age. Professionals choosing to specialize in CHD surgery face numerous challenges, not only related to mastering surgical techniques and the complexity of the diseases but also to the lack of recognition by medical societies as a separate subspecialty. Furthermore, families face difficulties when access to services capable of providing treatment for these children. To address these challenges, it is essential to have specialized hospitals, qualified professionals, updated technologies, sustainable industry, appropriate financing, quality assessment systems, and knowledge generation. The path to excellence involves specialization across all involved parties. As we reflect on the importance of Pediatric Cardiovascular Surgery and Congenital Heart Diseases establishing themselves as a subspecialty of Cardiovascular Surgery, it is essential to look beyond our borders to countries like the United States of America and United Kingdom, where this evolution is already a reality. This autonomy has led to significant advancements in research, education, and patient care outcomes, establishing a care model. By following this path in Brazil, we not only align our practice with the highest international standards but also demonstrate our maturity and the ability to meet the specific needs of patients with CHD and those with acquired childhood heart disease.
  • article 0 Citação(ões) na Scopus
    Rheumatoid arthritis-associated airway disease: longitudinal pulmonary function behavior
    (2024) SABBAG, Maria Laura Bertozo; MOLINA, Camila de Assis; SAWAMURA, Marcio Valente Yamada; BONFIGLIOLI, Karina; MEDEIROS-RIBEIRO, Ana Cristina; PUGLIESI, Alisson; NAKAGAWA, Renato Hideo; ARIMURA, Fabio Eiji; ATHANAZIO, Rodrigo Abensur; KAIRALLA, Ronaldo Adib; BALDI, Bruno Guedes; KAWANO-DOURADO, Leticia
  • article 0 Citação(ões) na Scopus
    Myocardial tissue expression of mRNA and preoperative neutrophil-lymphocyte ratio in children undergoing congenital heart surgery
    (2024) MANUEL, Valdano; MIANA, Leonardo A.; FONSECA-ALANIZ, Miriam Helena; HERNAN, Gabriel Carrillo; TENORIO, Davi Freitas; BADO, Celestino; CARVALHO, Mariana Lombardi Peres de; MEIRELLES, Matheus; TELLES, Joao Paulo Mota; PENHA, Juliano Gomes; TANAMATI, Carla; CANEO, Luiz Fernando; KRIEGER, Jose Eduardo; JATENE, Fabio Biscegli; JATENE, Marcelo Biscegli
    Background: The neutrophil-lymphocyte ratio (NLR) is an easily accessible and inexpensive biomarker that has been shown to predict morbidity and mortality in congenital cardiac surgery. However, its regulatory mechanism remains unclear. This study aims to compare and correlate the tumor necrosis factor alpha (TNF-alpha), interleukin (IL)-1 beta, IL-6, and IL-10 messenger RNAs (mRNAs) with the NLR in patients with tetralogy of Fallot (ToF) and ventricular septal defect (VSD). Methods: A prospective translational study was conducted on 10 children with ToF and 10 with VSD, aged between 1 and 24 months. The NLR was calculated from the blood count taken 24 hours before surgery. The expression of these mRNAs was analyzed in the myocardial tissue of the right atrium prior to cardiopulmonary bypass. Results: Patients with ToF exhibited a higher NLR [ToF 0.46 (interquartile range; IQR) 0.90; VSD 0.28 (IQR 0.17); P=0.02], longer mechanical ventilation time [ToF 24 h (IQR 93); VSD 5.5 h (IQR 8); P<0.001], increased use of vasoactive drugs [ToF 2 days (IQR 1.75); VSD 0 (IQR 1); P=0.01], and longer ICU [ToF 5.5 (IQR 1); VSD 2 (IQR 0.75); P=0.02] and hospital length of stays [ToF 18 days (IQR 17.5); VSD 8.5 days (IQR 2.5); P<0.001]. A negative correlation was found between NLR and oxygen saturation (SaO2) (r=-0.44; P=0.002). In terms of mRNA expression, the ToF group showed a lower expression of IL-10 mRNA (P=0.03). A positive correlation was observed between IL-10-mRNA and SaO2 (r=0.40; P=0.07), and a negative correlation with NLR (r=-0.27; P=0.14). Conclusions: Patients with ToF demonstrated a higher preoperative NLR and lower IL-10 mRNA expression by what appears to be a pro-inflammatory phenotype of cyanotic patients.
  • article 1 Citação(ões) na Scopus
    First-Pass Kinetics Model to Estimate Pulmonary Perfusion by Electrical Impedance Tomography During Uninterrupted Breathing
    (2024) VICTOR, Marcus; XIN, Yi; ALCALA, Glasiele; GAULTON, Timothy; COSTA, Eduardo; WINKLER, Tilo; BERRA, Lorenzo; AMATO, Marcelo; CEREDA, Maurizio
  • article 4 Citação(ões) na Scopus
    Expiratory Muscle Activity Counteracts Positive End-Expiratory Pressure and Is Associated with Fentanyl Dose in Patients with Acute Respiratory Distress Syndrome
    (2024) PLENS, Glauco M.; DROGHI, Maddalena T.; ALCALA, Glasiele C.; PEREIRA, Sergio M.; WAWRZENIAK, Iuri C.; VICTORINO, Josue A.; CRIVELLARI, Chiara; GRASSI, Alice; REZOAGLI, Emanuele; FOTI, Giuseppe; COSTA, Eduardo L. V.; AMATO, Marcelo B. P.; BELLANI, Giacomo
    Rationale: Hypoxemia during mechanical ventilation might be worsened by expiratory muscle activity, which reduces end-expiratory lung volume through lung collapse. A proposed mechanism of benefit of neuromuscular blockade in acute respiratory distress syndrome (ARDS) is the abolition of expiratory efforts. This may contribute to the restoration of lung volumes. The prevalence of this phenomenon, however, is unknown. Objectives: To investigate the incidence and amount of end-expiratory lung impedance (EELI) increase after the administration of neuromuscular blocking agents (NMBAs), clinical factors associated with this phenomenon, its impact on regional lung ventilation, and any association with changes in pleural pressure. Methods: We included mechanically ventilated patients with ARDS monitored with electrical impedance tomography (EIT) who received NMBAs in one of two centers. We measured changes in EELI, a surrogate for end-expiratory lung volume, before and after NMBA administration. In an additional 10 patients, we investigated the characteristic signatures of expiratory muscle activity depicted by EIT and esophageal catheters simultaneously. Clinical factors associated with EELI changes were assessed. Measurements and Main Results: We included 46 patients, half of whom showed an increase in EELI of.10% of the corresponding VT (46.2%; IQR, 23.9-60.9%). The degree of EELI increase correlated positively with fentanyl dosage and negatively with changes in end-expiratory pleural pressures. This suggests that expiratory muscle activity might exert strong counter-effects against positive end-expiratory pressure that are possibly aggravated by fentanyl. Conclusions: Administration of NMBAs during EIT monitoring revealed activity of expiratory muscles in half of patients with ARDS. The resultant increase in EELI had a dose-response relationship with fentanyl dosage. This suggests a potential side effect of fentanyl during protective ventilation.
  • article 0 Citação(ões) na Scopus
    Fifth ""Jatene Lecture on Surgical Innovation"": Innovation in Congenital Heart Surgery: Contributions From South America
    (2024) JUANEDA, Ignacio; KREUTZER, Christian; JATENE, Marcelo B.
    We present the fifth ""Jatene Lecture on Surgical Innovation"" on Innovation in Congenital Heart Surgery, given at the Eighth Scientific Meeting of the World Society for Pediatric and Congenital Heart Surgery and Eighth World Congress of Pediatric Cardiology and Cardiac Surgery in Washington DC in 2023. We highlight what surgical innovation is and how innovation was accomplished in cardiac surgery and particularly in congenital heart surgery. A brief history of the development of congenital heart surgery across the world is summarized and we finally illustrate the South American contributions to congenital heart surgery, acknowledging the great innovations of Adib Jatene and Guillermo Kreutzer to our field.
  • article 0 Citação(ões) na Scopus
    Organ donation consent after death
    (2024) GARCIA, Valter Duro; PESTANA, Jose Osmar Medina de Abreu; PEGO-FERNANDES, Paulo Manuel
  • article 0 Citação(ões) na Scopus
    Clinical, tomographic and functional comparison of sporadic and tuberous sclerosis complex-associated forms of lymphangioleiomyomatosis: a retrospective cohort study
    (2024) OLIVEIRA, Martina Rodrigues; WANDERLEY, Mark; FREITAS, Carolina Salim Goncalves; KAIRALLA, Ronaldo Adib; CHATE, Rodrigo Caruso; AMARAL, Alexandre Franco; ARIMURA, Fabio Eiji; SAMORANO, Luciana Paula; WATANABE, Elieser Hitoshi; CARVALHO, Carlos Roberto Ribeiro; BALDI, Bruno Guedes
    Background Lymphangioleiomyomatosis (LAM) is a rare disease that can occur sporadically (S-LAM) or associated with the tuberous sclerosis complex (TSC-LAM). The natural history of LAM is not completely understood, including whether there is a difference between the clinical courses of the two forms. This study aimed to compare the clinical, functional and tomographic features between S-LAM and TSC-LAM, and evaluate the annual rates of change in lung function. Methods This retrospective cohort study included patients with LAM followed up between 1994 and 2019. Clinical, functional and imaging variables were evaluated, and the lung cysts were automatically quantified. Quality of life and predictors of lung function impairment were accessed, and the annual rate of lung function decline was compared between S-LAM and TSC-LAM. Results Of the 107 patients included, 77 had S-LAM and 30 had TSC-LAM. Although patients with TSCLAM had a higher prevalence of renal angiomyolipomas and neurological and dermatological manifestations, pulmonary function tests were similar. Patients with S-LAM had a greater rate of forced expiratory volume in 1 s decline and a higher extent of cysts. Pneumothorax, desaturation in the 6-minute walking test and a higher extent of lung cysts were predictors of functional impairment. A greater impact on vitality and emotional health was observed in the TSC-LAM. Conclusion Greater functional decline and a higher cystic extension were found in patients with S-LAM. Our study provides a broad clinical, functional and tomographic characterisation of patients with LAM, adding valuable information to the existing evidence to better understand the two forms of the disease.
  • article 0 Citação(ões) na Scopus
    Evolocumab Treatment in Pediatric Patients With Homozygous Familial Hypercholesterolemia: Pooled Data From Three Open-Label Studies
    (2024) RAAL, Frederick J.; HEGELE, Robert A.; RUZZA, Andrea; LOPEZ, J. Antonio G.; BHATIA, Ajay K.; WU, Johnny; WANG, Huei; GAUDET, Daniel; WIEGMAN, Albert; WANG, Jian; SANTOS, Raul D.
    BACKGROUND:Pediatric patients with homozygous familial hypercholesterolemia (HoFH) have an increased risk of atherosclerotic cardiovascular disease and difficulty meeting low-density lipoprotein cholesterol (LDL-C) goals. In this post hoc analysis, we evaluated pooled safety and efficacy data from 3 studies in pediatric patients with HoFH treated with the PCSK9 (proprotein convertase subtilisin/kexin type 9) monoclonal antibody inhibitor evolocumab.METHODS:Patients with HoFH aged 10 to 17 years received treatment with open-label evolocumab 420 mg subcutaneously monthly or biweekly in the TAUSSIG, RAMAN, or HAUSER-OLE clinical studies. All patients received background statins with or without ezetimibe. Study duration ranged from 12 to 260 weeks. The primary end point was treatment-emergent adverse events per 100 patient-years. Efficacy end points were changes from baseline to week 12 in lipids and PCSK9.RESULTS:Of the 39 patients in the pooled analysis, 69.2% were males, median age was 13.0 years, and 79.5% (31/39) had genotyped HoFH with LDLR pathogenic variants. Overall, median exposure to evolocumab was 18.2 (Q1, Q3: 3.0, 18.5) months. Treatment-emergent adverse events with an exposure-adjusted patient incidence rate of >= 5% were upper respiratory tract infection (6.6%), influenza (5.2%), and acne (5.0%) per 100 patient-years. Exposure-adjusted patient incidence of serious treatment-emergent adverse events was 13.3% per 100 patient-years. Excluding 4 patients receiving lipoprotein apheresis, week 12 median percentage change from baseline in LDL-C was -2.9% (Q1, Q3: -21.7, 1.5); however, 42.9% (15/35) of patients achieved >= 15% reduction in LDL-C from baseline. Residual LDLR (LDL receptor) activity was not associated with a reduction in LDL-C.CONCLUSIONS:In this pooled data analysis from 3 studies in pediatric patients with HoFH, evolocumab was well tolerated, with no new safety signals reported. These safety findings are consistent with findings from previous studies of evolocumab. Patients showed marked variability in LDL-C reduction. Results from this pooled analysis support guidelines suggesting a trial of PCSK9 inhibitor therapy regardless of estimated residual LDLR function.REGISTRATION:URL:; Unique identifier: NCT01624142, NCT03403374, and NCT02624869.
  • article
    Interpreting Acute Myocardial Infarction 40 Years Later. Evolution of Knowledge: What is the Best Explanation?
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