Registro Multicêntrico de Takotsubo (REMUTA) – Aspectos Clínicos,Desfechos Intra-Hospitalares e Mortalidade a Longo Prazo

BackgroundTakotsubo syndrome (TTS) is an acquired form of cardiomyopathy. National Brazilian data on this condition are scarce. The Takotsubo Multicenter Registry (REMUTA) is the first to include multicenter data on this condition in Brazil.ObjectiveTo describe the clinical characteristics, prognosis, in-hospital treatment, in-hospital mortality, and mortality during 1 year of follow-up.MethodsThis is an observational, retrospective registry study including patients admitted to the hospital with diagnosis of TTS and patients admitted for other reasons who developed this condition. Evaluated outcomes included triggering factor, analysis of exams, use of medications, complications, in-hospital mortality, and mortality during 1 year of follow-up. A significance level of 5% was adopted.ResultsThe registry included 169 patients from 12 centers in the state of Rio de Janeiro, Brazil. Mean age was 70.9 ± 14.1 years, and 90.5% of patients were female; 63% of cases were primary TTS, and 37% were secondary. Troponin I was positive in 92.5% of patients, and median BNP was 395 (176.5; 1725). ST-segment elevation was present in 28% of patients. Median left ventricular ejection fraction was 40 (35; 48)%. We observed invasive mechanical ventilation in 25.7% of cases and shock in 17.4%. Mechanical circulatory support was used in 7.7%. In-hospital mortality was 10.6%, and mortality at 1 year of follow-up was 16.5%. Secondary TTS and cardiogenic shock were independent predictors of mortality.ConclusionThe results of the REMUTA show that TTS is not a benign pathology, as was once thought, especially regarding the secondary TTS group, which has a high rate of complications and mortality. (Arq Bras Cardiol. 2020; 115(2):207-216)     

基于广义逆的无谱逆反卷积算法

在时域循环卷积运算实现反卷积方法的基础上，基于广义逆的概念提出了一种改进算法，该算法不仅可以有效地避开无谱逆问题，而且运算量增加较少，易于编程实现。     

17β-雌二醇对子宫内膜异位症患者在位子宫内膜间质细胞β-catenin mRNA和蛋白表达的影响

目的研究17β-雌二醇(17β-E2)对子宫内膜异位症(内异症)患者在位子宫内膜间质细胞β-catenin mRNA和蛋白表达的影响,探讨Wnt/β-catenin信号通路在介导雌激素促进内异症发生发展的作用。方法体外分离培养内异症患者在位子宫内膜间质细胞。用不同浓度17β-E2处理子宫内膜间质细胞48 h;此后选用10-10mol/L 17β-E2处理子宫内膜间质细胞12、24和48 h,逆转录聚合酶链反应(RT-PCR)和免疫印迹法(Western blotting)检测17β-E2处理前后子宫内膜间质细胞β-catenin mRNA和蛋白的表达水平。同法分析雌激素受体拮抗剂ICI182,780(10-6mol/L)对17β-E2促进β-catenin mRNA和蛋白表达的影响。免疫组织化学染色观察17β-E2作用后β-catenin在子宫内膜间质细胞中的定位。结果17β-E2能明显促进内异症患者在位子宫内膜间质细胞β-catenin mRNA和蛋白的表达,并呈剂量和时间依赖性,于10-10mol/L作用48 h最明显。雌激素受体拮抗剂ICI182,780能明显抑制17β-E2对子宫内膜间质细胞β-catenin mRNA和蛋白的表达。免疫组织化学染色发现17β-E2能促进β-catenin在子宫内膜间质细胞核内的表达。结论雌激素可能通过激活Wnt/β-catenin信号通路促进内异症在位子宫内膜的异位种植。     

川芎嗪对急性心肌梗死血运重建后"心肌无复流"患者心肌组织灌注的影响

目的 观察川芎嗪对急性心肌梗死（AMI）患者梗死相关血管（mA）再通后心肌无复流（No．reflow，NR）现象的疗效。方法 首次急性sr段抬高心肌梗死（STEMI）患者，急诊经皮经腔冠状动脉介入（PCI）后，经单光子发射型计算机断层显像（SPECT）诊断为心肌NR者，随机分为治疗组（40例）和对照组（42例）。对照组接受常规治疗，治疗组在常规治疗基础上静脉给予川芎嗪注射液。分别于24h内（4—24h）及15d后（15—28d）复查SPECT，观察左室心肌灌注缺损积分（myocardium peffusion defect score，MPDS），左室射血分数（LVEF）、左室舒张末期容积（LVEDV）和左室收缩末期容积（LVESV）。结果 24h内及15d后，治疗组的MPDS均较PCI后即刻减低，其减低幅度均显著大于对照组（均P〈0．05）；两组的LVESV和LVEDV均呈增加趋势，但治疗组LVESV和LVEDV的增加幅度显著低于对照组（均P〈0．05）；15d后治疗组SPECT心肌NR的发生率显著低于对照组。结论 川芎嗪可显著改善心肌组织灌注，减轻心肌NR现象，从而缩小心肌坏死范围。抑制心室重构。     

Interstitial deletion in the long arm of chromosome no. 5

A case of a male infant with several congenital anomalies combined with an interstitial deletion of the long arm of chromosome no. 5 is presented. The symptoms of the infant were compared to five previous reported cases with similar interstitial deletions in 5q.     

Coronary Reperfusion Following Experimental Myocardial Infarction

Numerous studies have shown that early coronary reperfusion is feasible in the setting of evolving acute myocardial infarction in man. While early reperfusion reduces myocardial infarct size, there are potentially deleterious consequences of reperfusion. The concept of "reperfusion injury", oxygen-free radical damage, no reflow phenomenon, and stunned myocardium are discussed.     

非断离腹壁韧带腹膜外剖宫产术式探讨

行腹膜外剖宫产术时,在侧脐韧带与中脐韧带之间进行操作,不切断腹壁任何韧带,用撕拉、钝性剥离的方法分离膀胱与腹膜,子宫切口连续缝合两层,并将宫颈前筋膜与子宫切口浅层一并连续缝合.该方法不仅缩短了手术时间,避免了新生儿Apgar's低评分、新生儿窒息的发生,而且维持了腹壁结构的完整性,可进一步降低术后各种近、远期并发症的发生率.     

Associations and community health workers: analysis and time trends over ten years of training-action

ObjectiveTo analyse the profile of the persons and associations that participated in the course, quantify peer education activities and analyse their evolution.MethodA quantitative study using an analysis of the course records from 2009 to 2018 was designed for this purpose inside mihsalud program designed to promote health amongst persons in vulnerable situations in the city of Valencia (Spain). It offers a yearly training-action course of community health workers (CHW) that is attended by persons who have been proposed by associations. The associations were defined according to their population (immigrant, local or intercultural) and the CHWs according to gender, country of birth, year of course, association and continuity after training. Means and confidence intervals were calculated at 95% and a bivariate analysis was conducted in order to compare the activities that took place in 2009 to 2013 with those of 2014 to 2018. The time trends were analysed by applying linear regression models that included the different years studied as the dependent variable.Results201 CHW of 31 nationalities were trained, 81.6% (95% confidence interval [95% CI]: 75.5-86.7] were women. Eighty-two associations participated, 51.2% (95% CI: 39.9-62.4] worked with culturally diverse populations. Participation by associations (p = .017) and CHWs (p = .377) increased in a statistically significant manner over the years. After the course, 35.3% (95% CI: 28.7-42.4] of the CHWs continued to collaborate voluntarily in the associations.ConclusionsThe results of the CHW training-action course improve over time given that a significant increase in participation by associations and women can be seen, along with a greater number of activities completed during the training. One effect of this is that CHWs are contracted or carry out voluntary activities in the associations.     

Delays in the health care system for children,adolescents, and young adults with bone tumors in Brazil

ObjectiveTo identify delays in the health care system experienced by children and adolescents and young adults (AYA; aged 0–29 years) with osteosarcoma and Ewing sarcoma using information from the Brazilian hospital-based cancer registries.MethodsPatient data were extracted from 161 Brazilian hospital-based cancer registries between 2007 and 2011. Hospital, diagnosis, and treatment delays were analyzed in patients without a previous histopathological diagnosis. Referral, hospital, and health care delays were calculated for patients with a previous histopathological diagnosis. The time interval was measured in days.ResultsThere was no difference between genders in overall delays. All delays increased at older ages. Patients without a previous histopathological diagnosis had the longest hospital delay when compared to patients with a previous histopathological diagnosis before first contact with the cancer center. Patients with Ewing sarcoma had longer referral and health care delays than those with osteosarcoma who had a previous histopathological diagnosis before first contact with the cancer center. The North and Northeast regions had the longest diagnosis delay, while the Northeast and Southeast regions had the longest treatment delay.ConclusionHealth care delay among patients with a previous diagnosis was longer, and was probably associated with the time taken for to referral to cancer centers. Patients without a previous histopathological diagnosis had longer hospital delays, which could be associated with possible difficulties regarding demand and high-cost procedures. Despite limitations, this study helps provide initial knowledge about the healthcare pathway delays for patients with bone cancer inside several Brazilian hospitals.