RESUMO
Resumo Fundamento O tecido adiposo epicárdico (TAE) tem sido associado à fibrilação atrial (FA), mas seus mecanismos fisiopatológicos permanecem obscuros. Objetivos Medir a correlação entre TAE e fibrose do átrio esquerdo (AE), e avaliar sua capacidade de prever recidiva após o isolamento da veia pulmonar (IVP). Métodos Pacientes com FA inscritos para um primeiro procedimento de IVP foram submetidos à tomografia computadorizada (TC) cardíaca e ressonância magnética cardíaca (RMC) em menos de 48 horas. Quantificou-se o TAECE em imagens de TC realçadas com contraste no nível do tronco da coronária esquerda. Quantificou-se a fibrose do AE em RMC tridimensional com realce tardio isotrópico de 1,5 mm. Após o isolamento da veia pulmonar (IVP), os pacientes foram submetidos a seguimento para checar a recidiva da FA. A significância estatística foi definida com p<0,05. Resultados A maioria dos 68 pacientes (46 homens, idade 61±12 anos) tinha FA paroxística (71%, n=48). Os pacientes apresentavam volume TAECE mediano de 2,4 cm3/m2 (intervalo interquartil [IIQ] 1,6-3,2 cm3/m2) e um volume médio de fibrose do AE de 8,9 g (IIQ 5-15 g). A correlação entre TAECE e fibrose do AE foi estatisticamente significativa, mas fraca (coeficiente de correlação de postos de Spearman = 0,40, p=0,001). Durante um seguimento médio de 22 meses (IIQ 12-31), 31 pacientes (46%) tiveram recidiva da FA. A análise multivariada produziu dois preditores independentes de recidiva da FA: TAECE (FC 2,05, IC de 95% 1,51-2,79, p<0,001) e FA não paroxística (FC 2,36, IC de 95% 1,08-5,16, p=0,031). Conclusão A correlação fraca entre TAE e AE sugere que a fibrose do AE não é o principal mecanismo que liga o TAE e a FA. O TAE mostrou-se mais fortemente associado à recidiva da FA do que à fibrose do AE, corroborando a existência de outros mediadores mais importantes do TAE e da FA.
Abstract Background Epicardial adipose tissue (EAT) has been associated with atrial fibrillation (AF), but its pathophysiological mechanisms remain unclear. Objectives To measure the correlation between EAT and left atrium (LA) fibrosis, and to assess their ability to predict relapse after pulmonary vein isolation (PVI). Methods Patients with AF enrolled for a first PVI procedure underwent both cardiac computerized tomography (CT) and cardiac magnetic resonance (CMR) imaging within less than 48 hours. EATLMwas quantified on contrast-enhanced CT images at the level of the left main. LA fibrosis was quantified on isotropic 1.5 mm 3D delayed enhancement CMR. After pulmonary vein isolation (PVI), patients were followed up for AF relapse. Statistical significance was set at p<0.05. Results Most of the 68 patients (46 men, age 61±12 years) had paroxysmal AF (71%, n=48). Patients had a median EATLMvolume of 2.4 cm3/m2(interquartile range [IQR] 1.6-3.2 cm3/m2), and a median amount of LA fibrosis of 8.9 g (IQR 5-15 g). The correlation between EATLMand LA fibrosis was statistically significant but weak (Spearman's R=0.40, p=0.001). During a median follow-up of 22 months (IQR 12-31), 31 patients (46%) had AF relapse. Multivariate analysis yielded two independent predictors of AF relapse: EATLM(HR 2.05, 95% CI 1.51-2.79, p<0.001), and non-paroxysmal AF (HR 2.36, 95% CI 1.08-5.16, p=0.031). Conclusion The weak correlation between EAT and LA suggests that LA fibrosis is not the main mechanism linking EAT and AF. EAT was more strongly associated with AF relapse than LA fibrosis, supporting the existence of other more important mediators of EAT and AF.
RESUMO
BACKGROUND: Epicardial adipose tissue (EAT) has been associated with atrial fibrillation (AF), but its pathophysiological mechanisms remain unclear. OBJECTIVES: To measure the correlation between EAT and left atrium (LA) fibrosis, and to assess their ability to predict relapse after pulmonary vein isolation (PVI). METHODS: Patients with AF enrolled for a first PVI procedure underwent both cardiac computerized tomography (CT) and cardiac magnetic resonance (CMR) imaging within less than 48 hours. EATLMwas quantified on contrast-enhanced CT images at the level of the left main. LA fibrosis was quantified on isotropic 1.5 mm 3D delayed enhancement CMR. After pulmonary vein isolation (PVI), patients were followed up for AF relapse. Statistical significance was set at p<0.05. RESULTS: Most of the 68 patients (46 men, age 61±12 years) had paroxysmal AF (71%, n=48). Patients had a median EATLMvolume of 2.4 cm3/m2(interquartile range [IQR] 1.6-3.2 cm3/m2), and a median amount of LA fibrosis of 8.9 g (IQR 5-15 g). The correlation between EATLMand LA fibrosis was statistically significant but weak (Spearman's R=0.40, p=0.001). During a median follow-up of 22 months (IQR 12-31), 31 patients (46%) had AF relapse. Multivariate analysis yielded two independent predictors of AF relapse: EATLM(HR 2.05, 95% CI 1.51-2.79, p<0.001), and non-paroxysmal AF (HR 2.36, 95% CI 1.08-5.16, p=0.031). CONCLUSION: The weak correlation between EAT and LA suggests that LA fibrosis is not the main mechanism linking EAT and AF. EAT was more strongly associated with AF relapse than LA fibrosis, supporting the existence of other more important mediators of EAT and AF.
FUNDAMENTO: O tecido adiposo epicárdico (TAE) tem sido associado à fibrilação atrial (FA), mas seus mecanismos fisiopatológicos permanecem obscuros. OBJETIVOS: Medir a correlação entre TAE e fibrose do átrio esquerdo (AE), e avaliar sua capacidade de prever recidiva após o isolamento da veia pulmonar (IVP). MÉTODOS: Pacientes com FA inscritos para um primeiro procedimento de IVP foram submetidos à tomografia computadorizada (TC) cardíaca e ressonância magnética cardíaca (RMC) em menos de 48 horas. Quantificou-se o TAECE em imagens de TC realçadas com contraste no nível do tronco da coronária esquerda. Quantificou-se a fibrose do AE em RMC tridimensional com realce tardio isotrópico de 1,5 mm. Após o isolamento da veia pulmonar (IVP), os pacientes foram submetidos a seguimento para checar a recidiva da FA. A significância estatística foi definida com p<0,05. RESULTADOS: A maioria dos 68 pacientes (46 homens, idade 61±12 anos) tinha FA paroxística (71%, n=48). Os pacientes apresentavam volume TAECE mediano de 2,4 cm3/m2 (intervalo interquartil [IIQ] 1,63,2 cm3/m2) e um volume médio de fibrose do AE de 8,9 g (IIQ 515 g). A correlação entre TAECE e fibrose do AE foi estatisticamente significativa, mas fraca (coeficiente de correlação de postos de Spearman = 0,40, p=0,001). Durante um seguimento médio de 22 meses (IIQ 1231), 31 pacientes (46%) tiveram recidiva da FA. A análise multivariada produziu dois preditores independentes de recidiva da FA: TAECE (FC 2,05, IC de 95% 1,512,79, p<0,001) e FA não paroxística (FC 2,36, IC de 95% 1,085,16, p=0,031). CONCLUSÃO: A correlação fraca entre TAE e AE sugere que a fibrose do AE não é o principal mecanismo que liga o TAE e a FA. O TAE mostrou-se mais fortemente associado à recidiva da FA do que à fibrose do AE, corroborando a existência de outros mediadores mais importantes do TAE e da FA.
Assuntos
Fibrilação Atrial , Ablação por Cateter , Veias Pulmonares , Tecido Adiposo/diagnóstico por imagem , Idoso , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/etiologia , Feminino , Fibrose , Átrios do Coração/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Veias Pulmonares/diagnóstico por imagem , RecidivaRESUMO
Chagas Disease (CD) is a neglected illness whose immunopathological mechanisms have not yet been plainly elucidated. The asymptomatic (indeterminate) form of CD is a long-term condition and approximately 20% to 35% of the individuals with this form evolve into one of the three chronic symptomatic clinical forms of CD, namely: cardiac, digestive or cardio-digestive (mixed). A variant of blood monocytes characterized by low expression of the HLA-DR antigen (CD14+/HLA-DRlow/â) constitutes a subtype of myeloid-derived suppressor cells (MDSCs) whose main function is to regulate exacerbated inflammatory processes. The development of the symptomatic forms of CD can be related to the interaction between the host's immune system and the CD14+/HLA-DRlow/â immunosuppressive monocytes. Here, we evaluated, by flow cytometry, the absolute number and the HLA-DR antigenic density of this population of MDSCs in 57 patients with the diagnosis of CD: 34 with the symptomatic clinical forms (26 cardiac and 8 mixed) and 23 with the asymptomatic (indeterminate) form. The asymptomatic form exhibited a greater number of CD14+/HLA-DRlow/â monocytes and, accordingly, a low HLA-DR antigenic density, when compared to the symptomatic forms. It is possible to speculate that the predominance of CD14+/HLA-DRlow/- monocytes in the patients with the asymptomatic (indeterminate) form might have been a factor that could delay or even prevent the evolution of the asymptomatic form to the symptomatic forms of Chagas Disease.
Assuntos
Doença de Chagas , Monócitos , Citometria de Fluxo , Antígenos HLA-DR , Humanos , Receptores de LipopolissacarídeosAssuntos
Anticorpos Monoclonais/imunologia , Citometria de Fluxo/normas , Imunofenotipagem/normas , Leucemia Linfocítica Crônica de Células B/diagnóstico , Humanos , Leucemia Linfocítica Crônica de Células B/sangue , Leucemia Linfocítica Crônica de Células B/patologia , Masculino , Pessoa de Meia-Idade , Patologia Molecular/normas , Patologia Molecular/tendênciasRESUMO
As key-components of the urban-drainage system, storm-drains and manholes are essential to the hydrological modeling of urban basins. Accurately mapping of these objects can help to improve the storm-drain systems for the prevention and mitigation of urban floods. Novel Deep Learning (DL) methods have been proposed to aid the mapping of these urban features. The main aim of this paper is to evaluate the state-of-the-art object detection method RetinaNet to identify storm-drain and manhole in urban areas in street-level RGB images. The experimental assessment was performed using 297 mobile mapping images captured in 2019 in the streets in six regions in Campo Grande city, located in Mato Grosso do Sul state, Brazil. Two configurations of training, validation, and test images were considered. ResNet-50 and ResNet-101 were adopted in the experimental assessment as the two distinct feature extractor networks (i.e., backbones) for the RetinaNet method. The results were compared with the Faster R-CNN method. The results showed a higher detection accuracy when using RetinaNet with ResNet-50. In conclusion, the assessed DL method is adequate to detect storm-drain and manhole from mobile mapping RGB images, outperforming the Faster R-CNN method. The labeled dataset used in this study is available for future research.
RESUMO
Este ensaio objetiva abordar a relação entre esporte e a questão racial, com reflexo nas práticas profissionais das Ciências do Esporte. Consideramos que essa relação é deturpada por estereótipos até os dias atuais com explicações pseudo-científicas, reducionismos filosóficos, teóricos e operacionais, inválidos e insustentáveis nas suas apropriações, porém raramente são desafiados de forma eficaz. Sugerimos o desenvolvimento de um trabalho orientado por princípios inclusivistas que permitam uma pedagogia do corpo no esporte, produzida no interior das relações sociais, com ações mais abrangentes e preocupadas com a diversidade humana.
This essay aims to discuss the relationship between sport and the racial question, with reflection on the professional practices of Sport Sciences. We consider this relationship to be distorted by stereotypes to the present day with pseudo-scientific explanations, philosophical, theoretical and operational reductions, invalid and unsustainable in their appropriations, but rarely are effectively challenged. We suggest a shift of conceptions to the development of a work guided by the principles of coeducation and regionalism, with integration/inclusion and situations of respect, that allows a pedagogy of the body in the sport, produced within social relations, with more comprehensive and preoccupied actions with human diversity.
Este ensayo tiene el objetivo abordar la relación entre deporte y la cuestión racial, con reflejo en las prácticas profesionales de las Ciencias del Deporte. Consideramos que esta relación es distorsionada por estereotipos hasta los días actuales con explicaciones pseudo-científicas, reduccionismos filosóficos, teóricos y operativos, inválidos e insostenibles en sus apropiaciones, pero rara vez son desafiados de forma eficaz. Se sugiere un desplazamiento de concepciones para el desarrollo de un trabajo orientado por los principios de la coeducación y regionalismo, con integración/inclusión y situaciones de respeto, que permita una pedagogía del cuerpo en el deporte, producida en el interior de las relaciones sociales, con acciones más amplias y preocupadas con la diversidad humana.
RESUMO
INTRODUCTION: Becton Dickinson (BD) FACSVia™ is a recently developed flow cytometer with which worldwide clinical experience is limited. Recently, our center started using the single-platform BD Stem Cell Kit (BD SCE) for the quantitation of viable CD34+ (7-aminoactinomycin D-7-AAD-negative cells) on a BD FACSVia™. Currently, there are no formal recommendations for the fluorescence compensation of 7-AAD in this scenario. METHODS: A 3-color fluorescence compensation matrix ("Optimized BD CS&T") was standardized based on the fluorescence of 7-AAD in samples of 27 individuals. The "Optimized BD CS&T" was compared with manual compensation (predicated method) and BD CS&T beads. RESULTS: The analysis of the viable CD34+ cells/mm3 showed a very strong correlation between the manual compensation versus "Optimized BD CS&T" (r = 1.00) and manual versus BD CS&T (r = .99). The analysis of CD34+ viability (%) showed a very strong correlation for manual versus "Optimized BD CS&T" (r = .99). However, for manual versus BD CS&T, the correlation was inferior (r = .86). For viable CD34+ cells/mm3 , Bland-Altman plots showed a better concordance between manual and "Optimized BD CS&T" than between manual and BD CS&T. For CD34+ viability (%), the concordance was very good between manual and "Optimized BD CS&T", while there was a poor concordance between manual and BD CS&T. CONCLUSION: "Optimized BD CS&T" matrix proved to be more precise than the conventional BD CS&T beads. The "Optimized BD CS&T" matrix can be used along with BD SCE kit on BD FACSVia™ flow cytometers.
Assuntos
Antígenos CD34/sangue , Citometria de Fluxo/instrumentação , Citometria de Fluxo/normas , Células-Tronco/citologia , Contagem de Células , Humanos , Padrões de ReferênciaRESUMO
Student conceptions of the purposes of assessment are an important aspect of self-regulated learning. This study advances our understanding of the Student Conceptions of Assessment Inventory (SCoA) by examining the generalizability of the factorial structure of the SCoA using bifactor analysis and conducting cross-cultural invariance testing between Brazil and New Zealand. Eight different models were specified and evaluated, with the best model being adopted for invariance testing. This research adds to our understanding of the cross-cultural properties of the SCoA because the introduction of the bifactor model resulted in metric equivalence between countries, which had previously had only partial metric equivalence. Future studies should attempt to create more items around several SCoA constructs. (AU)
As concepções de estudantes dos propósitos da avaliação são um aspecto importante da aprendizagem autorregulada. Este estudo avança nossa compreensão do Inventário de Concepções de Avaliação de Estudantes (CAE), pelo exame da generalização da estrutura fatorial do CAE usando análise bifatorial e realizando testes de invariância transcultural entre o Brasil e a Nova Zelândia. Oito modelos diferentes foram especificados e avaliados, com o melhor modelo adotado para o teste de invariância. Esta pesquisa acrescenta à nossa compreensão das propriedades transculturais do CAE porque a introdução do modelo bifatorial resultou em equivalência métrica entre países, que anteriormente tinham apenas equivalência métrica parcial. Estudos futuros devem tentar criar mais itens em torno de vários construtos do CAE. (AU)
Las concepciones de los estudiantes sobre los própositos de evaluación, son un aspecto importante del aprendizaje autorregulado. Este estudio amplía nuestra comprensión sobre el Inventario de Concepciones de Evaluación de Estudiantes (CEE), mediante la investigación de la generalización de la estructura factorial del CEE utilizando análisis bifactorial y realizando tests de invariancia transcultural entre Brasil y Nueva Zelanda. Se especificaron y evaluaron ocho modelos diferentes,con el mejor modelo adoptado para el test de invariancia. Esta investigación aumenta nuestra comprensión de las propiedades transculturales del CEE, ya que la introducción del modelo bifactorial resultó con equivalencia métrica entre países, que anteriormente tenían sólo equivalencia métrica parcial. En el futuro, otros estudios posiblemente tratarán de crear más ítems sobre varios constructos del CEE. (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Estudantes/psicologia , Comparação Transcultural , Avaliação Educacional , Autogestão/psicologia , Aprendizagem , Análise FatorialRESUMO
BACKGROUND: Identifying the patients with hypertrophic cardiomyopathy (HCM) in whom the risk of sudden cardiac death (SCD) justifies the implantation of a cardioverter-defibrillator (ICD) in primary prevention remains challenging. Different risk stratification and criteria are used by the European and American guidelines in this setting. We sought to evaluate the role of cardiovascular magnetic resonance (CMR) late gadolinium enhancement (LGE) in improving these risk stratification strategies. METHODS: We conducted a multicentric retrospective analysis of HCM patients who underwent CMR for diagnostic confirmation and/or risk stratification. Eligibility for ICD was assessed according to the HCM Risk-SCD score and the American College of Cardiology Foundation/American Heart Association (ACCF/AHA) algorithm. The amount of LGE was quantified (LGE%) and categorized as 0%, 0.1-10%, 10.1-19.9% and ≥ 20%. The primary endpoint was a composite of SCD, aborted SCD, sustained ventricular tachycardia (VT), or appropriate ICD discharge. RESULTS: A total of 493 patients were available for analysis (58% male, median age 46 years). LGE was present in 79% of patients, with a median LGE% of 2.9% (IQR 0.4-8.4%). The concordance between risk assessment by the HCM Risk-SCD, ACCF/AHA and LGE was relatively weak. During a median follow-up of 3.4 years (IQR 1.5-6.8 years), 23 patients experienced an event (12 SCDs, 6 appropriate ICD discharges and 5 sustained VTs). The amount of LGE was the only independent predictor of outcome (adjusted HR: 1.08; 95% CI: 1.04-1.12; p < 0.001) after adjustment for the HCM Risk-SCD and ACCF/AHA criteria. The amount of LGE showed greater discriminative power (C-statistic 0.84; 95% CI: 0.76-0.91) than the ACCF/AHA (C-statistic 0.61; 95% CI: 0.49-0.72; p for comparison < 0.001) and the HCM Risk-SCD (C-statistic 0.68; 95% CI: 0.59-0.78; p for comparison = 0.006). LGE was able to increase the discriminative power of the ACCF/AHA and HCM Risk-SCD criteria, with net reclassification improvements of 0.36 (p = 0.021) and 0.43 (p = 0.011), respectively. CONCLUSIONS: The amount of LGE seems to outperform the HCM Risk-SCD score and the ACCF/AHA algorithm in the identification of HCM patients at increased risk of SCD and reclassifies a relevant proportion of patients.
Assuntos
Cardiomiopatia Hipertrófica/diagnóstico por imagem , Meios de Contraste/administração & dosagem , Morte Súbita Cardíaca/etiologia , Imageamento por Ressonância Magnética/normas , Guias de Prática Clínica como Assunto/normas , Adulto , Brasil , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/terapia , Tomada de Decisão Clínica , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Cardioversão Elétrica/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Portugal , Valor Preditivo dos Testes , Prevenção Primária , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de RiscoRESUMO
INTRODUÇÃO: Pacientes com quadro de insuficiência respiratória aguda ou crônica necessitam de suporte através da Ventilação Mecânica Invasiva (VMI), após a correção do evento que levou o paciente a necessitar de VMI é iniciado o processo de desmame, definido como a transição da ventilação artificial para a espontânea. A Ventilação Não-Invasiva (VNI) tem-se mostrado eficiente no processo de desmame, otimizando o processo de transição e evitando a reintubação. OBJETIVO: Avaliar o uso da VNI no processo de desmame da VMI em pacientes adultos. MÉTODOS: Revisão integrativa, o levantamento de pesquisas indexadas se deu nos meses de março a maio de 2018, através do acesso as bases de dados: PubMed/MEDLINE, SciELO e LILACS, utilizando os descritores: weaning mechanical ventilation e ventilator weaning, non-invasive, non-invasive ventilation, continuous positive airway pressure, CPAP ventilation, bilevel continuous positive airway pressure, intervention studies e clinical trials, extubation, extubation failure, reintubation, reintubation failure e weaning. Os descritores foram utilizados de maneira individual e cruzada. RESULTADOS: Um total de 123 artigos foram encontrados com a busca nas bases de dados, 60 artigos foram excluídos após a leitura dos resumos por não se enquadrarem nos critérios de inclusão do estudo, 63 artigos foram lidos na íntegra, de onde 10 foram eleitos para integrar esta revisão integrativa. CONCLUSÃO: A VNI é uma terapêutica que se mostrou viável em alguns estudos para reduzir os riscos de reintubação em pacientes com diversidade diagnóstica que apresentaram insuficiência respiratória aguda após a extubação. Porém, esse resultado não foi unanimidade, o que dificulta sua recomendação.
INTRODUCTION: Patients with diagnosis of acute or chronic respiratory insufficiency need support through invasive mechanical ventilation (IMV), after the correction of the event that led the patient to need IMV, the weaning process is started, defined as the transition from artificial to spontaneous ventilation. Non-invasive ventilation (NIV) has been shown to be efficient in the weaning process, optimizing it and avoiding reintubation. OBJECTIVE: To evaluate the use of NIV in the weaning process of IMV in adult patients. METHODS: Integrative review, the survey of indexed researches was carried out from 2018 March to May, through the databases: PubMed/MEDLINE, Scielo and LILACS, using the descriptors: "weaning mechanical ventilation" and "ventilator weaning", "noninvasive", "non-invasive ventilation", "continuous positive airway pressure", "CPAP ventilation", "bilevel continuous positive airway pressure", "intervention studies" and "clinical trials", "extubation", "extubation failure", "reintubation", "reintubation failure" and "weaning". The descriptors were used individually and cross-checked. RESULTS: A total of 123 articles were found with the search in the databases, 60 articles were excluded after reading the abstracts because they did not fit the inclusion criteria of the study, 63 articles were read in full, from where 10 were elected to integrate this integrative review. CONCLUSION: NIV is a therapy that has proven feasible in some studies to reduce the risk of reintubation in patients with diagnostic diversity who presented acute respiratory failure after extubation. However, this result was not unanimous, which hinders its recommendation.