ABSTRACT Objective: To identify the prevalence of non-communicable chronic diseases: arterial hypertension, diabetes mellitus, and associated risk factors in long-lived elderly people from three Brazilian regions. Methods: This is a multicenter, cross-sectional, and comparative study conducted with elderly people aged 80 years or older. Results: Higher prevalence of arterial hypertension were observed among those who use polypharmacy (75.7%), among elderly people aged between 80 and 84 years (33.9%), as well as in elderly people who are overweight (78.2%). The prevalence of diabetes was 24% (RP: 0.76; 95% CI: 0.59-0.98) lower among women compared to men and 2.15 times higher among those who use five or more medications (RP: 2.15; 95% CI: 1.63-2.85). Conclusions: In our sample, polypharmacy, body weight, and gender determine the prevalence of non-communicable chronic diseases: arterial hypertension and diabetes mellitus in long-lived elderly people.

RESUMEN Objetivo: Identificar la prevalencia de enfermedades crónicas no transmisibles: hipertensión arterial, diabetes mellitus y los factores de riesgo asociados en ancianos longevos de tres regiones brasileñas. Métodos: Se trata de un estudio multicéntrico, transversal y comparativo, realizado con ancianos con edad igual o superior a 80 años. Resultados: Se observaron mayores prevalencias de hipertensión arterial entre aquellos que hacen uso de polifarmacia (75,7%), entre los ancianos con edad entre 80 y 84 años (33,9%), así como en ancianos que presentan sobrepeso (78,2%). La prevalencia de diabetes fue 24% (RP: 0,76; IC 95%: 0,59-0,98) menor entre las mujeres en comparación con los hombres y 2,15 veces mayor entre aquellos que utilizan cinco o más medicamentos (RP: 2,15; IC 95%: 1,63-2,85). Conclusión: En nuestra muestra, la polifarmacia, el peso corporal y el sexo determinan la prevalencia de las enfermedades crónicas no transmisibles: hipertensión arterial y diabetes mellitus en ancianos longevos.

RESUMO Objetivo: identificar a prevalência das doenças crônicas não transmissíveis: hipertensão arterial, diabetes mellitus e os fatores de risco associados em pessoas idosas longevas de três regiões brasileiras. Métodos: trata-se de um estudo multicêntrico, transversal e comparativo, realizado com pessoas idosas com idade igual ou superior a 80 anos. Resultados: foram observadas maiores prevalências de hipertensão arterial entre aqueles que fazem uso de polifarmácia (75,7%), entre as pessoas idosas com idade entre 80 e 84 anos (33,9%), bem como em pessoas idosas que apresentam sobrepeso (78,2%). A prevalência de diabetes foi 24% (RP: 0,76; IC 95%: 0,59-0,98) menor entre as mulheres quando comparadas aos homens e 2,15 vezes maior entre aqueles que utilizam cinco ou mais medicamentos (RP: 2,15; IC 95%: 1,63-2,85). Conclusões: Em nossa amostra, a polifarmácia, o peso corporal e o sexo determinam a prevalência das doenças crônicas não transmissíveis: hipertensão arterial e diabetes mellitus em pessoas idosas longevas.

Abstract Background Our aim was to compare the efficacy of rituximab, tocilizumab, and abatacept in individuals with rheumatoid arthritis (RA) refractory to treatments with MTX or TNFi agents. Methods We searched 6 databases until January 2023 for phase 2–4 RCTs evaluating patients with RA refractory to MTX or TNFi therapy treated with rituximab, abatacept, and tocilizumab (intervention arm) compared to controls. Study data were independently assessed by two investigators. The primary outcome was considered as achieving ACR70 response. Results The meta-analysis included 19 RCTs, with 7,835 patients and a mean study duration of 1.2 years. Hazard ratios for achieving an ACR70 response at six months were not different among the bDMARDs, however, we found high heterogeneity. Three factors showing a critical imbalance among the bDMARD classes were identified: baseline HAQ score, study duration, and frequency of TNFi treatment in control arm. Multivariate meta-regression adjusted to these three factors were conducted for the relative risk (RR) for ACR70. Thus, heterogeneity was attenuated (I2 = 24%) and the explanatory power of the model increased (R2 = 85%). In this model, rituximab did not modify the chance of achieving an ACR70 response compared to abatacept (RR = 1.773, 95%CI 0.113–10.21, p = 0.765). In contrast, abatacept was associated with RR = 2.217 (95%CI 1.554–3.161, p < 0.001) for ACR70 compared to tocilizumab. Conclusion We found high heterogeneity among studies comparing rituximab, abatacept, and tocilizumab. On multivariate metaregressions, if the conditions of the RCTs were similar, we estimate that abatacept could increase the chance of reaching an ACR70 response by 2.2-fold compared to tocilizumab. Key messages Abatacept could increase the chance of reaching an ACR70 response by 2.2-fold compared to tocilizumab.

ABSTRACT The problem of finding the shortest path between a source and a destination node, commonly represented by graphs, has several computational algorithms as an attempt to find what is called the minimum path. Depending on the number of nodes in-between the source and destination, the process of finding the shortest path can demand a high computational cost (with polynomial complexity). A solution to reduce the computational cost is the use of the concept of parallelism, which divides the algorithm tasks between the processing cores. This article presents a comparative analysis of the main algorithms of the shortest path class: Dijkstra, Bellman-Ford, Floyd-Warshall and Johnson. The performance of each algorithm was evaluated considering different parallelization approaches and they were applied on general and open-pit mining databases present in the literature. The experimental results showed an improvement in performance of about 55% on the execution time depending on the chosen parallelization point.

Abstract The sugary cassava cultivar BRS 438 has high roots yield (with expressive concentration of free sugars), adaptation to mechanized planting, and moderate resistance to bacterial diseases. These characteristics make it an option for production of sugars, alcohol, and animal feed (additive in forage grass silage), among other possibilities.

ABSTRACT The availability of water above compacted soil layer improves the performance of soybean (Glycine max (L.) Merr.) gas exchanges. However, studies do not address the responses of the photosynthetic process of soybean in compacted soil. The objective of this study was to evaluate the dynamics of gas exchange, growth and performance of soybean in compacted soil with poor irrigation. The experiment was conducted in a greenhouse with a completely randomized design in a 3 × 4 split plot for three soil densities (1.0 ± 0.013, 1.15 ± 0.022 and 1.30 ± 0.035 Mg m-3) and four daily water depths (4.0, 5.0, 6.0 and 7.0 mm d-1) with three replicates. Net photosynthesis rate (A), transpiration rate (E), stomatal conductance (gs), water use efficiency (WUE), instantaneous water use efficiency (iWUE), net assimilation rate, growth rate of shoot and root, relative growth rate of shoot and root, shoot biomass, root biomass at different layers (upper, compacted and lower), total root biomass and pod biomass were evaluated. The 4.0 and 5.0 mm d-1 water depths provided higher WUE and iWUE, but not soybean biomass accumulation; with these water depths and 1.15 Mg·dm-3, gas exchange and accumulation of shoot biomass improved. From 45 to 65 d after emergence (DAE), shoot growth rate had a maximum peak at 7.0 mm d-1 in compacted soil. The growth rate and relative growth rate of soybean roots had smaller increases in biomass at 65 DAE. Daily water depths of 4.0 and 5.0 mm d-1 provided the best results in terms of WUE, however, it did not reflect an accumulation in soybean biomass. In these depths, soil compaction at 1.15 Mg m-3 provided an increase in gs, E, and A.

ABSTRACT Water stress is intrinsically related to soil water availability which is determinant in gas exchanges, as well as soil compaction in soybean growth and development. This study aimed to evaluate the leaf gas exchange, water stress index, and dry mass accumulation of soybean cultivated in different daily irrigation depths and bulk density. The treatments were distributed in pots subdivided in a 4×4 factorial scheme: four levels of bulk density of the soil (1.0, 1.15, 1.30 and 1.45 g cm-3) and four daily irrigation depths (4.0, 5.0, 6.0- and 7.0-mm day-1), with three replications. Physiological and morphological variables were analyzed. There were low transpiration rates due to water deficit in the 4 mm daily irrigation depth that resulted in stomatal closure and impaired the performance of the photosynthetic process in soybean. The increase in soil density provided gains in shoot and dry root mass in the layer above the compacted one. Low availability of water in the soil reduces the photosynthesis and growth of soybean plants. Increase in bulk density of the soil promotes greater root development, with the layer above the compacted being the one that concentrates most of the roots.

ABSTRACT Introduction: Tissue transfer has been used in urethral reconstruction for decades, and several grafts have been described (1, 2). The ideal graft would have optimal tissue characteristics and lead to minimal morbidity at the donor site. Urethroplasty using bladder mucosa was first described by Memmelaar in 1947 (3). The main limitation in using bladder mucosal grafts has been the invasiveness of open harvesting (4). We describe an endoscopic technique using Holmium: YAG laser to harvest bladder mucosal graft for substitution urethroplasty. Methodology: A 33-year-old male with no history of urethral instrumentation, trauma, or infection presented with obstructive lower urinary tract symptoms. On retrograde urethrogram a 6cm bulbar urethral stricture was identified. Several options were discussed, and the patient opted for a one-sided onlay dorsal urethroplasty (5) using a bladder mucosal graft. Equipment used to harvest the graft included an 18.5Fr continuous flow laser endoscope with a Kuntz working element (RZ) and a 60W Holmium Laser (Quanta) with 550μm laser fiber. The procedure was started by making a perineal incision, urethral mobilization and incision of the stricture segment. The laser endoscope was then introduced via the perineum. Settings of 0.5J, 30 Hz, and long pulse were used and a 7 x 2.5cm graft was harvested from the posterior bladder wall. Hemostasis of the harvest site was performed. The bladder mucosal graft was thinned in similar fashion to a buccal mucosal graft and sutured as per previously described techniques. Conclusion: Endoscopic Holmium Laser harvesting of bladder mucosal graft is feasible and may allow this graft to become an alternative to buccal mucosa. Further studies are required to define its role in urethral reconstruction.

RESUMO: Compreender a diversidade genética e contornar os problemas causados pela interação genótipos por ambientes é uma etapa importante em programas de melhoramento. Este estudo teve como objetivo estimar a diversidade genética e aplicar a metodologia de biplot genótipo + genótipo por ambiente (GGE biplot) em doze genótipos de algodão avaliados quanto ao rendimento da fibra, comprimento da fibra, resistência da fibra e micronaire. A estimativa dos componentes de variância e dos parâmetros genéticos foi feita através do método da máxima verossimilhança restrita e a predição dos valores genotípicos por meio da melhor predição linear não enviesada. Os métodos de Tocher modificado e análise de componentes principais (PCA) foram utilizados para quantificar a diversidade genética entre os genótipos. O método GGE biplot foi conduzido para encontrar os melhores genótipos em relação à adaptabilidade e estabilidade. As técnicas de Tocher e PCA permitiram a formação de clusters de genótipos semelhantes com base em uma estrutura multivariada. O GGE biplot indicou que os genótipos IMACV 690 e IMA08 WS foram altamente adaptáveis e estáveis para as principais características do algodão. O cruzamento dentre os genótipos IMACV 690 e IMA08 WS é o mais recomendado para aumentar o desempenho das principais características na cultura do algodão.

ABSTRACT: Understanding the genetic diversity and overcoming genotype-by-environment interaction issues is an essential step in breeding programs that aims to improve the performance of desirable traits. This study estimated genetic diversity and applied genotype + genotype-by-environment (GGE) biplot analyses in cotton genotypes. Twelve genotypes were evaluated for fiber yield, fiber length, fiber strength, and micronaire. Estimation of variance components and genetic parameters was made through restricted maximum likelihood and the prediction of genotypic values was made through best linear unbiased prediction. The modified Tocher and principal component analysis (PCA) methods, were used to quantify genetic diversity among genotypes. GGE biplot was performed to find the best genotypes regarding adaptability and stability. The Tocher technique and PCA allowed for the formation of clusters of similar genotypes based on a multivariate framework. The GGE biplot indicated that the genotypes IMACV 690 and IMA08 WS were highly adaptable and stable for the main traits in cotton. The cross between the genotype IMACV 690 and IMA08 WS is the most recommended to increase the performance of the main traits in cotton crops.

Resumo A associação simbiótica entre espécies frutíferas nativas com fungos Micorrízicos Arbusculares (FMAs) pode contribuir para o crescimento e a qualidade de mudas em solos com baixa disponibilidade de nutrientes. Desse modo, objetivou-se, com este trabalho, avaliar os efeitos da inoculação com FMAs e adubação fosfatada sobre o crescimento e a qualidade de mudas de jatobazeiro (Hymenaea courbaril L.). O experimento foi realizado em delineamento inteiramente casualizado, em esquema fatorial 5 x 5. Os tratamentos foram constituídos pela inoculação com os FMAs: Clareoideoglomus etunicatum, Rhizoglomus heterosporum, , MIX Rhizoglomus clarum(mistura dos inóculos) e sem inoculação com os FMAs, associados a cinco doses de P: 0; 60; 120; 180 e 240 mg kg-1, com avaliação de crescimento aos 30; 60; 90; 120 e 150 dias após o transplantio (DAT). Aos 150 DAT, determinaram-se a produção de biomassa, a qualidade das mudas, o índice de clorofila, a dependência e a eficiência micorrízica. O fósforo não contribuiu no crescimento das mudas de jatobazeiro, nas condições deste estudo. Mudas com R. clarum e MIX tiveram maior crescimento aos 150 DAT, enquanto as mudas com R. clarum também resultaram em maior acúmulo de biomassa. A dependência e a eficiência micorrízica foi afetada pela adubação fosfatada, evidenciando que o jatobazeiro é uma espécie de associação micorrízica facultativa.

Abstract The symbiotic association between native fruit species with Arbuscular Mycorrhizal fungi (AMFs) can contribute to the growth and quality of seedlings in soils with low nutrient availability. Thus, the objective of this study was to evaluate the effects of inoculation with AMFs and phosphate fertilization on the growth and quality of jatobazeiro seedlings ( LHymenaea courbaril.). The experiment was conducted in a completely randomized design in a 5 x 5 factorial scheme. The treatments were constituted by inoculation with the AMFs: Clareoideoglomus etunicatum, Rhizoglomus heterosporum, Rhizoglomus clarum, MIX (mixture of inoculations) and without inoculation with the AMFs, associated with five P doses: 0, 60, 120, 180 and 240 mg kg-1, with growth evaluation at 30, 60, 90, 120 and 150 days after transplantation (DAT). At 150 DAT, the production of biomass, the quality of seedlings, the chlorophyll index, the dependence and mycorrhizal efficiency were determined. Phosphorus did not contribute to the jatobazeiro seedlings growth in the conditions of this study. Seedlings with R. clarum and MIX had the highest growth at 150 DAT, while seedlings with R. clarum also resulted in a greater biomass accumulation. The mycorrhizal dependence and efficiency was affected by phosphate fertilization, evidencing that jatobazeiro is a kind of optional mycorrhizal association.

ABSTRACT. In cotton crops, the cotton seed yield significantly contributes with the success of any cultivar. However, other traits are considered when an ideotype is pointed out in the selection, such as the fiber quality traits. The aim of this study was to applied genotype by yield*trait (GYT) biplot to a multi-environment trial data of cotton genotypes and selected the best genotypes. For this end, thirteen genotypes from nineteen trials were assessed. Seven traits were evaluated [cotton seed yield (SY), fiber percentage (FP), fiber length (FL), fiber uniformity (FU), short fiber index (SFI), fiber strength (FS), and elongation (EL)] and residual error variances structures [identity variance (IDV) and diagonal (Diag)] were tested by bayesian information criterion. After, the REML/BLUP approach was applied to predict the genetic values of each trait and the selective accuracy were measured from the prediction. Then, the GYT-biplot were applied to the data. For SP and SFI traits, the model with Diag residual variance was indicated, whereas for SY FL, FU, FS, and EL traits the model with IDV residual variance demonstrated the best fit to the data. Values of accuracy were higher than 0.9 for all traits analyzed. In the GYT-biplot acute angles were find for all traits relations, which means high correlation between the yield*traits combination. Besides that, the correlation still can be seen in the GYT-biplot, as shown by the magnitudes of the angles between the pairs Yield*FU-Yield*FS and Yield*FS-Yield*EL. Also, the GYT-biplot indicates the genotype G4 with the best performance for Yield*FS, Yield*SFI, Yield*FU, Yield*FL, and Yield*FP combined. The genotypes G4, G1, G13, G8, and G9 represent those genotypes with yield advantage over the other cultivars. Then, the genotype G4 combines all desirable characteristics and demonstrate have large potential in the cotton breeding. The GYT approach were valuable and were highly recommended in cotton breeding programs for selection purpose in a multivariate scenario.

Abstract Background: Transplant Renal Artery Stenosis (TRAS) is a recognized vascular complication after kidney transplantation. The overall risk predictors of TRAS are poorly understood. Methods: Retrospective analysis of patients with suspected TRAS (Doppler ultrasound PSV > 200 cm/s) who underwent angiographic study in a single center between 2007 and 2014. All patients with stenosis > 50% were considered with TRAS. Stenosis restricted in the body of the artery was also analyzed in a subgroup. Results: 274 patients were submitted to a renal angiography and 166 confirmed TRAS. TRAS group featured an older population (46.3 ± 11.0 vs. 40.9 ±14.2 years; p = 0.001), more frequent hypertensive nephropathy (30.1% vs. 15.7%; p = 0.01), higher incidence of Delayed Graft Function (DGF) (52.0% vs. 25.6%; p < 0.001) and longer Cold Ischemia Time (CIT) (21.5 ± 10.6 vs. 15.7 ± 12.9h; p < 0.001). In multivariable analyses, DGF (OR = 3.31; 95% CI 1.78-6.30; p < 0.0001) was independent risk factors for TRAS. DM and CIT showed a tendency towards TRAS. The compound discriminatory capacity of the multivariable model (AUC = 0.775; 95% CI 0.718-0.831) is significantly higher than systolic blood pressure and creatinine alone (AUC = 0.62; 95% CI 0.558-0.661). In body artery stenosis subgroup, DGF (OR = 1.86; 95% CI 1.04-3.36; p = 0.03) and Diabetes Mellitus (DM) (OR = 2.44; 95% CI 1.31-4.60; p = 0.005) were independent risk factors for TRAS. Conclusion: In our transplant population, DGF increased more than 3-fold the risk of TRAS. In the subgroup analysis, both DGF and DM increases the risk of body artery stenosis. The addition of other factors to hypertension and renal dysfunction may increase diagnostic accuracy.

Resumo Neste trabalho procuramos explorar possíveis significados e sentidos relacionados com a temática socioambiental, mobilizados a partir da proposta curricular de uma escola técnica agrícola. Neste artigo, em particular, optamos por explorar os enunciados que fazem referências à relação entre a temática socioambiental, o processo educativo e questões relativas à técnica aplicadas às práticas da agricultura. Trata-se de uma pesquisa de natureza qualitativa, desenvolvida a partir da análise documental. As análises nos permitiram evidenciar certa tendência de incentivo à utilização da técnica, no que diz respeito aos processos de mecanização e modernização da agricultura, relacionados ao aumento da produtividade agrícola. Há, também, indícios de um deslocamento da responsabilidade em relação às questões ambientais, uma vez que se coloca ênfase na técnica como um caminho para a solução dos problemas ambientais.

Abstract In this paper we seek to explore possible meanings and senses related socioenvironmental issues mobilized in response to the proposed curriculum in a technical-agricultural school. In this article, in particular, we have chosen to explore the statements that make references to the relationship between socio-environmental topics, the educational process, and issues related to techniques applied to agricultural practices. This is a qualitative study, grounded on documentary analysis. The analysis allowed us to show a certain tendency to encourage the use of techniques regarding the processes of mechanization and modernization of agriculture, related to the increase in agricultural productivity. There are also signs of a shift in accountability for environmental issues, as the emphasis is placed on techniques as solutions to environmental problems.

Resumo Fundamento: A proteína C-reativa (PCR) é um biomarcador de inflamação preditor de eventos adversos em procedimentos cardiovasculares. Na avaliação do implante da válvula aórtica transcateter (transcatheter aortic valve implantation, TAVI) em relação ao prognóstico de longo prazo ainda é incipiente. Objetivo: Avaliar a PCR como marcador prognóstico no primeiro ano pós-TAVI na estenose aórtica (EAo). Métodos: A PCR foi avaliada na primeira semana do peroperatório numa coorte de casos retrospectiva com EAo. Correlacionou-se a PCR pré- e pós-TAVI com a mortalidade e foram pesquisados fatores preditores de mortalidade em 1 ano. Realizada regressão de Cox multivariada para identificar os preditores independentes de óbito em 1 ano. Resultados: Estudados 130 pacientes submetidos a TAVI, com mediana de idade de 83 anos, sendo 49% deles do sexo feminino. A PCR pré-TAVI elevada (> 0,5 mg/dL) ocorreu em 34,5% dos casos. O pico de PCR foi 7,0 (5,3-12,1) mg/dL no quarto dia. A mortalidade em 1 ano foi 14,5% (n = 19), sendo maior nos grupos com PCR pré-TAVI elevada (68,8% vs 29,1%; p = 0,004) e pico de PCR ≥ 10,0 mg/dL (64,7% vs 30,8%; p = 0,009). Os fatores preditores independentes de mortalidade foram insuficiência renal aguda (IRA) [razão de risco (RR) = 7,43; intervalo de confiança de 95% (IC95%), 2,1-24,7; p = 0,001], PCR pré-TAVI elevada [RR = 4,15; IC95%, 1,3-12,9; p=0,01] e hemotransfusão volumosa [HR = 4,68; 1,3-16,7; p = 0,02]. Conclusões: A PCR pré-TAVI elevada mostrou-se fator preditor independente de mortalidade no primeiro ano, assim como a ocorrência de IRA e hemotransfusões volumosas.

Abstract Background: C-reactive protein (CRP) is an inflammation biomarker that can be a predictor of adverse events in cardiovascular procedures. Its use in the assessment of long-term prognosis of transcatheter aortic valve implantation (TAVI) is still incipient. Objective: To evaluate CRP as a prognostic marker in the first year after TAVI in aortic stenosis (AoS). Methods: CRP was assessed on the first postoperative week in a retrospective cohort of patients with AoS. Pre- and post- CRP levels were correlated with mortality, and predictors of 1-year mortality were investigated. Multivariate Cox regression was performed to identify independent factors of 1-year mortality. Results: This study evaluated 130 patients who underwent TAVI, with median age of 83 years, and 49% of women. High pre-TAVI CRP (> 0.5 mg/dL) was observed in 34.5% of the cases. Peak CRP was 7.0 (5.3-12.1) mg/dL no quarto dia. The rate of 1-year mortality was 14.5% (n = 19), being greater in the groups with high pre-TAVI CRP (68.8% vs 29.1%; p = 0,004) and with peak CRP ≥ 10.0 mg/dL (64.7% vs 30.8%; p = 0,009). Independent predictors of mortality were acute renal failure (ARF) (hazard ratio [HR] = 7.43; 95% confidence interval [95%CI], 2.1-24.7; p = 0,001), high pre-TAVI CRP (HR 4.15; 95%CI, 1.3-12.9; p = 0.01), and large blood transfusion [HR 4,68; 1,3-16,7; p = 0.02]. Conclusions: High pre-TAVI CRP showed to be an independent predictor of 1-year mortality, as well as the presence of ARF and large blood transfusions.

Resumo Fundamento A baixa escolaridade tem sido considerada um fator de risco modificável significativo para o desenvolvimento de doenças cardiovasculares há bastante tempo. Apesar disso, ainda não se sabe muito sobre esse fator impactar ou não os desfechos após infarto do miocárdio com supradesnivelamento do segmento ST (IAMCSST). Objetivo Investigar se a escolaridade é um fator de risco independente para mortalidade em pacientes com IAMCSST. Métodos Os pacientes com diagnóstico de IAMCSST foram consecutivamente incluídos em uma coorte prospectiva (Brasília Heart Study) e categorizados de acordo com os anos dos quartis de estudo (0-3, 4-5, 6-10 e >10 anos). Os grupos foram comparados pelo teste t de Student para variáveis contínuas e qui-quadrado para categóricas. A incidência de mortalidade por todas as causas foi comparada com Kaplan-Meyer com regressão de Cox ajustada por idade, sexo e escore GRACE. Valores de p < 0,05 foram considerados significativos. SPSS21.0 foi utilizado para todas as análises. Resultados A média de escolaridade foi de 6,63±4,94 anos. Durante o período de acompanhamento (média: 21 meses; até 6,8 anos), 83 pacientes vieram à óbito (mortalidade cumulativa de 15%). A taxa de mortalidade foi maior entre o quartil inferior em comparação com aqueles do quartil superior [18,5 vs. 6,8%; RR 2,725 (IC 95%: 1,27-5,83; p=0,01)]. Na análise multivariada, a baixa escolaridade perdeu significância estatística para mortalidade por todas as causas após ajuste para idade e sexo, com RR 1,305 (IC 95%: 0,538-3,16; p=0,556), e após ajuste pelo escore GRACE com RR 1,767 (IC 95%: 0,797-3,91; p=0,161). Conclusão Investigar se a escolaridade é um fator de risco independente para mortalidade em pacientes com IAMCSST.

Abstract Background Low schooling has been considered an important modifiable risk factor for the development of cardiovascular disease for a long time. Despite that, whether this factor impacts the outcomes following ST-segment elevation myocardial infarction (STEMI) is poorly understood. Objective To investigate whether schooling stands as an independent risk factor for mortality in STEMI patients. Methods STEMI-diagnosed patients were consecutively enrolled from a prospective cohort (Brasilia Heart Study) and categorized according to years of study quartiles (0-3, 4-5, 6-10 and >10 years). Groups were compared by student’s t test for continuous variables and qui-square for categorical. Incidence of all-cause mortality was compared with Kaplan-Meyer with Cox regression adjusted by age, gender, and GRACE score. Values of p < 0.05 were considered significant. SPSS21.0 was used for all analysis. Results The mean schooling duration was 6.63±4.94 years. During the follow-up period (mean: 21 months; up to 6.8 years), 83 patients died (cumulative mortality of 15%). Mortality rate was higher among the lowest quartile compared to those in the highest quartile [18.5 vs 6.8%; HR 2.725 (95% CI: 1.27-5.83; p=0.01)]. In multivariate analysis, low schooling has lost statistical significance for all-cause mortality after adjustment for age and gender, with HR of 1.305 (95% CI: 0.538-3.16; p=0.556), and after adjustment by GRACE score with an HR of 1.767 (95% CI: .797-3.91; p=0.161). Conclusion Low schooling was not an independent risk factor for mortality in STEMI patients.

Resumo Fundamento A regurgitação mitral (RM) é prevalente em pacientes submetidos a implante transcateter de válvula aórtica (TAVI). Há algumas controvérsias sobre o impacto prognóstico da RM na sobrevida de pacientes submetidos a TAVI. Objetivo Examinar a relação entre TAVI e RM em uma população de pacientes do Registro Brasileiro de TAVI. Métodos Setecentos e noventa e cinco pacientes do Registro Brasileiro de TAVI foram divididos na linha de base, alta e acompanhamento de acordo com o grau da RM da maneira seguinte: ausente/leve (RMAL) ou moderado/grave (RMMG). Eles foram subsequentemente reagrupados de acordo com as mudanças imediatas e tardias na gravidade da RM após TAVI da maneira seguinte: RM sem mudança, melhora ou piora. Foram analisados os preditores e o impacto prognóstico na linha de base, bem como as mudanças na gravidade da RM. A significância estatística foi estabelecida em p < 0,05. Resultados RMMG basal estava presente em 19,3% dos pacientes e foi um preditor de aumento da mortalidade tardia. Imediatamente após o TAVI, 47,4% dos casos melhoraram para RMAL, previsto por uma pontuação mais alta da Society of Thoracic Surgeons e um grau mais alto de regurgitação aórtica basal. No acompanhamento, 9,2% dos casos de RMAL pioraram para RMMG, enquanto 36,8% dos casos de RMMG melhoraram para RMAL. Fração de ejeção do ventrículo esquerdo (FEVE) mais baixa na linha de base e melhora na FEVE durante o acompanhamento foram preditores de melhora da RM. Piora progressiva da RM no acompanhamento foi um preditor independente de maior mortalidade tardia após TAVI (p = 0,005). Conclusões A RMMG na linha de base é um preditor de mortalidade tardia após TAVI. FEVE mais baixa e melhora na FEVE durante o acompanhamento são preditores de melhora da RM após TAVI. A pior progressiva da gravidade da RM durante o acompanhamento é um preditor independente de mortalidade tardia; isto é um achado raro na literatura.

Abstract Background Mitral regurgitation (MR) is prevalent in patients undergoing transcatheter aortic valve implantation (TAVI). There are some controversies about the prognostic impact of MR in survival of TAVI patients. Objective To examine the relationship between TAVI and MR in a patient population from the Brazilian TAVI Registry. Methods Seven hundred and ninety-five patients from the Brazilian TAVI Registry were divided at baseline, discharge, and follow-up according to their MR grade as follows: absent/mild (AMMR) or moderate/severe (MSMR). They were subsequently regrouped according to their immediate and late changes in MR severity after TAVI as follows: no change, improved, or worsened MR. Predictors and prognostic impact on baseline as well as changes in MR severity were analyzed. Statistical significance was set at p < 0.05. Results Baseline MSMR was present in 19.3% of patients and was a predictor of increased late mortality. Immediately after TAVI, 47.4 % of cases improved to AMMR, predicted by a higher Society of Thoracic Surgeons score and a higher grade of baseline aortic regurgitation. Upon follow-up, 9.2% of cases of AMMR worsened to MSMR, whereas 36.8% of cases of MSMR improved to AMMR. Lower baseline left ventricular ejection fraction (LVEF) and improvement in LVEF at follow-up were predictors of MR improvement. Progressive worsening of MR upon follow-up was an independent predictor of higher late mortality after TAVI (p = 0.005). Conclusions Baseline MSMR predicts late mortality after TAVI. Lower LVEF and improved LVEF at follow-up predict MR improvement after TAVI. Progressive worsening of MR severity at follow-up is an independent predictor of late mortality, which is a rare finding in the literature.