It is estimated that atrial fibrillation (AF) affects approximately 1.5 million people in Brazil; however, epidemiological data are limited. We sought to evaluate the characteristics, treatment ...patterns, and clinical outcomes in patients with AF in Brazil by creating the first nationwide prospective registry.
RECALL was a multicenter, prospective registry that included and followed for 1 year 4,585 patients with AF at 89 sites across Brazil from April 2012 to August 2019. Patient characteristics, concomitant medication use, and clinical outcomes were analyzed using descriptive statistics and multivariable models.
Of 4,585 patients enrolled, the median age was 70 (61, 78) years, 46% were women, and 53.8% had permanent AF. Only 4.4% of patients had a history of previous AF ablation and 25.2% had a previous cardioversion. The mean (SD) CHA2DS2-VASc score was 3.2 (1.6); median HAS-BLED score was 2 (2, 3). At baseline, 22% were not on anticoagulants. Of those taking anticoagulants, 62.6% were taking vitamin K antagonists and 37.4% were taking direct oral anticoagulants. The primary reasons for not using an oral anticoagulant were physician judgment (24.6%) and difficulty in controlling (14.7%) or performing (9.9%) INR. Mean (SD) TTR for the study period was 49.5% (27.5). During follow-up, the use of anticoagulants and INR in the therapeutic range increased to 87.1% and 59.1%, respectively. The rates/100 patient-years of death, hospitalization due to AF, AF ablation, cardioversion, stroke, systemic embolism, and major bleeding were 5.76 (5.12-6.47), 15.8 (14.6-17.0), 5.0 (4.4-5.7), 1.8 (1.4-2.2), 2.77 (2.32-3.32), 1.01 (0.75-1.36), and 2.21 (1.81-2.70). Older age, permanent AF, New York Heart Association class III/IV, chronic kidney disease, peripheral arterial disease, stroke, chronic obstructive pulmonary disease, and dementia were independently associated with increased mortality while the use of anticoagulant was associated with lower risk of death.
RECALL represents the largest prospective registry of patients with AF in Latin America. Our findings highlight important gaps in treatment, which can inform clinical practice and guide future interventions to improve the care of these patients.
As shown by the Green Deal's ambition, the European Commission is progressively pushing for an environmental shift and climate action in Europe. For the Common Agricultural Policy (CAP), this ...involves a stronger focus on greening policy objectives. For agri-environmental schemes, this entails changes toward performance-based payments, partially replacing traditional activity-based payments. The CAP foresees greater flexibility in national programs and tailor-made solutions centered on results (i.e. environmental outcomes), benefiting farmers who go beyond the minimum environmental performance required. The environmental outcomes of farm practices must be assessed so that changes can be monitored over time and linked to payment delivery. This requires stakeholders to collaborate with researchers to identify farm-based indicators that are easily applicable, to achieve environmental results that are dependent on farm practices, and to assess and monitor changes in outcomes over time. The analysis in this paper is based on a transdisciplinary process that began in 2017 in a Natura 2000 site and its surroundings in Southern Portugal, to identify result-based measures for the Montado silvo-pastoral system. Farmers' understanding of how to adapt their practices to reach better environmental results was combined with scientific knowledge of the relevant environmental outcomes and how these can be assessed with indicators. Ten field-based visual indicators were defined, which farmers applied in the field, and validated by technical staff. These indicators are related to several aspects of the silvo-pastoral system: soil quality, pasture diversity, tree renewal, tree health, singular landscape elements, and biodiversity. The approach used in this process was innovative. We describe each step and present its advantages and drawbacks for designing and implementing result-based payments. Ultimately, their implementation is expected to lead to higher sustainability in the Montado.
This study aimed to investigate the impact of 12 weeks of high-intensity interval training (HIIT) on hemodynamic variables at rest and during exercise in patients with obstructive sleep apnoea. ...Twenty-six obese adults with moderate-to-severe OSA (AHI = 42 ± 22.9 e/h) were randomly assigned to HIIT or a control group. Sleep parameters, ambulatorial, aortic, and during-exercise SBP and DBP were assessed at baseline and after 12 weeks. Generalized estimated equations assessed differences between groups over time. When compared with control group, HIIT reduced AHI (17.1 ± 6.2; e/h, P < 0.01), SBP nighttime (10.2 ± 5.0 mmHg; P = 0.034), DBP nighttime (7.9 ± 4.0 mmHg; P = 0.038), DBP aortic (5.5 ± 2.9 mmHg; P = 0.048), and SBP max (29.6 ± 11.8 mmHg; P = 0.045). In patients with OSA, 12 weeks of HIIT decreases sleep apnoea severity and blood pressure in rest and during exercise.
Abstract
Cell culture models are important tools to study epileptogenesis mechanisms. The aim of this work was to characterize the spontaneous and synchronized rhythmic activity developed by cultured ...hippocampal neurons after transient incubation in zero Mg
2+
to model
Status Epilepticus
. Cultured hippocampal neurons were transiently incubated with a Mg
2+
-free solution and the activity of neuronal networks was evaluated using single cell calcium imaging and whole-cell current clamp recordings. Here we report the development of synchronized and spontaneous Ca
2+
i
transients in cultured hippocampal neurons immediately after transient incubation in a Mg
2+
-free solution. Spontaneous and synchronous Ca
2+
i
oscillations were observed when the cells were then incubated in the presence of Mg
2+
. Functional studies also showed that transient incubation in Mg
2+
-free medium induces neuronal rhythmic burst activity that was prevented by antagonists of glutamate receptors. In conclusion, we report the development of epileptiform-like activity, characterized by spontaneous and synchronized discharges, in cultured hippocampal neurons transiently incubated in the absence of Mg
2+
. This model will allow studying synaptic alterations contributing to the hyperexcitability that underlies the development of seizures and will be useful in pharmacological studies for testing new drugs for the treatment of epilepsy.
Summary
Background
After reversal of a rocuronium‐induced neuromuscular blockade with sugammadex, the recovery of train‐of‐four ratio to 0.9 is faster than recovery of first twitch of the ...train‐of‐four to 90% in adults. These findings after reversal of neuromuscular blockade with sugammadex have not yet been investigated in pediatric patients.
Aims
The aim of this retrospective analysis was to investigate the relationship of the recovery of first twitch of the train‐of‐four height and train‐of‐four ratio after reversal of rocuronium‐induced neuromuscular blockade with sugammadex in pediatric patients.
Methods
Patients ASA I‐III, aged 2‐11 years, and who underwent abdominal and/or perineal surgery were included in the analysis. After extracting the necessary data from the hospital database, the patients were divided into 2 groups based on the dose of sugammadex received: group A: 2 mg.kg−1 for reversal of moderate neuromuscular blockade and group B: 4 mg.kg−1 for reversal of deep neuromuscular blockade. The relationship of the recovery of first twitch of the train‐of‐four height and train‐of‐four ratio in these 2 groups were analyzed.
Results
Data from 43 pediatric patients aged 2‐11 years could be analyzed. The first twitch of the train‐of‐four height at the recovery of train‐of‐four ratio to 0.9 in group B was statistically significantly lower compared with group A. This height 3 and 5 minutes after the train‐of‐four ratio reached 0.9 showed no statistically significant differences between groups.
Conclusion
The results were in line with the results found in adults and showed that the train‐of‐four ratio recovered to 0.9 was faster than first twitch of the train‐of‐four height recovered to the same level.
Background
Latin America comprises an extensive and diverse territory composed of 33 countries in the Caribbean, Central, and South America where Romance languages–languages derived from Latin are ...predominantly spoken. Economic disparities exist, with inequitable access to pediatric surgical care. The Latin American Surgical Outcomes Study in Pediatrics (LASOS‐Peds), a multi‐national collaboration, will determine safety of pediatric anesthesia and perioperative care.
Objective
Below, we provide a descriptive initiative to share how pediatric anesthesia in Brazil, Chile, and Mexico operate. Theses descriptions do not represent all of Latin America.
Descriptions and Conclusions
Brazil an upper middle‐income country, population 203 million, has a public system insufficiently resourced and a private system, resulting in inequitable safety and accessibility. Surgical complications constitute the third leading cause of mortality. Anesthesiology residency is 3 years, with required rotations in pediatric anesthesia; five hospitals offer pediatric anesthesia fellowships. Anesthesiology is a physician‐only practice. A Pediatric Anesthesia Committee within the Brazilian Society of Anesthesiology offers education through seasonal courses and workshops including pediatric advanced life support. Chile is a high‐income country, population 19.5 million, the majority cared for in the public system, the remainder in university, private, or military systems. Government efforts have gradually corrected the long‐standing anesthesiology shortage: twenty 3‐year residency programs prepare graduates for routine pediatric cases. The Chilean Society of Anesthesiology runs a 1‐month program for general anesthesiologists to enhance pediatric anesthesia skills. Pediatric anesthesia fellowship training occurs in Europe, USA, and Australia, or in two 2‐year Chilean university programs. Public health policies have increased the medical and surgical pediatric specialists and general anesthesiologists, but not pediatric anesthesiologists, which creates safety concerns for neonates, infants, and medically complex. Chile needs more pediatric anesthesia fellowship programs. Mexico, an upper middle‐income country, with a population of about 126 million, has a five‐sector healthcare system: public, social security for union workers, state for public employees, armed forces for the military, and a private “self‐pay.” There are inequities in safety and accessibility for children. Pediatric Anesthesiology fellowship is 2 years, after 3 years residency. A shortage of pediatric anesthesiologists limits accessibility and safety for surgical care, driven by added training at low salary and hospital under appreciation. The Mexican Society of Pediatric Anesthesiology conducts refresher courses, workshops, and case conferences. Insufficient resources and culture limits research.
Background
Early and delayed behavioral changes are well recognized after anesthesia. Intravenous anesthesia may prevent emergence delirium. However, it has not been evaluated as a preventive ...strategy for delayed postoperative behavior changes.
Aims
We aimed to determine whether intravenous anesthesia is effective at reducing postoperative behavior changes in children undergoing ambulatory endoscopic procedures when compared to inhalation anesthesia.
Methods
This randomized, double‐blinded controlled trial was approved by the local IRB. Children aged 1–12 years who underwent ambulatory endoscopic procedures were recruited. Preoperative anxiety was evaluated through the modified Yale Preoperative Anxiety Scale. All children underwent face mask inhalation induction with sevoflurane. After a peripheral line was placed, each child was allocated to sevoflurane or propofol maintenance. Emergence delirium was evaluated through the Pediatric Anesthesia Emergence Delirium scale. The child was discharged home, and behavioral changes were assessed through the Posthospitalization Behavior Questionnaire for Ambulatory Surgery on Days 1, 7, and 14.
Results
Overall, 175 children were enrolled. On Day 1 after the procedure, 57 children presented at least one negative behavior. On Days 7 and 14, 49 and 44 children presented at least one negative behavior, respectively. The median number of negative behaviors was similar between the groups. Post hoc analyses showed a moderate correlation between emergence delirium and negative postoperative behavior on Day 7 (r = .34; p = <.001) and an increase of 3.31 (95% CI 1.90; 4.36 p < .001) points in the mean summed score of new negative behaviors for individuals with emergence delirium.
Conclusion
The incidence of postoperative behavior changes in children undergoing ambulatory endoscopic procedures was similar when comparing intravenous with inhalation anesthesia. Children who experience emergence delirium might show a greater incidence of negative postoperative behavior changes.
In this work, hybrid materials within the polydimethylsiloxane-silica (PDMS-SiO
) system, synthesized via the sol-gel method, were developed and characterized for their potential to incorporate and ...release the bioactive compound resveratrol (RES). RES was incorporated into the materials with a high loading efficiency (>75%) using the rotary evaporator technique. This incorporation induced the amorphization of RES, resulting in enhanced solubility and
release when compared to the free polyphenolic compound. The release profiles displayed pH dependence, exhibiting notably faster release at pH 5.2 compared to pH 7.4. The gradual release of RES over time demonstrated an initial time lag of approximately 4 h, being well described by the Weibull model.
cytotoxicity studies were conducted on human osteosarcoma cells (MG-63), revealing a concentration-dependent decrease in cell viability for RES-loaded samples (for concentrations >50 µg mL
).
•Comparison of Lithium-ion batteries with Vanadium flow batteries in island settings.•Battery degradation and future cost of fossil fuel included in the investment analysis.•Vanadium flow batteries ...are more profitable than lithium-ion for projected cost scenario.•Batteries allow RES-share of electricity production to grow up to 46%.
The decarbonization of the electricity supply in isolated and remote energy systems is an open challenge in the transition to a sustainable energy system. In this paper, the possibility to increase the penetration of renewable energy sources for electricity generation on the island of Terceira (Azores) is investigated through the installation of a utility-scale energy storage facility. The electric power dispatch on the island is simulated through a unit commitment model of the fossil and renewable power plants that has the objective of minimizing the cost of electricity generation. Battery energy storage is employed to partially decouple production and supply, and to provide spinning reserve in case of sudden generator outage. Two technological options, namely lithium-ion and vanadium flow batteries, are compared in terms of net present value and return on investment, with the aim of supporting the decision-making process of the local utility. The economic evaluation takes also into account the degradation of the battery performance along the years. The results, obtained in a future-price scenario, show that both the technologies entail a positive investment performance. However, vanadium flow batteries have the best results, given that they can produce a net present value that exceeds 430% of the initial capital invested after 20 years, with a return on investment higher than 35%. In this scenario, the renewable share can reach up to 46%, compared to the current 26%.
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