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In due time, the Brazilian Society of Cardiology decided to create a guideline on telemedicine applied to cardiology, also known as telecardiology. According to the Pan American Health Organization (PAHO) and the World Health Organization (WHO), telemedicine is “The delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment, and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities.” Such a seemingly simple and altruistic definition carries a wide range of potential implications at various levels, from an ethical point of view to a potential impact on clinical practice and outcomes. Hence, the importance of guidelines, organized by the medical community through scientific societies, in offering to all of those involved in the process a reference based, as much as possible, on expert opinion, current scientific evidence, and on respect for medical ethical and deontological values. Oportunamente, a Sociedade Brasileira de Cardiologia decidiu criar uma diretriz sobre a telemedicina aplicada à cardiologia, também conhecida como telecardiologia. Segundo a Organização Pan-Americana da Saúde (OPAS) e a Organização Mundial da Saúde (OMS), a telemedicina é “A prestação de serviços de saúde, onde a distância é um fator crítico, por todos os profissionais de saúde que utilizam tecnologias de informação e comunicação para a troca de informações válidas para diagnóstico, tratamento e prevenção de doenças e lesões, pesquisa e avaliação, e para a educação continuada dos profissionais de saúde, tudo no interesse do avanço da saúde dos indivíduos e de suas comunidades”. Tal definição aparentemente simples e altruísta carrega uma ampla gama de implicações potenciais em vários níveis, desde um ponto de vista ético até um potencial impacto na prática clínica e nos resultados. Daí a importância das diretrizes, organizadas pela comunidade médica por meio das sociedades científicas, em oferecer a todos os envolvidos no processo uma referência baseada, tanto quanto possível, na opinião de especialistas, nas evidências científicas atuais e no respeito à ética médica e valores deontológicos.

BACKGROUND Developing countries struggle to diagnose and treat ST-segment elevation myocardial infarction (STEMI) patients in a timely manner, and subsequent outcomes are suboptimal. METHODS The Latin America Telemedicine Network (LATIN) functioned between 2013 to present in four countries-Brazil, Colombia, Mexico, and Argentina. A Hub and Spoke platform was developed to expand access to >100 million population for STEMI care. Patients were triaged at spokes that included small clinics and primary health care centers in remote South American locations. Three telemedicine command sites provided immediate 24/7 electrocardiogram diagnosis and teleconsultation of the STEMI process at 355 centers in four countries. RESULTS LATIN Spokes (n = 313) screened up to 30,000 patients per month, and a total of 780,234 patients over the study period. Telemedicine experts diagnosed 8395 (1·1%) with STEMI, of which a total of 3872 (46·1%) were urgently treated at 47 Hubs. A total of 3015 patients (78%) were reperfused with percutaneous coronary intervention. Time-to-telemedicine diagnosis averaged 3·5 min. Average door-to-balloon time improved from 120 to 48 min during the study period and overall STEMI mortality was 5·2%. INTERPRETATION Telemedicine transcends boundaries and enables access to millions of patients for STEMI care. With this initiative, LATIN has created a template for reducing disparities in STEMI management between developed and developing countries.

This study investigated the sexual dimorphism, allometric growth, and morphological maturity of six sympatric species of Alpheus. The samplings occurred in August 2015, February and August 2016, and February 2017, in the intertidal, during low spring tides, in two localities in the northeastern Brazilian coast. In total, 3038 individuals were captured: 302 A. angulosus, 400 A. bouvieri, 516 A. buckupi, 410 A. carlae, 1002 A. estuariensis, and 408 A. nuttingi. According to our data, the six species lack sexual dimorphism regarding the carapace length. However, the major chelipeds were more robust in males of five species, whereas abdominal structures (pleurae and sternites) were larger in females, both indicatives of sexual dimorphism. The analyses of the relative growth of cheliped dimensions versus body size demonstrate that males of six species invest more energy in the chelipeds during the adult and juvenile phases. On the other hand, in the females the cheliped growth is higher during the juvenile phase. The analysis of energy allocation (calculated using body and chelipeds mass) also confirmed a high energetic investment in this appendage in males (minimum 32% of the body mass). Our results also show that females can also invest a lot of energy in the chelipeds (minimum 22% of the body mass). However, the intraspecific sex differences may be consequences of a trade-off between embryo production and cheliped development. The growth rate of pleura and sternites were higher in the adult females of all species except for A. bouvieri. In the males of the six species the appendix masculina grows faster during the juvenile phase. Lastly, in the six species of Alpheus studied, males and females reach the morphological maturity at very similar sizes, indicating a synchrony of reproduction and growth.

The use of bioclimatic models to predict areas subject to invasion by exotic species has been important in the development of preventive conservation measures. The native New Zealand mudsnail Potamopyrgus antipodarum is an invasive mollusc, now with a worldwide distribution, that causes economic and ecological problems in invaded areas and has recently been designated as one of the 100 worst invasive species in Europe. In this study we sought to determine the potential distribution of and areas susceptible to invasion by P. antipodarum in South America and worldwide, in present and future scenarios (2070), using MaxEnt models. The models were developed using georeferenced occurrence data and bioclimate and hydroclimate variables to predict scenarios of the geographical distribution of P. antipodarum. Possible routes of invasion into South America were predicted. Present‐day scenario of the worldwide distribution (all known occurrences) of P. antipodarum, based on the bioclimatic and hydroclimatic models, are highly accurate, with area under curve higher than of 0.87. The models indicated that environmentally suitable areas exist in South America and in other regions of the world where the species has not yet been recorded. The predicted susceptibility includes approximately 80 protected areas in the South American continent. Models projected in an optimistic and pessimistic future scenario, based on the worldwide distribution, show increased environmental suitability of regions outside the current species distribution, including Brazil (south‐west), Uruguay (near Mirim Lagoon), Nigeria, Ethiopia (lakes Tana and Chomen), Tanzania, Cameroon (bordering lakes Bamendjing, Bankim, and Mbakaou), Equatorial Guinea, Congo, Rwanda, Burundi (Lake Tanganyika environs), Uganda, Tanzania (Naivasha), and South Africa (surrounding Gordon's Bay). The main vector for dispersal to South America would be ballast water coming from waterways and ports located in the predicted areas. Fish farming is also a possible route, since the mudsnail is resistant to the digestive tract of rainbow trout (Oncorhynchus mykiss). Current records and predicted susceptible areas coincide with port areas and sites where this fish is farmed. Geographical distribution modelling proved to be helpful in identifying environmentally suitable areas for the invasion of P. antipodarum. The model also suggests a future expansion of the species distribution, possibly affected by climate change.

A irrigação localizada tem sua importância dentro da agricultura brasileira, principalmente pelo baixo consumo de água em função da crise hídrica que o pais vem enfrentando nos últimos anos. O entupimento dos emissores, ocasionado pelas partículas do solo ou intrusão radicular objetivou avaliar diferentes gramaturas de geotêxtil na cobertura dos gotejadores instalados subsuperficalmente com uma lâmina física no cultivo de gramas. O experimento foi conduzido em casa de vegetação, no Departamento de Solos e Recursos Ambientais da Faculdade de Ciências Agronômicas, UNESP, município de Botucatu - SP. O delineamento experimental foi em blocos casualizados (DBC), com oito tratamentos: T1 sem geotêxtil, T2 geotêxtil não tecido agulhado em polipropileno (N26.1), T3 geotêxtil não tecido agulhado em polipropileno (N30.1) e T4 geotêxtil não tecido agulhado em polipropileno (N40.1), com cinco repetições, e duas gramíneas, totalizando 40 unidades. Observou-se que as espécies de gramas cultivadas não apresentaram resultados significativos ao analisar as imagens pelo WinRhizo, em número de raízes, comprimento e volume entre espécies e tratamentos aos 30, 60, 90 e 120 (DAP). A massa fresca avaliada das aparas apresentaram resultados significativos entre tratamentos e não entre espécies, sendo a gramatura N.30 superior aos demais resultados. Não houve nenhuma raiz aderida nos emissores. Palavras-chave: gramado ornamental, gramado esportivo, irrigação localizada, irrigação por gotejamento

AIMS The aim of this study was to evaluate the safety and efficacy of the BioMime sirolimus-eluting coronary stent (SES) compared to the XIENCE family of everolimus-eluting coronary stents (EES) in the treatment of patients with de novo native coronary artery lesions. METHODS AND RESULTS The meriT-V is a prospective, multicentre, randomised, open-label, active-controlled, non-inferiority trial. A total of 256 patients with up to two de novo native coronary artery lesions were enrolled and randomly assigned (2:1) to BioMime SES or XIENCE EES. BioMime SES was non-inferior to XIENCE EES for the primary endpoint of in-stent late lumen loss (0.15±0.27 mm vs. 0.15±0.29 mm; difference: -0.006 mm; 95% confidence interval: -0.085 to 0.072; p=0.87; p for non-inferiority

Made available in DSpace on 2021-06-25T10:12:35Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-02-01 Temperature and other abiotic factors, such water and nutrient availability, play an important role for plants in response to the changing environments. At this regard, both warming and drought might affect the nutrient use efficiency (NUE) and growth of Megathyrsus maximus a C4 forage grass of high interest for cattle feeding. However, the nutrient requirements of this species under climate change are unknown. Therefore, we aimed to evaluate the individual and combined effects of two levels of temperature: ambient and elevated temperature (2°C above ambient temperature), and two levels of soil water availability: irrigated plants and non-irrigated plants on accumulation of leaf nutrients, NUE and biomass production of M. maximus. Temperature control was performed by a temperature free-air-controlled enhancement (T-FACE) system under field conditions. In general, we observed that warming under well-irrigated conditions increased the leaf accumulation of most nutrients, improving the NUE of N, P, K, Ca, Mg, Cu, Mn and Zn. Plant growth was also enhanced under warming effects, with higher leaf dry mass accumulation and root development. Meanwhile, drought decreased NUE of K, Ca, B and leaf dry biomass, while root growth was stimulated. The combined effects of warming and drought on nutrient accumulation, NUE and plant growth tended to be greater than the individual effects expected from a single factor; thus, warming mitigated the negative impacts of individual drought. In summary, our findings suggest that warming and drought, both as individual and combined factors, will change the nutrient requirements of M. maximus in tropical ecosystems. Faculty of Agricultural and Veterinarian Sciences São Paulo State University (UNESP) Department of Biology Ribeirão Preto (FFCLRP) University of São Paulo São Paulo Agribusiness Technology Agency (APTA) Center of Nuclear Energy in Agriculture University of São Paulo Faculty of Agricultural and Veterinarian Sciences São Paulo State University (UNESP)

Contains fulltext : 225405.pdf (Publisher’s version ) (Open Access) BACKGROUND AND AIMS: The prognostic impact of pre-procedure heart rate (PHR) following percutaneous coronary intervention (PCI) has not yet been fully investigated. This post-hoc analysis sought to assess the impact of PHR on medium-term outcomes among patients having PCI, who were enrolled in the "all-comers" GLOBAL LEADERS trial. METHODS AND RESULTS: The primary endpoint (composite of all-cause death or new Q-wave myocardial infarction [MI]) and key secondary safety endpoint (bleeding according to Bleeding Academic Research Consortium [BARC] type 3 or 5) were assessed at 2 years. PHR was available in 15,855 patients, and when evaluated as a continuous variable (5 bpm increase) and following adjustment using multivariate Cox regression, it significantly correlated with the primary endpoint (hazard ratio [HR] 1.06, 95% confidence interval [CI] 1.03-1.09, p 67 bpm was associated with increased all-cause mortality (HR 1.38, 95%CI 1.13-1.69, p = 0.002) and more frequent new Q-wave MI (HR 1.41, 95%CI 1.02-1.93, p = 0.037). No significant association was found between PHR and BARC 3 or 5 bleeding (HR 1.04, 95% CI 0.99-1.09, p = 0.099). There was no interaction with the primary (p-inter = 0.236) or secondary endpoint (p-inter = 0.154) when high and low PHR was analyzed according to different antiplatelet strategies. CONCLUSIONS: Elevated PHR was an independent predictor of all-cause mortality at 2 years following PCI in the "all-comer" GLOBAL LEADERS trial. The prognostic value of increased PHR on outcomes was not affected by the different antiplatelet strategies in this trial.

The aim of this cross-sectional study was to evaluate the impact of anxiety and quality of sleep on quality of life (QOL) in undergraduate dental students. A total of 141 students were enrolled. All were required to answer the following questionnaires: the State-Trait Anxiety Inventory (STAI) subscale state (S) (STAI-S); the Sleep Assessment Questionnaire (SAQ); and the simplified World Health Organization Quality of Life survey (WHO QOL-bref). The statistical analysis included univariate and bivariate analyses and Poisson regressions. The mean age of the participants was 22.9 (SD=5.2) years; 81.6% were women, and 37.6% studied during the morning shift. The mean STAI-S score was 50.3 (SD=9.4). Sleep problems, classified as "always" or "frequently", were reported by 11.3% and 18.4% of the sample, respectively. Quality of life had a mean score of 13.2 (SD=2.0). The STAI-S and SAQ scores showed a significant association with all WHOQOL-bref dimensions (p

Made available in DSpace on 2020-12-12T01:18:18Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-01-01 Panicum maximum Jacq. 'Mombaça' (Guinea grass) is a C4 forage grass widely used in tropical pastures for cattle feeding. In this study, we evaluated the isolated and combined effects of warming and elevated CO2 concentration [CO2] during summer on nutrient content, nutrient accumulation, nutrient use efficiency and growth of P. maximum under field conditions. Field temperature and [CO2] were controlled by temperature free-air controlled enhancement and free-air CO2 enrichment systems, respectively. We tested two levels of canopy temperature: Ambient temperature (aT) and 2°C above ambient temperature (eT), as well as two levels of atmospheric [CO2]: Ambient [CO2] (aCO2) and 200 ppm above ambient CO2 (eCO2). The experiment was established in a completely randomized design with four replications, in a 2×2 factorial scheme. After pasture establishment, plants were exposed to the treatments during 30 days, with evaluations at 9, 16, 23 and 30 days after the treatments started. Results were dependent on the time of the evaluation, but in the last evaluation (beginning of the grazing), contents of N, K, Mg and S did not change as a function of treatments. However, P decreased as a function of warming under both levels of [CO2], and Ca increased under [eCO2] combined with warming. There was an increase in root dry mass under warming treatment. Combined treatment increased N, Ca and S accumulation without a corresponding increase in the use efficiency of these same nutrients, indicating that the fertiliser dose should increase in the next decades due to climate change. Our short-term results in young and well fertilized pasture suggest that under the combination of [eCO2] and eT conditions, P. maximum productivity will increase and the nutritional requirement for N, Ca and S will also increase. Department of Soils and Fertilizers São Paulo State University (UNESP) School of Agricultural and Veterinarian Sciences Department of Biology FFCLRP São Paulo University (USP) São Paulo Agribusiness Technology Agency (APTA) Department of Soils and Fertilizers São Paulo State University (UNESP) School of Agricultural and Veterinarian Sciences

Folic acid content was evaluated in food preparations containing wheat and corn flour submitted to baking, deep-frying, and steaming. Commercially fortified flours showed the absence of folic acid. Flours with laboratory folic acid fortification showed 487 and 474 μg of folic acid in 100 g of wheat and corn flours, respectively. In the corn flour preparations, the cake had the highest retention (99%) when compared to couscous (97%). Besides, the cake showed higher retention when compared to the wheat flour preparations due to the interactions of the folic acid with the hydrophobic amino acids of the Zein, a protein found in corn. In wheat flour preparations, vitamin retention was 87%, 80% and 57% in bread, cake, and White sauce respectively. These findings relate to the change of the physicochemical properties of food components that occurs during mixing and cooking of the ingredients.

Made available in DSpace on 2020-12-12T01:16:27Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-01-01 Stylosanthes capitata Vogel is a C3 forage legume widely cultivated in tropical and subtropical pastures. However, the nutrient dynamics of this species under future climate change is unknown. Therefore, this study aimed to evaluate the nutrient content, nutrient accumulation, nutrient use efficiency and growth of S. capitata exposed to increased [CO2] and temperature under field conditions using two levels of atmospheric [CO2] (ambient and elevated—600 ppm) and two canopy temperature (ambient and elevated—2°C). Treatments were applied at field conditions, for 30 days, using a free-air carbon dioxide enrichment (FACE) and a free-air temperature-controlled enhancement (T-FACE) systems. Warming showed no effects on macronutrient content, but increased the accumulation of nitrogen, potassium, calcium, magnesium and sulphur, the nutrient use efficiency and root dry mass. Elevated [CO2] alone had no effect on most of the parameters evaluated. However, the combination of elevated [CO2] with warming improved the nutrient accumulation, nutrient use efficiency and whole-plant growth more than under isolated conditions of elevated [CO2] or warming. Based on our short-term results, we concluded that an increment of atmospheric [CO2] and temperature will benefit S. capitata growth, suggesting no alterations in the actual fertilizer programs for this species. Department of Soils and Fertilizers School of Agricultural and Veterinarian Sciences São Paulo State University (UNESP) Department of Biology FFCLRP University of São Paulo (USP) São Paulo Agribusiness Technology Agency (APTA) Department of Soils and Fertilizers School of Agricultural and Veterinarian Sciences São Paulo State University (UNESP)

Objetivo: Compreender as repercussões da pandemia da covid-19 na saúde mental dos adultos, durante o período de isolamento social. Revisão bibliográfica: O distanciamento social adotado para reduzir a infecção pelo SARS-CoV-2 provocou grandes mudanças no dia a dia, na economia e nas relações entre as pessoas. Além disso, a rotina dos indivíduos mudou durante o período de isolamento social levando a problemas do sono, apetite, conflitos familiares, uso de drogas lícitas e ilícitas, assim podendo desencadear ou agravar os transtornos de ansiedade e depressão. Durante a pandemia e consequentemente com o isolamento social, é natural que haja uma desordem emocional e psíquica na população, agravando sintomas de compulsão alimentícia, bem como ansiedade e depressão. Considerações finais: Assim, por meio da instauração da pandemia, é possível averiguar a desestruturação da população frente ao quadro, acompanhando assim o aumento na incidência e prevalência dos transtornos mentais no decorrer da pandemia do coronavírus.

RESUMO Introducao A aspiracao manual de trombos durante a intervencao coronaria percutânea primaria foi muito utilizada no fim da decada passada, mas, a partir de resultados de publicacoes recentes, houve queda em seu grau de recomendacao. O objetivo deste trabalho foi avaliar o uso desta tecnica no Brasil. Metodos Utilizando dados da Central Nacional de Intervencoes Cardiovasculares (CENIC) do periodo de 2008 a 2016, avaliamos pacientes submetidos a intervencao coronaria percutânea primaria que realizaram tromboaspiracao manual. Dividimos a analise em [...]

Resumen: Introducción: la Telemedicina ofrece una herramienta poderosa, rentable y escalable que permite reducir las diferencias en el tratamiento del infarto agudo de miocardio entre países desarrollados y en vía de desarrollo. Métodos: se incorpora una estrategia en la que centros de salud en áreas remotas se conectaron estratégicamente a clínicas con salas de cateterismo 24/7. Expertos en Bogotá proporcionaron diagnóstico electrocardiográfico y tele-consulta para LATIN, activando el envío de ambulancias y la implementación de protocolos LATIN. Resultados: un total de 113 centros en Colombia se conectaron en red cubriendo un gran segmento de la población. De los 110.823 pacientes examinados, 1.014 (1%) fueron diagnosticados con infarto agudo de miocardio - ST. Un total de 472 (46%) pacientes se reperfundieron, la mayoría mediante intervención coronaria percutánea, 324 (68,6%). Las principales razones para el no tratamiento incluyeron rechazo de seguro médico, falta de unidades de cuidados intensivos y dolor torácico > 12 horas. El tiempo de diagnóstico fue de 5.5 con una precisión del 98%. Conclusiones: LATIN demuestra la posibilidad de crear una estrategia para tratar el infarto agudo de miocardio con base en la población y guiada por Telemedicina, la cual expande el acceso al tratamiento de emergencia en países en vía de desarrollo, en los cuales ésta adquiere importantes implicaciones en salud pública como una aproximación global al cuidado urgente de esta afección. Abstract: Introduction: Telemedicine offers a powerful and cost-effective tool that uses scales in order to reduce the differences in the treatment of acute myocardial infarction between the developed and developing countries. Methods: A strategy was used, in which health centres in remote areas were strategically connected to clinics with 24/7 catheter laboratories. Experts in Bogota provided the electrocardiographic diagnosis and tele-consultation using the Latin America Telemedicine Infarct Network (LATIN), activating the sending of ambulances, and the implementation of the LATIN protocols. Results: A total of 113 centres in Colombia were connected to a network covering a large segment of the population. Of the 110,823 patients examined, 1014 (1%) were diagnosed with an acute ST-myocardial infarction. A total of 472 (46%) of these patients were reperfused, with the majority (324, 68.6%) by means of percutaneous coronary intervention. The main reasons for non-treatment included refusal of medical insurance, lack of intensive care units, and chest pain > 12 hours. The time to diagnosis was 5.5 minutes with an accuracy of 98%. Conclusions: LATIN demonstrates the possibility of creating a strategy for treating acute myocardial infarction in a population base and guided by Telemedicine. This widens the access to emergency treatment in developing countries, where this acquires significant implications in public health, such as an overall approach to the urgent treatment of this condition. Palabras clave: Telemedicina, Infarto agudo de miocardio, Sistemas de cuidado, Keywords: Telemedicine, Acute myocardial infarction, Health care systems

Os Centros de Especialidades Odontológicas (CEOs) dão continuidade ao tratamento realizado pela rede de atenção básica, ofertando serviços odontológicos especializados. Objetivo: Avaliar a qualidade técnica e o índice de sucesso dos tratamentos endodônticos realizados no CEO-UP no período de abril a dezembro de 2016. Material e métodos: No período de interesse da pesquisa foram realizados 187 tratamentos endodônticos em 170 pacientes. Avaliaram-se os participantes da pesquisa por meio dos dados contidos no prontuário, de exames clínicos e radiográficos. Os dentes tratados endodonticamente foram examinados por um especialista em Endodontia, um ano após a conclusão do tratamento, que avaliou a condição clínica e comparou e analisou as radiografias realizadas no fim do tratamento com as radiografias atuais. Os dados coletados foram apresentados de forma descritiva mediante números absolutos e percentuais. Resultados: Compareceram à avaliação 53 pacientes, totalizando 59 dentes tratados. Destes, 98% apresentavam correta adaptação do material obturador e 84% estavam com o limite apical da obturação adequado. Quanto à condição do dente, 71% estavam restaurados com material definitivo. Oitenta por cento dos dentes não apresentavam lesão periapical, e em 17% a lesão havia diminuído. Conclusão: Os tratamentos endodônticos realizados no CEO-UP possuem uma adequada qualidade técnica, resultando no sucesso do tratamento endodôntico feito por esse serviço.

Our previous research found seven specific factors that cause system delays in ST-elevation Myocardial infarction management in developing countries. These delays, in conjunction with a lack of organized STEMI systems of care, result in inefficient processes to treat AMI in developing countries. In our present opinion paper, we have specifically explored the three most pertinent causes that afflict the seven specific factors responsible for system delays. In doing so, we incorporated a unique strategy of global STEMI expertise. With this methodology, the recommendations were provided by expert Indian cardiologist and final guidelines were drafted after comprehensive discussions by the entire group of submitting authors. We expect these recommendations to be utilitarian in improving STEMI care in developing countries.

BACKGROUND: Patients with peripheral artery disease have an increased risk of cardiovascular morbidity and mortality. Antiplatelet agents are widely used to reduce these complications.METHODS: This was a multicentre, double-blind, randomised placebo-controlled trial for which patients were recruited at 602 hospitals, clinics, or community practices from 33 countries across six continents. Eligible patients had a history of peripheral artery disease of the lower extremities (previous peripheral bypass surgery or angioplasty, limb or foot amputation, intermittent claudication with objective evidence of peripheral artery disease), of the carotid arteries (previous carotid artery revascularisation or asymptomatic carotid artery stenosis of at least 50%), or coronary artery disease with an ankle-brachial index of less than 0·90. After a 30-day run-in period, patients were randomly assigned (1:1:1) to receive oral rivaroxaban (2·5 mg twice a day) plus aspirin (100 mg once a day), rivaroxaban twice a day (5 mg with aspirin placebo once a day), or to aspirin once a day (100 mg and rivaroxaban placebo twice a day). Randomisation was computer generated. Each treatment group was double dummy, and the patient, investigators, and central study staff were masked to treatment allocation. The primary outcome was cardiovascular death, myocardial infarction or stroke; the primary peripheral artery disease outcome was major adverse limb events including major amputation. This trial is registered with ClinicalTrials.gov, number NCT01776424, and is closed to new participants.FINDINGS: Between March 12, 2013, and May 10, 2016, we enrolled 7470 patients with peripheral artery disease from 558 centres. The combination of rivaroxaban plus aspirin compared with aspirin alone reduced the composite endpoint of cardiovascular death, myocardial infarction, or stroke (126 [5%] of 2492 vs 174 [7%] of 2504; hazard ratio [HR] 0·72, 95% CI 0·57-0·90, p=0·0047), and major adverse limb events including major amputation (32 [1%] vs 60 [2%]; HR 0·54 95% CI 0·35-0·82, p=0·0037). Rivaroxaban 5 mg twice a day compared with aspirin alone did not significantly reduce the composite endpoint (149 [6%] of 2474 vs 174 [7%] of 2504; HR 0·86, 95% CI 0·69-1·08, p=0·19), but reduced major adverse limb events including major amputation (40 [2%] vs 60 [2%]; HR 0·67, 95% CI 0·45-1·00, p=0·05). The median duration of treatment was 21 months. The use of the rivaroxaban plus aspirin combination increased major bleeding compared with the aspirin alone group (77 [3%] of 2492 vs 48 [2%] of 2504; HR 1·61, 95% CI 1·12-2·31, p=0·0089), which was mainly gastrointestinal. Similarly, major bleeding occurred in 79 (3%) of 2474 patients with rivaroxaban 5 mg, and in 48 (2%) of 2504 in the aspirin alone group (HR 1·68, 95% CI 1·17-2·40; p=0·0043).INTERPRETATION: Low-dose rivaroxaban taken twice a day plus aspirin once a day reduced major adverse cardiovascular and limb events when compared with aspirin alone. Although major bleeding was increased, fatal or critical organ bleeding was not. This combination therapy represents an important advance in the management of patients with peripheral artery disease. Rivaroxaban alone did not significantly reduce major adverse cardiovascular events compared with asprin alone, but reduced major adverse limb events and increased major bleeding.FUNDING: Bayer AG.

Background We hypothesised that ticagrelor, in combination with aspirin for 1 month, followed by ticagrelor alone, improves outcomes after percutaneous coronary intervention compared with standard antiplatelet regimens. Methods GLOBAL LEADERS was a randomised, open-label superiority trial at 130 sites in 18 countries. Patients undergoing percutaneous coronary intervention with a biolimus A9-eluting stent for stable coronary artery disease or acute coronary syndromes were randomly assigned (1:1) to 75-100 mg aspirin daily plus 90 mg ticagrelor twice daily for 1 month, followed by 23 months of ticagrelor monotherapy, or standard dual antiplatelet therapy with 75-100 mg aspirin daily plus either 75 mg clopidogrel daily (for patients with stable coronary artery disease) or 90 mg ticagrelor twice daily (for patients with acute coronary syndromes) for 12 months, followed by aspirin monotherapy for 12 months. Randomisation was concealed, stratified by centre and clinical presentation (stable coronary artery disease vs acute coronary syndrome), and blocked, with randomly varied block sizes of two and four. The primary endpoint at 2 years was a composite of all-cause mortality or non-fatal centrally adjudicated new Q-wave myocardial infarction as assessed by a core lab in a blinded manner. The key secondary safety endpoint was site-reported bleeding assessed according to the Bleeding Academic Research Consortium criteria (grade 3 or 5). Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01813435, and is closed to new participants, with followup completed. Findings Between July 1, 2013, and Nov 9, 2015, 15 968 participants were randomly assigned, 7980 to the experimental group and 7988 to the control group. At 2 years, 304 (3.81%) participants in the experimental group had died or had a non-fatal centrally adjudicated new Q-wave myocardial infarction, compared with 349 (4.37%) participants in the control group (rate ratio 0.87 [95% CI 0. 75-1. 01]; p=0.073]). There was no evidence for a difference in treatment effects for the primary endpoint across prespecified subgroups of acute coronary syndromes and stable coronary artery disease (p=0.93). Grade 3 or 5 bleeding occurred in 163 participants in the experimental group and 169 in the control group (2.04% vs 2.12%; rate ratio 0.97 [95% CI 0. 78-1. 20]; p=0.77). Interpretation Ticagrelor in combination with aspirin for 1 month followed by ticagrelor alone for 23 months was not superior to 12 months of standard dual antiplatelet therapy followed by 12 months of aspirin alone in the prevention of all-cause mortality or new Q-wave myocardial infarction 2 years after percutaneous coronary intervention. Copright (C) 2018 Elsevier Ltd. All rights reserved. European Clinical Research Institute; Biosensors International; AstraZeneca; Medicines Company; Canada Research Chairs Programme

The study evaluated the fatty acid profile of raw and heated virgin coconut oil by using eleven food preparations submitted to two treatments: dry and moist, and crude and heat. The fat extraction was performed by the Soxhlet method and the fatty acid profile was analysed using gas chromatography. Kuskal-Wallis test was utilised to evaluate the differences among food preparation methods. The lauric acid was present in the coconut oils analysed (16.07g/L ± 1.28) and in all the preparations in which coconut oil was used. The highest concentration of lauric acid was found in Corn starch cookies (16.60g/L ± 0.32). The cookie and the cake were the preparations that showed the lowest concentration, 6.14 g/L ± 0.05 and 5.05 g/L± 0.05, respectively. The results obtained in this study are unprecedented and enable professionals in the field of food and nutrition to prescribe the best usage of coconut oil in cooking.

This study investigated recruitment, sex ratio, growth, longevity, density, and distribution pattern of a population of the snapping shrimp Alpheus estuariensis in a tropical estuarine tidal mudflat in northeastern Brazil. Individuals were captured monthly from September 2011 to October 2012 in Pontal Bay, Ilheus, Bahia, Brazil. In total, 863 shrimps were collected: 311 males, 305 females (134 breeding and 171 non-breeding), and 247 juveniles. Individuals smaller than 5.9 mm (carapace length of the smallest breeding female) were considered juveniles. Both adults and juveniles occurred throughout the sampling period. Although there was no relationship between abundance and environmental factors (temperature, rainfall, and salinity), some months had more individuals than others. Recruitment was continuous. Total and monthly sex ratio did not differ from 1:1 (M:F). The sex ratio by size-frequency class (carapace length) was similar to Wenner’s “Standard Pattern”; however, no deviation in favor of males was observed in the largest size classes. Compared with Gompertz and logistic functions, the von Bertalanffy Growth model gave the best fit to the data, describing growth with the equation: Length = 14.64*(1-e(−1.21*(age-0.03))). The estimated life span of A. estuariensis was 1.07 years. Juveniles and adults were more abundant in small grain size sediments, which might facilitate excavation during shelter construction.

Polydora websteri belongs to a group of the Spionidae known as the Polydora complex, members of which are known for building tubes within the shells of mussels and for their ability to infest commercially valuable bivalves, which causes serious losses for malacoculture. P. websteri is a species subjected to increasing research due to the global scale at which these infestations occur. In this paper, we describe the larval development of P.cf. websteri associated with the oyster Crassostrea cf. brasiliana in a tropical region of north-east Brazil. The main structures of all stages of development were analysed and compared to other populations of P. websteri. Ovigerous capsules of P.cf. websteri were cultured in the laboratory and the larval stages were analysed until metamorphosis. Ovigerous capsules were present in all sampling intervals, indicating that this population exhibits continuous reproduction. Up to 21 capsules per tube were found, and the number of eggs per capsule varied from 20 to 40....

The presence of polydorids shell-borer and the epifaunal polychaetes on Crassostrea cf. brasiliana were studied in five estuaries in Northeastern Brazil: The prevalence of shell-boring polychaetes in oysters varied significantly, showing dominance of Polydora websteri, with 57% of sampled oysters, and Boccardiella ligerica, with 11%, but the prevalence was significant different among estuaries sampled. Capibaribe River showed the highest infestation, with 81% these mud-blisters, but in Massangana River had no presence of these polychaetes. The linear regression between the number of polychaetes, and the size of oysters was significant, suggesting that infestation increases with age.

Background Cangrelor, an intravenous, reversible P2Y12 antagonist, is approved for use in patients undergoing percutaneous coronary intervention (PCI). Objectives This study sought to evaluate the efficacy and safety of cangrelor compared with clopidogrel in subgroups that did and did not receive glycoprotein IIb/IIIa inhibitors (GPIs). Methods This pooled, patient-level analysis of the 3 CHAMPION (Cangrelor versus Standard Therapy to Achieve Optimal Management of Platelet Inhibition) trials analyzed all randomized patients who underwent PCI and received the study drug (n = 24,902). Only bailout/rescue GPI use was permitted, except in CHAMPION PCI, in which routine or bailout/rescue GPI use was at the site investigator’s discretion. The primary efficacy endpoint was the composite of all-cause mortality, myocardial infarction, ischemia-driven revascularization, or stent thrombosis at 48 h after randomization. Results Overall, 3,173 patients (12.7%) received a GPI, most commonly eptifibatide (69.4%). Despite variation in indications for GPIs, baseline characteristics were well balanced between the cangrelor and clopidogrel arms in subsets receiving and not receiving GPIs. Rates of the primary composite endpoint were lower with cangrelor compared with clopidogrel in patients who did (4.9% vs. 6.5%; odds ratio [OR]: 0.74; 95% confidence interval [CI]: 0.55 to 1.01) or did not receive a GPI (3.6% vs. 4.4%; OR: 0.82; 95% CI: 0.72 to 0.94; Pint = 0.55). Cangrelor did not increase the primary safety endpoint, GUSTO-defined severe/life-threatening bleeding, in patients who did (0.4% vs. 0.5%; OR: 0.71; 95% CI: 0.25 to 1.99) or did not receive GPIs (0.2% vs. 0.1%; OR: 1.56; 95% CI: 0.80 to 3.04; Pint = 0.21). GPI use was associated with increased risk of bleeding in both treatment arms. Conclusions Cangrelor’s efficacy in reducing ischemic complications in patients undergoing PCI was maintained irrespective of GPI administration. GPI use was associated with substantially higher bleeding rates, regardless of the randomization to cangrelor or clopidogrel. (A Clinical Trial to Demonstrate the Efficacy of Cangrelor [PCI]: NCT00305162 ; Cangrelor Versus Standard Therapy to Achieve Optimal Management of Platelet Inhibition [PLATFORM]: NCT00385138 ; A Clinical Trial Comparing Cangrelor to Clopidogrel Standard Therapy in Subjects Who Require Percutaneous Coronary Intervention [PCI] [CHAMPION PHOENIX] [CHAMPION]: NCT01156571 )

A catalogue of the terrestrial Eudrilidae and Megascolecidae is provided, with 10 genera and 18 species reported to date from South America. In addition, we provide the valid names, their synonyms, and the original citation. Eudrilidae and Megascolecidae contain members that have a global distribution, probably as a result of human dispersion. The species of eudrilid Eudrilus eugeniae is very common in other regions with a tropical climate, while the megascolecid species Amynthas gracilis is by far the most common earthworm in large cities such as Sao Paulo and Rio de Janeiro in Brazil. Two samples taken in Brazil revealed two new exotic species from this country: Amynthas robustus (Perrier, 1872) and Pithemera bicincta (Perrier, 1875), which are described and illustrated. Finally, we provide a taxonomic key to the genera of both families.

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate ≥25 mL/min/1.73 m2 and albuminuria (urinary albumin-to-creatinine ratio ≥30 to ≤5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level α = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049.

Background The behemoth telemedicine program, Latin America Telemedicine Infarct Network (LATIN) has exponentially grown in 4 countries in Central and South America. It has provided AMI coverage to >100 million patients and it has contributed to transforming AMI care in the continent by its “halo” effect. We continue our meticulous search in evaluating the impact of LATIN and in doing so, we have confronted a sobering reality. Purpose To make continued improvements in population-based AMI management, the continued success of the initiative requires participation from healthcare policy makers, health economists, and payers. Methods LATIN was created as a hub and spoke model to hugely increase access (>100 million population coverage) to quality AMI treatment primarily with short door to balloon time (D2B) PCI. Innovative telemedicine platforms were created and networked at all 350 centers that were located in small clinics and primary health centers in poor sections of the countries (spokes) and at 24/7 PCI capable institutions (hubs). Remote cardiologists, located in 3 central locations, provided immediate EKG diagnosis (time to telemedicine diagnosis, TTD Results 784,395 patients were screened at 350 LATIN centers (Brazil 143, Colombia 118, Mexico 82, Argentina 7). With expanded reach, 8,440 (1.08%) patients were diagnosed and 3,924 (46.5%) urgently reperfused, including 3,048 (77.7%) with PCI. Time to Telemedicine Diagnosis (TTD) was 3 min, tele-accuracy 98.9%, D2B 51 min, and in-hospital mortality 5.2%. Over 4 years of operation, the proportion of reperfused STEMI patients has ranged between 41–48% - the major reasons for non-treatment were insurance, lack of ICU beds and delayed presentation. Conclusions Sustained improvements, as a result of stringent QA processes and continuous education, have resulted in reduced D2B, TTD, DIDO, TT, and in overall mortality. However, LATIN remains constrained with a large proportion of patients that are diagnosed but not treated, largely because of payer denials. Although this metric is showing improvement from broad dissemination of LATIN benefits, further gains from LATIN will result mainly from improved reimbursements.

Background “Cόdigo Infarto”, the vast patient-centric, app-based, educational crusade of the Mexican Society of Interventional Cardiology (SOCIME) has been combined with the Latin America Telemedicine Infarct Network (LATIN) to create a comprehensive, national AMI program for Mexico. Purpose To demonstrate the benefits of amalgamating educational initiatives of national cardiology societies with a global telemedicine program for improving AMI management. Methods “Cόdigo Infarto” App connects patients to a network of several hundred cardiologists and 250 Primary PCI-capable labs. LATIN provides the partnership with its robust telemedicine platform, a hub-spoke strategy that supports patient's access to appropriate medical management. Remotely located experts, in Colombia, provide urgent EKG diagnosis via tele-consultation to the entire LATIN Mexico network. They activate ambulance dispatch and implement guideline-based protocols. Results Numerous “Cόdigo Infarto” sites have incorporated LATIN to provide a simple and accelerated management of AMI patients. Currently, the partnership (7 hubs, 78 spokes) has screened 19,886 patients. A total of 359 STEMI cases (1.8%) have been diagnosed; 118 patients (33%) were urgently reperfused, Primary PCI was performed in 74% of the latter cases. D2B time was 41 min. Reasons for the lack of treatment include delayed presentation, lack of ICU beds and insurance denials. Currently, these constraints are being methodically probed. Updated results will be available at time of presentation. Conclusions The synergy of the AMI initiative for Mexico provides a template for similar initiatives in developing countries.

Background The Latin American Telemedicine Infarct Network (LATIN), a program for managing population-based AMI care, has utilized an innovative hub-spoke strategy and remote guidance to expand medical access in remote parts of Brazil, Colombia, Mexico, and Argentina. Based on the Global Lumen Organization for Women (GLOW) project, that has previously demonstrated gender inequalities and worse outcomes for women who undergo Primary PCI, our research explored the management of female patients in our network. Purpose To demonstrate gender disparities in a telemedicine-guided, population based AMI program. Methods Meta-analysis of >750,000 patients within LATIN. Telemedicine was employed as a screening tool to accurately diagnose AMI. According to the duration of chest pain and transfer time, AMI patients were triaged into guidelines-based pathways of thrombolysis, pharmaco-invasive management or Primary PCI. Resource allocation was identical for men and women. Results Data from 784,395 screened patients reveals broad gender disparities. The critical results yielded that female patients have a lower prevalence of STEMI diagnosis and treatment regardless of the technique – PCI, pharmaco-invasive or CABG (p Conclusions LATIN gender data signals the urgency to demand better AMI care for women.

Background Telemedicine is a powerful, cost-efficient, and scalable tool for population-based AMI management. Traditional metrics of D2N, D2B do not gauge telemedicine effectiveness. We explored the utility of TTD in 784,947-screened patients within the Latin America Telemedicine Infarct Network (LATIN). Purpose To evaluate the competence of TTD as an efficiency indicator in telemedicine. Methods LATIN employed a spoke-hub strategy to expand access in Brazil, Colombia, Mexico, and Argentina. Small clinics (spokes) in remote areas were strategically connected to PCI-capable facilities (hubs). Experts at 4 remote locations provided urgent EKG diagnosis via tele-consultation, additionally, they triggered ambulance dispatch and implementation of guidelines-based protocols. Investing in updated telemedicine technology provided a system-wide TTD reduction. Results 714,450 patients were screened for AMI at 350 LATIN centers (Brazil 143, Colombia 118, Mexico 82, Argentina 7). Within our territories 8,448 (1.08%) patients were diagnosed as STEMI; 3,911 (46.3%) were urgently reperfused, of those 3,049 (78%) underwent Primary PCI. TTD was 3 min, demonstrating 98.9% tele-accuracy. D2B was 51 min; in-hospital mortality 5.2%. We encountered a linear correlation between D2B and TTD. The latter was, also, inversely related to the number of screened patients - both associations are favorable for LATIN. Conclusions TTD is an important indicator of telemedicine efficiency. LATIN will continue to explore this value's strength and other important associations.

Background Our previous work demonstrated the diagnostic value of Artificial Intelligence (AI) -driven algorithms for ST-Elevation Myocardial Infarction (STEMI). In the present research, we explore the importance of demographic data inclusion, in order to achieve a more accurate diagnosis. Purpose To demonstrate that incorporation of demographic variables into the sample records will augment the accuracy of AI-based protocols for STEMI diagnosis. Methods An observational, retrospective, case-control study. Demographic data (age and gender) male/female ratio 1.3, ages 98–18 years was added to the sample records. Sample: 8,511 EKG records, previously diagnosed as normal, abnormal (over 200 conditions) or STEMI. Records excluded other patient and medical information. The sample was derived from the private International Telemedical Systems (ITMS) database. LUMENGT-AI Algorithm was employed. Preprocessing: detection of QRS complexes by wavelet system, segmentation of each EKG into individual heartbeats (90,592 total beats) with fixed window of 0.4s to the left and 0.9s to the right of main QRS; Classification: A 1-D convolutional neural network was implemented, “STEMI” and “Not-STEMI” classes were considered for each heartbeat, individual probabilities were aggregated to generate the final label for each record. Training & Testing: 90% and 10% of the sample was used, respectively. Experiments: Intel PC i7 8750H processor at 2.21GHz, 16GB RAM, Windows 10 OS with Nvidia GTX 1070GPU, 8GB RAM. Results The model yielded an accuracy of 97.1%, a sensitivity of 96.8%, and a specificity of 97.5%. Conclusions The ability of AI-guided algorithms to diagnose STEMI is increased by expanding the morphological variables with demographic data. This approach may be applied to improve the EKG diagnosis of other cardiovascular entities and improve clinical management.

Background AMI is a unique entity where the immediate diagnosis can be made by a single test, the EKG. Despite this matchless attribute of easy diagnosis, developing (and some developed) countries lack resources and efficient pathways for urgent and reliable diagnosis of AMI. With Latin Telemedicine Infarct Network (LATIN), we have previously presented Telemedicine as a pragmatic solution for urgent and accurate diagnosis of AMI. In this work, we reveal pathways of scalable population-based AMI management models. Purpose To utilize telemedicine as a foundation pillar for creating cost-effective and global models of AMI management. Methods LATIN pilot tested the hypothesis of remote guidance of AMI management and expanded access by creating a hub and spoke, STEMI systems of care that exploited regional resources. A highly efficient, web-based, cloud-computing prototype was developed and scrupulously monitored with a new metric of time to telemedicine diagnosis (TTD). STEMI systems of care were created to efficiently triage the diagnosed patients for being treated with thrombolysis, pharmaco-invasive management or Primary PCI. This stratagem had enormous provincial variability and was constrained mainly by ambulance structure. Telemedicine and IT costs were forced lower and enabled a cost-effective process to hugely provide access to 100 million patients located in poorer regions of Colombia, Brazil, Mexico, and Argentina. Education and training have formed the mantra for LATIN and stakeholder development, and ambulance systems development has remained immutable goals. Results Almost 800,000 patients were successfully screening through LATIN with a cost for accurate STEMI diagnosis of < $3, a tele accuracy that exceeded 95% and with TTD Conclusions Global financial and philanthropic institutions should contemplate models analogous to LATIN for saving the lives of millions of poor patients in developing countries from AMI.

Background The Latin America Telemedicine Infarct Network (LATIN) has exploited the remarkable competence of telemedicine for remote guidance. In doing so, LATIN created a mammoth population-based AMI network that employed experts located several hundred miles away to guide the reperfusion strategies for almost 800,000 screened patients. In this pioneering project, telemedicine was initially utilized to guide AMI management within national confines. We speculated whether LATIN telemedicine navigation could outstrip countrywide borders. Purpose To maximally harness the vast possibilities of telemedicine for improving AMI care. Methods During its pilot phase, LATIN began as a hub and spoke, AMI system in Colombia where 20 spokes (small community health centers and rural clinics) were configured with 3 hubs that could perform Primary PCI. These sites were linked through web-based connectivity. Expert cardiologists, located 50–250 miles away in Bogota, Colombia, used sophisticated telemedicine platforms for urgent EKG diagnosis and teleconsultation of the entire AMI process. Based upon the duration of chest pain and travel time to the hub, these experts guided patients through guideline-based strategies of thrombolysis, pharmaco invasive management or primary PCI. Efficiency of the telemedicine process was measured with the new metric of time to telemedicine diagnosis (TTD). Cloud computing, GPS navigation, and numerous business intelligent tools were gradually incorporated into LATIN telemedicine. As systems became more scalable, the program was expanded to Brazil, where LATIN flourished. Over the last 18 months, LATIN telemedicine capabilities have been pressed across national boundaries. Presently, all 82 LATIN centers in Mexico are guided by experts located in Bogota, Colombia and the 7 Argentina centers channeled through Santiago, Chile. Results 784,947 patients were screened for AMI at 350 LATIN centers (Brazil 143, Colombia 118, Mexico 82, Argentina 7). Navigation pathways are depicted in the attached figure. TTD remains extremely low in all four countries, and comparable efficiency and tele-accuracy have been achieved. With expanded geographic reach, 8,448 (1.08%) patients were diagnosed with STEMI and 3,911 (46.3%) urgently reperfused, including 3,049 (78%) with Primary PCI. Time to TTD ranged between 2.8 to 5.8 minutes, with a mean of 3.5 min. Tele-accuracy was 98.5%, D2B 51 min, and in-hospital mortality 5.2%. Various other comparative metrics for the 4 countries are being gathered and will be available at the time of presentation. Conclusions LATIN demonstrates the robust ability of telemedicine to transcend national boundaries to guide AMI management. This strategy can be adopted in under-developed countries in Asia and Africa to provide an umbrella of AMI care for the millions of disadvantaged patients.

Objectives To evaluate the long-term safety and efficacy of the novel combined sirolimus-eluting endothelial progenitor cell capture Combo stent (OrbusNeich, Fort Lauderdale, FL) at 5 years in the REMEDEE (Randomized study to Evaluate the safety and effectiveness of an abluMinal sirolimus coated bio-Engineered stEnt) trial. Background Drug-eluting stents have limited restenosis and reintervention but are complicated by late and very late thrombosis and accelerated neoatherosclerosis. Alternative or adjunctive technologies are needed to address these limitations. Methods A total of 183 patients with de novo lesions in native coronary arteries were randomized 2:1 to Combo (n = 124) or Taxus Liberte (n = 59). Primary endpoint was 9 month angiographic in-stent late lumen loss and the secondary endpoint was the occurrence of major adverse events (MACE) through 5-year follow-up. Results Compared with Taxus, after 5 years the Combo stent was associated with similar rates of MACE (18.3% vs. 16.9%, p = .89), cardiac death (0.8% vs. 5.1%, p = .07), myocardial infarction (4.1% vs. 3.4%, p = .81), target lesion (9.4% vs. 10.2%, p = .78), and target vessel revascularization (14.4% vs. 11.9%, p = .73). No cases of definite stent thrombosis were reported in the Combo group. The follow-up rate at 5 years was 97.7%. Conclusion At 5-year follow-up, the Combo stent remained clinically safe and effective with an overall low rate of MACE comparable to Taxus.

Esta pesquisa analisa as imagens do Brasil moderno produzidas pela filmografia da Companhia Cinematográfica Vera Cruz no período de 1949 a 1954. Destaca a dicotomia entre os personagens periféricos e os das elites econômicas da metrópole paulista, estes retratados como símbolos da cidadania e da ética. Trata o espaço da capital paulistana como o centro da modernidade e das oportunidades empreendedoras do país; da celebração, através das instituições públicas e privadas, daquela cidade como o palco da ascensão social através do poder aquisitivo econômico. A esse respeito, a historiografia sobre a Companhia evidencia a importância desta na projeção da metrópole paulistana como o centro da modernidade brasileira, mas que também foi um lugar de profundas desigualdades sociais, as quais puseram em questão o que significou a modernidade da metrópole paulista na década de 1950, configurando um movimento ideológico no qual a nacionalidade e a identidade caracterizavam os padrões do empresariado local, o qual produzira instituições de cultura e de saber para autointitularem-se os detentores do progresso e do desenvolvimento no país. This research analyzes the images of modern Brazil produced by the filmography of the Vera Cruz Film Company from 1949 to 1954. It highlights the dichotomy between the peripheral characters and those of the economic elites of the São Paulo metropolis, which are portrayed as symbols of citizenship and ethics. It treats the space of the capital of São Paulo as the center of modernity and entrepreneurial opportunities in the country; of the celebration, through public and private institutions, of that city as the stage of social ascension through economic purchasing power. In this regard, the historiography of the Company highlights its importance in the projection of the São Paulo metropolis as the center of Brazilian modernity, but it was also a place of profound social inequalities, which questioned what the modernity of the São Paulo metropolis meant. 1950s, constituting an ideological movement in which nationality and identity characterized the patterns of local entrepreneurship, which had produced institutions of culture and knowledge to self-label the holders of progress and development in the country.