ABSTRACT Background: Transcatheter aortic valve implantation (TAVI) is becoming the standard procedure for high-risk patients requiring aortic valve replacement. This technique has evolved rapidly and the so-called minimalist strategy is gaining worldwide attention, while supporting evidence is still being assembled. Objective: The aim of this study was to compare 30-day outcomes of the minimalist approach (MA) versus the standard approach (SA) for TAVI performed in a single center. Methods: Between September 2009 and February 2018, 303 consecutive TAVI procedures were performed, 229 (75.6%) using the MA and 74 (24.4%) with the SA. Results: Mean age was 79.5 years and both groups had similar characteristics. There were no differences in hypertension, diabetes, smoking habits, previous percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery, acute myocardial infarction (AMI), chronic obstructive pulmonary disease, atrial fibrillation and dialysis. PCI before TAVI (combined procedure) and kidney failure (eGFR <60 ml / min / 1.73 m2) were more common in the SA group. The STS score was similar in both groups. The total duration of the procedure and in-hospital stay were lower in the MA group (125±26 vs. 211±48 minutes; p <0.001, and 4.1 vs. 6.3 days; p=0.01, respectively). There were no differences in mortality (3.9% vs. 1.4%; p=ns), incidence of AMI, stroke, major bleeding requiring transfusion or vascular complications at 30 days. The closure device failed in four patients (one underwent surgical repair and three required a covered stent). Moderate paravalvular leaks (PVL) were more frequent in the SA group (11.8% vs. 23%; p=0.01) but the incidence of severe PVL was similar (1.3% vs. 2.7%). Conclusion: The MA for TAVI proved to be feasible and safe, reducing the procedure duration and in-hospital stay, with 30-day outcomes similar to those of the SA but providing better comfort for the patient.

RESUMEN Introducción: El reemplazo de válvula aórtica transcatéter (TAVR) se está convirtiendo en un procedimiento estándar para pacientes con alto riesgo quirúrgico que necesitan el reemplazo de la válvula aórtica. Esta técnica ha evolucionado rápidamente y la llamada estrategia minimalista está ganando adeptos en todo el mundo, mientras la evidencia en su favor todavía se está acumulando. Objetivo: Analizar los resultados a 30 días de la estrategia minimalista (MIN-A) en comparación con la técnica convencional (CON-A) en la experiencia de un solo centro. Material y métodos: Entre septiembre de 2009 y febrero de 2018, se realizaron 303 procedimientos consecutivos de TAVR por acceso femoral, 229 (75,6%) de ellos con MIN-A y 74 (24,4%) con CON-A. Resultados: La edad promedio de los pacientes fue de 79,5 años y ambos grupos tenían características similares. No hubo diferencias entre estos en lo referido a hipertensión, diabetes, tabaquismo, ICP o CRM previa, IAM, EPOC, fibrilación auricular y diálisis. La ATC por etapas antes del TAVR (procedimiento combinado) y la insuficiencia renal (eGFR < 60 ml / min / 1,73 m2) fueron más frecuentes en los sometidos a CON-A. El score del STS fue similar en ambos grupos. El tiempo del procedimiento fue menor en el grupo MIN-A (125 ± 26 vs. 211 ± 48 minutos; p < 0,001), al igual que el tiempo de hospitalización (4,1 vs. 6,3 días; p = 0,01). A los 30 días, no hubo diferencias en la mortalidad (3,9% frente a 1,4%; p = 0,29), IAM, accidente cerebrovascular, hemorragia, transfusión y complicaciones vasculares. Cuatro pacientes tuvieron falla del dispositivo de cierre (1 requirió reparación quirúrgica, 3 requirieron stent cubierto). Las fugas paravalvulares (PVL) moderadas fueron más frecuentes en el grupo CON-A (11,8% vs. 23%; p = 0,01), pero las PVL graves tuvieron similar incidencia (1,3% vs. 2,7%). Conclusión: La estrategia minimalista en el implante percutáneo de la válvula aórtica demostró ser factible y segura; dicha estrategia disminuyó el tiempo del procedimiento y la estadía en el hospital, con similares resultados clínicos que la estrategia convencional a 30 días, pero con mejor confort para el paciente.

ABSTRACT Objective: To analyze and report our initial outcomes of Percutaneous Mitral Valve Repair (PMVR) with MitraClip® for patients with severe symptomatic Mitral Regurgitation (MR) and high surgical risk. Methods: Between March 2016 and October 2018 twelve consecutive PMVR with MitraClip® were performed in patients with severe symptomatic MR and contraindication or high surgical risk. Implantation Success (IS) was defined as adequate leaflets grasping, leaving < moderate residual MR at the end of the procedure and 30-day Procedural Success when IS was achieved without any Major Adverse Cardiovascular Event (MACE: death, AMI, Stroke, need of valvular surgery, pericardial effusion, tamponade or major bleeding). Results: Mean age was 74.1±8.9 years, all of them had hypertension and Dyslipemia 7 were men, 3 diabetics, 4 smokers, 5 had previous atrial fibrillation, 2 permanent pacemakers, 3 previous AMI, 2 of them had received PCI and 4 cardiac surgery. The eGFR was 73.8±34.8 ml/m2, 2 had <60 ml/m2 and one on dialysis. All Ptes were in FC III-IV and history of previous hospitalizations because heart failure. Echocardiographic findings: Left Ventricle End Diastolic Diameter (LVEDD) 61.8±6.4, End Systolic Diameter (LVESD) 46.3±2.1; left ventricular ejection fraction (LVEF) 47.5±13.4 (25-60). MI were degenerative in 7 Ptes and functional in 5. Risk Scores: EuroSCORE log was 9.6±6.8, STS for mortality 16.1±13.5 and the STS for morbimortality of 22.8±17.7 EI was achieved in all Ptes; 1 Single Clip was implanted in 7 Pts and 2 Clips in 5; Mean residual post-implantation gradient was 3.6±0.2 mmHg. IS was achieved in all; post-procedural MR was mild in 11 and trivial in one. Mean length of hospital stay was 1.9±0.8 (1-3) days. At 30 days all were in FC 0-II, no one presented MACE or rehospitalization because heart failure. Follow-Up was performed in all Ptes with an average time of 8.8±6.7 (1-30) months. Two patients died (1 from pneumonia at 14 months and another at 30 months due to refractory cardiac failure after TAVI, maintaining mild MR.) There were no other complications, all were in FC I-II, one required rehospitalization due to heart failure (at 7 month). Echo Doppler at follow-Up showed that 11 Ptes had <2 MR and 1 had >2 MR. The QOL improved during the follow-up Conclusion: In this initial series, from a single center that includes the learning curve of the team, PMVR with MitraClip® in Ptes with severe mitral regurgitation and high surgical risk was safe and effective, with a significant clinical improvement at follow-up

RESUMEN Objetivos: Reportar y analizar los resultados iniciales de una serie de pacientes con insuficiencia mitral (IM) grave sintomática y alto riesgo para cirugía que recibieron reparación percutánea de la válvula mitral (RPVM) con MitraClip®. Material y métodos: Entre marzo de 2016 y octubre de 2018 recibieron RPVM con MitraClip® en forma consecutiva 12 sujetos con IM grave sintomática, con alto riesgo o contraindicación para cirugía. Se consideró “éxito del implante” (EI) el correcto agarre de las valvas con el clip que dejó una IM residual leve o moderada al finalizar el procedimiento, y “éxito del procedimiento (EP) a 30 días” el EI en ausencia de eventos adversos mayores (MACE), los que incluyeron muerte, infarto agudo de miocardio (IAM), accidente cerebrovascular (ACV), necesidad de cirugía valvular, derrame pericárdico, taponamiento o sangrado mayor. Datos basales y antecedentes de los pacientes: la media de edad fue de 74,1 ± 8,9 años; 7 eran hombres; 3, diabéticos; 10 eran hipertensos y dislipidémicos; 4 eran tabaquistas, 5 tenían fibrilación auricular, 2 portaban marcapasos definitivo, 3 documentaban IAM previo, 2 habían sido sometidos antes a ATC y 4 a cirugía cardíaca. La tasa de filtración glomerular estimada (eGFR) fue de 73,8 ± 34,8 ml/m2, 2 tenían < 60 ml/m2 y uno se encontraba en diálisis. Todos los pacientes estaban en clase funcional (CF) III-IV, con antecedentes de internaciones por insuficiencia cardíaca (IC). Características ecográficas: diámetro diastólico del ventrículo izquierdo (DDVI): 61,8 ± 6,4 mm; diámetro sistólico (DSVI): 46,3±2,1 mm; fracción de eyección del ventrículo izquierdo (FEVI): 47,5±13,4% (rango: 25-60%). La causa de la IM era degenerativa en 7 pacientes y funcional en 5. La evaluación del riesgo mostró un EuroSCORElog de 9,6±6,8; el STS score de mortalidad fue 16,1 ±1 3,5 y el de morbimortalidad 22,8 ± 17,7. Resultados: Se obtuvo EI en todos los pacientes; en 7 enfermos se implantó 1 solo clip y en los otros 5 se colocaron 2 clips; el gradiente residual medio posimplante fue 3,6 ± 0,2 mmHg. La IM posprocedimiento fue leve en 11 y mínima en 1. La estadía hospitalaria media fue de 1,9 ± 0,8 días (rango: 1-3 días). A los 30 días, todos los sujetos se encontraban en CF I-II; ningún paciente presentó eventos mayores o reinternación por IC. El seguimiento abarcó a todos los pacientes y se extendió por un tiempo medio de 8,8 ± 6,7 meses (rango: 1-30 meses). Dos pacientes fallecieron: 1 de neumonía a los 14 meses y otro a los 30 meses por IC refractaria luego de un reemplazo valvular aórtico por cateterismo (TAVI), manteniendo IM leve. No hubo otras complicaciones. Todos se encontraban en CF I-II, 1 requirió reinternación por IC (a los 7 meses). El eco-Doppler cardíaco de seguimiento demostró IM leve en 11 pacientes y moderada a grave en 1. Hubo una mejoría en la calidad de vida en todos los casos. Conclusiones: En esta serie inicial de un solo centro y que incluye la curva de aprendizaje, la RPVM con MitraClip® en pacientes con IM grave sintomática y alto riesgo quirúrgico fue segura y efectiva, con una mejoría clínica significativa y también en la calidad de vida en el seguimiento.

ABSTRACT The timbó (Magonia pubescens A. St.-Hil.) is a tree species of the family Sapindaceae occurring naturally in the Cerrados of Central Brazil. The objective of this study is to verify the influence of seed size, pre-soaking time in water and seedling production containers in the development of timbó seedlings. The experiment was completely randomized with a 2 × 3 × 2 factorial design (two seed sizes, three pre-soaking times in water and two seedling production containers) with four replicates composed of six containers, each containing one seed. Large seeds presented a better germination and a greater expressiveness of the characteristics evaluated in seedlings. The pre-soaking of seeds did not interfere with the final percentage of germination. However, it accelerated the germination process, favoring the formation of normal seedlings. The polyethylene bag favored base diameter, length and root fresh matter.

Resumo: O timbó (Magonia pubescens A. St.-Hil.) é uma espécie com potencial ornamental, podendo ser usado na composição de jardins e praças e, principalmente, para arborização de ruas; é ainda indicado para plantios em áreas degradadas de preservação permanente. O objetivo neste trabalho foi verificar o efeito do tamanho das sementes, do armazenamento e do tempo de pré-embebição das sementes na sua germinação e vigor. O delineamento utilizado foi inteiramente casualizado, em parcela subdividida no tempo, sendo alocados na parcela principal: tamanho da semente (grandes e pequenas), embalagem (polietileno transparente com espessura de 0,5 mm e saco de papel kraft) e tempo de embebição em água (0, 12 e 24 horas); e nas subparcelas o tempo de armazenamento (0, 3, 6, 9 e 12 meses), com cinco repetições de dez sementes. As características avaliadas foram o teor de água das sementes, a porcentagem de germinação (%G), o tempo médio de germinação (TMG), a altura da parte aérea (cm), o diâmetro do colo (mm), o número de folhas e as massas fresca e seca da parte aérea (g). O tamanho da semente não influenciou na porcentagem de germinação, porém, as sementes grandes formaram plântulas mais vigorosas. O armazenamento não prejudicou a germinação das sementes, nem mesmo o vigor das plântulas. A pré-embebição das sementes não influenciou na porcentagem de germinação, no entanto, diminuiu o tempo médio de germinação, formando plântulas mais vigorosas. Para se conseguir plântulas de timbó mais vigorosas sementes grandes são a melhor opção, podendo ser armazenadas por até 12 meses sem perda de vigor e pré-embebidas para acelerar o início da germinação, formando um lote de plântulas mais homogêneo.

Abstract: Timbó (Magonia pubescens A. St.-Hil.) is a species with ornamental potential, which can be used in composition of gardens, squares and especially in streets landscaping. It is also suitable for planting in degraded areas of permanent preservation. This work aimed to verify the effect of seed size, storage and pre-imbibition time on seed germination and vigor. The test design was completely randomized, in a plot scheme subdivided in time. The main plots were seed size (large and small), packaging (0.5 mm-thick transparent polyethylene and kraft paper bag), and time of imbibition in water (0, 12 and 24 hours); and as subplots, it was considerate the storage times (0, 3, 6, 9 and 12 months). The tests were carried out in five replications of ten seeds, and the evaluated variables were: water content of the seeds, percentage of germination (% G), mean germination time (MGT), shoot height (cm), collar diameter (mm), number of leaves, and fresh and dry mass of the aerial part (g). The size of the seed did not influence the germination percentage, but large seeds formed more vigorous seedlings. The storage did not affect seeds germination, nor the vigor of the seedlings. Seed pre-imbibition did not influence the percentage of germination, but the mean germination time decreased, and more vigorous seedlings were formed. In order to obtain more vigorous Timbó seedlings, the best option is to use large seeds. They can be stored for up to 12 months without losing vigor and pre-soaked to accelerate the beginning of germination, thus forming a more homogeneous lot of seedlings.

This paper provides an updated review of the main contributions of Psychosomatic Medicine to clinical and preventive medicine. Metaanalyses, comprehensive reviews and controlled studies were selected. Current advances in the field indicate that health care can be improved by using a psychosomatic approach that takes into account psychosocial factors affecting individual vulnerability, the holistic consideration of patient care, and the integration of psychological interventions in medicine. Consolidated evidence in Psychosomatic Medicine provides the ideal background for dealing with new needs emerging in medical practice, including chronic illness management, somatic unexplained symptoms, the shift in the role of patients from health consumers to actively health producers, primary early-life prevention, and the appraisal of health outcomes beyond the biomedical reductionism.

El trabajo ofrece una revisión actualizada de las principales contribuciones de la Medicina Psicosomática a la medicina clínica y preventiva. Su contenido se basa en los resultados de revisiones sistemáticas, meta-análisis y estudios controlados. La evidencia acumulada indica que la perspectiva psicosomática podría contribuir significativamente a mejorar los resultados de la atención sanitaria, mediante una práctica clínica holística, la evaluación de los factores psicosociales implicados en la vulnerabilidad individual y la integración de intervenciones psicológicas en medicina. Dicha evidencia constituye el terreno ideal para afrontar necesidades emergentes en sanidad, como la gestión de enfermedades crónicas y de síntomas inexplicables, el paciente como productor activo de salud, la prevención temprana y una valoración de resultados que supere el reduccionismo biomédico.

RESUMO: A presente pesquisa objetivou avaliar a qualidade fisiológica de sementes de pimenta (Capsicum chinense Jacq.) var. Bode Vermelha obtidas de frutos em diferentes estádios de maturação. Os frutos de C. chinense foram separados em cinco estádios de maturação, baseando-se na coloração do pericarpo (frutos verdes - estádio 1, frutos alaranjados - estádio 2, frutos vermelhos-claros - estádio 3, frutos vermelhos - estádio 4 e frutos vermelho-carmim - estádio 5). Para a avaliação da maturação e da qualidade fisiológica das sementes foram determinadas as características biométricas dos frutos e sementes, massa de mil sementes, teor de água das sementes, condutividade elétrica, teste padrão de germinação, tempo médio de germinação, porcentagem de plântulas normais, velocidade de formação de plântulas, além dos testes de envelhecimento acelerado, e comprimento de plântulas. Os caracteres comprimento, diâmetro, massa e número de sementes dos frutos e comprimento, largura, espessura e massa das sementes foram analisados por meio de parâmetros estimados utilizando-se estatística descritiva. Para as demais variáveis foi utilizado delineamento experimental inteiramente casualizado. Os resultados foram submetidos à análise de variância e a comparação de médias pelo teste Scott-Knott, ao nível de 5% de probabilidade. O estádio de maturação influencia na qualidade fisiológica das sementes de Capsicum chinense Jacq. var. Bode Vermelho, sendo as sementes oriundas de frutos de coloração vermelho (estádio 4) a vermelho-carmim (estádio 5) as que apresentaram os melhores desempenhos e, portanto, estão fisiologicamente maduras, sendo os mais indicados para obtenção das sementes.

ABSTRACT: This research aimed to evaluate the physiological quality of pepper (Capsicum chinense Jacq.) var. Bode Vermelha seeds, obtained from fruits at different ripening stages. The fruits of C. Chinese were separated according to the ripening stages, based on pericarp color (green fruits - stage 1, orange fruits - stage 2, light red fruits - stage 3, red fruits - stage 4, and carmine-red fruits - stage 5). To evaluate the ripeness and the physiological quality of the seeds were determined the biometric characteristics of the fruits and seeds, mass of thousand seeds, seeds water content, electrical conductivity, standard germinations test, speed of germination index, percentage of normal seedlings, speed of seedlings formation, accelerated aging, and seedling length. The characters length, diameter, weight, and number of seeds of the fruits and length, width, thickness, and mass of the seeds were analyzed by the estimated parameters using descriptive statistics. For the other variables was used the completely randomized design. The results were submitted to variance analysis and comparison of means by the Scott-Knott test at 5% probability. The ripeness stage affects the physiological quality of C. chinense Jacq. var. Bode Red seeds, being the seeds from red (stage 4) to carmine-red (stage 5) fruits those with the best performance thus, they are physiologically ripe, being the most indicated to seeds obtaining.

Respostas impressionantes e boa tolerância transformaram o imatinibe no "padrão ouro" de tratamento de primeira linha na LMC em fase crônica precoce. Evolução favorável em mais de 2/3 dos pacientes com LMC é obtida com dose standard de 400 mg por dia. Critérios para estabelecer falha de tratamento e resposta "sub-ótima" têm sido definidos. Guidelines têm sugerido que o escalonamento da dose do imatinibe possa melhorar a resposta em subgrupo de pacientes. Entretanto, a despeito de todos os esforços para otimizar a resposta ao imatinibe, casos de resistência realmente existem. Para os casos de intolerância ou resistência ao imatinibe, inibidores potentes de segunda geração foram desenvolvidos e registrados (nilotinibe e dasatinibe). Além disto, terapêutica sequencial de inibidores podem ultrapassar a resistência, e a terapia combinada usada sequencialmente ou simultaneamente pode ser usada como estratégia futura.

Impressive response rates and the good tolerability have allowed imatinib to become the gold standard frontline therapy for all CML patients in the early chronic phase. Optimal outcomes are attained with more than two thirds of the CML cases treated with standard dose imatinib (400 mg daily). Criteria to establish failure and suboptimal responses to imatinib have been defined. Treatment guidelines have also suggested imatinib dose escalation based on clinical assessments of disease response. However, despite all the effort to optimize therapy with imatinib, cases of real resistance exist. For imatinib resistant and intolerant cases, second generation powerful tyrosine kinase inhibitors (TKIs) have been developed and registered. Sequential kinase inhibitor therapy is used to overcome resistance however, a future strategy might be a combination therapy with different ABL kinase inhibitors in the same therapeutic scheme, used sequentially or simultaneousl.

Neste artigo os autores abordam a origem e o desenvolvimento da Fundação SEADE como órgão oficial responsável pela produção de dados estatísticos no Estado de São Paulo, evidenciando as condições e os desafios enfrentados pelas instituições antecessoras. Inclui, também, uma reflexão sobre os valores que norteiam a estratégia institucional.

This article describes the origin and development of the SEADE Foundation as an official entity charged with producing statistical data for the State of São Paulo. Attention is also given to some of the institutions that preceded SEADE, the conditions under which they operated and the challenges they faced. The authors also reflect on the institution's guiding principles.