Resumen Introducción. La heterogeneidad de los sistemas agropecuarios dificulta evaluar su sustentabilidad, pues no existen herramientas que puedan aplicarse a la generalidad de los casos, con indicadores de fácil comprensión por los actores del medio. Una herramienta de uso posible es el análisis energético. Objetivos. Contextualizar la heterogeneidad de los modelos de producción primaria de leche, con base en flujogramas de energía. Materiales y métodos. Se trabajó con datos retrospectivos de nueve establecimientos comerciales de producción de leche en la Región Pampeana Argentina, durante el período comprendido entre julio de 2014 a junio de 2015. Estos se diferenciaron según variables como carga animal y nivel de suplementación alimentaria. Se utilizó la metodología de estudio de casos, con análisis energéticos para cada caso, configurándose para cada uno flujogramas y cuantificándose ingresos, egresos y eficiencia de uso de la energía. Resultados. Se determinó la existencia de tres tipos de sistemas: mixto lechero-agrícola con invernada (proceso de engorde), mixto lechero-agrícola y lechero puro con invernada. Los sistemas mixtos son importantes por el caudal energético que aportan la agricultura, para compensar la significativa pérdida de energía de los subsistemas de leche y carne; sin embargo, los sistemas ganaderos puros resultaron más eficientes en el uso de la energía, debido al menor consumo energético y a la producción forrajera. Conclusiones. El análisis energético resultó útil para caracterizar la heterogeneidad entre sistemas a partir de la construcción de flujogramas. También permitió evaluar aspectos sociales y ambientales, que en análisis tradicionales quedan excluidos; pero que, dado el volumen del flujo energético que proveen, motivan la necesidad de incluirlos en la contabilidad por su importancia para el proceso lechero y por el estrecho vínculo entre naturaleza y sociedad, asociado al complejo hombre-ecosistema.

Abstract Introduction. The heterogeneity of agricultural systems makes it difficult to assess their sustainability, since there are no tools that can be applied to most cases, with indicators that are easily understood by the stakeholders in the field. One possible tool for use is energy analysis. Objectives. To contextualize the heterogeneity of primary milk production models, based on energy flowcharts. Materials and methods. A retrospective data from nine commercial milk production establishments in the Argentine Pampas Region, during the period from July 2014 to June 2015 were worked with. These were differentiated according to variables such as animal stocking rate and level of feed supplementation. The case study methodology was used, with energy analysis for each case, configuring flowcharts for each one, and quantifying inputs, outputs, and energy use efficiency. Results. The existence of three systems was determined: mixed dairy-agricultural with fattening, mixed dairy-agricultural, and pure dairy with fattening. The mixed systems are important, due to the energy flow provided by agriculture to compensate for the significant energy loss of the milk and meat subsystems; however, the purely livestock systems turned out to be more efficient in energy use, due to lower energy consumption and forage production. Conclusions. The energy analysis was useful to characterize the heterogeneity between systems through the construction of flow charts. It also allowed evaluating social and environmental aspects, which in traditional analyzes are excluded; but which, given the volume of energy flow they provide, motivate the need to include them in accounting due to their importance for the dairy process and due to the close link between nature and society, associated with the man-ecosystem complex.

Resumen Introducción. La actividad agropecuaria es usuaria y productora de energía, puede evaluarse mediante el análisis energético, que también relaciona conceptos de física, bioquímica y biología. Objetivos. Evaluar desde un enfoque energético expandido, distintos modelos comerciales de producción primaria de leche. Materiales y métodos. Se trabajó con datos retrospectivos de nueve establecimientos lecheros de la Región Pampeana Argentina, entre julio de 2014 a junio de 2015. Se calcularon cuatro indicadores: egreso energético (EE), ingreso energético (IE), eficiencia energética (EE/IE) y anergía (A). Resultados. Los mayores EE se basaron en productividad primaria neta, en condiciones de alta suplementación. El IE promedió fue 239,9 GJ/ha/año, rango en que se alinearon los sistemas con carga animal media. El agua (67 %) fue la principal aportante. La eficiencia (EE/IE) presentó marcada variabilidad, basada en los IE; aunque la biomasa vegetal fue la mayor causa de fluctuación de los EE, ya que los aportes de leche y carne no difirieron entre sistemas. El stock (almacenamiento) energético remanente no se utilizó dentro del sistema, ni contribuyó con el mismo mediante su exportación, por lo que se definió como una fracción sin utilidad práctica (A). Conclusiones. El análisis energético fue una herramienta válida para evaluar la sustentabilidad de los sistemas, se aplicó en modelos de producción con diferentes estrategias de intensificación. Al incluir la biomasa vegetal, los mayores egresos energéticos (EE) se apreciaron en modelos de alta suplementación, pero en el subsistema lechero tomado de manera individual, se asoció carga animal con mayores EE (por incremento de productividad) y mayores ingresos energéticos (IE), debido al incremento en el agua consumida.

Abstract Introduction. Agricultural activity is a user and producer of energy, which can be evaluated through energy analysis, which also relates concepts of physics, biochemistry, and biology. Objectives. To evaluate from an expanded energy approach, different commercial models of primary milk production. Materials and methods. The study was based on retrospective data from nine dairy farms in the Pampa's Argentina Region, between July 2014 and June 2015. Four indicators were calculated: energy output (EE), energy input (IE), energy efficiency (EE/IE), and anergy (A). Results. The highest EE were based on net primary productivity, under high supplementation conditions. The average IE was 239.9 GJ/ha/year, a range in which the systems with medium stocking rates were aligned. Water (67 %) was the main contributor. The efficiency (EE/IE) showed marked variability, based on the IE; although the vegetal biomass was the main cause of EE fluctuation, since the contributions of milk and meat did not differ between systems. The remaining energy stock (storage) was not used within the system, nor did it contribute to the system through its export, so it was defined as a fraction without practical use (A). Conclusions. The energy analysis was a valid tool to evaluate the sustainability of the systems, it was applied in production models with different intensification strategies. When including vegetal biomass, the highest energy outputs (EE) were seen in models with high supplementation, but in the dairy subsystem taken individually, animal stocking rate was associated with higher EE (due to increased productivity) and higher IE, due to the increase of water consumption.

Abstract The worldwide consumption of electric energy destined for air conditioners, expected to triple by 2050, can be lessened by geothermal piles, which transfer heat from the internal environment of buildings to the subsoil. This paper shows the influence of pile geometry and properties of soil, pile, and pipe materials on the heat transfer of a geothermal pile to the surrounding soil, to support design from the viewpoint of thermal performance optimization. A numerical model was developed with ANSYS CFX 19.2, a high-performance Computational Fluid Dynamics tool, and calibrated using data from a thermal response test performed in a saturated sandy soil in São Paulo, Brazil. A parametric analysis was carried out varying pile length, diameter, and slenderness; soil and pile material conductivities; degree of saturation; fluid inlet temperature; fluid flow rate; and pipe thermal resistance. Results show that the fluid inlet temperature is the most influential parameter on the thermal performance of the pile. Heat transfer grows when geometrical parameters (diameter and length) are increased mainly due to an increase in heat exchange surface area, whereas the normalized heat transfer rate per unit of surface area of the pile is practically unaltered. Higher soil, pipe and pile thermal conductivities improve thermal performance. The degree of saturation increases the thermal conductivity of the soil; however, the effect is not remarkable on the system’s thermal performance for saturation degrees higher than 20%. The fluid flow must be turbulent but increases above a certain flow rate do not improve the thermal performance.

Abstract Adenocalymma axillarum (K.Schum.) L.G. Lohmann is a liana belonging to the family Bignoniaceae. In traditional medicine, the genus Adenocalymma is used to treat fever, skin ailments, and body, joint, and facial muscle pains, and it is also applied as cosmetic. Biological assays conducted with the A. axillarum crude leaf ethanol extract have indicated leishmanicidal activity and absence of cytotoxicity. This study aimed to analyze the A. axillarum leaf ethanol crude extract by high-performance liquid chromatography-high-resolution mass spectrometry- diode array detector (HPLC-HRMS-DAD) and to evaluate the leishmanicidal and cytotoxic activities of this crude extract, its fractions, and isolated compounds. HPLC-HRMS-DAD analysis of this extract revealed that it consisted mainly of flavonoids, with nine major compounds. Extract purification yielded 4-hydroxy-N-methylproline, 6-β-hydroxyipolamiide, quercetin-3-O-robinobioside, hyperin, isorhamnetin-3-O-robinobioside, and 3’-O-methylhyperin, which were identified by Nuclear Magnetic Resonance. The isolated compounds were inactive against Leishmania amazonensis promastigotes and human lung fibroblast cells.

Abstract The hypothesis that geomorphometric parameters and structural-geological features are diagnostic of reactivation of the Blumenau-Soledade Lineament in central-western Santa Catarina, Brazil was tested by confronting data on asymmetry, elongation, morphological markers, drainage patterns, and river anomalies of the Pelotinhas catchment and structural data for the Serra Geral Group (Paraná Basin). The results indicate reactivation of the lineament as a dextral strike-slip fault, as the cause of an associated morphostructure characterized by an escarpment along the left bank of the river as well as being responsible for catchment asymmetry and morphometric anomalies. Although fault data indicate paleostress correlatable to regional tectonic events described in the literature, we propose that the earliest paleostress pulse possibly was active during the Paleocene-Eocene transition, with σ1 oriented NE-SW and σ3 NW-SE. In the early Paleogene, the stress system evolved as an extensional pulse. During the Paleogene and early Neogene, the paleostress field rotated with reorientation of the σ1 axis between NNW and NNE. The current tectonic regime was established between the Late Pleistocene and Holocene, with compressional stress σ1 oriented approximately WNW-ESE and σ3 NNE-SSW, as it generally occurs in the South American Plate.

Abstract Stevia rebaudiana (Bert.) Bertoni contains steviol glycosides with emphasis to rebaudioside A, which presents a stronger sweet flavor, more stability, good solubility and lower bitter residual taste, which benefits its application in foods and drinks. The objective of this study was to determine the equivalent amount of rebaudioside A necessary to promote the same degree of sweetness of sucralose in the grape- and peach-flavored soy beverages and evaluate their physicochemical characteristics and consumer acceptance. At the Natural Products Center of the State University of Maringa, the rebaudioside A was purified from the M1 Alvarez variety of Stevia plants. Through sensory analysis established that the ideal quantity of rebaudioside A to substitute sucralose in foods with peach soy and grape soy would be 3 times the quantity of sucralose. The results revealed no signifcant differences for the physicochemical and sensorial characteristics (p < 0.05) between the two formulations. The results also indicate that the rebaudioside A with high purity rate (97%) obtained from selected stevia varieties can substitute sucralose in peach soy foods and grape soy foods.

RESUMO Embora a Educação Física escolar tenha historicamente se baseado em estratégias de ensino predominantemente diretivas, é possível especular que metodologias menos diretivas possam contribuir de forma mais efetiva para o aprendizado. O objetivo do presente estudo foi comparar as possíveis implicações da utilização de diferentes estilos de ensino na aprendizagem do jogo da modalidade esportiva voleibol. Para tanto, 27 adolescentes divididos em três grupos (Grupo Diretivo; Grupo Indiretivo e Grupo Controle) foram submetidos a um programa de intervenção de oito encontros voltados ao ensino de conteúdos procedimentais do voleibol. De modo geral, os resultados encontrados sugerem que estilos de ensino indiretivos contribuem de forma mais efetiva para a participação no jogo e para a tomada de decisão, o que provoca uma reflexão sobre a necessidade de se revisitar as estratégias de ensino utilizadas pelos professores e pela necessidade de uma abordagem mais sistêmica para o ensino de jogos.

ABSTRACT Although Physical Education has historically been based on teaching strategies predominantly directives, it is possible speculate that less directive methodologies might contribute more effectively to learning. The aim of this study was to compare the possible implications of using different teaching styles for learning volleyball game. Thus end, 27 teenagers divided into three groups (Directive Group; Indirective group and control group) took part for an intervention program of eight meetings aimed at teaching procedural volleyball contents. Overall, the results suggest that indirective teaching styles contribute more effectively to participation decision, which causes a reflection on the need to revisit the teaching strategies used by teachers and the need for a more systemic approach to teaching games.

This current study aims to analyze the contribution of futsal practice in global praxis and body image in children in a specialized motor stage, evaluating the motor performance before and after an intervention in the following factors: hands and feet global praxis and body image. It was adopted the application method of 18 one-hour twice a week session, divided into three modules, I) displacement activities in different directions; II) coordination activities and reaction time and III) throwing and kicking activities. Twenty male participants, aged 8 to 12 years, with normal motor development were used. The survey was conducted at a private school. The results found were a significant improvement in the hits of the tennis balls with hands and make the number of hits in kicking the ball with his feet. Regarding the analysis of body image after the proposed intervention, the children has shown the body parts performance incorporated in drawings that were not previously present. It is concluded that there are positive contributions of the futsal practice in respect to the global praxis practice and body image in children in a specialized motor stage.

ABSTRACT Pancreatic malignant tumors suffers from an unfortunate prognosis. It is accepted that surgical resection is the only treatment that achieves long-term survival; however, at the moment of their diagnosis, only among 10%-20% the patients are candidates for surgery. Without treatment the survival average is from 3 to 6 months. Just 15-20% will benefit from a resection with curative intent at the time of the diagnosis, less than 20% will survive one year, the 5-year overall survival is not more than 3% .

RESUMEN Los tumores pancreáticos malignos tienen un pronóstico desfavorable. Se acepta que la resección quirúrgica es el único tratamiento que logra la supervivencia a largo plazo; sin embargo, en el momento de su diagnóstico, solo entre 10% -20% los pacientes son candidatos para cirugía. Sin tratamiento, el promedio de supervivencia es de 3 a 6 meses. Solo 15-20% se beneficiarán de una resección con intención curativa una vez hecho el diagnóstico, y menos del 20% sobrevivirán un año, presentando una supervivencia global a 5 años no superior al 3%

ABSTRACT: The Paraná basin is one of the major morphotectures of the South American continent. Although its tectono-sedimentary evolution has been widely studied and fairly well understood, this paper aims to fill a gap in knowledge comprising the tectonic evolution after the end of its last sedimentary cycle, in the Upper Cretaceous. In this context, the Jordan River watershed, situated in the surroundings of Guarapuava municipality, south central region of Paraná State, was selected for structural and morphometric analysis where the Cretaceous volcanic rocks of Serra Geral Formation are exposed. The Jordan River watershed was studied for the influence exerted by Taxaquara Fault Zone on its morphologic evolution, since Taxaquara Fault Zone is associated to the Brazilian cycle and extends eastwards to the Ribeira belt in the state of São Paulo. The morphometric analysis consisted in the interpretation of the Jordan River watershed drainage network and relief elements, considering the distribution of existing knickpoints in the water courses. Structural analysis was based on the calculation of the stress fields responsible for the activation of local fault zones, which were determined by their spatial arrangement and the statistical and mechanical treatments of structural data. During the Oligocene and Miocene, erosional processes developed a planing surface which marks the relief in the central region of the Jordan River watershed and serves as a stratigraphic marker for the associated deformational events. Three events that contributed to the morphological framework of the Jordan River watershed were defined: an oldest one, probably active before the development of the Jordan pediplane in the Paleogene, by a NE-SW maximum horizontal stress (SHmax); and two more recent ones, being one of Plio-Pleistocene age, with a N05W SHmax, and a still active event of transtensive nature showing a N75W SHmax. The paleostress analysis points to a similarity between the Cenozoic evolution of Paraná Basin and the tafrogenic basins of southeast Brazil, revealing the amplitude of the deformation events associated to the studied period and ensuring the importance of further studies on the morphotectonic evolutions of intracratonic regions of the South American plate and their correlation to the Andean tectonic cycle.

O presente estudo buscou investigar as possíveis associações existentes entre o tempo de interação com aparelhos eletrônicos e o nível de desenvolvimento motor de escolares do ensino fundamental de diferentes classes econômicas. Para tanto, tomaram parte do estudo 44 jovens (média de idade de 7 anos e 8 meses e desvio padrão = 5 meses) de ambos os sexos, estudantes das redes pública e privada do município de São Paulo. Todos eles preencheram um questionário como forma de se estimar o seu tempo semanal de interação com aparelhos eletrônicos. Além disso, eles foram avaliados com base no teste de desenvolvimento motor global (TGMD). De modo geral, os resultados não permitem inferir que o tempo de interação com aparelhos eletrônicos seja considerado nocivo ao processo de desenvolvimento motor das crianças. Ao contrário, entre as crianças das classes A/B identificou-se uma associação positiva entre o tempo de interação com aparelhos eletrônicos o seu nível de desempenho atingido no TGMD. Tais resultados incitam uma discussão sobre o acompanhamento pais ou responsáveis com as atividades diárias dos seus filhos, bem como, sobre a natureza de atividades de lazer e entretenimento que são proporcionadas a escolares de diferentes classes sociais.

The present study sought to investigate the possible associations between the time of interaction with electronic equipment and the level of motor development of primary school students of different economic classes. Thus, 44 youngsters (mean age of 7 years and 8 months and standard deviation = 5 months) of both sexes, students of public and private schools of the city of São Paulo, were included in the study. All of them completed a questionnaire as a way of estimating their weekly interaction time with electronic equipment. In addition, they were assessed based on the Test of Global Motor Development (TGMD). In general, the results do not allow inferring that the time of interaction with electronic equipment is considered harmful to the process of children's motor development. On the contrary, among children of the A/B classes, a positive association between the time of interaction with electronic equipment and their level of performance reached in the TGMD was identified. These results stimulate a discussion about the accompanying parents or guardians with the daily activities of their children, as well as about the nature of leisure and entertainment activities that are provided to schoolchildren of different social classes.

O presente estudo teve por objetivo analisar os efeitos da distribuição da prática (DP): prática maciça (PD) versus prática distribuída (PM) por meio de análise do desempenho (notas) de 5 elementos além da nota final de uma rotina técnica (RT) de nado sincronizado (NS). Participaram do estudo 24 voluntários de ambos os sexos, os grupos foram caracterizados como: GPM e GPD. Ambos os grupos receberam 10 sessões com frequência de três vezes por semana, sendo 9 sessões no período de aquisição e 1 sessão para o teste de retenção após 48 horas. Cada voluntário recebeu um feedback visual e verbal antes da tarefa a ser executada e, em cada sessão, foram realizadas 4 tentativas da RT, com intervalos de descanso (ID) distintos entre elas. Já no teste de retenção, ambos os grupos tiveram o mesmo ID para cada tentativa. Os resultados identificaram efeito do fator teste no elemento 3, entre os momentos pré e retenção com nota maior na retenção (3,45 ± 0,96 vs 4,02 ± 0,62) e (3,86 ± 0,56 vs 4,17 ± 0,83) (p = 0,009). Nos elementos 1, 2, 4 e 5 não houve efeito do fator teste nem interação entre os fatores teste e grupo. Já na nota final, houve efeito do fator teste identificando uma tendência entre os momentos pré e retenção (3,73 ± 0,80 vs 4,10 ± 0,60) e (3,85 ± 0,58 vs 4,14 ± 0,74) (p = 0,013). Conclui-se que a aprendizagem de uma habilidade seriada é possível independente da prática utilizada: PM e PD. Uma variável importante que merece discussão para futuras investigações em tarefas desta natureza é o feedback.

The aim of the present study was to analyze the effects of distribution of practice (DP): massed practice (MP) versus distributed practice (DP) through performance analysis (scores) of 5 elements in addition to the final score of a technical routine (TR) of synchronized swimming (SS). 24 volunteers from both genres took part in the study and the groups were characterized as: MPG and DPG. Both groups received 10 sessions, 9 of them in the acquisition period and 1 for the retention test after 48 hours. Before the trials each volunteer watched a video with task to be performed and in each session, 4 TR attempts were performed with different rest breaks (RB) between them. In the retention test, both groups had the same RB for each trial. The results identified a positive effect of the test factor in element 3 between the pre and retention moments with a higher retention score (3.45 ± 0.96 vs 4.02 ± 0.62) and (3.86 ± 0.56 vs 4.17 ± 0.83) (p = 0.009). In elements 1, 2, 4 and 5 there was no effect of the test factor or interaction between the test and group factors. On the other hand, on the final score for the TR, there was an effect of the test factor identifying a trend between the pre and retention moments (3.73 ± 0.80 vs 4.10 ± 0.60) and (3.85 ± 0.58 vs 4.14 ± 0.74) (p = 0.013). It is concluded that the learning of a serial skill is possible independently of the used practice: MP or DP. An important variable that deserves discussion in future investigations in tasks of this nature is feedback.

RESUMO Objetivo: Avaliar a capacidade do eluato proveniente da membrana de plasma rico em fibrina (PRF) de induzir proliferação e diferenciação das células-tronco humanas isoladas de tecido adiposo (CTDAh) em condrócitos. Método: As membranas de PRF foram obtidas por centrifugação de sangue periférico de dois indivíduos saudáveis, cortadas, colocadas em poços de placa de cultivo por 48 h para obtenção do eluato de fibrina. As CTDAh foram isoladas do tecido adiposo por digestão com solução de colagenase e expandidas in vitro. As células foram expandidas e tratadas com meio de cultivo DMEM-F12, meio comercial para diferenciação condrocítica, e eluato de fibrina durante três dias e marcadas com BrdU para avaliação quantitativa da proliferação celular com o uso do sistema de imagens High-Content Operetta®. Para o ensaio de diferenciação condrogênica, as CTDAh foram cultivadas em micromassa por 21 dias e coradas com azul de toluidina e agrecana para avaliação qualitativa em microscópio óptico. As avaliações estatísticas foram feitas por meio dos testes Anova e Tukey. Resultados: Houve uma maior proliferação das células tratadas com o eluato de fibrina comparativamente com os outros dois tratamentos, nos quais o teste Anova apontou significância (p < 0,001). A diferenciação em condrócitos foi visualizada pela presença de mucopolissacarídeos na matriz das células tratadas com meio de diferenciação ou eluato e marcação positiva para agrecana. Conclusões: O tratamento com o eluato da membrana de fibrina estimulou a proliferação celular e induziu a diferenciação das células-tronco em condrócitos, o que sugere uma potencial aplicação da membrana de PRF nas terapias de regeneração de cartilagem hialina.

ABSTRACT Objective: To evaluate the ability of the eluate from fibrin-rich plasma (FRP) membrane to induce proliferation and differentiation of isolated human adipose-derived stem cells (ASCs) into chondrocytes. Method: FRP membranes were obtained by centrifugation of peripheral blood from two healthy donors, cut, and maintained in culture plate wells for 48 h to prepare the fibrin eluate. The SCATh were isolated from adipose tissue by collagenase digestion solution, and expanded in vitro. Cells were expanded and treated with DMEM-F12 culture, a commercial media for chondrogenic differentiation, and eluate from FRP membrane for three days, and labeled with BrdU for quantitative assessment of cell proliferation using the High-Content Operetta® imaging system. For the chondrogenic differentiation assay, the SCATh were grown in micromass for 21 days and stained with toluidine blue and aggrecan for qualitative evaluation by light microscopy. The statistical analysis was performed using ANOVA and Tukey's test. Results: There was a greater proliferation of cells treated with the eluate from FRP membrane compared to the other two treatments, where the ANOVA test showed significance (p < 0.001). The differentiation into chondrocytes was visualized by the presence of mucopolysaccharide in the matrix of the cells marked in blue toluidine and aggrecan. Conclusions: Treatment with eluate from FRP membrane stimulated cell proliferation and induced differentiation of the stem cells into chondrocytes, suggesting a potential application of FRP membranes in hyaline cartilage regeneration therapies.

Abstract This study investigated the acquisition of a serial motor skill in individuals with Down syndrome with two levels of handicap, mild group (mean age = 14.5 years, SD = 2.3, 7 individuals) and moderate group (mean age = 15.2 years, SD = 3.2, 7 individuals). The task involved single-arm sequential movements to five. The measures to access performance were overall sequence error, reaction time, and total movement time. To evaluate action program, formation variability of sequencing and relative timing variability were considered. Although there was no clear practice effect, the results showed that the level of handicap led to different strategies to plan and control the actions. The moderate group presented a less stable action program expressed in the variability in sequencing and timing. Their longer reaction times also suggest a heavy demand on central processing in accord with the one-target advantage hypothesis and also due to memory deficits to select and plan movements.

Resumo Fundamento: Ainda há debate sobre a relação de alterações da repolarização ventricular ao eletrocardiograma de superfície e a gravidade da cirrose. Objetivo: Estudar a relação entre variáveis relacionadas à repolarização ventricular e a gravidade clínica da doença cirrótica. Métodos: Foram selecionados 79 sujeitos com cirrose hepática, classificados segundo os critérios Child-Pugh-Turcotte (Child A, B e C). Foram medidos intervalos QT e QT corrigido (QTc), o intervalo entre o ápice e o final da onda T (TpTe) e identificados os respectivos valores mínimos, máximos e médios nas 12 derivações do eletrocardiograma. Foram calculados também as dispersões dos intervalos QT (DQT) e QTc (DQTc). Resultados: Em 12 meses de acompanhamento clínico, nove sujeitos foram submetidos a transplante hepático (Child A: 0 (0%); Child B: 6 (23,1%); Child C: 3 (18,8%); p=0,04) e 12 faleceram (Child A: 3 (12,0%); Child B: 4 (15,4%); Child C: 5 (31,3%); p=0,002). Não foram observadas diferenças significativas entre os grupos cirróticos relacionadas aos valores mínimos, máximos e médios dos intervalos QT, QTc, TpTe, DQT e DQTc. O intervalo TpTe mínimo ≤50ms foi preditor de desfecho composto de óbito ou transplante hepático com sensibilidade de 90% e especificidade de 57% (p=0,005). Na análise multivariada de Cox, grupos Child e TpTe mínimo ≤50ms foram preditores independentes de desfechos compostos. Conclusão: Os intervalos QT, QTc, DQT, DQTc e TpTe apresentam distribuições semelhantes entre diferentes estágios de gravidade da doença cirrótica. O intervalo TpTe mostra-se marcador prognóstico em sujeitos cirróticos, independente da gravidade da doença. (NCT01433848).

Abstract Background: There is still debate about the relationship between changes in ventricular repolarization on the surface electrocardiogram and cirrhosis severity. Objective: To study the relationship between variables related to ventricular repolarization and the clinical severity of the cirrhotic disease. Methods: We selected 79 individuals with hepatic cirrhosis, classified according to the Child-Pugh-Turcotte criteria (Child A, B, and C). We measured the QT and corrected QT (QTc) intervals, and the interval between the peak and the end of the T wave (TpTe), and we identified their minimum, maximum, and mean values in the 12-lead electrocardiogram. We also calculated the dispersion of the QT (DQT) and QTc (DQTc) intervals. Results: In 12 months of clinical follow-up, nine subjects underwent hepatic transplantation (Child A: 0 [0%]; Child B: 6 [23.1%]; Child C: 3 [18.8%]; p = 0.04) and 12 died (Child A: 3 [12.0%]; Child B: 4 [15.4%]; Child C: 5 [31.3%]; p = 0.002). No significant differences were observed between the cirrhotic groups related to the minimum, maximum, and mean values for the QT, QTc, TpTe, DQT, and DQTc intervals. A minimum TpTe interval ≤ 50 ms was a predictor for the composite endpoints of death or liver transplantation with a sensitivity of 90% and a specificity of 57% (p = 0.005). In the Cox multivariate analysis, the Child groups and a minimum TpTe of ≤ 50 ms were independent predictors of the composite endpoints. Conclusion: The intervals QT, QTc, DQT, DQTc, and TpTe have similar distributions between different severity stages in cirrhotic disease. The TpTe interval proved to be a prognostic marker in subjects with cirrhosis, regardless of disease severity (NCT01433848).