Resumen: Se presentan, en un trabajo conjunto, las recomendaciones para la evaluación cardiovascular de personas menores de 35 años que realizan ejercicio y deportes. Se establecen pautas en cuanto a la valoración y la habilitación que tendrá dicha evaluación, quiénes estarán a cargo de su realización y cuáles son los componentes fundamentales de una correcta valoración cardiovascular. Se toman en cuenta los antecedentes familiares y personales, el examen físico exhaustivo y se considera conveniente la realización del ECG como parte integrante obligatorio. Se hacen referencia a otros estudios funcionales como opcionales, así como la posible derivación a los especialistas cuando se considere necesario.

Summary: We hereby present joint recommendations for cardiovascular assessment of people under 35 years of age who do exercise and sports. We set the guidelines regarding evaluation and score of such assessment, the agents in charge of implementing it and the main components of a correct cardiovascular assessment. We take into account the family and personal history and perform a comprehensive physical examination as well as an ECG as a mandatory part of this comprehensive approach. We mention other optional functional studies as well as reference to specialists whenever necessary.

Resumo: Apresentamos através dum paper conjunto recomendações para a avaliação cardiovascular de pessoas de 35 anos de idade que praticam exercício e esportes. Estabelecem-se as diretrizes quanto à qualificação dessa avaliação, quem a realizará e quais são os componentes fundamentais de uma correta avaliação cardiovascular. Consideramos obrigatório incluir a história familiar e pessoal, o exame físico exaustivo e o ECG opcional. Referimo-nos a outros estudos funcionais opcionais, assim como ao possível encaminhamento para especialistas quando for necessário.

Abstract Background In transanalminimally-invasive surgery (TAMIS), the closure of the rectal defect is controversial, and endoluminal suture is one of the most challenging aspects. The goal of the present study is to evaluate the short- andmedium-term complications of a consecutive series of patients with extraperitoneal rectal injuries who underwent TAMIS without closure of the rectal defect. Materials and Methods A prospective, longitudinal, descriptive study conducted between August 2013 and July 2019 in which all patients with extraperitoneal rectal lesions, who were operated on using the TAMIS technique, were consecutively included. The lesions were: benign lesions ≥ 3 cm; neuroendocrine tumors ≤ 2 cm; adenocarcinomas in stage T1N0; and adenocarcinomas in stage T2N0, with high surgical risk, or with the patients reluctant to undergo radical surgery, and others with doubts about complete remission after the neoadjuvant therapy. Bleeding, infectious complications, rectal stenosis, perforations, and death were evaluated. Results A total of 35 patients were treated using TAMIS without closure of the defect. The average size of the lesionswas of 3.68±2.1 cm(95% confidence interval [95%CI]: 0.7cmto 9 cm), their average distance from the anal margin was of 5.7±1.48cm, and the average operative time was of 39.2±20.5 minutes, with a minimum postoperative follow-up of 1 year. As for the pathologies, they were: 15 adenomas; 3 carcinoid tumors; and 17 adenocarcinomas. In all cases, the rectal defect was left open. The overall morbidity was of 14.2%. Two patients (grade II in the Clavien-Dindo classification) were readmitted for pain treatment, and three patients (grade III in the Clavien-Dindo classification) were assisted due to postoperative bleeding, one of whom required reoperation. Conclusion The TAMIS technique without closure of the rectal defect yields good results, and present a high feasibility and low complication rate.

ABSTRACT Background: Exercise capacity of patients with advanced heart failure improves after heart transplantation (HTX). Cardiopulmonary exercise test (CPET) is recognized as the “gold standard” study for the evaluation of aerobic exercise capacity. Objective: The aim of this study was to analyze the characteristics of CPET in HTX recipients. Methods: A cross-sectional study was performed in patients over 18 years of age undergoing HTX from November 1, 2013 to June 30, 2019, and with a CPET within the first year after transplantation. Clinical and CPET variables were analyzed. Results: A total of 122 patients with mean age of 50.1 ± 11.8 years and 77.0% men were included in the study. Peak oxygen consumption (VO2) was 23.3 ± 5.3 mL/min/kg and 45.9% of patients achieved the anaerobic threshold. In 68.0% and 28.7% of cases, the population presented normal oxygen pulse and oxygen uptake efficiency slope (OUES) values, respectively. Mild, moderate, or severe reduced functional capacity was found in 46.7%, 23.0%, and 3.3% of patients, respectively. Oxygen uptake efficiency slope was low in 80.0%, 71.4% and 92.9% of patients with decreased functional capacity of cardiovascular, peripheral, and mixed origin, respectively. Conclusion: In this population of HTX recipients, a considerable proportion of subjects showed reduced functional capacity or abnormal OUES values. The evaluation of these patients through CPET could favor early referral to cardiovascular rehabilitation centers.

RESUMEN Introducción: La capacidad de ejercicio de los pacientes con insuficiencia cardíaca avanzada mejora después del trasplante cardíaco (TXC). La prueba de ejercicio cardiopulmonar (PECP) es reconocida como el estudio “estándar de oro” para la evaluación de la capacidad de ejercicio aeróbico. El objetivo del estudio fue analizar las características de la PECP realizada en receptores de TXC. Material y métodos: Se realizó un estudio de corte transversal. Se incluyeron pacientes mayores de 18 años receptores de TXC desde el 1 de noviembre de 2013 hasta el 30 de junio de 2019, que hubieran realizado una PECP dentro del primer año posterior al trasplante. Se analizaron variables clínicas y de la PECP. Resultados: Se incluyeron 122 pacientes (edad media 50,1 ± 11,8 años, 77,0% hombres). El consumo de oxígeno (VO2) pico fue de 23,3 ± 5,3 mL/min/kg y el 45,9% alcanzó el umbral anaeróbico. El 68,0% y el 28,7% de la población mostró valores de pulso de oxígeno y de la pendiente de la eficiencia del VO2 (OUES) normales, respectivamente. El 46,7%, 23,0% y 3,3% presentaron una reducción leve, moderada o grave de la capacidad funcional, respectivamente. El valor de OUES fue bajo en el 80,0%, 71,4% y 92,9% de los pacientes con disminución de la capacidad funcional de origen cardiovascular, periférico y mixto, respectivamente. Conclusión: En esta población de receptores de TXC, la proporción de sujetos con capacidad funcional reducida o valores de OUES alterados fue considerable. La evaluación de estos pacientes a través de la PECP podría favorecer la derivación temprana a centros de rehabilitación cardiovascular.

ABSTRACT Background: The aim of the study was to compare if there were any differences between discontinuation of vitamin K antagonists and direct oral anticoagulants and evaluate the factors associated with such discontinuation in newly diagnosed nonvalvular atrial fibrillation. Methods: We conducted a prospective cohort study. Patients were followed-up for 12 months. Since the assignment of anticoagulation treatment was not randomized, propensity score weighting was used considering the baseline characteristics potentially associated with the exposure and result. Factors associated with the discontinuation of anticoagulant treatment were analyzed with a weighted Cox proportional hazards model. A total of 379 patients were included; mean age was 78 years (SD ± 9) and 58% were women. Median follow-up was 362 days (interquartile range: 347-370 days) and 1% was lost to follow-up. Results: The model of time to discontinuation based on inverse probability treatment weighting showed a crude HR of 1.40 (95% CI, 0.79-2.48, and of 1.26 (95% CI, 0.75-2,12, after adjustment for age, type of atrial fibrillation, radiofrequency catheter ablation, bleeding, number of chronic medications and number of medical visits during follow-up for the group treated with direct oral anticoagulants compared with the vitamin K antagonists. Conclusions: In our setting, anticoagulant discontinuation in nonvalvular atrial fibrillation would not be associated with the type of drug used, age or type of atrial fibrillation. Radiofrequency catheter ablation, bleeding events and the number of medical visits were associated with treatment discontinuation.

RESUMEN Introducción: El objetivo del estudio fue comparar si existe diferencia en la discontinuación de los antagonistas de la vitamina K y los anticoagulantes directos y evaluar sus factores asociados en la fibrilación auricular de reciente diagnóstico. Material y métodos: Se realizó un estudio de cohortes prospectivo. El período de seguimiento fue de 12 meses. Debido a que la asignación del tratamiento no fue al azar, se realizó una ponderación por puntaje de propensión considerando las características basales potencialmente asociadas a la exposición y al resultado. Se evaluaron factores asociados a la discontinuación del anticoagulante mediante un modelo de Cox ponderado. Se incluyeron 379 pacientes con una edad media de 78 años (DE ± 9) y una prevalencia de sexo femenino del 58%. La mediana de seguimiento fue de 362 días (rango intercuartilo: 347-370 días). La pérdida de seguimiento fue del 1%. Resultados: El modelo de tiempo a la discontinuación del tratamiento anticoagulante ponderado evidenció un HR crudo de 1,40 (IC 95%: 0,79-2,48) y uno ajustado por edad, tipo de fibrilación auricular, ablación por radiofrecuencia, sangrado, cantidad de fármacos crónicos y de consultas médicas durante el seguimiento de 1,26 (IC 95%: 0,75-2,12) para el grupo tratado con anticoagulantes directos en comparación con el tratado con antagonistas de la vitamina K. Conclusiones: En nuestro medio, la discontinuación de los anticoagulantes en la fibrilación auricular no se asociaría con el tipo de fármaco empleado, la edad o el tipo de arritmia. La ablación por radiofrecuencia, la ocurrencia de sangrado y el número de consultas médicas se asociaron con la discontinuación.

ABSTRACT Despite the widespread use of chlorhexidine (CHX) to prevent infection, data regarding the in vitro action of CHX against methicillin-resistant Staphylococcus aureus (MRSA) are limited. Clinical isolates from Hospital das Clinicas, Sao Paulo, Brazil, identified during 2002/2003 and 2012/2013 were studied to describe the susceptibility to CHX and mupirocin, molecular characteristics, and virulence profile of MRSA. Susceptibility test to Mupirocin was performed by the disk diffusion method and to CHX by the agar dilution technique. PCR for virulence genes, mecA gene and Staphylococcal Cassette Chromosome mec (SCCmec) types were investigated as well. Mupirocin- and CHX-resistant isolates were sequenced using the IlluminaTM plataform. Two hundred and sixteen MRSA clinical isolates were evaluated: 154 from infected and 62 from colonized patients. Resistance to mupirocin was observed in four isolates assigned as SCCmec type III and STs (ST05; ST239 and ST105) carrying mupA and blaZ, two of them co-harboring the ileS gene. Only one isolate assigned as SCCmec type III was resistant to CHX (MIC of 8.0 μg.mL-1) and harbored the qacA gene. Resistance to chlorhexidine and mupirocin were found in isolates carrying qacA and mupA in our hospital. Since these genes are plasmid-mediated, this finding draws attention to the potential spread of resistance to mupirocin in our hospital.

Resumen: Se presentan, en un trabajo conjunto, las recomendaciones para la evaluación cardiovascular de personas menores de 35 años que realizan ejercicio y deportes. Se establecen pautas en cuanto a la valoración y la habilitación que tendrá dicha evaluación, quiénes estarán a cargo de su realización y cuáles son los componentes fundamentales de una correcta valoración cardiovascular. Se toman en cuenta los antecedentes familiares y personales, el examen físico exhaustivo y se considera conveniente la realización del electrocardiograma como parte integrante obligatorio. Se hacen referencia a otros estudios funcionales como opcionales, así como la posible derivación a los especialistas cuando se considere necesario.

Summary: Guidelines are established regarding the assessment and qualification that said evaluation will have, who will be in charge of carrying it out and what are the fundamental components of a correct cardiovascular evaluation. The family and personal history and an exhaustive physical examination are taken into account and the performance of the electrocardiogram is considered advisable as a mandatory integral part. Reference is made to other functional studies as optional as well as possible referral to specialists when deemed necessary.

Resumo: Estabelecem-se as diretrizes quanto à avaliação e qualificação que terá essa avaliação, quem se encarregará de realizá-la e quais são os componentes fundamentais de uma correta avaliação cardiovascular. A história familiar e pessoal, o exame físico exaustivo são levados em consideração e a realização do electrocardiograma é considerada aconselhável como parte integrante obrigatória. É feita referência a outros estudos funcionais como opcional, bem como possível encaminhamento para especialistas quando considerado necessário.

ABSTRACT The application of an adequate rate and splitting of nitrogen is essential for wheat grain yield and protein content. The aim of this work was to adjust nitrogen management approaches regarding agronomic performance and protein content of wheat cultivars in various environments. Field experiments were conducted under no-tillage system on soybean mulch during the 2011 and 2012 growing seasons in Londrina and Pato Branco regions. The experimental design was a randomized block in split plot with four replicates. Four wheat cultivars (IPR Catuara TM, BRS Gaivota, Quartzo, CD 120) were tested with six nitrogen (N) management forms. Were evaluated: number of ears per unit area (NEA); plant height (PH); thousand-kernel weight (TKW); test weight (TW); grain yield (GY); and protein content (PC). The combined ANOVA (p ? 0.01) and Tukey’s test (p ? 0.01) were used. The interaction between cultivars and environments influence all yield components, GY and PC. The interaction management forms of N and environments affected the TKW, NEA, GY and PC. The results showed that in low-rainfall environments, nitrogen topdressing could be suppressed with no negative effects on GY or PC. Under ideal weather conditions, the GY of wheat cultivars was enhanced on application of 60 kg.ha–1 N of urea at the beginning of tillering as well 20 kg.ha–1 of N at booting. Matching the appropriate cultivars to the ideal growth environment is essential for achieving high GY values. The nitrogen forms on the topdressing do not influence the PC of cultivars in Pato Branco.

Thin films deposited from propanol-chloroform-argon mixtures by plasma enhanced chemical vapor deposition at different partial pressures of chloroform in the feed, CCl, were characterized after two years of aging and their characteristics compared with their as-deposited properties. Film thickness decreased and surface roughness increased with aging. Surface contact angles also increased with aging for the chlorinated films. For the film deposited with 40% chloroform in the feed the contact angle increased about 14°. Transmission infrared and Energy dispersive X-ray spectroscopy revealed that the films gain carbonyl and hydroxyl groups and lose chlorine and hydrogen on aging. Chlorination appears to make the films more durable. Delamination was observed for the unchlorinated films.

ABSTRACT Objectives To analyze the role of moderate-to-vigorous physical activity (MVPA) in mediating the relationship between central adiposity and immune and metabolic profile in postmenopausal women. Materials and methods Cross-sectional study comprising 49 postmenopausal women (aged 59.26 ± 8.32 years) without regular physical exercise practice. Body composition was measured by dual-energy X-ray absorptiometry. Fasting blood samples were collected for assessment of nonesterified fatty acids, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), adiponectin, insulin and estimation of insulin resistance (HOMA-IR). Physical activity level was assessed with an accelerometer (Actigraph GTX3x) and reported as a percentage of time spent in sedentary behavior and MVPA. All analyses were performed using the software SPSS 17.0, with a significance level set at 5%. Results Sedentary women had a positive relationship between trunk fat and IL-6 (rho = 0.471; p = 0.020), and trunk fat and HOMA-IR (rho = 0.418; p = 0.042). Adiponectin and fat mass (%) were only positively correlated in physically active women (rho = 0.441; p = 0.027). Physically active women with normal trunk fat values presented a 14.7% lower chance of having increased HOMA-IR levels (β [95%CI] = 0.147 [0.027; 0.811]). Conclusions The practice of sufficient levels of MVPA was a protective factor against immunometabolic disorders in postmenopausal women.

Resumo Oligochaeta é um dos táxons mais comuns e abundantes na fauna aquática continental. No entanto, o conhecimento da sua distribuição nos ecossistemas brasileiros ainda é incompleto e fragmentado. Assim, o objetivo deste estudo foi desenvolver um inventário de oligoquetos aquáticos na Reserva Extrativista do Lago Cuniã no estado de Rondônia, Brasil. Foram realizadas duas coletas, cobrindo o período seco (agosto 2015) e chuvoso (fevereiro 2016). As amostras de sedimento foram coletadas perto da região marginal do lago pelo método de amostragem Kick sampling usando um amostrador Kick-net (malha de 0,25 mm). Nós catalogamos 12 táxons do total de 383 espécimes, distribuídos em duas famílias: Naididae (95,08%) e Opistocystidae (4,92%). A subfamília Pristininae foi a mais significativa (85,68%), seguida das subfamílias: Naidinae (8,36%), Tubificinae (0,52%) e Rhyacondrilinae (0,52%). Além disso, algumas espécies, como Allonais inaequalis, Aulophorus furcatus, Dero nivea, Pristina synclites, Pristina menoni e Opistocysta serrata, tiveram o primeiro registro na Amazônia brasileira. Assim, os resultados deste estudo contribuem para aumentar o conhecimento da distribuição da classe Oligochaeta no Brasil, particularmente no Norte do país, que é tão extenso e rico em recursos hídricos, porém pouco estudado.

Abstract Oligochaeta is one of the most common and abundant taxon in continental aquatic fauna. However, knowledge of their distribution in Brazilian ecosystems is still incomplete and fragmented. Thus, the aim of this study was to develop an inventory of aquatic oligochaetes in the Extractive Reserve of Lake Cuniã in the State of Rondônia, Brazil. Collections of data were performed during the dry (August 2015) and rainy seasons (February 2016). The sediment samples were collected near the lakeside region using the kick sampling method and a kick-net sampler (mesh size of 0.25mm). This paper provides a catalog with 12 taxon from a total of 383 specimens, distributed into two families: Naididae (95.08%) and Opistocystidae (4.92%). The Pristininae subfamily was the most significant (85.68%), followed by subfamilies: Naidinae (8.36%), Tubificinae (0.52%) and Rhyacondrilinae (0.52%). In addition, some species such as Allonais inaequalis, Aulophorus furcatus, Dero nivea, Pristina synclites, Pristina menoni and Opistocysta serrata, were recorded for the first time in the Brazilian Amazon region. Therefore, the results of this study contribute to increase knowledge on the distribution of the Oligochaeta class in Brazil, particularly in the North of the country, which is so extensive and rich in water resources, but not extensively studied.

Objectives: To describe the incidence of respiratory tract infections (RTIs) in tracheostomized patients hospitalized in a weaning and rehabilitation center (WRC) and to identify risk factors (RFs) for the development of RTI. Materials and methods: A nested case-control study was conducted. Age was used as the matching variable. All tracheostomized patients who were hospitalized from March, 2013, to February, 2015, were included. The incidence of RTI was recorded. Results: A total of 167 patients were included, with 73 RTI episodes being recorded in 46 patients (27.5%). Cumulative incidence was 27.5%, and incidence rate was 2.22 episodes per 1,000 days of stay. Bacteria were recovered in 50 of the 73 episodes recorded, with Pseudomonas aeruginosa being the most prevalent organism (34.3%). The lowest albumin values proved to be a RF for the development of RTI (p 0.001, odds ratio [OR] 5.82, confidence interval [CI] 2.08-16.2). The highest hemoglobin values on admission acted as protective factors (p 0.048, OR 0.74, CI 0.55-0.99). Diagnoses of stroke (p 0.025, OR 3.45, CI 1.16-10.2), Parkinson (p 0.011, OR 18.9, CI 1.93-185) or amyotrophic lateral sclerosis (ALS) (p 0.013, OR 6.34, IC 1.47-27.2) on admission were established as risk factors for the development of RTI. Conclusion: For the first time in our setting, it was possible to determine the incidence of RTI in tracheostomized patients and the most common pathogens, although comparison with other WRCs is needed. The association found between albumin values and the subsequent development of RTI might be more related to an incidental finding than to a significant clinical difference. Patients with certain neurologic diseases are at increased risk for RTI.

Objetivos: Describir la incidencia de infecciones respiratorias (IR) en pacientes traqueostomizados (TQT) internados en un centro de desvinculación de la ventilación mecánica y rehabilitación (CDVMR). Identificar factores de riesgo (FR) para el desarrollo de IR. Materiales y métodos: Se realizó un estudio de casos y controles anidado en una cohorte. La variable utilizada para el apareamiento fue la edad. Se incluyeron a todos los pacientes TQT internados durante el período de marzo del 2013 a febrero del 2015. Se registró la incidencia de IR. Resultado: Se incluyeron 167 pacientes, registrándose 73 eventos de IR en 46 pacientes. La incidencia acumulada fue de 27,5% y la tasa de incidencia fue de 2,22 eventos/1000 días de estadía. De los 73 eventos registrados, se obtuvieron rescates bacteriológicos en 50 de ellos, siendo Pseudomonas aeruginosa (34,3%) el microorganismo más prevalente. Los valores más bajos de albúmina resultaron ser un FR para el desarrollo de IR (p 0.001, OR 5.82, IC 2.08-16.2). Los valores más altos de hemoglobina de ingreso se comportaron como factor protector (p 0.048, OR 0.74, IC 0.55-0.99). Se establecieron como FR para el evento IR: ingresar con diagnóstico de ACV (p 0.025, OR 3.45 1.16-10.2), Parkinson (p 0.011, OR 18.9, IC 1.93-185) o ELA (p 0.013, OR 6.34, IC 1.47-27.2). Conclusión: Se logró determinar por primera vez en nuestro medio la incidencia de IR en pacientes TQT y los patógenos más comunes, aunque esto necesita contraste con otros CDVMR. La asociación encontrada entre los valores de albúmina y el posterior desarrollo de IR podría estar relacionada más a un sesgo probabilístico que a una diferencia clínica significativa. Los pacientes con determinadas enfermedades neurológicas presentan mayor riesgo de IR.

Lineage delimitation is of extreme importance in evolutionary biology and constitutes an essential tool in basic and applied fields including conservation. We addressed the delimitation of two closely related species complexes of South American rodents of the genus Ctenomys (tuco-tucos), namely the C. pearsoni and Corrientes groups, whose relationships have been unclear or conflicting in previous phylogenetic studies. We performed a molecular phylogenetic analysis, increasing the number of representatives of each group and including sequences of three mitochondrial loci (the complete cytochrome b coding sequence, and partial regions of the cytochrome oxydase I gene and the D-loop of the control region). The trees obtained using Bayesian Inference and Maximum Parsimony methods show the Corrientes group and the C. pearsoni complex as reciprocally monophyletic sister clades, with higher values of intergroup compared to intragroup genetic distances. These results indicate that the Corrientes group and the C. pearsoni complex are differentiated lineages. The resulting tree topology is in agreement with a scenario of independent chromosomal rearrangements from the ancestral karyomorph (2n = 70 FN = 84), leading to the considerable chromosomal diversity that characterizes both groups.

La delimitación de linajes tiene una gran importancia en biología evolutiva y constituye una herramienta fundamental en disciplinas básicas y aplicadas incluyendo la conservación. Abordamos la delimitación de dos complejos de especies de roedores sudamericanos del género Ctenomys (tuco-tucos), denominados grupos C. pearsoni y Corrientes, cuyas relaciones resultaron poco claras o conflictivas en estudios filogenéticos previos. Realizamos una filogenia molecular, aumentando el número de representantes de cada grupo e incluyendo secuencias de tres marcadores mitocondriales (la secuencia completa de la región codificante del gen del citocromo b y secuencias parciales del gen de la enzima citocromo oxidasa I, y del D-loop de la región control). Los árboles obtenidos mediante métodos de inferencia bayesiana y máxima parsimonia muestran que el grupo Corrientes y el complejo C. pearsoni son grupos hermanos recíprocamente monofiléticos con mayores valores de distancias genéticas entre grupos que dentro de los grupos. Estos resultados indican que el grupo Corrientes y el complejo C. pearsoni son linajes diferenciados. La topología resultante es consistente con un escenario de fijación de reordenamientos cromosómicos independientes a partir del cariomorfo ancestral (2n = 70 NF = 84), dando origen a la considerable diversidad cromosómica que caracteriza a ambos grupos.

Abstract This study examined the relationship between resting heart rate (RHRr) and anthropometric, metabolic and hemodynamic parameters in subjects aged 80 years and over. One hundred thirteen individuals were divided into two groups (RHR:<66 beats/min and ≥66 beats/min). Anthropometric parameters (weight, height, body mass index and waist circumference (WC) were measured. Hemodynamic parameters (systolic (SBP) and diastolic (DBP) pressure) were measured and pulse pressures (PP) were obtained. Metabolic parameters were fasting blood glucose, triglycerides and total cholesterol. In elderly aged 80 and over, RHR influenced the changes observed in DBP, PP and triglycerides. Additionally, subjects with RHR≥66 beats/min had higher DBP, glucose, total cholesterol and lower PP as compared with elderly with RHR<66 beats/min. Men demonstrated greater weight, height, and WC than women while women had higher percentage of body fat, trunk fat, and higher total cholesterol. Thus, subjects with 80 years old and over who present RHR≥66 have higher DBP and lower PP and heart rate variability compared with the elderly with RHR<66.