Hypertension is one of the primary modifiable risk factors for morbidity and mortality worldwide, being a major risk factor for coronary artery disease, stroke, and kidney failure. Furthermore, it is highly prevalent, affecting more than one-third of the global population. Blood pressure measurement is a MANDATORY procedure in any medical care setting and is carried out by various healthcare professionals. However, it is still commonly performed without the necessary technical care. Since the diagnosis relies on blood pressure measurement, it is clear how important it is to handle the techniques, methods, and equipment used in its execution with care. It should be emphasized that once the diagnosis is made, all short-term, medium-term, and long-term investigations and treatments are based on the results of blood pressure measurement. Therefore, improper techniques and/or equipment can lead to incorrect diagnoses, either underestimating or overestimating values, resulting in inappropriate actions and significant health and economic losses for individuals and nations. Once the correct diagnosis is made, as knowledge of the importance of proper treatment advances, with the adoption of more detailed normal values and careful treatment objectives towards achieving stricter blood pressure goals, the importance of precision in blood pressure measurement is also reinforced. Blood pressure measurement (described below) is usually performed using the traditional method, the so-called casual or office measurement. Over time, alternatives have been added to it, through the use of semi-automatic or automatic devices by the patients themselves, in waiting rooms or outside the office, in their own homes, or in public spaces. A step further was taken with the use of semi-automatic devices equipped with memory that allow sequential measurements outside the office (ABPM; or HBPM) and other automatic devices that allow programmed measurements over longer periods (HBPM). Some aspects of blood pressure measurement can interfere with obtaining reliable results and, consequently, cause harm in decision-making. These include the importance of using average values, the variation in blood pressure during the day, and short-term variability. These aspects have encouraged the performance of a greater number of measurements in various situations, and different guidelines have advocated the use of equipment that promotes these actions. Devices that perform HBPM or ABPM, which, in addition to allowing greater precision, when used together, detect white coat hypertension (WCH), masked hypertension (MH), sleep blood pressure alterations, and resistant hypertension (RHT) (defined in Chapter 2 of this guideline), are gaining more and more importance. Taking these details into account, we must emphasize that information related to diagnosis, classification, and goal setting is still based on office blood pressure measurement, and for this reason, all attention must be given to the proper execution of this procedure.

La hipertensión arterial (HTA) es uno de los principales factores de riesgo modificables para la morbilidad y mortalidad en todo el mundo, siendo uno de los mayores factores de riesgo para la enfermedad de las arterias coronarias, el accidente cerebrovascular (ACV) y la insuficiencia renal. Además, es altamente prevalente y afecta a más de un tercio de la población mundial. La medición de la presión arterial (PA) es un procedimiento OBLIGATORIO en cualquier atención médica o realizado por diferentes profesionales de la salud. Sin embargo, todavía se realiza comúnmente sin los cuidados técnicos necesarios. Dado que el diagnóstico se basa en la medición de la PA, es claro el cuidado que debe haber con las técnicas, los métodos y los equipos utilizados en su realización. Debemos enfatizar que una vez realizado el diagnóstico, todas las investigaciones y tratamientos a corto, mediano y largo plazo se basan en los resultados de la medición de la PA. Por lo tanto, las técnicas y/o equipos inadecuados pueden llevar a diagnósticos incorrectos, subestimando o sobreestimando valores y resultando en conductas inadecuadas y pérdidas significativas para la salud y la economía de las personas y las naciones. Una vez realizado el diagnóstico correcto, a medida que avanza el conocimiento sobre la importancia del tratamiento adecuado, con la adopción de valores de normalidad más detallados y objetivos de tratamiento más cuidadosos hacia metas de PA más estrictas, también se refuerza la importancia de la precisión en la medición de la PA. La medición de la PA (descrita a continuación) generalmente se realiza mediante el método tradicional, la llamada medición casual o de consultorio. Con el tiempo, se han agregado alternativas a través del uso de dispositivos semiautomáticos o automáticos por parte del propio paciente, en salas de espera o fuera del consultorio, en su propia residencia o en espacios públicos. Se dio un paso más con el uso de dispositivos semiautomáticos equipados con memoria que permiten mediciones secuenciales fuera del consultorio (AMPA; o MRPA) y otros automáticos que permiten mediciones programadas durante períodos más largos (MAPA). Algunos aspectos en la medición de la PA pueden interferir en la obtención de resultados confiables y, en consecuencia, causar daños en las decisiones a tomar. Estos incluyen la importancia de usar valores promedio, la variación de la PA durante el día y la variabilidad a corto plazo. Estos aspectos han alentado la realización de un mayor número de mediciones en diversas situaciones, y diferentes pautas han abogado por el uso de equipos que promuevan estas acciones. Los dispositivos que realizan MRPA o MAPA, que además de permitir una mayor precisión, cuando se usan juntos, detectan la hipertensión de bata blanca (HBB), la hipertensión enmascarada (HM), las alteraciones de la PA durante el sueño y la hipertensión resistente (HR) (definida en el Capítulo 2 de esta guía), están ganando cada vez más importancia. Teniendo en cuenta estos detalles, debemos enfatizar que la información relacionada con el diagnóstico, la clasificación y el establecimiento de objetivos todavía se basa en la medición de la presión arterial en el consultorio, y por esta razón, se debe prestar toda la atención a la ejecución adecuada de este procedimiento.

A hipertensão arterial (HA) é um dos principais fatores de risco modificáveis para morbidade e mortalidade em todo o mundo, sendo um dos maiores fatores de risco para doença arterial coronária, acidente vascular cerebral (AVC) e insuficiência renal. Além disso, é altamente prevalente e atinge mais de um terço da população mundial. A medida da PA é procedimento OBRIGATÓRIO em qualquer atendimento médico ou realizado por diferentes profissionais de saúde. Contudo, ainda é comumente realizada sem os cuidados técnicos necessários. Como o diagnóstico se baseia na medida da PA, fica claro o cuidado que deve haver com as técnicas, os métodos e os equipamentos utilizados na sua realização. Deve-se reforçar que, feito o diagnóstico, toda a investigação e os tratamentos de curto, médio e longo prazos são feitos com base nos resultados da medida da PA. Assim, técnicas e/ou equipamentos inadequados podem levar a diagnósticos incorretos, tanto subestimando quanto superestimando valores e levando a condutas inadequadas e grandes prejuízos à saúde e à economia das pessoas e das nações. Uma vez feito o diagnóstico correto, na medida em que avança o conhecimento da importância do tratamento adequado, com a adoção de valores de normalidade mais detalhados e com objetivos de tratamento mais cuidadosos no sentido do alcance de metas de PA mais rigorosas, fica também reforçada a importância da precisão na medida da PA. A medida da PA (descrita a seguir) é habitualmente feita pelo método tradicional, a assim chamada medida casual ou de consultório. Ao longo do tempo, foram agregadas alternativas a ela, mediante o uso de equipamentos semiautomáticos ou automáticos pelo próprio paciente, nas salas de espera ou fora do consultório, em sua própria residência ou em espaços públicos. Um passo adiante foi dado com o uso de equipamentos semiautomáticos providos de memória que permitem medidas sequenciais fora do consultório (AMPA; ou MRPA) e outros automáticos que permitem medidas programadas por períodos mais prolongados (MAPA). Alguns aspectos na medida da PA podem interferir na obtenção de resultados fidedignos e, consequentemente, causar prejuízo nas condutas a serem tomadas. Entre eles, estão: a importância de serem utilizados valores médios, a variação da PA durante o dia e a variabilidade a curto prazo. Esses aspectos têm estimulado a realização de maior número de medidas em diversas situações, e as diferentes diretrizes têm preconizado o uso de equipamentos que favoreçam essas ações. Ganham cada vez mais espaço os equipamentos que realizam MRPA ou MAPA, que, além de permitirem maior precisão, se empregados em conjunto, detectam a HA do avental branco (HAB), HA mascarada (HM), alterações da PA no sono e HA resistente (HAR) (definidos no Capítulo 2 desta diretriz). Resguardados esses detalhes, devemos ressaltar que as informações relacionadas a diagnóstico, classificação e estabelecimento de metas ainda são baseadas na medida da PA de consultório e, por esse motivo, toda a atenção deve ser dada à realização desse procedimento.

ABSTRACT Underground dams have been widely deployed in the semi-arid region of Rio Grande do Norte, a state in the Brazilian Northeast, aiming to mitigate the effects caused by water scarcity. In this study, the geographic distribution of the electrical conductivity of water of underground dams was evaluated at the end of the dry season of 2018 and at the end of the rainy season of 2019. Maps were created in ArcGIS 10.4.1 software using the Inverse Distance Weighted interpolator. The results indicated high electrical conductivity variability in the evaluated underground dams. The highest values were obtained in the eastern portion of the Rio Grande do Norte state, except for two dams, located in the municipalities of Apodi and Severiano Melo. In most of the underground dams (64%), the water has an electrical conductivity with low soil salinization potential (EC < 0.7 dS m-1). It was observed that the salinity of the underground dams is influenced by several factors, such as climate, relief, land use and occupation due to rural agglomerations and animal husbandry in the dam hydrographic basin, and intensive nutritional management with fertilizers in the dam area.

RESUMO As barragens subterrâneas é uma tecnologia de convivência com a seca amplamente construída na zana semiárida do Rio Grande do Norte como garantia da segurança hídrica devido à escassez de água superficial. Neste trabalho avaliou-se a distribuição geográfica da condutividade elétrica da água (CEa) de barragens subterrâneas, no final do período seco de 2018 e no final do período chuvoso de 2019. Após a coleta e análise da CE da água das barragens foram elaborados os mapas utilizado o software ArcGIS 10.4.1, com auxílio do interpolador de ponderação do inverso da distância. Os resultados indicaram grande variabilidade da CEa nas barragens avaliadas, sendo os maiores valores de CEa registrados nas barragens situadas na porção leste do estado do Rio Grande do Norte - Classes C2 e C3, exceto nas duas barragens localizadas nos municípios de Apodi e Severiano Melo. A maioria das águas das barragens (64%), devido à baixa CEa, não tem restrição de uso quanto aos riscos de acúmulo de sais quando utilizadas para a irrigação (CE < 0,7 dS m-1). Observou-se que a salinidade das barragens é influenciada por fatores edafoclimáticos, uso e ocupação do solo e, ainda pela presença de aglomerados rurais, criação de animais na bacia hidrográfica da barragem e, pelo uso intensivo do manejo nutricional com fertilizantes na área do barramento.

RESUMO Práticas inadequadas de manejo antes do abate podem comprometer o bem-estar animal e a qualidade da carne suína. Este estudo visou avaliar os efeitos do período de transporte (TT), período de descarga (TD), e período de pré-abate (TE) nos indicadores termofisiológicos animais e no pH da carne suína, utilizando uma abordagem multivariada. Este estudo foi realizado num matadouro localizado em Aquiraz, Ceará, Brasil. Um total de 60 suínos mestiços com 107 ± 5 kg de peso corporal foram distribuídos em três grupos experimentais: grupo A (TT = 180 min, TD ≤ 10 min, e TE = 24 horas), grupo B (TT = 60 min, TD ≤ 15 min, e TE = 18 horas), e grupo C (TT = 45 min, TD ≤ 5 min, e TE = 24 horas). A análise discriminante canônica foi implementada e as diferenças entre tratamentos são representadas graficamente. Os dois primeiros componentes foram responsáveis por 97% dos tratamentos. A análise discriminante mostrou que o grupo C apresentou diferenças multivariadas em relação aos outros, particularmente com temperatura retal elevada antes do abate (38,4 ± 0,23 °C) e frequência respiratória (131 ± 7,0 respirações min-1) e temperatura retal (39,7 ± 0,18 °C) à chegada ao matadouro. O período de transporte (TT), período de descarga (TD) e o stress térmico das instalações influenciaram variáveis fisiológicas, tais como a temperatura retal e a frequência respiratória. Além disso, as variáveis de estresse fisiológico também favoreceram cortes com pH básico, resultando em perda de qualidade.

ABSTRACT Inadequate pre-slaughter handling practices may compromise animal welfare and pork quality. This study aimed to evaluate the effects of transport period (TT), unloading period (UT), and pre-slaughtering period (WT) on animal thermophysiological indicators and pork pH using a multivariate approach. This study was conducted in a slaughterhouse located in Aquiraz, Ceará state, Brazil. A total of 60 mestizo pigs with 107 ± 5 kg body weight were distributed into three experimental groups: group A (TT = 180 min, UT ≤ 10 min, and WT = 24 hours), group B (TT = 60 min, UT ≤ 15 min, and WT = 18 hours), and group C (TT = 45 min, UT ≤ 5 min, and WT = 24 hours). Canonical discriminant analysis was implemented and the differences between treatments are represented graphically. The first two components accounted for 97% treatments. The discriminant analysis showed that group C presented multivariate differences in relation to others, particularly with high rectal temperature before slaughter (38.4 ± 0.23 °C) and respiratory rate (131 ± 7.0 breaths min-1) and rectal temperature (39.7 ± 0.18 °C) upon arrival at the slaughterhouse. Transport period (TT), unloading period (UT), and thermal stress of the facilities influenced physiological variables, such as rectal temperature and respiratory rate. Furthermore, the physiological stress variables also favored cuts with basic pH, resulting in quality loss.

This study aimed to evaluate the effect of gamma irradiation (GI) on the physicochemical, technological, antioxidant and microbiological characteristics of different whole sorghum flours (WSF), as well as to characterize the profile of chemical constituents by paper spray mass spectrometry (PS-MS). The doses applied interfered in the staining characteristics of the evaluated flours, providing the darkening of the same. For the other physicochemical, technological, and antioxidant parameters, no significant influence of the process was observed. The fingerprint obtained in both ionization modes had not been influenced by irradiation, being flavonoids, phenylpropanoids, amino acids, benzoic acid derivatives, carboxylic acids, and sugars tentatively identified. In microbiological terms, there was a reduction of molds, yeasts, and Bacillus cereus in irradiated WSF compared to control (non-irradiated). Therefore, the application of low doses of gamma irradiation represents an advantageous alternative for the conservation of WSF and maintenance of bioactive compounds identified by the PS-MS technique.

Abstract Objective: To assess the predictive value of selected growth phenotypes for neonatal morbidity and mortality in preterm infants < 30 weeks and to compare them with INTERGROWTH-21st (IG21). Methods: Retrospective analysis of data from the Brazilian Neonatal Research Network (BNRN) database for very low birth weight (VLBW) at 20 public tertiary-care university hospitals. Outcome: the composite neonatal morbidity and mortality (CNMM) consisted of in-hospital death, oxygen use at 36 weeks, intraventricular hemorrhage grade 3 or 4, and Bell stage 2 or 3 necrotizing enterocolitis. Selected growth phenotypes: small-for-gestational-age (SGA) defined as being < 3rd (SGA3) or 10th (SGA10) percentiles of BW, and large-for-gestational-age (LGA) as being > 97th percentile of BW. Stunting as being < 3rd percentile of the length and wasting as being < 3rd percentile of BMI. Single and multiple log-binomial regression models were fitted to estimate the relative risks of CNMM, comparing them to IG21. Results: 4,072 infants were included. The adjusted relative risks of CNMM associated with selected growth phenotypes were (BNRN/IG21): 1.45 (0.92–2.31)/1.60 (1.27–2.02) for SGA; 0.90 (0.55–1.47)/1.05 (0.55–1.99) for LGA; 1.65 (1.08–2.51)/1.58 (1.28–1.96) for stunting; and 1.48 (1.02–2.17) for wasting. Agreement between the two references was variable. The growth phenotypes had good specificity (>95%) and positive predictive value (70-90%), with poor sensitivity and low negative predictive value. Conclusion: The BNRN phenotypes at birth differed markedly from the IG21 standard and showed poor accuracy in predicting adverse neonatal outcomes.

ABSTRACT Several studies have shown that the survival and reproduction of lacewings varies depending on the type of prey they consumed, especially during the first instar. In this study, we evaluated the effect of a diet consisting of Ephestia kuehniella (EK) and/or Planococcus-citri (PC) eggs offered to first instar Chrysoperla externa on subsequent development and survival. Larvae supplied only with P. citri (PC) nymphs had extended immature development, low survival, adults with lower weight and longevity, low fecundity and egg viability, and lower net reproduction rate (R0). Larvae submitted to the treatment EK+PC responded positively to the diet, showing results similar to those obtained in the control-EK treatment. Therefore, this mealybug supports suitable development and reproduction of C. externa when it is provided to second instar larvae after they fed on E. kuehniella eggs as first instars. As far as we know, this is the first report that demonstrates the effect of natural prey and alternatives on different larval stages of lacewings. This information is valuable in developing protocols for use of C. externaas a pest control agent.

Abstract Many of the drugs used to fight cancer cells induce various damage causing hepatotoxic effects which are characterized by tissue changes. The aim of the study is to know the possible effects of salazinic acid on livers of mice exposed to Sacoma-180. The tumor was grown in the animals in ascitic form and inoculated subcutaneously in the axillary region of the mouse developing the solid tumor. Treatment with salazinic acid (25 and 50 mg/kg) and 5-Fluorouracil (20 mg/kg) started 24-hours after inoculation and was performed for 7 days. To verify these effects, the qualitative method of histological criteria investigated in liver tissue was used. It was observed that all treated groups showed an increase of pyknotic nuclei in relation to the negative control. There was an increase in steatosis in all groups compared to the negative control but there was a decrease in the groups treated with salazinic acid in the 5-Fluorouracil. There was no necrosis in the salazinic acid treated groups. However, this effect was seen in 20% of the positive control group. Therefore, it can be concluded that salazinic acid did not show hepatoprotective action on mice but demonstrated a decrease in steatosis and absence of tissue necrosis.

Abstract In this study, green high-density polyethylene (GHDPE) composites with 5, 10 and 15% natural powdered cork (CP) with and without 5% maleic anhydride (PE-g-MA) were developed in order to evaluate the potential of these materials for civil construction applications. The composites were produced in a co-rotating twin-screw extruder and injection molded. An impedance tube was used to determine the acoustic behavior of the composites, which were then used as ceiling tiles in prototypes of provisional constructions in order to study ascertain their performance with respect to thermal comfort in the City of Teresina, PI - Brazil. Our data indicates that composites sound absorption coefficient values are good between 500 and 1200 Hz, especially for those with a higher percentage of cork, with the lowest absorption rate observed for composites containing PE-g-MA. The composites used in the prototypes provided a decrease in the internal temperature of the built structure.

The Ti-19Nb-2.5Fe-6Sn alloy subjected to proper heat treatments is a promising material to be applied in orthopedic implants. This type of Ti alloy presents relatively low cost, good biocompatibility, and reasonable mechanical strength combined with low elastic modulus. In such an alloy, Fe improves mechanical strength while ω phase precipitation can be controlled by Sn addition. In this work, samples of the Ti-19Nb-2.5Fe-6Sn (wt.%) alloy were prepared by arc melting, hot swaging, and solution heat treatment. Results from the literature combined with thermodynamic simulations, differential scanning calorimetry (DSC), and heating/cooling experiments coupled with microstructural analyses were applied to determine the β transus temperature of this alloy. Following, the samples were solution heat treated in the β field and continuously cooled to room temperature at different rates. The effects of cooling rates on intergranular and intragranular α phase precipitation were evaluated. It was found that low cooling rates lead to intergranular precipitation while moderate cooling rates provide more expressive intragranular precipitation.

Abstract Healthcare workers present an increased risk of contagion for the SARS-CoV-2 virus due to their labor exposure. Here, we describe the clinical, laboratory, and immunological characteristics of healthcare workers, before vaccine application, exposed to SARS-CoV-2-infected patients. We collected sociodemographic, clinical, and laboratory information from 50 professionals who worked during the COVID-19 pandemic at the Clinical Hospital of the Northwest in Brazil. The results showed that most workers are women, over 50 years old, and worked as nursing technicians. Approximately 56% of workers were positive for a previous infection by RT-PCR and/or anti-SARS-CoV-2-immunoglobulin tests. Increased levels of hematocrit, neutrophils, NK lymphocytes, and fibrinogen, were found in positive healthcare workers, suggesting a light inflammatory status. The immunological findings showed an increase in IL-17 production and a Th2/Th17/Th22 profile followed by high serology for anti-SARS-CoV-2 IgM and IgG. Those data reveal the importance of studies with healthcare workers to investigate if the continuous exposition to the virus may result in chronic activation of the immune system and/or pulmonary inflammation in this target group.

Abstract Cereus jamacaru is a cactus distributed in Northeastern Brazil, with high symbolic value to this region. However, the interaction, behavior and the role of pollinators remains poorly understood. Here, we investigate the reproductive biology, addressing the ecological significance of floral attributes, including details about floral signaling. The study was carried at three areas of the Caatinga, in 2015, 2017 and 2021. We analyzed the floral morphometry, volume and concentration of the nectar, and characterized the colour and scent of flowers. Additionally, we described the pollinator behavior and performed controlled pollination experiments. The ‘Mandacaru’ is self-incompatible, has nocturnal anthesis and the nectar is accumulated as droplets in a long hypanthial tube. The flowers have a reflective pattern with a dark outer surface and a white inner surface. (E)-nerolidol is the major component (87.4%) of its floral perfume. We registered the sphingid moth Cocytius antaeus visiting the flowers. The floral attributes, attractants and rewards drives to a sphingophily, and the pollination treatments showed the dependence to fruit set by C. antaeus, the pollinator registered. In this case, if the apparent lack of pollinator diversity encompasses its entire range, the loss of the hawkmoth could severely impact the reproductive success of the cactus.

ABSTRACT Obesity is a chronic disease associated with impaired physical and mental health. A widespread view in the treatment of obesity is that the goal is to normalize the individual's body mass index (BMI). However, a modest weight loss (usually above 5%) is already associated with clinical improvement, while weight losses of 10%-15% bring even further benefits, independent from the final BMI. The percentage of weight reduction is accepted as a treatment goal since a greater decrease in weight is frequently difficult to achieve due to metabolic adaptation along with environmental and lifestyle factors. In this document, the Brazilian Society of Endocrinology and Metabolism (SBEM) and the Brazilian Society for the Study of Obesity and Metabolic Syndrome (ABESO) propose a new obesity classification based on the maximum weight attained in life (MWAL). In this classification, individuals losing a specific proportion of weight are classified as having “reduced” or “controlled” obesity. This simple classification – which is not intended to replace others but to serve as an adjuvant tool – could help disseminate the concept of clinical benefits derived from modest weight loss, allowing individuals with obesity and their health care professionals to focus on strategies for weight maintenance instead of further weight reduction. In future studies, this proposed classification can also be an important tool to evaluate possible differences in therapeutic outcomes between individuals with similar BMIs but different weight trajectories.

ABSTRACT Obesity is a chronic disease associated with impaired physical and mental health. A widespread view in the treatment of obesity is that the goal is to normalize the individual's body mass index (BMI). However, a modest weight loss (usually above 5%) is already associated with clinical improvement, while weight losses of 10%-15% bring even further benefits, independent from the final BMI. The percentage of weight reduction is accepted as a treatment goal since a greater decrease in weight is frequently difficult to achieve due to metabolic adaptation along with environmental and lifestyle factors. In this document, the Brazilian Society of Endocrinology and Metabolism (SBEM) and the Brazilian Society for the Study of Obesity and Metabolic Syndrome (ABESO) propose a new obesity classification based on the maximum weight attained in life (MWAL). In this classification, individuals losing a specific proportion of weight are classified as having “reduced” or “controlled” obesity. This simple classification – which is not intended to replace others but to serve as an adjuvant tool – could help disseminate the concept of clinical benefits derived from modest weight loss, allowing individuals with obesity and their health care professionals to focus on strategies for weight maintenance instead of further weight reduction. In future studies, this proposed classification can also be an important tool to evaluate possible differences in therapeutic outcomes between individuals with similar BMIs but different weight trajectories.

Resumo Fundamentos Uma metodologia para identificação de pacientes portadores de aneurisma de aorta ascendente (AAAs) sob alto risco de remodelamento aórtico não está completamente definida. Objetivo Esta pesquisa objetiva caracterizar numericamente o fluxo sanguíneo aórtico, relacionando a distribuição do estresse mecânico resultante com o crescimento de AAAs. Métodos Estudo analítico, observacional, unicêntrico, em que um protocolo de fluidodinâmica computacional (CFD - Computacional Fluid Dynamics) foi aplicado a imagens de angiotomografia computadorizada (ATC) de aorta de pacientes portadores de AAAs. Duas ATC de aorta com pelo menos um ano de intervalo foram obtidas. Dados clínicos dos pacientes foram registrados e, a partir das imagens de ATC, foram gerados modelos tridimensionais. Foram realizados estudos do campo de velocidade e estruturas coerentes (vórtices) com o objetivo de relacioná-los ao crescimento ou não do aneurisma e, posteriormente, compará-los com os dados clínicos dos pacientes. O teste de Kolmogorov-Smirnov foi utilizado para avaliar a normalidade da amostra e o teste não-paramétrico Wilcoxon signed-rank foi aplicado para comparações de dados pareados entre os ângulos aórticos. A significância estatística foi fixada em 5%. Resultados Para o grupo que apresentou crescimento do aneurisma, a incidência do jato na parede aórtica gerou áreas de recirculação posterior ao jato, induzindo à formação de vórtices complexos, ocasionando um incremento na pressão média no endotélio aórtico. O grupo sem crescimento do aneurisma apresentou diminuição na pressão média. Conclusão Este estudo piloto mostrou que a CFD baseada em ATC pode, em um futuro próximo, ser uma ferramenta auxiliar na identificação dos padrões de fluxo associados ao processo de remodelamento de AAAs.

Abstract Background A methodology to identify patients with ascending aortic aneurysm (AsAA) under high risk for aortic growth is not completely defined Objetive This research seeks to numerically characterize the aortic blood flow by relating the resulting mechanical stress distribution with AsAA growth. Methods Analytical, observational, single-center study in which a computational fluid dynamics (CFD) protocol was applied to aortic computed tomography angiogram (CTA) images of patients with AsAA. Two CTA exams taken at a minimum interval of one year were obtained. From the CTA-gathered images, three-dimensional models were built, and clinical data were registered. Study of velocity field and coherent structures (vortices) was performed aiming to relate them to the presence or absence of aneurysm growth, as well as comparing them to the patients’ clinical data. The Kolmogorov-Smirnov test was used to evaluate the normality of the distribution, and the non-parametric Wilcoxon signed-rank test, for non-normal distribution, was used to compare the paired data of the aortic angles. Statistical significance was set at 5%. Results The incident jet in the aortic wall generated recirculation areas in the posterior region of the jet, inducing complex vortices formation in the group with aneurysm growth, leading to an average pressure increase in the ascending aortic wall between exams. In the group without aneurysm growth, the average pressure decreased. Conclusion This pilot study showed that CFD based on CTA may in the near future be a tool to help identify flow patterns associated with AsAA remodeling process.