Publications by authors named "Marcelo Lopes"

57 Publications

Routinely measured cardiac troponin I and N-terminal pro-B-type natriuretic peptide as predictors of mortality in haemodialysis patients.

ESC Heart Fail 2022 Jan 13. Epub 2022 Jan 13.

Fukuoka Renal Clinic, Fukuoka, Japan.

Aims: Cardiac troponin (cTn) and B-type natriuretic peptide (BNP) are elevated in haemodialysis (HD) patients, and this elevation is associated with HD-induced myocardial stunning/myocardial strain. However, studies using data from the international Dialysis Outcomes and Practice Patterns Study (DOPPS) have shown that these cardiac biomarkers are measured in <2% of HD patients in real-world practice. This study aimed to examine whether routinely measured N-terminal pro-BNP (NT-proBNP) and cTnI (contemporary assay) are more appropriate than clinical models for reclassifying the risk of HD patients who have the highest risk of death.

Methods And Results: Pre-dialysis levels of cTnI and NT-proBNP at study enrolment were measured in 1152 HD patients (Japan DOPPS Phase 5). The patients were prospectively followed for 3 years. Cox regression was used to test the associations of cardiac biomarkers with all-cause mortality, adjusting for potential confounders. Subgroup analyses were performed to assess potential effect modification of clinical characteristics, such as age, systolic blood pressure, HD vintage, diabetes mellitus, coronary artery disease, and a history of congestive heart failure. At baseline, 337 (29%) patients had elevated cTnI (99th percentile of a healthy population: >0.04 ng/mL) with a median (inter-quartile range) level of 0.020 (0.005-0.041) ng/mL, and 1140 (99%) patients had elevated NT-proBNP (cut-off for heart failure: >125 pg/mL) with a median level of 3658 (1689-9356) pg/mL. There were 167 deaths during a median follow-up of 2.8 (2.2-2.8) years. Higher levels of both cardiac biomarkers were incrementally associated with mortality after adjustment for potential confounders. Even after adjustment for alternative cardiac biomarkers, the overall P value for the association was <0.01 for both biomarkers. However, the prognostic significance of NT-proBNP was moderately diminished when cTnI was added to the model. The hazard ratios of mortality for cTnI > 0.04 ng/mL (vs. cTnI < 0.006 ng/mL) and NT-proBNP > 8000 pg/mL (vs. NT-proBNP < 2000 pg/mL) were 2.56 (95% confidence interval: 1.37-4.81) and 1.90 (95% confidence interval: 0.95-3.79), respectively. Subgroup analyses showed that the associations of both cardiac biomarkers with mortality were generally consistent between stratified groups.

Conclusions: Routinely measured NT-proBNP and cTnI levels are strongly associated with mortality among prevalent HD patients. These associations remain robust, even after adjustment for alternative biomarkers, suggesting that cTnI and NT-proBNP have identical prognostic significance and may reflect different pathological aspects of cardiac abnormalities.
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http://dx.doi.org/10.1002/ehf2.13784DOI Listing
January 2022

Immunoinformatics Design of Multi-Epitope Peptide-Based Vaccine Against Using Transmembrane Proteins as a Target.

Front Immunol 2021 2;12:621706. Epub 2021 Mar 2.

Laboratório de Biologia Molecular, Universidade Federal de São João del-Rei, Divinópolis, Brazil.

Schistosomiasis remains a serious health issue nowadays for an estimated one billion people in 79 countries around the world. Great efforts have been made to identify good vaccine candidates during the last decades, but only three molecules reached clinical trials so far. The reverse vaccinology approach has become an attractive option for vaccine design, especially regarding parasites like spp. that present limitations for culture maintenance. This strategy also has prompted the construction of multi-epitope based vaccines, with great immunological foreseen properties as well as being less prone to contamination, autoimmunity, and allergenic responses. Therefore, in this study we applied a robust immunoinformatics approach, targeting transmembrane proteins, in order to construct a chimeric antigen. Initially, the search for all hypothetical transmembrane proteins in GeneDB provided a total of 584 sequences. Using the PSORT II and CCTOP servers we reduced this to 37 plasma membrane proteins, from which extracellular domains were used for epitope prediction. Nineteen common MHC-I and MHC-II binding epitopes, from eight proteins, comprised the final multi-epitope construct, along with suitable adjuvants. The final chimeric multi-epitope vaccine was predicted as prone to induce B-cell and IFN-γ based immunity, as well as presented itself as stable and non-allergenic molecule. Finally, molecular docking and molecular dynamics foresee stable interactions between the putative antigen and the immune receptor TLR 4. Our results indicate that the multi-epitope vaccine might stimulate humoral and cellular immune responses and could be a potential vaccine candidate against schistosomiasis.
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http://dx.doi.org/10.3389/fimmu.2021.621706DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7961083PMC
August 2021

COVID-19 Chain of Survival 2020.

Arq Bras Cardiol 2021 Feb;116(2):351-354

Hospital Alberto Urquiza Wanderley - Hemodinâmica e Cardiologia Intervencionista, João Pessoa, PB - Brasil.

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http://dx.doi.org/10.36660/abc.20201171DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7909961PMC
February 2021

Serum biomarkers of iron stores are associated with worse physical health-related quality of life in nondialysis-dependent chronic kidney disease patients with or without anemia.

Nephrol Dial Transplant 2021 08;36(9):1694-1703

Arbor Research Collaborative for Health, Ann Arbor, MI, USA.

Background: Iron deficiency (ID) is a common condition in nondialysis-dependent chronic kidney disease (NDD-CKD) patients that is associated with poorer clinical outcomes. However, the effect of ID on health-related quality of life (HRQoL) in this population is unknown. We analyzed data from a multinational cohort of NDD-CKD Stages 3-5 patients to test the association between transferrin saturation (TSAT) index and ferritin with HRQoL.

Methods: Patients from Brazil (n = 205), France (n = 2015) and the USA (n = 293) in the Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps, 2013-2019) were included. We evaluated the association of TSAT and ferritin (and functional and absolute ID, defined as TSAT ≤20% and ferritin ≥300 or <50 ng/mL) on pre-specified HRQoL measures, including the 36-item Kidney Disease Quality of Life physical component summary (PCS) and mental component summary (MCS) as the primary outcomes. Models were adjusted for confounders including hemoglobin (Hb).

Results: TSAT ≤15% and ferritin <50 ng/mL and ≥300 ng/mL were associated with worse PCS scores, but not with MCS. Patients with composite TSAT ≤20% and ferritin <50 or ≥300 ng/mL had lower functional status and worse PCS scores than those with a TSAT of 20-30% and ferritin 50-299 ng/mL. Patients with a lower TSAT were less likely to perform intense physical activity. Adjustment for Hb only slightly attenuated the observed effects.

Conclusions: Low TSAT levels, as well as both low TSAT with low ferritin and low TSAT with high ferritin, are associated with worse physical HRQoL in NDD-CKD patients, even after accounting for Hb level. Interventional studies of iron therapy on HRQoL among NDD-CKD individuals are needed to confirm these findings.
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http://dx.doi.org/10.1093/ndt/gfab050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8396397PMC
August 2021

Painting the History of Brazilian Cardiology.

Arq Bras Cardiol 2020 12;115(6):1047-1050

Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas Instituto do Coração, São Paulo, SP - Brasil.

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http://dx.doi.org/10.36660/abc.20201133DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8133712PMC
December 2020

A real-world longitudinal study of anemia management in non-dialysis-dependent chronic kidney disease patients: a multinational analysis of CKDopps.

Sci Rep 2021 01 19;11(1):1784. Epub 2021 Jan 19.

Arbor Research Collaborative for Health, 3700 Earhart Road, Ann Arbor, MI, 48105, USA.

Previously lacking in the literature, we describe longitudinal patterns of anemia prescriptions for non-dialysis-dependent chronic kidney disease (NDD-CKD) patients under nephrologist care. We analyzed data from 2818 Stage 3-5 NDD-CKD patients from Brazil, Germany, and the US, naïve to anemia medications (oral iron, intravenous [IV] iron, or erythropoiesis stimulating agent [ESA]) at enrollment in the CKDopps. We report the cumulative incidence function (CIF) of medication initiation stratified by baseline characteristics. Even in patients with hemoglobin (Hb) < 10 g/dL, the CIF at 12 months for any anemia medication was 40%, and 28% for ESAs. Patients with TSAT < 20% had a CIF of 26% and 6% for oral and IV iron, respectively. Heart failure was associated with earlier initiation of anemia medications. IV iron was prescribed to < 10% of patients with iron deficiency. Only 40% of patients with Hb < 10 g/dL received any anemia medication within a year. Discontinuation of anemia treatment was very common. Anemia treatment is initiated in a limited number of NDD-CKD patients, even in those with guideline-based indications to treat. Hemoglobin trajectory and a history of heart failure appear to guide treatment start. These results support the concept that anemia is sub-optimally managed among NDD-CKD patients in the real-world setting.
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http://dx.doi.org/10.1038/s41598-020-79254-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7815803PMC
January 2021

The combination of malnutrition-inflammation and functional status limitations is associated with mortality in hemodialysis patients.

Sci Rep 2021 01 15;11(1):1582. Epub 2021 Jan 15.

Arbor Research Collaborative for Health, Ann Arbor, MI, USA.

The identification of malnutrition-inflammation-complex (MIC) and functional status (FS) is key to improving patient experience on hemodialysis (HD). We investigate the association of MIC and FS combinations with mortality in HD patients. We analyzed data from 5630 HD patients from 9 countries in DOPPS phases 4-5 (2009-2015) with a median follow-up of 23 [IQR 11, 31] months. MIC was defined as serum albumin < 3.8 g/dL and serum C-reactive protein > 3 mg/L in Japan and > 10 mg/L elsewhere. FS score was defined as the sum of scores from the Katz Index of Independence in Activities of Daily Living and the Lawton-Brody Instrumental Activities of Daily Living Scale. We investigated the association between combinations of MIC (+/-) and FS (low [< 11]/high [≥ 11]) with death. Compared to the reference group (MIC-/high FS), the adjusted hazard ratios [HR (95% CI)] for all-cause mortality were 1.82 (1.49, 2.21) for MIC-/low FS, 1.57 (1.30, 1.89) for MIC+/high FS, and 3.44 (2.80, 4.23) for MIC+/low FS groups. Similar associations were observed with CVD-related and infection-related mortality. The combination of MIC and low FS is a strong predictor of mortality in HD patients. Identification of MIC and poor FS may direct interventions to lessen adverse clinical outcomes in the HD setting.
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http://dx.doi.org/10.1038/s41598-020-80716-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7811014PMC
January 2021

Strain-inducing photochemical chlorination of graphene nanoribbons on SiC (0001).

Nanotechnology 2021 Apr;32(14):145707

Instituto de Química, UFRGS, 90650-001 Porto Alegre, Brazil.

As different low-dimensional materials are sought to be incorporated into microelectronic devices, graphene integration is dependent on the development of band gap opening strategies. Amidst the different methods currently investigated, application of strain and use of electronic quantum confinement have shown promising results. In the present work, epitaxial graphene nanoribbons (GNR), formed by surface graphitization of SiC (0001) on crystalline step edges, were submitted to photochemical chlorination. The incorporation of Cl into the buffer layer underlying graphene increased the compressive uniaxial strain in the ribbons. Such method is a promising tool for tuning the band gap of GNRs.
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http://dx.doi.org/10.1088/1361-6528/abd43aDOI Listing
April 2021

The influence of implant surface roughness on decontamination by antimicrobial photodynamic therapy and chemical agents: A preliminary study in vitro.

Photodiagnosis Photodyn Ther 2021 Mar 18;33:102105. Epub 2020 Nov 18.

Department of Prosthodontics and Periodontics, Bauru School of Dentistry, University of Sao Paulo, Bauru, SP, Brazil. Electronic address:

Background: The aim of this preliminary study was to analyze the effectiveness of three different protocols of decontamination on five commercial moderate rough implants.

Material And Methods: The types of implants investigated were: Neoporos Drive CM (CM; Neodent®), Drive CM Acqua (ACQ; Neodent®), SLActive (SLA; Straumann®), Osseotite (OT; Biomet 3i®) and Nanotite (NT; Biomet 3i®). Implant surface properties (n = 2/type of implant; control groups) were analyzed by scanning electron microscopy (SEM) images to determine surface roughness parameters (SRP) and energy disperse X-ray spectrometry to determine the chemical composition. Implants were then inoculated with Aggregatibacter actinomycetencomitans in vitro (n = 6/type of implant;experimental groups) and the contaminated areas were determined in SEM images (500x magnifications). Decontamination of implants was performed in duplicate by three protocols: antimicrobial photodynamic therapy (aPDT), EDTA associated with citric acid (EDTA + CA) and 0.12 % chlorhexidine (CHX). The remaining contaminated area (rCtA) was determined in SEM images (500x magnifications). All quantitative analysis through SEM images were analyzed in ImageJ® software for two-dimensional parameters.

Results: No significant differences were found in SRP among implants (control group), except for Rv (lowest valley) between SLA vs. OT (p=0.0031; Kruskal Wallis post hoc Dunn). NT implants showed highest contaminated area vs. ACQ implants (68.19 % ± 8.63 % and 57.32 % ± 5.38 %, respectively; p = 0.0016, Tukey's test). SRP after decontamination showed statistical difference for Ra (arithmetical mean deviation) for all decontamination groups when compared to control (p < 0.05; ANOVA with post-hoc Tukey's multiple comparisons test), only CM implants showed statistical difference when compared decontamination protocols to control with highest modification of SRP for EDTA + AC group. For decontamination analysis, for applicability of different protocols in the same type of implant, only SLA showed statistical significant difference for aPDT vs. EDTA + CA (p = 0.0114; ANOVA with post-hoc Tukey's multiple comparisons test) with lowest rCTA for aPDT, however for ACQ implants the aPDT showed lowest rCTA with no statistical difference (p > 0.05; ANOVA with post-hoc Tukey's multiple comparisons test). No statistical difference was observed between the decontamination protocols at other implant types.

Conclusion: It can be suggested that the chemical-physical characteristics of dental implants can be effected by the process of contamination and decontamination by aPDT and chemical agents.
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http://dx.doi.org/10.1016/j.pdpdt.2020.102105DOI Listing
March 2021

COVID-19, Renin-Angiotensin System, Angiotensin-Converting Enzyme 2, and Nicotine: What is the Interrelation?

Arq Bras Cardiol 2020 10;115(4):708-711

Instituto do Coração do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil.

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http://dx.doi.org/10.36660/abc.20200653DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8386966PMC
October 2020

Vascular calcification by conventional X-ray and mortality in a cohort of predominantly African descent hemodialysis patients.

Int J Artif Organs 2021 May 16;44(5):318-324. Epub 2020 Oct 16.

Unit of Clinical Epidemiology and Evidence Based Medicine, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador, BA, Brazil.

Background/objective: There is a lack of studies describing the prevalence of vascular calcification (VC) and its association with mortality in maintenance hemodialysis (MHD) patients of African descent. We investigated if a VC score based on the number of calcified vascular beds was associated with mortality in MHD patients.

Methods: We analyzed data from 211 MHD patients enrolled from January 2010 to January 2011 in the prospective cohort study, "The Prospective Study of the Prognosis of Chronic Hemodialysis Patients (PROHEMO)," developed in Salvador, BA, Brazil. VC was evaluated using radiographs of the hands, abdomen, hip, and chest; the score was calculated by the number of calcified sites as 0 (absence of calcification), 1 (one calcified site), 2 (two sites), 3 (⩾3 sites). We used Cox's regression to estimate the hazard ratio (HR) and 95% confidence interval (CI) of associations between VC and mortality with adjustments for age and comorbidities.

Results: VC was detected in 114 (54.0%) patients; 37 (17.5%) with a VC score = 1; 21 (10%) with VC score = 2 and 56 (26.5%) with VC score = 3. Compared with VC score = 0, the adjusted hazard of death was 2.67 (95% CI: 1.12, 6.33) for patients with VC score = 1; HR = 2.89 (95% CI: 0.95, 7.63) for VC score = 2; and HR = 3.27 (95% CI: 1.47, 7.28) for VC score = 3.

Conclusion: The present study in an African descent MHD population provides support for the VC score based on conventional radiography as a prediction tool for the clinical practice. As shown, the VC score was monotonically and independently associated with mortality.
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http://dx.doi.org/10.1177/0391398820962805DOI Listing
May 2021

Excess of cardiovascular deaths during the COVID-19 pandemic in Brazilian capital cities.

Heart 2020 12 15;106(24):1898-1905. Epub 2020 Oct 15.

Serviço de Cardiologia e Cirurgia Cardiovascular, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil

Introduction: During the COVID-19 pandemic, excess mortality has been reported, while hospitalisations for acute cardiovascular events reduced. Brazil is the second country with more deaths due to COVID-19. We aimed to evaluate excess cardiovascular mortality during COVID-19 pandemic in 6 Brazilian capital cities.

Methods: Using the Civil Registry public database, we evaluated total and cardiovascular excess deaths, further stratified in specified cardiovascular deaths (acute coronary syndromes and stroke) and unspecified cardiovascular deaths in the 6 Brazilian cities with greater number of COVID-19 deaths (São Paulo, Rio de Janeiro, Fortaleza, Recife, Belém, Manaus). We compared observed with expected deaths from epidemiological weeks 12-22 of 2020. We also compared the number of hospital and home deaths during the period.

Results: There were 65 449 deaths and 17 877 COVID-19 deaths in the studied period and cities for 2020. Cardiovascular mortality increased in most cities, with greater magnitude in the Northern capitals. However, while there was a reduction in specified cardiovascular deaths in the most cities, the Northern capitals showed an increase of these events. For unspecified cardiovascular deaths, there was a marked increase in all cities, which strongly correlated to the rise in home deaths (r=0.86, p=0.01).

Conclusion: Excess cardiovascular mortality was greater in the less developed cities, possibly associated with healthcare collapse. Specified cardiovascular deaths decreased in the most developed cities, in parallel with an increase in unspecified cardiovascular and home deaths, presumably as a result of misdiagnosis. Conversely, specified cardiovascular deaths increased in cities with a healthcare collapse.
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http://dx.doi.org/10.1136/heartjnl-2020-317663DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7565269PMC
December 2020

Cardiovascular Imaging and Interventional Procedures in Patients with Novel Coronavirus Infection.

Arq Bras Cardiol 2020 07 7;115(1):111-126. Epub 2020 Aug 7.

Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, SP, Brasil.

The coronavirus disease 2019 (COVID-19) pandemic is a huge challenge to the health system because of the exponential increase in the number of individuals affected. The rational use of resources and correct and judicious indication for imaging exams and interventional procedures are necessary, prioritizing patient, healthcare personnel, and environmental safety. This review was aimed at guiding health professionals in safely and effectively performing imaging exams and interventional procedures.
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http://dx.doi.org/10.36660/abc.20200370DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8384321PMC
July 2020

Mast cells exhibit intracellular microbicidal activity against Aggregatibacter actinomycetemcomitans.

J Periodontal Res 2020 Oct 29;55(5):744-752. Epub 2020 Jul 29.

Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil.

Background And Objective: Several studies have demonstrated that mast cells are equipped with versatile tools to combat and kill bacteria. Additionally, mast cells produce and secrete a variety of mediators, which either regulate the host's immune system or directly attack bacteria. In this study, the intracellular microbicidal capacity of mast cells against Aggregatibacter actinomycetemcomitans was evaluated.

Methods: Murine mast cells were challenged in vitro with A actinomycetemcomitans for 3, 5, 10, and 24 hours. Subsequently, the colony-forming units were counted. Additionally, the production and release of nitric oxide and hydrogen peroxide were analyzed by DAF-FM diacetate, the Griess reaction, and the Amplex Red kit, respectively. Cell death was evaluated using FITC Annexin V and propidium iodide staining.

Results: Mast cells are able to efficiently eliminate periodontopathogen, with best results after 10 hours of intracellular challenge. The production/release of nitric oxide-and to a lesser extent of hydrogen peroxide-by mast cells was in agreement with its microbicidal capacity. Ninety percent of the mast cells  maintained their cellular viability even after 24 hours of bacterial challenge.

Conclusions: This is-to the best of our knowledge-the first report to describe the intracellular microbicidal activity of mast cells against A actinomycetemcomitans, concerning the production and release of potentially bactericidal substances. Further, the low number of cell deaths confirms that the decreased number of colony-forming units was due to the higher antimicrobial activity of mast cells. The results highlight the importance of these cells in the defense mechanisms of biofilm-induced periodontal disease.
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http://dx.doi.org/10.1111/jre.12763DOI Listing
October 2020

Functional dependence and the mental dimension of quality of life in Hemodialysis patients: the PROHEMO study.

Health Qual Life Outcomes 2020 Jul 17;18(1):234. Epub 2020 Jul 17.

Unit of Clinical Epidemiology and Evidence Based Medicine, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador, BA, Brazil.

Background: Functional dependence is highly prevalent in maintenance hemodialysis (MHD) settings. Also, poor health-related quality of life (HRQoL) and high levels of depressive symptoms have been reported by MHD patients. We investigated associations between functional status and mental aspects of quality of life in Brazilian MHD patients.

Methods: Cross sectional study of 235 patients enrolled in two of the four participating MHD clinics of the Prospective Study of the Prognosis of Chronic Hemodialysis Patients (PROHEMO) in Salvador, BA, Brazil. Data were collected from September 2016 to August 2017. The Katz's questionnaire was used for basic activities of daily living (ADL) and the Lawton-Brody's questionnaire for instrumental activities of daily living (IADL). ADL and IADL scores were combined to create 3 functional status groups: highly dependent (n = 47), moderately dependent (n = 109) and independent (n = 82). The validated Brazilian version of the Kidney Disease Quality of Life Short Form (KDQOL-SF) was used for scores of two distinct HRQoL measures, i.e., the mental component summary (MCS) and the 5-item mental health inventory (MHI-5). We used linear regression to estimate differences in scores with adjustment for possible confounders: months of dialysis, age, gender, other sociodemographic variables, body mass index, type of vascular access, dialysis dose by Kt/V, laboratory variables (albumin, blood hemoglobin, calcium, phosphorus, urea, creatinine and parathyroid hormone) and nine comorbid conditions.

Results: Mean age was 51.2 ± 12.4 yr (median age = 51.0 yr), 59.1% were male, 93.2% were non-White. The prevalence of self-reported functional status differed by age: 54.4% for age < 45 yr, 67.8% for age 45-60 yr and 73.9% for age ≥ 60 yr. Using functionally independent as reference, lower scores were observed for highly dependent patients in MCS (difference: -4.69, 95% CI: -8.09, -0.29) and MHI-5 (difference: -5.97, 95% CI: -8.09, -1.29) patients. These differences changed slightly with extensive adjustments for covariates.

Conclusions: Our results call attention to a high prevalence of functional dependence in younger and older MHD patients. The results suggest that the lower self-reported mental quality of life in functionally dependent MHD patients cannot be explained by differences in age and comorbidities.
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http://dx.doi.org/10.1186/s12955-020-01464-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7368696PMC
July 2020

Position Statement: Cardiopulmonary Resuscitation of Patients with Confirmed or Suspected COVID-19 - 2020.

Arq Bras Cardiol 2020 06 3;114(6):1078-1087. Epub 2020 Jul 3.

Hospital Alberto Urquiza Wanderley, João Pessoa, PB, Brasil.

Care for patients with cardiac arrest in the context of the coronavirus disease 2019 (COVID-19) pandemic has several unique aspects that warrant particular attention. This joint position statement by the Brazilian Association of Emergency Medicine (ABRAMEDE), Brazilian Society of Cardiology (SBC), Brazilian Association of Intensive Care Medicine (AMIB), and Brazilian Society of Anesthesiology (SBA), all official societies representing the corresponding medical specialties affiliated with the Brazilian Medical Association (AMB), provides recommendations to guide health care workers in the current context of limited robust evidence, aiming to maximize the protection of staff and patients alike. It is essential that full aerosol precautions, which include wearing appropriate personal protective equipment, be followed during resuscitation. It is also imperative that potential causes of cardiac arrest of particular interest in this patient population, especially hypoxia, cardiac arrhythmias associated with QT prolongation, and myocarditis, be considered and addressed. An advanced invasive airway device should be placed early. Use of HEPA filters at the bag-valve interface is mandatory. Management of cardiac arrest occurring during mechanical ventilation or during prone positioning demands particular ventilator settings and rescuer positioning for chest compressions which deviate from standard cardiopulmonary resuscitation techniques. Apart from these logistical issues, care should otherwise follow national and international protocols and guidelines, namely the 2015 International Liaison Committee on Resuscitation (ILCOR) and 2019 American Heart Association (AHA) guidelines and the 2019 Update to the Brazilian Society of Cardiology Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Guideline.
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http://dx.doi.org/10.36660/abc.20200548DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8416124PMC
June 2020

Impact of longer term phosphorus control on cardiovascular mortality in hemodialysis patients using an area under the curve approach: results from the DOPPS.

Nephrol Dial Transplant 2020 10;35(10):1794-1801

Arbor Research Collaborative for Health, Ann Arbor, MI, USA.

Background: Serial assessment of phosphorus is currently recommended by the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, but its additional value versus a single measurement is uncertain.

Methods: We studied data from 17 414 HD patients in the Dialysis Outcomes and Practice Patterns Study, a prospective cohort study, and calculated the area under the curve (AUC) by multiplying the time spent with serum phosphorus >4.5 mg/dL over a 6-month run-in period by the extent to which this threshold was exceeded. We estimated the association between the monthly average AUC and cardiovascular (CV) mortality using Cox regression. We formally assessed whether AUC was a better predictor of CV mortality than other measures of phosphorus control according to the Akaike information criterion.

Results: Compared with the reference group of AUC = 0, the adjusted hazard ratio (HR) of CV mortality was 1.12 [95% confidence interval (CI) 0.90-1.40] for AUC > 0-0.5, 1.26 (95% CI 0.99-1.62) for AUC > 0.5-1, 1.44 (95% CI 1.11-1.86) for AUC > 1-2 and 2.03 (95% CI 1.53-2.69) for AUC > 2. The AUC was predictive of CV mortality within strata of the most recent phosphorus level and had a better model fit than other serial measures of phosphorus control (mean phosphorus, months out of target).

Conclusions: We conclude that worse phosphorus control over a 6-month period was strongly associated with CV mortality. The more phosphorus values do not exceed 4.5 mg/dL the better is survival. Phosphorus AUC is a better predictor of CV death than the single most recent phosphorus level, supporting with real-world data KDIGO's recommendation of serial assessment of phosphorus to guide clinical decisions.
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http://dx.doi.org/10.1093/ndt/gfaa054DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7538234PMC
October 2020

Percutaneous Transseptal Bioprosthetic Implantation in Failed Prosthetic Surgical Mitral Valve - Brazilian Multicenter Experience.

Arq Bras Cardiol 2020 09;115(3):515-524

Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas Instituto do Coração - Hemodinâmica, São Paulo, SP - Brasil.

Background: Percutaneous intervention in patients with bioprosthetic mitral valve dysfunction is an alternative to conventional surgical treatment.

Objectives: To report the first Brazilian experience with transseptal transcatheter bioprosthetic mitral valve-in-valve implantation (transseptal-TMVIV).

Methods: Patients with surgical bioprosthetic dysfunction submitted to transseptal-TMVIV in 12 Brazilian hospitals were included. The significance level adopted was p<0.05.

Results: From June/2016 to February/2019, 17 patients underwent transseptal-TMVIV. Their median age was 77 years (IQR,70-82) and median Society of Thoracic Surgeons predicted risk of mortality (STS-PROM) score was 8.7% (IQR,7.2-17.8). All patients had limiting symptoms of heart failure (FC≥III) and 5 (29.4%) had undergone more than one previous thoracotomy. Transseptal-TMVIV was successful in all patients. Echocardiographic assessment showed a significant reduction in mean mitral valve gradient (pre-intervention, 12±3.8 mmHg; post-intervention, 5.3±2.6 mmHg; p<0.001), in addition to an increase in mitral valve area (pre-intervention, 1.06±0.59 cm2; post-intervention, 2.18±0.36 cm2; p<0.001) sustained for 30 days. There was a significant and immediate reduction in the pulmonary artery systolic pressure, with an additional reduction in 30 days (pre-intervention, 68.9±16.4 mmHg; post-intervention, 57.7±16.5 mmHg; 30 days, 50.9±18.7 mmHg; p<0.001). During follow-up (median, 162 days; IQR, 102-411), significant clinical improvement (FC≤II) was observed in 87.5% of the patients. One patient (5.9%) had left ventricular outflow tract (LVOT) obstruction and died right after the procedure, and another died at 161 days of follow-up.

Conclusion: The first Brazilian experience with transseptal-TMVIV shows the safety and effectivity of the new technique. The LVOT obstruction is a potentially fatal complication, reinforcing the importance of patients' selection and of procedural planning. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0).
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http://dx.doi.org/10.36660/abc.20190252DOI Listing
September 2020

Echoes of Telecardiology Guideline.

Arq Bras Cardiol 2020 01;114(1):130-132

Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brazil.

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http://dx.doi.org/10.36660/abc.20190720DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7025306PMC
January 2020

Influence of Proximity to Supporting Substrate on van der Waals Epitaxy of Atomically Thin Graphene/Hexagonal Boron Nitride Heterostructures.

ACS Appl Mater Interfaces 2020 Feb 4;12(7):8897-8907. Epub 2020 Feb 4.

Leibniz-Institut im Forschungsverbund Berlin e.V. , Paul-Drude-Institut für Festkörperelektronik , Hausvogteiplatz 5-7 , 10117 Berlin , Germany.

Combining graphene and the insulating hexagonal boron nitride (h-BN) into two-dimensional heterostructures is promising for novel, atomically thin electronic nanodevices. A heteroepitaxial growth, in which these materials are grown on top of each other, will be crucial for their scalable device integration. However, during this so-called van der Waals epitaxy, not only the atomically thin substrate itself must be considered but also the influences from the supporting substrate below it. Here, we report not only a substantial difference between the formation of h-BN on single- (SLG) and on bi-layer epitaxial graphene (BLG) on SiC, but also vice versa, that the van der Waals epitaxy of h-BN at growth temperatures well below 1000 °C affects the varying number of graphene layers differently. Our results clearly demonstrate that the additional graphene layer in BLG enhances the distance to the corrugated, carbon-rich interface of the supporting SiC substrate and thereby diminishes its influence on the van der Waals epitaxy, leading to a homogeneous formation of a smooth, atomically thin heterostructure, which will be required for a scalable device integration of 2D heterostructures.
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http://dx.doi.org/10.1021/acsami.9b21490DOI Listing
February 2020

Digital Health, Universal Right, Duty of the State?

Arq Bras Cardiol 2019 29;113(3):429-434. Epub 2019 Aug 29.

Centro de Ciências Jurídicas da Universidade Federal da Paraíba, João Pessoa, PB - Brazil.

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http://dx.doi.org/10.5935/abc.20190161DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6882383PMC
April 2020
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