Anorectal Anatomy Quiz: Practical Review.

Understanding anorectal and pelvic floor anatomy can be challenging but is paramount for every physician managing patients with anorectal pathology. Knowledge of anorectal anatomy is essential for managing benign, malignant, traumatic, and infectious diseases affecting the anorectum. This quiz is intended to provide a practical teaching guide for medical students, medical and surgical residents, and may serve as a review for practicing general surgeons and specialists.

Clinimetric properties of the Perme Intensive Care Unit Mobility Score -a multicenter study for minimum important difference and responsiveness analysis

Background: The use of instruments in clinical practice with measurement properties tested is highly recommended, in order to provide adequate assessment and measurement of outcomes. Objective: To calculate the minimum clinically important difference (MCID) and responsiveness of the Perme Intensive Care Unit Mobility Score (Perme Score). Methods: This retrospective, multicentric study investigated the clinimetric properties of MCID, estimated by constructing the Receiver Operating Characteristic (ROC). Maximizing sensitivity and specificity by Youden's, the ROC curve calibration was performed by the Hosmer and Lemeshow goodness-of-fit test. Additionally, we established the responsiveness, floor and ceiling effects, internal consistency, and predictive validity of the Perme Score. Results: A total of 1.200 adult patients records from four mixed general intensive care units (ICUs) were included. To analyze which difference clinically reflects a relevant evolution we calculated the area under the curve (AUC) of 0.96 (95% CI: 0.95-0.98), and the optimal cut-off value of 7.0 points was established. No substantial floor (8.8%) or ceiling effects (4.9%) were observed at ICU discharge. However, a moderate floor effect was observed at ICU admission (19.3%), in contrast to a very low incidence of ceiling effect (0.6%). The Perme Score at ICU admission was associated with hospital mortality, OR 0.86 (95% CI: 0.82-0.91), and the predictive validity for ICU stay presented a mean ratio of 0.97 (95% CI: 0.96-0.98). Conclusion: Our findings support the establishment of the minimum clinically important difference and responsiveness of the Perme Score as a measure of mobility status in the ICU.

Antecedentes: Se recomienda encarecidamente el uso de instrumentos en la práctica clínica con propiedades de medición probadas, con el fin de proporcionar una evaluación y medición adecuada de los resultados. Objetivo: Calcular la diferencia mínima clínicamente importante (MCID) y la capacidad de respuesta de la puntuación de movilidad de la unidad de cuidados intensivos de Perme (Perme Score). Métodos: Este estudio multicéntrico retrospectivo investigó las propiedades clinimétricas de MCID, estimadas mediante la construcción de la característica operativa del receptor (ROC). Maximizando la sensibilidad y especificidad mediante la prueba de Youden, la calibración de la curva ROC se realizó mediante la prueba de bondad de ajuste de Hosmer y Lemeshow. Además, establecimos la capacidad de respuesta, los efectos suelo y techo, la consistencia interna y la validez predictiva del Perme Score. Resultados: Se incluyeron un total de 1,200 registros de pacientes adultos de cuatro unidades de cuidados intensivos (UCI) generales mixtas. Para analizar qué diferencia refleja clínicamente una evolución relevante calculamos el área bajo la curva (AUC) de 0.96 (95% CI: 0.95-0.98); y se estableció el valor de corte óptimo de 7.0 puntos. No se observaron efectos suelo (8.8%) o techo (4.9%) sustanciales al alta de la UCI. Sin embargo, se observó un efecto suelo moderado al ingreso en la UCI (19.3%), en contraste con una incidencia muy baja del efecto techo (0.6%). El Perme Score al ingreso en UCI se asoció con la mortalidad hospitalaria, OR 0.86 (95% CI: 0.82-0.91), y la validez predictiva de estancia en UCI presentó una relación media de 0.97 (95% CI: 0.96-0.98). Conclusiones: Nuestros hallazgos respaldan el establecimiento de la diferencia mínima clínicamente importante y la capacidad de respuesta de el Perme Score como medida del estado de movilidad en la UCI.

Early diagnosis of neural impairment in seropositive leprosy household contacts: The experience of a reference center in Brazil.

Introduction: Leprosy is an infectious disease that remains with a high number of new cases in developing countries. Household contacts have a higher risk for the development of the disease, but the neural impairment in this group is not well elucidated yet. Here, we measured the chance of occurrence of peripheral neural impairment in asymptomatic leprosy household. Methods: Contacts who present anti-PGL-I IgM seropositivity, through electroneuromyography (ENMG) evaluation. We recruited 361 seropositive contacts (SPC) from 2017 to 2021, who were subjected to an extensive protocol that included clinical, molecular, and electroneuromyographic evaluations. Results: Our data revealed a positivity of slit skin smear and skin biopsy qPCR of 35.5% (128/361) and 25.8% (93/361) respectively. The electroneuromyographic evaluation of the SPC showed neural impairment in 23.5% (85/361), with the predominance of a mononeuropathy pattern in 62.3% (53/85). Clinical neural thickening was observed in 17.5% (63/361) of seropositive contacts, but among the individuals with abnormal ENMG, only 25.9% (22/85) presented neural thickening in the clinical exam. Discussion: Ours results corroborates the need to make the approach to asymptomatic contacts in endemic countries more timely. Since leprosy in its early stages can present an indolent and subclinical evolution, serological, molecular, and neurophysiological tools are essential to break the disease transmission chain.

Sports practice after lumbar discectomy in non-professional athletes: a cross-sectional study / Prática esportiva após discectomia lombar em atletas não profissionais: estudo transversal / Práctica deportiva tras discectomía lumbar en atletas no profesionales: un estudio transversal

ABSTRACT: Introduction: Most athletes treated for lumbar disc herniation return to play between 3 and 9 months after conservative or surgical treatment. In the last two decades, the general population increased the practice and participation in amateur competitions, being more prone to overload injuries. Objectives: To evaluate sports practice after lumbar discectomy in non-professional athletes. Methods: In the last five years, a digital questionnaire was sent to patients submitted to up to two levels of open discectomy. After signing the informed consent form, the patients were instructed to answer the questionnaire with personal and clinical data related to disc treatment and sports practice after the procedure. Results: Of 182 contacted patients, a hundred answered the questionnaire; 65% practiced regular sports activities before surgery. From patients who practiced sports before surgery, 75.38% returned to sports activities after the procedure. 39.29% returned between 3 and 6 months. Only 12.31% referred to impaired sports performance, while 56.92% performed unaffected, and 21.54% reported improved performance after surgery. Prior sports practice, participation in amateur competitions, and regular core strengthening were significantly associated with sports practice after surgery (P<0,05). Conclusions: From the participants who had already practiced sports before surgery, 75.38% returned after the surgical procedure. Sports practice before surgery, participation in amateur competitions, and regular core strengthening were positively associated with a return to sports practice after lumbar discectomy. The study shows that core strengthening should be encouraged and recommended to all non-professional athletes who intend to return to sports after microdiscectomy surgeries. Level of Evidence: III; Cross-Sectional Retrospective Study.

RESUMO: Introdução: A maioria dos atletas tratados de hérnia de disco lombar volta a jogar em um período entre 3 e 9 meses, após tratamento conservador ou cirúrgico. Nas últimas duas décadas, a população em geral aumentou a prática e participação em competições amadoras; sendo mais propenso a lesões por uso excessivo. Objetivos: Avaliar a prática esportiva após discectomia lombar em atletas não profissionais. Métodos: Um questionário digital foi enviado aos pacientes submetidos à discectomia aberta de até 2 níveis, nos últimos cinco anos. Após a assinatura do termo de consentimento livre e esclarecido, os pacientes foram orientados a responder o questionário com dados pessoais e clínicos relacionados ao tratamento e à prática esportiva após o procedimento. Resultados: Dos 182 pacientes contatados, cem responderam ao questionário; destes, 65% praticavam atividades esportivas regulares antes da cirurgia. Dos pacientes que praticavam esportes antes da cirurgia, 75,38% retornaram à atividade esportiva após o procedimento. 39,29% retornaram entre 3 e 6 meses. Apenas 12,31% relataram piora no desempenho esportivo, enquanto para 56,92% o desempenho não foi afetado e 21,54% relataram melhora no desempenho após a cirurgia. A prática esportiva prévia, a participação em competições amadoras e o fortalecimento regular do core foram significativamente associados à prática esportiva após a cirurgia (P<0,05). Conclusões: Dos participantes que já praticavam esportes antes da cirurgia, 75,38% retornaram após o procedimento cirúrgico. A prática esportiva prévia à cirurgia, a participação em competições amadoras e o fortalecimento regular do core foram positivamente associados ao retorno à prática esportiva após a discectomia lombar. O estudo mostra que o fortalecimento do core deve ser incentivado e recomendado para todos os atletas não profissionais que pretendem retornar ao esporte após cirurgias de microdiscectomia. Nível de Evidência III; Estudio Transversal Retrospectivo.

RESUMEN: Introducción: La mayoría de los atletas tratados por hernia de disco lumbar regresan a jugar en un período de entre 3 y 9 meses, luego de un tratamiento conservador o quirúrgico. En las últimas dos décadas, la población en general incrementó la práctica y participación en competencias aficionadas; siendo más propensos a sufrir lesiones por sobrecarga.Objetivos: Evaluar la práctica deportiva posterior a discectomía lumbar en deportistas no profesionales. Métodos: Se envió un cuestionario digital a los pacientes sometidos a discectomía abierta de hasta 2 niveles, en los últimos cinco años. Tras firmar el consentimiento informado, se instruyó a los pacientes para que respondieran el cuestionario con datos personales y clínicos, relacionados con el tratamiento discal y la práctica deportiva posterior al procedimiento. Resultados: De 182 pacientes contactados, cien respondieron el cuestionario; de estos, el 65% practicaba actividades deportivas regulares antes de la cirugía. De los pacientes que practicaban deporte antes de la cirugía, el 75,38% retornó a la actividad deportiva después del procedimiento. El 39,29% volvió entre los 3 y 6 meses. Solo el 12,31 % refirió deterioro del rendimiento deportivo, mientras que para el 56,92 % el rendimiento no se vio afectado y el 21,54 % refirió mejora del rendimiento después de la cirugía. La práctica deportiva previa, la participación en competiciones aficionadas y la realización regular de fortalecimiento del core, se asociaron significativamente con la práctica deportiva tras la cirugía (P<0,05). Conclusiones: De los participantes que ya practicaban deporte antes de la cirugía, el 75,38% regresaron después del procedimiento quirúrgico. La práctica deportiva previa a la cirugía, la participación en competiciones de aficionados y la realización de un fortalecimiento core periódico se asociaron positivamente con la vuelta a la práctica deportiva tras la discectomía lumbar. El estudio muestra que se debe alentar y recomendar el fortalecimiento del core a todos los atletas no profesionales que tengan la intención de volver al deporte después de las cirugías de microdiscectomía. Nivel de Evidencia III; Estudio Retrospectivo Transversal.

Vena Cava Filter Misplacement: A Killer Traveler

ABSTRACT Inferior vena cava filter embolization is not uncommon and can reach 11.8%. However, device migration to the heart is not frequent and occurs in cases after inferior vena cava filter fracture. We present the case of a young woman who was submitted to a routine inferior vena cava filter placement three days before and presented with hemodynamic instability. Since the device was not retrievable, the surgical team opted for an open cardiac surgery under cardiopulmonary bypass to remove the inferior vena cava filter and avoid other further complications.

Vena Cava Filter Misplacement: A Killer Traveler.

Inferior vena cava filter embolization is not uncommon and can reach 11.8%. However, device migration to the heart is not frequent and occurs in cases after inferior vena cava filter fracture. We present the case of a young woman who was submitted to a routine inferior vena cava filter placement three days before and presented with hemodynamic instability. Since the device was not retrievable, the surgical team opted for an open cardiac surgery under cardiopulmonary bypass to remove the inferior vena cava filter and avoid other further complications.

IgA Nephropathy Is the Most Common Underlying Disease in Patients With Anticoagulant-Related Nephropathy.

Introduction: Anticoagulant-related nephropathy (ARN) is a relatively novel recognized entity characterized by hematuria-associated acute kidney injury (AKI) in the context of overanticoagulation. Preexisting or underlying kidney disease seems to be a predisposing factor; however, few studies have described histologic findings in patients with ARN. We aimed to evaluate underlying kidney pathology in patients on oral anticoagulation who presented an episode of AKI with hematuria in whom a kidney biopsy was performed. Methods: Retrospective observational multicenter case study in patients treated with oral anticoagulants who developed macroscopic or intense hematuria followed by AKI. Only patients with available kidney biopsy specimens were included. Histologic findings and clinical data throughout follow-up were analyzed. Results: A total of 26 patients were included with a median age of 75 years (62-80) and a follow-up period of 10.1 months. Of the patients, 80% were male, and most cases (92%) were on anticoagulation with vitamin K antagonists (VKAs). At admission, median serum creatinine (SCr) level was 4.2 mg/dl (2.8-8.2), median international normalized ratio (INR) 2.4 (1.5-3.4), and 11 patients (42%) required acute dialysis during hospitalization. Kidney biopsy results revealed that all patients except 1 had an underlying nephropathy: IgA nephropathy (IgAN) in 19, probable IgAN in 1, diabetic nephropathy in 3, nephrosclerosis in 1, and idiopathic nodular glomerulosclerosis in 1. At 12 weeks after discharge, only 6 subjects (24%) attained complete kidney recovery whereas 7 (28%) remained on chronic dialysis. Conclusion: IgAN was the most common underlying kidney disease in our biopsy-proven series of ARN, in which a significant percentage of patients did not achieve kidney function recovery.

Effect of the Unilateral Breast Cancer Surgery on the Shoulder Movement: Electromyographic and Motion Analysis / Efecto de la cirugía unilateral del cáncer de mama en el movimiento del hombro: análisis electromiográfico y de movimiento

ABSTRACT After breast cancer surgery, women might develop musculoskeletal impairments that affect movements of the upper limbs and reduce the quality of life. The objective of this research was to analyze the effect of the unilateral breast cancer surgery on the kinematics of the shoulder and the electrical activity of the upper trapezius, middle deltoid and pectoralis major muscles. Eight right-handed female participants, mean age 46.5 ± 5.45 years and mean body mass 71.21 ± 13.33 kg, with unilateral breast cancer surgery, without breast reconstruction and without lymphedema symptoms were included in the research. Flexion-extension and abduction-adduction movements of the shoulder were evaluated with infrared cameras and the electrical activity was measured using surface electromyography. The statistical analysis of the direction angles showed a significant reduction of the flexion-extension and abduction-adduction movements in the affected side in most of the participants (p<0.05). The muscle electrical activity did not present a significant difference between the two sides for the flexion-extension and abduction-adduction movements (p>0.05). The results suggest that the surgical procedure could compromise the range of motion of the affected side. Furthermore, this research contributes to clarify the effect of the surgical procedure in the range of motion of the upper limbs.

RESUMEN Después de la cirugía de cáncer de mama, las mujeres pueden desarrollar deficiencias musculoesqueléticas que afectan los movimientos de las extremidades superiores y reducen la calidad de vida. El objetivo de esta investigación fue analizar el efecto de la cirugía unilateral del cáncer de mama sobre la cinemática del hombro y la actividad eléctrica de los músculos trapecio superior, deltoides medio y pectoral mayor. Se incluyeron ocho participantes diestras, edad promedio 46.5 ± 5.45 años y masa promedio 71.21 ± 13.33 kg, con cirugía de cáncer de mama unilateral, sin reconstrucción mamaria y sin síntomas de linfedema. Los movimientos de flexión-extensión y abducción-aducción del hombro se evaluaron con cámaras infrarrojas y se midió la actividad eléctrica mediante electromiografía de superficie. El análisis estadístico de los ángulos de dirección mostró una reducción significativa del movimiento de flexión-extensión y abducción-aducción en el lado afectado en la mayoría de las participantes (p<0.05). La actividad eléctrica muscular no presentó diferencia significativa entre los dos lados para los movimientos de flexión-extensión y abducción-aducción (p>0.05). Los resultados sugieren que el procedimiento quirúrgico podría comprometer el rango de movimiento del lado afectado. Además, esta investigación contribuye a esclarecer el efecto del procedimiento quirúrgico en el rango de movimiento de los miembros superiores.

Cognitive impairment in patients with psoriatic arthritis.

BACKGROUND: Psoriatic arthritis (PsA) is an inflammatory rheumatic disorder associated with cutaneous psoriasis. Neurological manifestations are not uncommon in rheumatic diseases and recent studies point to a possible underestimation of cognitive impairment in this group of diseases. Our aim was to assess the cognitive impairment in patients with PsA. METHODS: We carried out a cross-sectional case-control study with consecutive patients with PsA. Trained interviewers conducted structured and standardized in-person assessments. At baseline, functional limitations were characterized using the Health Assessment Questionnaire (HAQ). Cognitive function was evaluated with the Montreal Cognitive Assessment (MoCA) and neuropsychiatric symptoms were investigated with the Hospital Anxiety and Depression Scale (HADS). Using a proper statistical analysis, we compared the differences in the neurological outcomes between cases and controls. RESULTS: A total of 37 patients with PsA and 36 healthy controls were included in our study. Patients with PsA had a worse MoCA score when compared to controls (p = 0.01). The proportion of patients with cognitive impairment according to MoCA between cases and controls was also statistically significant (91.9% vs 58.3%, p = 0.002). Executive skills, naming, language, and abstraction were the most affected domains. There was no statistical difference between the prevalence of neuropsychiatric symptoms between the two groups. Patients with increased functional limitations are associated with poor cognitive performance (p < 0.05). CONCLUSION: Cognitive impairment might be a neurological manifestation of PsA.

El e-learning e impacto en la enseñanza y evaluación de anatomía humana durante la COVID 19: una revisión de la calidad de la literatura / E-learning and impact on the teaching and assessment of human anatomy during COVID 19: a review of the quality of the literature

RESUMEN: El e-learning (aprendizaje electrónico) es el proceso de enseñanza, aprendizaje y evaluación, a través de internet y la tecnología, es decir, está centrado en los métodos de aprendizaje, la expansión y conexión de información, que en el uso de una computadora como un artefacto en el proceso de aprendizaje. El propósito de esta revisión fue identificar estudios que exploraran las tecnologías e-learning y su impacto en el proceso de enseñanza y evaluación de Anatomía Humana, y evaluar la calidad de investigación publicada. Se realizó una revisión sistemática de la literatura en las bases de datos Pudmed (Medline), Ovid (cochrane Central), Ovid (Medline), Scopus, Web of science (clarivate) y Science Direct, incluyendo las palabras claves: Examination, Teaching, COVID-19 medical education, COVID-19, Medical student exams, Anatomy, Students, Medical. Se evaluó la calidad de las investigaciones a través del instrumento de Calidad del Estudio de Investigación de Educación Médica (MERSQI). En total se encontraron 202 artículos de investigación, y al aplicar los criterios de inclusión y exclusión se identificaron un total de 24 artículos; tras leer los artículos, se escogieron cuatro investigaciones que cumplieron con los criterios de síntesis en esta revisión. En general, los resultados mostraron un impacto favorable de las tecnologías e-learning pues facilitó el acceso, la flexibilidad y el ritmo de aprendizaje para cada estudiante, también promovió nuevas formas de enseñanza y evaluación en la disciplina de la Anatomía Humana en estudiantes de medicina durante la pandemia la COVID-19. Así, la educación médica para la ciencia básica en anatomía humana indica una transición a un aprendizaje combinado de lo presencial y virtual a un modelo de aprendizaje mixto (b-learning).

SUMMARY: E-learning (electronic learning) is the process of teaching, learning and evaluation, through the internet and technology, that is, it is focused on learning methods, the expansion and connection of information, which in the use of a computer as an artifact in the learning process. The purpose of this review was to identify studies that explore e-learning technologies and their impact on the teaching and assessment process of Human Anatomy, and to assess the quality of published research. A systematic review of the literature was carried out in the databases Pudmed (Medline), Ovid (Cochrane Central), Ovid (Medline), Scopus, Web of science (clarivate) and Science Direct, including the keywords: Examination, Teaching, COVID-19 medical education, COVID-19, Medical student exams, Anatomy, Students, Medical. Research quality was assessed using the Medical Education Research Study Quality (MERSQI) instrument. In total, 202 research articles were found, and when applying the inclusion and exclusion criteria, a total of 24 articles were identified; After reading the articles, four investigations were chosen that met the synthesis criteria in this review. In general, the results showed a favorable impact of e-learning technologies since it facilitated access, flexibility and learning pace for each student, it also promoted new forms of teaching and evaluation in the discipline of Human Anatomy in medical students. during the Covid-19 pandemic. Thus, medical education for basic science in human anatomy indicates a transition from blended face-to-face and virtual learning to a blended learning model (b-learning).

Perfil e desfechos clínicos de pacientes internados por covid-19 em um hospital do sul do brasil / Perfil y resultados clínicos de pacientes internados por covid-19 en un hospital del sur de brasil / Clinical profile and outcomes of patients hospitalized for covid-19 in a hospital in southern brazil

Objetivo: descrever perfil e desfechos clínicos de pacientes diagnosticados com COVID-19 admitidos em hospital privado na região Sul do Brasil. Método: estudo descritivo, realizado com 110 pacientes com COVID-19 que necessitaram de internação hospitalar entre março e maio de 2020. Foram coletados dados sociodemográficos, perfil clínico, sinais e sintomas e desfechos clínicos. Adotou-se análise descritiva para interpretação dos dados. Resultados: predominou sexo masculino (64,5%). Comorbidade prevalente: Hipertensão Arterial Sistêmica (45,5%). Sinais e sintomas com maior destaque: tosse (53,6%) e dispneia (48,2%). Desfechos clínicos evidenciados: tomografia de tórax com opacidades em vidro fosco (98,2%), suplementação com oxigenoterapia (86,4%), encaminhamento para Unidade de Internação (90,9%). Intercorrências observadas: arritmias cardíacas (18,2%) e hipoxemia (18,2%). Desfecho final predominante foi alta melhorada (90%). Conclusão: a descrição de perfil e desfecho clínico de pacientes com COVID-19 proporcionará o direcionamento de cuidados com fluxos e protocolos assistenciais que garantam qualidade da assistência e segurança na prática clínica.

Objetivo: describir perfil y resultados clínicos de pacientes diagnosticados con COVID-19 admitidos en hospital privado en la región Sur de Brasil. Método: estudio descriptivo, realizado con 110 pacientes con COVID-19 que necesitaron de internación hospitalaria entre marzo y mayo de 2020. Se recogieron datos sociodemográficos, perfil clínico, signos y síntomas y resultados clínicos. Se adoptó análisis descriptivo para interpretación de los datos. Resultados: predominó sexo masculino (64,5%). Comorbilidad prevalente: Hipertensión Arterial Sistémica (45,5%). Signos y síntomas con mayor destaque: tos (53,6%) y disnea (48,2%). Resultados clínicos evidenciados: tomografía de tórax con opacidades en vidrio esmerilado (98,2%), suplementación con oxigenoterapia (86,4%), encaminamiento para Unidad de Internación (90,9%). Complicaciones observadas: arritmias cardíacas (18,2%) e hipoxemia (18,2%). Resultado final predominante fue alta mejorada (90%). Conclusión: la descripción de perfil y resultado clínico de pacientes con COVID-19 proporcionará la orientación de cuidados con flujos y protocolos asistenciales que garanticen calidad de la asistencia y seguridad en la práctica clínica.

Objective: to describe the clinical profile and outcomes of patients diagnosed with COVID-19 admitted to a private hospital in southern Brazil. Method: descriptive study, conducted with 110 patients with COVID-19 who required hospitalization between March and May 2020. Sociodemographic data, clinical profile, signs and symptoms, and clinical outcomes were collected. Descriptive analysis was adopted for data interpretation. Results: male predominated (64.5%). Prevalent comorbidity: Systemic Arterial Hypertension (45.5%). Signs and symptoms with greater prominence: cough (53.6%) and dyspnea (48.2%). Clinical outcomes evidenced: chest tomography with ground-glass opacities (98.2%), supplementation with oxygen therapy (86.4%), referral to the Hospitalization Unit (90.9%). Observed complications: cardiac arrhythmias (18.2%) and hypoxemia (18.2%). Predominant outcome was improved discharge (90%). Conclusion: the description of the clinical profile and outcome of patients with COVID-19 will provide the direction of care with care flows and protocols that guarantee quality of care and safety in clinical practice.

Update on Minimally Invasive Surgical Approaches for Rectal Cancer.

PURPOSE OF REVIEW: This review aims to clarify the current role of minimally invasive surgery in the treatment of rectal cancer, highlighting short- and long-term outcomes from the latest trials and studies. RECENT FINDINGS: Data from previous trials has been conflicting, with some failing to demonstrate non-inferiority of laparoscopic surgical resection of rectal cancer compared to an open approach and others demonstrating similar clinical outcomes. Robot-assisted surgery was thought to be a promising solution to the challenges faced by laparoscopic surgery, and even though the only randomized controlled trial to date comparing these two techniques did not show superiority of robot-assisted surgery over laparoscopy, more recent retrospective data suggests a statistically significant higher negative circumferential resection margin rate, decreased frequency of conversion to open, and less sexual and urinary complications. Minimally invasive surgery techniques for resection of rectal cancer, particularly robot-assisted, offer clear short-term peri-operative benefits over an open approach; however, current data has yet to display non-inferiority in terms of oncological outcomes.

Clinical Outcomes Following Single vs. Multiple Vessel Living-Donor Kidney Transplantation: A Retrospective Comparison of 210 Patients.

Background: The use of living-donor kidney allografts with multiple vessels continues to rise in order to increase the donor pool. This requires surgeons to pursue vascular reconstructions more often, which has previously been associated with a higher risk of developing early post-transplant complications. We therefore wanted to investigate the prognostic role of using living-donor renal allografts with a single artery (SA) vs. multiple arteries (MA) at the time of transplant. Methods: We retrospectively analyzed a cohort of 210 consecutive living-donor kidney transplants performed between January, 2008 and March, 2019, and compared the incidence of developing postoperative complications and other clinical outcomes between SA vs. MA recipients. Results: No differences were observed between SA (N = 161) and MA (N = 49) kidneys in terms of the incidence of developing a postoperative (or surgical) complication, a urologic complication, hospital length of stay, delayed graft function, estimated glomerular filtration rate at 3 or 12 mo post-transplant, and graft survival. Conclusions: The use of live-kidney allografts with MA requiring vascular reconstruction shows excellent clinical outcomes and does not increase the risk of developing postoperative complications or other adverse outcomes when compared with SA renal allografts.

Clinical trials in cardiac xenotransplantation: Are we ready to overcome barriers?

Heart allotransplantation has become one of the methods of choice in the treatment of severe heart failure. In the face of its difficulties, such as the unmet balance between organ supply and demand, the use of xenotransplantation (XTx) might be an attractive option shortly, even more with the ongoing progress achieved regarding the avoidance of hyperacute rejection and primary organ disfunction, maintenance of xenograft function and control of xenograft growth. To make possible this translational challenge, some points must be taken into account indeed, and they are the equipoise of human benefit and animal suffering, the risk of unknown infections, a well prepared informed consent, ethical and religious beliefs, and the role of cardiac XTx in a ventricular assistance device era.

Las tecnologías e-learning y TIC en el aprendizaje a largo plazo de la anatomía humana en estudiantes del área de la salud: una revisión de la literatura / E-learning and TIC technologies in long-term learning of human anatomy of health students: a review of the literature

RESUMEN: Los propósitos de esta revisión literaria fueron, identificar estudios que explorarenlas tecnologías e-learning y TIC y su impacto en el aprendizaje a largo plazo, y evaluar la calidad de los estudios en esta aérea. Se realizaron búsquedas en las bases de datos PubMed (Medline), Ovid (cochrane Central), Ovid (Medline), Ovid (Global Health), Scopus, Web of Science (clarivate) y Science Direct, incluyendo las palabras clave: Education Distance, eLearning, Learning, Learning Curve, Long Term Memory, active learning, Repetion Anatomy, Anatomy Cross-Sectional, Anatomy Regional, Students Health Occupations y Medical education. Tres evaluadores de forma independiente evaluaron la calidad de las investigaciones utilizando el instrumento de Calidad del Estudio de Investigación de Educación Médica (MERSQI). El total de resultados inicialmente fueron 557 artículos de investigación, al aplicar los criterios de inclusión y exclusión por los evaluadores se identificaron un total de 25 artículos. Posterior a la revisión de los artículos se incluyeron 2 investigaciones que cumplieron con los criterios de síntesis en esteestudio. En conclusión, la incorporación de las tecnologías e - learning y TIC permitió evaluar el aprendizaje a largo plazo, aporto motivación y aumento en las habilidades del conocimiento, además de ser una herramienta para el proceso de Enseñanza - aprendizaje -evaluación, sin embargo, se necesitan investigaciones que evalúen cuidadosamente el impacto de los factores preponderantes del aprendizaje largo plazo, mientras se utilizan las tecnologías e-learning y TIC.

SUMMARY: The objective of this review was to identify studies that explore e-learning and ICT technologies and their impact on long-term learning, and to evaluate the quality of studies in this area. Searches were carried out in databases PubMed (Medline), Ovid (Cochrane Central), Ovid (Medline), Ovid (Global Health), Scopus, Web of Science (clarivate) and Science Direct, including keywords: Education Distance, e-Learning, Learning , Learning Curve, Long Term Memory, Active Learning, Repetition Anatomy, Anatomy Cross-Sectional, Anatomy Regional, Students Health Occupations and Medical education. Three evaluators independently assessed the quality of the studies using the Medical Education Research Study Quality (MERSQI) instrument. The to- tal results were initially 557 research articles, and after applying inclusion and exclusion criteria, a total of 25 articles were identified. Following a review of the articles, 2 studies were included that met the synthesis criteria in this study. In conclusion, integrating e-learning and ICT technologies facilitate the evaluation of long- term learning, provide motivation and increase knowledge skills, in addition to being a tool for the Teaching-learning-evaluation process. However, further research is needed to evaluate the impact of the preponderant factors of long-term learning, while using e- learning and ICT technologies.