Tumor-derived hypoxic small extracellular vesicles promote endothelial cell migration and tube formation via ALS2/Rab5/ß-catenin signaling.

Tumor hypoxia has been associated with cancer progression, angiogenesis, and metastasis via modifications in the release and cargo composition of extracellular vesicles secreted by tumor cells. Indeed, hypoxic extracellular vesicles are known to trigger a variety of angiogenic responses via different mechanisms. We recently showed that hypoxia promotes endosomal signaling in tumor cells via HIF-1α-dependent induction of the guanine exchange factor ALS2, which activates Rab5, leading to downstream events involved in cell migration and invasion. Since Rab5-dependent signaling is required for endothelial cell migration and angiogenesis, we explored the possibility that hypoxia promotes the release of small extracellular vesicles containing ALS2, which in turn activate Rab5 in recipient endothelial cells leading to pro-angiogenic properties. In doing so, we found that hypoxia promoted ALS2 expression and incorporation as cargo within small extracellular vesicles, leading to subsequent transfer to recipient endothelial cells and promoting cell migration, tube formation, and downstream Rab5 activation. Consequently, ALS2-containing small extracellular vesicles increased early endosome size and number in recipient endothelial cells, which was followed by subsequent sequestration of components of the ß-catenin destruction complex within endosomal compartments, leading to stabilization and nuclear localization of ß-catenin. These events converged in the expression of ß-catenin target genes involved in angiogenesis. Knockdown of ALS2 in donor tumor cells precluded its incorporation into small extracellular vesicles, preventing Rab5-downstream events and endothelial cell responses, which depended on Rab5 activity and guanine exchange factor activity of ALS2. These findings indicate that vesicular ALS2, secreted in hypoxia, promotes endothelial cell events leading to angiogenesis. Finally, these events might explain how tumor angiogenesis proceeds in hypoxic conditions.

Trauma resulting in rare avulsion-type renal injury and lobe migration: An uncommon case report.

In this case report, we discuss a rare incident of avulsion-type renal injury in a 24-year-old male with no significant medical history. The injury occurred during a traffic accident, where he was involved in a direct impact collision between a motorcycle and a vehicle, leading to altered corticomedullary differentiation in the right kidney, a retroperitoneal hematoma, and free fluid in the cavity. The patient underwent successful emergency abdominal surgery, which involved the removal of the damaged kidney due to the severity of the injury. During his postoperative recovery in the ICU, he received extensive care, including sedation, mechanical ventilation, and vasopressor support. Ultimately, he made a successful recovery and was discharged after rehabilitation. This case highlights the complexities involved in managing patients with renal injuries resulting from high-energy impact accidents. It emphasizes the importance of a multidisciplinary approach in treatment, the challenges associated with deciding on surgical intervention, and the significance of rehabilitation in patient recovery. The uniqueness of this case, characterized by its distinct mechanism of injury and the severity of the trauma, contributes to our broader understanding of renal trauma management in the field of trauma medicine. It underscores the need for personalized patient care strategies and emphasizes the effectiveness of surgical interventions in severe cases of renal trauma.

Gene Expression and Prognostic Value of NADPH Oxidase Enzymes in Breast Cancer.

NADPH oxidase enzymes (NOX) are involved in all stages of carcinogenesis, but their expression levels and prognostic value in breast cancer (BC) remain unclear. Thus, we aimed to assess the expression and prognostic value of NOX enzymes in BC samples using online databases. For this, mRNA expression from 290 normal breast tissue samples and 1904 BC samples obtained from studies on cBioPortal, Kaplan-Meier Plotter, and The Human Protein Atlas were analyzed. We found higher levels of NOX2, NOX4, and Dual oxidase 1 (DUOX1) in normal breast tissue. NOX1, NOX2, and NOX4 exhibited higher expression in BC, except for the basal subtype, where NOX4 expression was lower. DUOX1 mRNA levels were lower in all BC subtypes. NOX2, NOX4, and NOX5 mRNA levels increased with tumor progression stages, while NOX1 and DUOX1 expression decreased in more advanced stages. Moreover, patients with low expression of NOX1, NOX4, and DUOX1 had lower survival rates than those with high expression of these enzymes. In conclusion, our data suggest an overexpression of NOX enzymes in breast cancer, with certain isoforms showing a positive correlation with tumor progression.

Lung cancer screening in Brazil: recommendations from the Brazilian Society of Thoracic Surgery, Brazilian Thoracic Association, and Brazilian College of Radiology and Diagnostic Imaging.

Although lung cancer (LC) is one of the most common and lethal tumors, only 15% of patients are diagnosed at an early stage. Smoking is still responsible for more than 85% of cases. Lung cancer screening (LCS) with low-dose CT (LDCT) reduces LC-related mortality by 20%, and that reduction reaches 38% when LCS by LDCT is combined with smoking cessation. In the last decade, a number of countries have adopted population-based LCS as a public health recommendation. Albeit still incipient, discussion on this topic in Brazil is becoming increasingly broad and necessary. With the aim of increasing knowledge and stimulating debate on LCS, the Brazilian Society of Thoracic Surgery, the Brazilian Thoracic Association, and the Brazilian College of Radiology and Diagnostic Imaging convened a panel of experts to prepare recommendations for LCS in Brazil. The recommendations presented here were based on a narrative review of the literature, with an emphasis on large population-based studies, systematic reviews, and the recommendations of international guidelines, and were developed after extensive discussion by the panel of experts. The following topics were reviewed: reasons for screening; general considerations about smoking; epidemiology of LC; eligibility criteria; incidental findings; granulomatous lesions; probabilistic models; minimum requirements for LDCT; volumetric acquisition; risks of screening; minimum structure and role of the multidisciplinary team; practice according to the Lung CT Screening Reporting and Data System; costs versus benefits of screening; and future perspectives for LCS.

Liposarcomas paratesticulares simultáneos con diferencias histopatológicas. Reporte de un caso

El liposarcoma es un tumor de origen mesenquimal que se presenta comúnmente en el retroperitoneo; es de crecimiento lento y su capacidad de producir metástasis depende de su tipo histológico. Este trabajo tiene como propósito presentar un caso de liposarcomas paratesticulares simultáneos con diferentes tipos histológicos, en un paciente masculino, de 80 años con antecedentes de salud y nivel socioeconómico bajo que venía presentando desde hacía dos años aumento de volumen en la región inguinal izquierda y testículo ipsilateral, al inicio fue indoloro; luego, a medida que aumentó de tamaño se tornó doloroso, abarcando la región inguinoescrotal derecha en su totalidad. El examen físico, incluido el signo de la transiluminación fue negativo. El estudio analítico mostró solamente velocidad de sedimentación globular en 95 mm/h y la LDH en 650 U/l; la ecografía testicular mostró una masa heterogénea, solida e hiperecoica, de aspecto graso inguinoescrotal y de más de 30 cm, sin llegarse a observar el testículo. Se realizó exéresis tumoral encontrándose tres tumores liposarcomatosos, dos de ellos con características histopatológicas similares y el otro con patrón histológico diferente. Luego del tratamiento quirúrgico el paciente se recuperó satisfactoriamente y no ha presentado recidiva según los controles periódicos realizados. Se consideró la publicación del caso pues los liposarcomas pueden llegar a confundirse a la exploración clínica con la presencia de una hernia inguinal de contenido graso con sintomatología similar a estas; por lo que debe hacerse una exploración clínica exhaustiva para realizar un correcto diagnóstico. El estudio histopatológico confirmó el diagnóstico de la enfermedad que, además, reveló la presencia de tres tumores liposarcomatosos y dos variantes histopatológicas del mismo, de lo cual no se encontraron reportes en la literatura revisada.

Liposarcoma is a mesenchymal origin tumor that commonly occurs in the retroperitoneum; It is slow growing and its ability to produce metastasis depends on its histological type. The purpose of this work is to present a case of simultaneous paratesticular liposarcomas with different histological types, in an 80-years-old male patient with a health history and low socioeconomic level; For two years he had been experiencing an increase in volume in the left inguinal region and ipsilateral testicle, which at first was painless; Then, as it increased in size, it became painful, covering the entire right inguinoscrotal region. Physical examination, including transillumination sign, was negative. The analytical study only showed erythrocyte sedimentation rate at 95 mm/h and LDH at 650 U/l; The testicular ultrasound showed heterogeneous, solid and hyperechoic mass, with a fatty inguinoscrotal appearance and measuring more tan 30 cm, without the testicle being observed. Tumor excision was performed and three liposarcomatous tumors were found, two of them with similar histopathological characteristics and the other with a different histological pattern. After the surgical treatment, the patient recovered satisfactorily and has not had a recurrence according to the periodic controls carried out. The publication of the case was considered because liposarcomas can be confused on clinical examination with the presence of an inguinal hernia with fatty content with symptoms similar to these; Therefore, a thorough clinical examination must be performed to make a correct diagnosis. The histopathological study confirmed the diagnosis of the disease; which, in addition, revealed the presence of three liposarcomatous tumors and two histopathological variants of the same, from which no reports were found in the reviewed literature.

Lung cancer screening in Brazil: recommendations from the Brazilian Society of Thoracic Surgery, Brazilian Thoracic Association, and Brazilian College of Radiology and Diagnostic Imaging / Recomendações da Sociedade Brasileira de Cirurgia Torácica, Sociedade Brasileira de Pneumologia e Tisiologia e Colégio Brasileiro de Radiologia e Diagnóstico por Imagem para o rastreamento do câncer de pulmão no Brasil

ABSTRACT Although lung cancer (LC) is one of the most common and lethal tumors, only 15% of patients are diagnosed at an early stage. Smoking is still responsible for more than 85% of cases. Lung cancer screening (LCS) with low-dose CT (LDCT) reduces LC-related mortality by 20%, and that reduction reaches 38% when LCS by LDCT is combined with smoking cessation. In the last decade, a number of countries have adopted population-based LCS as a public health recommendation. Albeit still incipient, discussion on this topic in Brazil is becoming increasingly broad and necessary. With the aim of increasing knowledge and stimulating debate on LCS, the Brazilian Society of Thoracic Surgery, the Brazilian Thoracic Association, and the Brazilian College of Radiology and Diagnostic Imaging convened a panel of experts to prepare recommendations for LCS in Brazil. The recommendations presented here were based on a narrative review of the literature, with an emphasis on large population-based studies, systematic reviews, and the recommendations of international guidelines, and were developed after extensive discussion by the panel of experts. The following topics were reviewed: reasons for screening; general considerations about smoking; epidemiology of LC; eligibility criteria; incidental findings; granulomatous lesions; probabilistic models; minimum requirements for LDCT; volumetric acquisition; risks of screening; minimum structure and role of the multidisciplinary team; practice according to the Lung CT Screening Reporting and Data System; costs versus benefits of screening; and future perspectives for LCS.

RESUMO O câncer de pulmão (CP) é uma das neoplasias mais comuns e letais no Brasil, e apenas 15% dos pacientes são diagnosticados nos estágios iniciais. O tabagismo persiste como o responsável por mais de 85% de todos os casos. O rastreamento do CP (RCP) por meio da TC de baixa dosagem de radiação (TCBD) reduz a mortalidade do CP em 20%, e, quando combinado com a cessação do tabagismo, essa redução chega a 38%. Na última década, diversos países adotaram o RCP como recomendação de saúde populacional. No Brasil, embora ainda incipiente, a discussão sobre o tema é cada vez mais ampla e necessária. Com o intuito de aumentar o conhecimento e estimular o debate sobre o RCP, a Sociedade Brasileira de Cirurgia Torácica, a Sociedade Brasileira de Pneumologia e Tisiologia e o Colégio Brasileiro de Radiologia e Diagnóstico por Imagem constituíram um painel de especialistas para elaborar as recomendações para o RCP. As recomendações aqui apresentadas foram baseadas em revisão narrativa da literatura, com ênfase em grandes estudos populacionais, em revisões sistemáticas e em recomendações de diretrizes internacionais, sendo construídas após ampla discussão pelo grupo de especialistas. Os temas revisados foram os seguintes: porque rastrear, considerações gerais sobre tabagismo, epidemiologia do CP, critérios de elegibilidade, achados incidentais, lesões granulomatosas, modelos probabilísticos, requisitos mínimos da TCBD, aquisições volumétricas, riscos do rastreamento, estrutura mínima e papel da equipe multidisciplinar, conduta segundo o Lung CT Screening Reporting and Data System (Lung-RADS), custos vs. benefícios e perspectivas do rastreamento.

Ghrelin misbalance affects mice embryo implantation and pregnancy success by uterine immune dysregulation and nitrosative stress.

Introduction: In a previous study we found that ghrelin (Ghrl) misbalance during the peri-implantation period significantly impaired fetus development. In this study we aimed to evaluate the putative mechanisms underlying these effects, including embryo implantation success, uterine nitric oxide synthase (NOS) activity, nitric oxide synthesis and the inflammatory/immune uterine profile. Methods: Ghrelin misbalance was induced by injecting 4nmol/animal/day of Ghrl (hyperghrelinemia) or 6nmol/animal/day of a Ghrl antagonist (Ant: (D-Lys3)GHRP-6) from day 3 to 8 of pregnancy. Control animals (C) were injected with de vehicle. Females were euthanized at pregnancy day 8 and their uteri excised in order to evaluate: the percentage of reabsorbed embryos (microscopically), eNOS, iNOS and nytrotirosine expression (by immunohistochemistry), nitrite synthesis (by Griess technique), VEGF, IL-10, IL-17, IL-6, MMP9 and GM-CSF expression (by qPCR) and leukocyte infiltration by flow cytometry (evaluating T cells, NK cells, granulocytes, dendritic cells and macrophages). Results: Ant-treatment significantly increased the percentage of reabsorbed embryos and the uterine expression of eNOS, iNOS and nytrotirosine. (D-Lys3)GHRP-6-treatment increased also the expression of the inflammatory cytokines IL-6, IL-17 and MMP9, and decreased that of IL-10 (anti-inflammatory). Moreover, Ant-treatment increased also the NK cells population and that of CD11b+ dendritic cells; and decreased T cells percentages. Similarly, hyperghrelinemia showed a significant increase vs. C on eNOS, iNOS and nytrotirosineuterine expression and a decrease in T cells percentages. Conclusion: Ghrl misbalance during the peri-implantation period induces pro-inflammatory changes and nitrosative stress in the gravid uterus, impairing significantly embryo implantation and/or development.

Corrected sinus node recovery time as a screening test in patients with typical atrial flutter post-ablation to predict pacemaker implantation / Tiempo de recuperación del nodo sinusal corregido como prueba de tamizaje en pacientes con aleteo atrial típico postablación para predecir la implantación de marcapasos

Abstract Objective: The objective of the study was to establish the prognostic value of CSNRT regarding the necessity for pacemaker implantation in patients with atrial flutter (AFL) post-ablation. Methods: This prospective cohort study, conducted at the National Institute of Cardiology "Ignacio Chavez" in Mexico City, assessed patients who had undergone ablation procedures to correct AFL, posterior to which an autonomic blockade was performed, and CSNRT was measured. Results: The sample for this investigation was 40 patients. These were subdivided into two study groups depending on their requirement of pacemaker implant post-ablation (Pacemaker P, No Pacemaker NP). Sinus node (SN) dysfunction was diagnosed in 13 (32.5%) of the 40 participants, 10 (71.43%) of which required a pacemaker implant, while only 4 participants (28.57%) with normal SN function required pacemakers. Ten out of the 14 patients (71.43%) who required a pacemaker had an elevated CSNRT > 500 ms (p ≤ 0.01). Post-ablation CSNRT mean was 383.54 ms ± 67.96 ms in the NP group versus 1972.57 ms ± 3423.56 ms in the P group. Furthermore, SN pause in the P group had a mean of 1.86 s ± 0.96 s versus the NP group with 1.196 s ± 0.52 s. Conclusion: CSNRT has the potential to be a quantitative prognostic tool for the assessment of future pacemaker implants in patients with AFL post-ablation. This could aid in the timely diagnosis of sinus node dysfunction, which could, in the long run, result in the reduction of cardiac functional capacity loss due to cardiac remodeling.

Resumen Objetivo: Establecer el valor pronóstico del TRNSC basado en la necesidad de marcapasos en pacientes diagnosticados con aleteo atrial, pos-ablación. Métodos: Este cohorte prospectivo, realizado en el Instituto Nacional de Cardiología "Ignacio Chávez" en la Ciudad de México, evaluó pacientes sometidos a ablación para corregir el aleteo atrial; se midió el TRNSC post bloqueo autonómico. Resultados: La muestra de 40 pacientes se subdividió en 2 grupos según su requerimiento de marcapasos posterior a la ablación (P y NP). Se diagnosticó disfunción del nodo sinusal en 13 participantes (32.5%), de los cuales 10 (71.43%) requirieron marcapasos en comparación a 4 (28.57%) con función normal. En el grupo P la pausa del nodo sinusal post-ablación tuvo una media de 1.86 ± 0.96 s versus el grupo NP con 1.196 ± 0.52 s. En relación con el TRNSC, el grupo NP tuvo una media de 383.54 ± 67.96 ms vs. 1972.57 ± 3423.56 ms en el grupo P. 10 pacientes (25%) obtuvieron un TRNSC > 500 ms, de los cuales 100% requirieron marcapasos; de los 14 pacientes que requirieron marcapasos 10 (71.43%) tenían un TRNSC elevado (p ≤ 0.01). Conclusiones: El TRNSC tiene el potencial de ser una herramienta de pronóstico cuantitativo para la necesidad de futuros implantes de marcapasos en pacientes con disfunción del nodo sinusal, resultado de aleteo atrial pos-ablación. Esto podría ayudar a diagnosticar más temprano una disfunción del nodo sinusal, resultando en la reducción de la pérdida a largo plazo de la función cardíaca como efecto de la remodelación.

Is Shoulder Imbalance a Useful Parameter in the Screening of Idiopathic Scoliosis? A Preliminary Study / O desequilíbrio do ombro é um parâmetro útil na triagem da escoliose idiopática? Um estudo preliminar

Abstract Objective The present study aims to analyze the use of shoulder imbalance as a parameter for scoliosis screening as well as its relationship with other parameters of physical examination. Methods This study assesses a smartphone application that analyzes several parameters of the physical examination in adolescent idiopathic scoliosis. Medical and non-medical examiners applied the screening tool in students in a public school and in a private sports club. After data collection, interobserver correlation was done to verify shoulder imbalance and to compare shoulder imbalance with Adam's bending test and with trunk rotation. Results Eighty-nine participants were examined, 18 of whom were women and 71 of whom were men. Two subjects were excluded from the analysis. The mean age of subjects from the public school was 11.30 years and, for those from the sports club, it was 11.92 years. The examiners had poor-to-slight interobserver concordance on shoulder asymmetry in the anterior and posterior view. No significant statistical correlation was found between shoulder asymmetry and positive Adam's forward bending test. Conclusion Our preliminary study shows that the shoulder asymmetry has a poor correlation with the Adam's forward bending test and measuring trunk rotation using a scoliometer. Therefore, the use of shoulder imbalance might not be useful for idiopathic scoliosis screening. Level of Evidence III; Diagnostic Study

Resumo Objetivo O objetivo deste estudo é analisar o uso da assimetria de ombros como parâmetro para a triagem de escoliose e sua relação a outros parâmetros do exame físico. Métodos Este estudo avalia um aplicativo para smartphone que analisa diversos parâmetros do exame físico de adolescentes com escoliose idiopática. Examinadores médicos e não médicos utilizaram o instrumento de triagem em alunos de uma escola pública e de um clube esportivo privado. Após a coleta de dados, a correlação interobservador foi determinada para verificar a assimetria de ombros e compará-la ao teste de inclinação de Adam e à medição da rotação do tronco. Resultados Oitenta e nove participantes foram examinados, sendo 18 do sexo feminino e 71 do sexo masculino. Dois indivíduos foram excluídos da análise. A média de idade dos participantes da escola pública foi de 11,30 anos e do clube esportivo, 11,92 anos. Os examinadores apresentaram concordância interobservador baixa a branda quanto à assimetria de ombros em incidência anterior e posterior. Não houve correlação estatística significativa entre a assimetria de ombros e o resultado positivo no teste de inclinação do tronco de Adam. Conclusão Nosso estudo preliminar mostra que a assimetria de ombros tem baixa correlação com o teste de inclinação de Adam e assim como com a medição de rotação do tronco com escoliômetro. Portanto, o uso da assimetria de ombros pode não ser útil na triagem da escoliose idiopática. Nível de Evidência III; Estudo Diagnóstico

Highly Active Nickel (II) Oxide-Supported Cerium Oxide Catalysts for Valorization of Glycerol into Oxygenated Fuel Additives.

Acetylation of glycerol to yield monoacetin (MAT), diacetin (DAT), and triacetin (TAT) over NiO-supported CeO2 (xNiO/CeO2) catalysts is reported. The catalysts were synthesized utilizing a sol-gel technique, whereby different quantities of NiO (x = 9, 27, and 45 wt%) were supported onto the CeO2 substrate, and hexadecyltrimethylammonium bromide (CTABr) served as a porogen. The utilization of EDX elemental mapping analysis confirmed the existence of evenly distributed Ni2+ ion and octahedral NiO nanoparticles on the CeO2 surface through the DRS UV-Vis spectroscopy. The most active catalyst is 27NiO/CeO2 based on TAT selectivity in the glycerol acetylation with ethanoic acid, attaining 97.6% glycerol conversion with 70.5% selectivity to TAT at 170 °C with a 1:10 glycerol/ethanoic acid molar ratio for 30 min using a non-microwave instant heating reactor. The 27NiO/CeO2 is reusable without significant decline in catalytic performance after ten consecutive reaction cycles, indicating high structure stability with accessible active acidity.

Detecting salivary host and microbiome RNA signature for aiding diagnosis of oral and throat cancer.

OBJECTIVE: Oral squamous cell carcinoma (OSCC) and oropharyngeal squamous cell carcinoma (OPSCC) can go undetected resulting in late detection and poor outcomes. We describe the development and validation of CancerDetect for Oral & Throat cancer™ (CDOT), to detect markers of OSCC and/or OPSCC within a high-risk population. MATERIAL AND METHODS: We collected saliva samples from 1,175 individuals who were 50 years or older, or adults with a tobacco use history. 945 of those were used to train a classifier using machine learning methods, resulting in a salivary microbial and human metatranscriptomic signature. The classifier was then independently validated on the 230 remaining samples prospectively collected and unseen by the classifier, consisting of 20 OSCC (all stages), 76 OPSCC (all stages), and 134 negatives (including 14 pre-malignant). RESULTS: On the validation cohort, the specificity of the CDOT test was 94 %, sensitivity was 90 % for participants with OSCC, and 84.2 % for participants with OPSCC. Similar classification results were observed among people in early stage (stages I & II) vs late stage (stages III & IV). CONCLUSIONS: CDOT is a non-invasive test that can be easily administered in dentist offices, primary care centres and specialised cancer clinics for early detection of OPSCC and OSCC. This test, having received FDA's breakthrough designation for accelerated review, has the potential to enable early diagnosis, saving lives and significantly reducing healthcare expenditure.

Diseño e implementación de la biblioteca virtual de la Facultad de Ciencias Médicas de Bayamo

Las páginas web constituyen un medio facilitador del conocimiento. El trabajo se realizó con el objetivo de diseñar e implementar una biblioteca virtual para favorecer el proceso de gestión de la información del Departamento de Información Científica-Técnica y Biblioteca de la Facultad de Ciencias Médicas de Bayamo. Para el desarrollo del contenido del sitio se emplearon: observación, encuestas y entrevistas. Para desarrollar el producto se llevaron a cabo cinco procesos: planificación inicial del sitio, definición, diseño y estándares, puesta en marcha y plan de mantenimiento. Para la confección de la página se empleó el gestor de contenidos WordPress, así como PHP, MySQL, Apache, XAMPP y Windows como lenguaje de programación, motor de bases de datos, servidor Web, paquete de software libre y sistema operativo respectivamente. Se concluye que la implementación de la biblioteca virtual, facilita el proceso de gestión de la información, despierta el interés por la investigación y contribuye a la alfabetización informacional de los usuarios de salud que ingresen a la web. Facilitará la visibilidad, la gestión técnica bibliotecaria; la divulgación, difusión, y uso de los servicios y recursos de información disponibles.

Web pages constitute a means of facilitating knowledge. The work was carried out with the objective of designing and implementing a virtual library to favor the information management process of the Department of Scientific and Technical Information and the Library of the Faculty of Medical Sciences of Bayamo. Observation, surveys and interviews were used in the development of the content of the site. Five processes were carried out to develop the product: initial planning of the site, definition, design and standards, commissioning, and maintenance plan. To create the page, the content manager WordPress was used; PHP, MySQL, Apache, XAMPP and Windows were used as the programming language, database engine, Web server, free software package and operating system, respectively. It is concluded that the implementation of the virtual library facilitates the information management process, awakens the interest in research, and contributes to the information literacy of health users who enter the web. It will facilitate visibility, library technical management, disclosure, dissemination, and use of available information services and resources.

Validation of qrs-polarity algorithm with special emphasis in parahisian pathways / Validación del algoritmo de la polaridad del qrs con especial énfasis en vías parahisianas

Abstract Background: In 1996 Iturralde et al. published an algorithm based on the QRS polarity to determine the location of the accessory pathways (AP), this algorithm was developed before the massive practice of invasive electrophysiology. Purpose: To validate the QRS-Polarity algorithm in a modern cohort of subjects submitted to radiofrequency catheter ablation (RFCA). Our objective was to determinate its global accuracy and its accuracy for parahisian AP. Methods: We conducted a retrospective analysis of patients with Wolff-Parkinson-White (WPW) syndrome who underwent an electrophysiological study (EPS) and RFCA. We employed the QRS-Polarity algorithm to predict the AP anatomical location and we compared this result with the real anatomic location determined in the EPS. To determine accuracy, the Cohen's kappa coefficient (k) and the Pearson correlation coefficient were used. Results: A total of 364 patients were included (mean age 30 years, 57% male). The global k score was 0.78 and the Pearson's coefficient was 0.90. The accuracy for each zone was also evaluated, the best correlation was for the left lateral AP (k of 0.97). There were 26 patients with a parahisian AP, who showed a great variability in the ECG features. Employing the QRS-Polarity algorithm, 34.6% patients had a correct anatomical location, 42.3% had an adjacent location and only 23% an incorrect location. Conclusion: The QRS-Polarity algorithm has a good global accuracy; its precision is high, especially for left lateral AP. This algorithm is also useful for the parahisian AP.

Resumen Antecedentes: En 1996 Iturralde y colaboradores publicaron un algoritmo basado en la polaridad del QRS para determinar la ubicación de las vías accesorias (VA), este algoritmo fue desarrollado antes de la práctica masiva de la electrofisiología invasiva. Objetivo: Validar el algoritmo de la polaridad del QRS en una cohorte moderna de sujetos sometidos a ablación con catéter por radiofrecuencia (ACRF). Nuestro objetivo fue determinar su precisión global y su precisión para las VA parahisianas. Métodos: Realizamos un análisis retrospectivo de pacientes con síndrome de Wolff-Parkinson-White (WPW) a los que se les realizó estudio electrofisiológico (EEF) y ACRF. Empleamos el algoritmo de la polaridad del QRS para predecir la ubicación anatómica de la VA y comparamos este resultado con la ubicación anatómica real determinada en el EEF. Para determinar la precisión se utilizaron el coeficiente kappa de Cohen (k) y el coeficiente de correlación de Pearson. Resultados: Se incluyeron un total de 364 pacientes (edad media 30 años, 57 % varones). La puntuación k global fue de 0,78 y el coeficiente de Pearson de 0,90. También se evaluó la precisión para cada zona, la mejor correlación fue para las VA laterales izquierdas (k de 0.97). Hubo 26 pacientes con VA parahisianas, que mostraron una gran variabilidad en las características del ECG. Empleando el algoritmo de la polaridad del QRS, el 34,6 % de los pacientes tenía una ubicación anatómica correcta, el 42,3 % tenía una ubicación adyacente y solo el 23 % una ubicación incorrecta. Conclusión: El algoritmo de la polaridad del QRS tiene una buena precisión global; su precisión es alta, especialmente para VA lateral izquierdo. Este algoritmo también es útil para la VA parahisiana.

Neurological recovery after surgical treatment in patients with thoracolumbar trm / Recuperação neurológica após tratamento cirúrgico em pacientes com trm toracolombar / Recuperación neurológica después de del tratamiento quirúrgico en pacientes con lme toracolumbar

ABSTRACT Objective: Evaluate the neurological recovery with a follow-up of 06 (six) months in victims of thoracic and lumbar fractures who underwent spinal decompression in less than 24 hours, between 24 and 48 hours, and more than 48 hours after the trauma. Methods: Data were collected on patients seen at a large public hospital in Belo Horizonte, between 2014 and 2018, who were victims of SCI who presented with neurological deficits at initial care, and the neurological recovery presented. Results: 41 SCI patients were evaluated, whose mean age was 34 years. There was a predominance of thoracic spine fractures (65.9% of the cases) and classified as AO Spine type C (75%). Regarding the time variable, about 68% of the patients were submitted to surgical treatment more than 48 hours after the trauma. It was observed that both the patients submitted to surgical decompression within less than 24 hours, and those operated on more than 48 hours after the trauma showed a slight neurological improvement at the 6-month follow-up. However, no statistical significance was found. It is worth noting that even when analyzing the 41 patients of the study, regardless of the surgical interval, it was impossible to observe a statistically significant neurological improvement at the 6-month follow-up. Conclusion: Our study could not demonstrate significant differences between those patients who operated early in less than 24 hours and those who operated after more than 48 hours. Level of Evidence III; Comparative retrospective study.

Resumo: Objetivo: Avaliar a recuperação neurológica com um acompanhamento de 06 (seis) meses em vítimas de fraturas torácicas e lombares submetidos a descompressão medular em menos de 24 horas, entre 24 e 48 horas e em mais de 48 horas do trauma. Métodos: Foram coletados dados relativos a pacientes atendidos em hospital público de grande porte de Belo Horizonte, no período de 2014 e 2018, vítimas de TRM que apresentavam déficits neurológicos no atendimento inicial, e a recuperação neurológica apresentada. Resultados: Foram avaliados 41 pacientes vítimas de TRM, cuja idade média foi de 34 anos. Observou-se predomínio de fraturas na coluna torácica (65.9% dos casos) e classificadas como AO Spine tipo C (75%). Em relação a variável tempo cerca de 68% dos pacientes foram submetidos a tratamento cirúrgico com mais de 48h decorridas do trauma. Observou-se que tanto nos pacientes submetidos a descompressão cirúrgica com menos de 24h quanto nos operados com mais de 48h após o trauma houve discreta melhora neurológica no follow-up de 6 meses. Não foi constatada, todavia, significância estatística. Cabe destacar ainda que mesmo analisando o conjunto dos 41 pacientes do estudo, independente do intervalo cirúrgico, não foi possível constatar melhora neurológica com significância estatística na reavaliação de 6 meses. Conclusão: Nosso trabalho não conseguiu demonstrar diferenças significativas entre aqueles pacientes operados precocemente em menos de 24 horas daqueles operados em mais de 48 horas. Nível de evidência III; Estudo retrospectivo comparativo.

Resumen: Objetivo: Evaluar la recuperación neurológica con un acompañamiento de 06 meses en víctimas de fracturas torácicas y lumbares sometidos a la descompresión medular en menos de 24 horas, entre 24 y 48 horas y en más de 48 horas del trauma. Métodos: Se recogieron datos de pacientes atendidos en un gran hospital público de Belo Horizonte, en el período de 2014 y 2018, víctimas de TRM que presentaban déficits neurológicos en el atendimiento inicial y la recuperación neurológica presentada. Resultados: Fueron evaluados 41 pacientes víctimas de TRM, cuya edad media fue de 34 años. Se ha observado una preponderancia de fracturas en la columna torácica (65.9% de los casos) y clasificadas como AO Spine tipo C (75%). En relación a la variable tiempo, un 68% de los pacientes fueron sometidos al tratamiento quirúrgico con más de 48h transcurridas del trauma. Se ha observado que tanto en los pacientes sometidos a la descompresión quirúrgica con menos de 24 horas cuanto en los operados con más de 48h tras el trauma hubo discreta mejora neurológica en "follow-up" de 6 meses. No fue averiguada, sin embargo, significancia estadística. Conviene resaltar todavía que, aunque analizando el conjunto de los 41 pacientes de estudio, independiente del intervalo quirúrgico, no fue posible observar mejora neurológica con significancia estadística en la revaluación de 6 meses. Conclusión: Nuestro trabajo no consiguió demostrar diferencias significativas entre aquellos pacientes operados tempranamente en menos de 24 horas de aquellos operados en más de 48 horas. Nivel de Evidencia III; Estudio retrospectivo comparativo.

Mesenquimoma pélvico maligno. Informe de caso

Se presentó un enfermo de 73 años en el Hospital Clínico Quirúrgico Docente "Amalia Simoni" de la ciudad de Camagüey, Cuba, que fue intervenido quirúrgicamente hace cinco años y cuyo resultado fue desconocido. En aquel entonces presentó dolor y limitación funcional del miembro inferior derecho, lo que motivó la resección de un tumor en el fémur ipsilateral; cinco años después recidiva, esta vez con invasión de la pelvis ósea y del recto, evidenciándose trastornos miccionales y constipación. La radiografía de pelvis ósea, tomografía computarizada y resonancia magnética de dicha región evidenciaron una imagen tumoral mixta con lesiones líticas que invadió y desplazó los órganos de la cavidad pélvica. El paciente fue sometido a exéresis del tumor, el cual fue de 173×156 mm, con un peso de aproximadamente 1 380 g. El análisis histopatológico de la pieza quirúrgica evidenció un mesenquimoma pélvico maligno.

It was reported a case of a 73 years old patient with a history of an unknown outcomes surgical procedure 5 years ago at the Hospital Clínico Quirúrgico Docente "Amalia Simoni" in Camaguey, Cuba. He presented pain and functional limitation of the right lower limb, which led to the resection of a tumor in the ipsilateral femur; five years later the tumor present signs of recurrence, this time with invasion of the bony pelvis and rectum and resulting in urinary disorders and constipation. Pelvis bone radiology, computed tomography scan and magnetic resonance imaging of the pelvis showed a mixed tumor with lytic lesions that invaded and displaced the organs in the pelvic cavity. The patient underwent excision of the tumor, which was 173×156 mm, weighing approximately 1.380 g. Histopathological analysis of the surgical resection specimen revealed a pelvic malignant mesenchymoma.

Apresentou-se um paciente de 73 anos, operado há 5 anos no Hospital Provincial Amalia Simoni, na cidade de Camagüey, Cuba, cujo resultado era desconhecido. Na época, apresentava dor e limitação funcional do membro inferior direito, o que levou à ressecção de tumoração no fêmur ipsilateral; cinco anos depois, recidiva, desta vez com invasão de pelve óssea e reto, evidenciando distúrbios miccionais e constipação. A radiografia óssea da pelve, a tomografia computadorizada e a ressonância magnética da referida região revelaram uma imagem tumoral mista com lesões líticas que invadiam e deslocavam os órgãos da cavidade pélvica. A paciente foi submetida à exérese do tumor, que media 173×156 mm, com peso aproximado de 1380 g. A análise histopatológica da peça cirúrgica revelou um mesenquimoma pélvico maligno.

Entorno virtual Estadística Sanitaria como herramienta didáctica para fortalecer la educación a distancia en Enfermería

La sociedad del conocimiento ha provocado cambios en la forma de generar y trasmitir el conocimiento; es por esto que el papel de la universidad hoy es proporcionar aprendizajes en los estudiantes en correspondencia con el desarrollo económico, cultural y social de cada país. Po tal motivo se diseñó el entorno virtual Estadística Sanitaria como herramienta didáctica para fortalecer la educación a distancia en Enfermería. Se realizó una investigación de desarrollo entre septiembre de 2018 a junio de 2020 en la Facultad de Ciencias Médicas de Bayamo "Efraín Benítez Popa. Para desarrollar el entorno virtual de aprendizaje se utilizó la plataforma Moodle. Para el diseño y evaluación del software se utilizó una configuración de RUP (por sus siglas, Rational Unified Process), el método Delphi y el coeficiente de concordancia W de Kendall. Se implementó una herramienta que permite a los profesores gestionar cursos virtuales en línea de apoyo a la enseñanza presencial. Su diseño proporciona facilidad de uso y de gestión, permite la administración de perfiles de usuario, la gestión de actividades y recursos de los cursos creados, y la administración del sitio. El software desarrollado es una herramienta didáctica flexible orientada al usuario para la gestión de los contenidos básicos de Estadística Sanitaria y responde a las necesidades del modelo del proceso enseñanza aprendizaje de la de esta asignatura.

The knowledge society has caused changes in the way knowledge is generated and transmitted; That is why the role of the university today is to provide learning in students in correspondence with the economic, cultural and social development of each country. For this reason, the virtual environment Health Statistics was designed as a didactic tool to strengthen distance education in Nursing. A development research was carried out between September 2018 and June 2020 at the Faculty of Medical Sciences of Bayamo "Efraín Benítez Popa. To develop the virtual learning environment, the Moodle platform was used. For the design and evaluation of the software, a configuration of RUP (for its acronym, Rational Unified Process), the Delphi method and the Kendall coefficient of agreement W were used. A tool was implemented that allows teachers to manage online virtual courses to support face-to-face teaching. Its design provides ease of use and management, allows the administration of user profiles, the management of activities and resources of the created courses, and the administration of the site. The software developed is a flexible didactic tool oriented to the user for the management of the basic contents of Health Statistics and responds to the needs of the model of the teaching-learning process of this subject.

A sociedade do conhecimento tem provocado mudanças na forma como o conhecimento é gerado e transmitido; É por isso que o papel da universidade hoje é proporcionar aprendizagem nos alunos em correspondência com o desenvolvimento econômico, cultural e social de cada país. Por essa razão, o ambiente virtual Estatísticas de Saúde foi concebido como uma ferramenta didática para fortalecer a educação a distância em Enfermagem. Uma pesquisa de desenvolvimento foi realizada entre setembro de 2018 e junho de 2020 na Faculdade de Ciências Médicas de Bayamo "Efraín Benítez Popa. Para o desenvolvimento do ambiente virtual de aprendizagem, foi utilizada a plataforma Moodle. Para o projeto e avaliação do software, foram utilizadas uma configuração de RUP (para sua sigla, Rational Unified Process), o método Delphi e o coeficiente de concordância de Kendall W. Foi implementada uma ferramenta que permite aos professores gerir cursos virtuais online para apoiar o ensino presencial. Seu design proporciona facilidade de uso e gerenciamento, permite a administração de perfis de usuários, o gerenciamento de atividades e recursos dos cursos criados e a administração do site. O software desenvolvido é uma ferramenta didática flexível orientada ao usuário para a gestão dos conteúdos básicos de Estatística em Saúde e responde às necessidades do modelo do processo de ensino-aprendizagem desta disciplina.

Guía práctica para seleccionar una prueba estadística a aplicar en una investigación biomédica

Introducción: el análisis estadístico se divide en dos componentes: el análisis descriptivo y el análisis inferencial, las pruebas estadísticas, se fraccionan en paramétricas y no paramétricas. Sin embargo, la elección de una prueba estadística apropiada, representa un reto. Objetivo: proponer una herramienta, que sirva para seleccionar una prueba estadística a aquellos no expertos en bioestadística, para las investigaciones biomédicas. Métodos: se realizó un estudio tipo revisión bibliográfica narrativa. Se partió de una revisión de la literatura sobre las principales pruebas estadísticas que se utilizan en la actualidad, disponibles en la literatura de las bases de datosbibliográficas como Pubmed/Medline, SciELO, SCOPUS, Springer, Web of Science, EBSCOhost entre otras. Dicha herramienta fue validada por criterio de expertos. Resultados: se diseñó un esquema, el que puede utilizarse de dos maneras: la primera consiste seguir el esquema hasta descubrir cuál es la técnica estadística apropiada para sus datos y la segunda: siguiendo el esquema hacia atrás, determinar si la prueba fue una elección lógica para los datos analizados. Para usarla, debe identificar variables dependientes e independientes, después llegará a una medida de síntesis o a una estimación puntual útil para sus datos, que irá seguida de una clasificación general de las pruebas estadísticas. Conclusiones: la guía propuesta es un intento de aportar una guía útil para seleccionar una técnica estadística para el análisis de datos en las investigaciones biomédicas.

Introduction: statistical analysis is divided into two components: descriptive analysis and inferential analysis, statistical tests, are divided into parametric and nonparametric. Choosing an appropriate statistical test, however, is challenging. Objective: to propose a tool, which serves to select a statistical test to those not experts in biostatistics, for biomedical research. Methods: a narrative literature review study was conducted. It was based on a review of the literature on the main statistical tests currently used, available in the literature of bibliographic databases such as Pubmed/Medline, SciELO, SCOPUS, Springer, Web of Science, EBSCOhost among others. This tool was validated by expert criteria. Results: a scheme was designed, which can be used in two ways: the first is to follow the scheme until discovering which is the appropriate statistical technique for your data and the second: following the scheme backwards, determine if the test was a logical choice for the analyzed data. To use it, you must identify dependent and independent variables, then you will arrive at a synthesis measure or a useful point estimate for your data, which will be followed by a general classification of statistical tests. Conclusions: the proposed guideline is an attempt to provide a useful guide to select a statistical technique for data analysis in biomedical research.

Introdução: a análise estatística é dividida em dois componentes: análise descritiva e análise inferencial, testes estatísticos, são divididos em paramétricos e não paramétricos. Escolher um teste estatístico apropriado, no entanto, é um desafio. Objetivo: propor uma ferramenta, que sirva para selecionar um teste estatístico para aqueles que nãosão especialistas em bioestatística, para pesquisa biomédica. Métodos: realizou-se um estudo de revisão narrativa da literatura. Baseou-se em uma revisão da literatura sobre os principais testes estatísticos atualmente utilizados, disponíveis na literatura de bases de dados bibliográficas como Pubmed/Medline, SciELO, SCOPUS, Springer, Web of Science, EBSCOhost entre outras. Esse instrumento foi validado por critérios de especialistas. Resultados: foi elaborado um esquema, que pode ser utilizado de duas formas: a primeira é seguir o esquema até descobrir qual é a técnica estatística apropriada para seus dados e a segunda: seguindo o esquema de trás para frente, determinar se o teste foi uma escolha lógica para os dados analisados. Para usá-lo, você deve identificar variáveis dependentes e independentes, então você chegará a uma medida de síntese ou uma estimativa pontual útil para seus dados, que será seguida por uma classificação geral de testes estatísticos. Conclusões: a diretriz proposta é uma tentativa de fornecer um guia útil para selecionar uma técnica estatística para análise de dados em pesquisa biomédica.