[Robotic Colorectal Surgery: Analysis of the First Three Years of Activity in a Hospital of the Portuguese National Health Service]. / Cirurgia Robótica em Patologia Colorretal: Análise dos Primeiros Três Anos de Atividade num Hospital do Serviço Nacional de Saúde em Portugal.

INTRODUCTION: Minimally invasive surgery has been increasingly accepted and used in colorectal surgery. Several studies report that robotic surgery may provide advantages over 'conventional' laparoscopy, namely in rectal surgery. This paper provides an account of the first three years of experience with robotic surgery in the Unidade de Patologia Colorretal of the Unidade Local de Saúde S. José. METHODS: Variables were defined to develop a prospective database containing the data of consecutive patients operated by three internationally certified colorectal surgeons using the Da Vinci Xi® system between November 2019 and October 2022. The database was converted into an anonymized version that was used for this study. The analysis was performed on the data of all the patients operated during this period. RESULTS: Eighty patients were included, 47 male, median age 70 years, and median BMI 26 kg/m2 . ASA score was II in 53.7% and III in 41.3% of pa- tients. Of the total, 97.6% had malignant or potentially malignant disease. Operative procedures consisted of 34 colectomies proximal to the splenic flexure, 20 distal colectomies and 26 anterior resections. There were two synchronous resections of liver metastases. Early perioperative outcomes and histopathological results were analyzed: median operative time: 300 minutes; median estimated blood loss: 50 mL; conversion rate: 2.5%; median days until first bowel movement: three days; median length of hospital stay: six days; complication rate: 20%, of which 5% were Clavien III and 0% Clavien IV/V; anastomotic leak rate: 2.5%; 30-day readmission rate: 1.3%; median lymph nodes resected: 20; R0 resection rate: 100%; mesorectal integrity rate: 95,8% complete/near complete. CONCLUSION: Our results show that the adoption of robotic colorectal surgery in our center was safe and resulted in similar or improved short-term clinical outcomes and histopathological results when compared to those described in the literature.

Introdução: A utilização da cirurgia minimamente invasiva no tratamento da patologia colorretal é hoje cientificamente aceite e o seu uso na prática clí- nica diária tem vindo a aumentar de forma sustentada. Diversos estudos indicam que a abordagem robótica pode trazer vantagens sobre a laparoscopia 'convencional', especialmente na cirurgia do reto. Este trabalho descreve e analisa os resultados dos primeiros três anos de cirurgia robótica na Unidade de Patologia Colorretal da Unidade Local de Saúde S. José. Métodos: Foram definidas as variáveis a analisar e construída uma base de dados prospetiva com os dados referentes aos doentes operados conse- cutivamente por três cirurgiões colorretais, acreditados internacionalmente na utilização do sistema Da Vinci Xi®, entre novembro de 2019 e outubro de 2022. A base de dados foi convertida numa versão anonimizada e foi sobre essa mesma que se procedeu à análise de dados. Foram analisados os dados de todos doentes operados nesse período. Resultados: Foram incluídos 80 doentes, 47 homens, mediana de idade de 70 anos e de IMC de 26 kg/m2 . O score ASA era II em 53,7% e III em 41,3% dos doentes. Do total, 97,6% apresentavam doença maligna ou potencialmente maligna. Realizaram-se 34 colectomias proximais ao ângulo esplénico, 20 distais e 26 ressecções anteriores do reto. Houve ressecção síncrona de metástases hepáticas em dois casos. Foram analisados os resultados peri-operatórios a curto prazo e histopatológicos: duração (mediana): 300 minutos; perda hemática estimada (mediana): 50 mL; taxa de conversão: 2,5%; dias até retomar trânsito intestinal (mediana): três dias; dias de internamento (mediana): seis dias; taxa de complicações pós-operatórias: 20%, das quais 5% Clavien III e 0% Clavien IV/V; taxa de deiscência anastomótica: 2,5%; taxa de reintervenção: 2,5%; taxa de readmissão pós-alta: 1,3%; gânglios linfáticos ressecados (mediana): 20; taxa de ressecção R0: 100%; taxa de integridade mesorretal: 95,8% completo/quase completo. Conclusão: Os nossos resultados mostram que a introdução da cirurgia colorretal robótica no nosso centro foi segura e garantiu resultados clínicos a curto prazo e histopatológicos semelhantes ou favoráveis face aos descritos na literatura.

Will you get what you want? Treatment goals and expectations of patients with femoroacetabular impingement syndrome regarding physiotherapist-led treatment.

OBJECTIVE: To (i) investigate the goals and expectations of participants enrolled in a clinical trial of physiotherapist-led treatment for femoroacetabular impingement (FAI) syndrome and (ii) explore associations between their expectations and self-reported hip burden and kinesiophobia. METHODS: Data from 150 participants with FAI syndrome who participated in a clinical trial were analysed. Participants described their most important treatment goal and the expectation of achieving this goal throughout physiotherapy treatment. The International Hip Outcome Tool (iHOT-33) subscales were used to assess self-reported hip burden. The Tampa Scale for Kinesiophobia was used to assess kinesiophobia. Participants goals were qualitatively analysed using content analysis. Linear regression was used to explore associations between patient expectations and iHOT and Tampa Scale for Kinesiophobia scores. RESULTS: Participants with FAI syndrome reported goals relating to exercise (52%), improving activities of daily living quality (23%), improving physical function (15%), and reducing pain (10%). Negative expectations regarding physiotherapist-led treatment were reported by 68% of participants. Those with negative expectations reported worse scores for the iHOT-Total score (mean difference = 12 points, 95%CI = [4 to 19]), and iHOT-Symptoms (14 points, [7 to 21]) and iHOT-Social (11 points, [2 to 21]) subscales compared to those with positive expectations. Treatment expectations were not associated with iHOT-Sport, iHOT-Job, and Tampa Scale for Kinesiophobia scores (p > 0.05). CONCLUSION: Patients with FAI syndrome had a generally negative expectation of physiotherapist-led treatment. There was a mismatch between patients' goals and current treatment approaches. Participants with FAI syndrome and negative expectations reported worse quality of life, symptoms, and social concerns than those with positive expectations.

Knotted or knotless double-row rotator cuff repair retear rates: a systematic review and meta-analysis.

Background: Arthroscopic rotator cuff tear repair techniques used to rely on knot-tying double row techniques, but the advent of knotless transosseous equivalent procedures introduced a new variable to the debate. The purpose of this study is to determine which technique is associated with lower retear rates. For its' biomechanical advantages, the authors' hypothesis is that knotless techniques would have lower retear rates. Methods: A systematic literature search was performed via PubMed and Google Scholar by two independent reviewers following PRISMA guidelines. Papers reporting retear rates after rotator cuff arthroscopic repair using knotted double-row or knotless transosseous equivalent techniques, evaluated by magnetic resonance imaging at least 6 months after surgery, were retrieved. Studies that do not differentiate between techniques and nonclinical reports were excluded. Eligible data was analyzed with Review Manager 5.4.1 using Mantel-Haenszel statistics with a fixed effect model. Results: The authors' initial literature search retrieved 511 reports. After the selection process, 24 articles were available for this review, and 9 were eligible for meta-analysis. A comparison of 1888 subjects from noncomparative reports and a meta-analysis of reports in which both techniques were studied could not show a statistically significant difference in technique retear rates. Discussion and conclusion: The current report revealed no significant difference in retear rates between the two arthroscopic repair techniques. Studies' quality was a limitation. Only two reported level 1 evidence. This review could not control variables such as cuff tear size, tissue quality, or individual comorbidities. Larger and longer follow-up studies could be helpful to further investigate this topic.

Are visual assessments of the single-leg squat valid to be used in clinical practice? A systematic review of measurement properties based on the COSMIN guideline.

OBJECTIVE: Evaluate the discriminative and convergent validity of visual scales for the assessment of movement quality in the single-leg squat. METHODS: Searches performed in CINAHL, Cochrane, Embase, PubMed, SPORTDiscus and Web of Science databases. Studies evaluating discriminative and convergent validity of movement quality visual assessments in single-leg squats were included. The COSMIN risk of bias checklist was used to assess the risk of bias, and certainty of evidence was assessed by the GRADE modified version. RESULTS: Ten studies evaluating three different methods of visual assessment of the single-leg squat (Crossley scale; Whatman score and Medial knee displacement) were included. Very low certainty evidence suggests that the Crossley scale had sufficient discriminative validity for patient-centred outcomes. Very low to moderate certainty evidence suggests that the three visual methods of assessment of the single-leg squat had insufficient discriminative validity for surrogate outcomes and groups. None of the three methods had the convergent validity assessed. CONCLUSION: The Crossley scale exhibited sufficient discriminative validity for patient-centred outcomes, although the evidence supporting this conclusion is of very low certainty. Visual scales for the assessment of the single-leg squat movement quality should be used with caution in clinical practice as most methods had insufficient discriminative validity and no reports of convergent validity.

Does response to preoperative intra-articular anesthetic injections predict outcomes of femoroacetabular impingement syndrome?

INTRODUCTION: Some patients with femoroacetabular impingement syndrome (FAIS) who undergo surgery do not show satisfactory outcomes. Reliable tests that can inform prognosis of FAIS surgery are needed for optimized indications and contraindications to surgery. We aimed to review and critically appraise available literature on the capability of patient response to preoperative intra-articular anesthetic injections (PIAI) to predict post-surgical outcomes in patients with FAIS. MATERIALS AND METHODS: This study was conducted in accordance with the PRISMA statement. Studies that assessed the patient pain response to PIAI and post-surgical outcomes in patients with FAIS were considered eligible. Study selection and data collection were performed by three independent reviewers. Main outcomes evaluated were those measured by hip outcome scales often used in assessing postoperative pain and functional recovery, such as the modified Harris Hip Score (mHHS) and international Hip Outcome Tool (iHOT). The likelihood ratio of achieving satisfactory postoperative outcomes at the mHHS (LHR) was extracted or calculated-for patients with significant response to PIAI and for those without a significant response to PIAI. The risk of bias was assessed using the Quality In Prognosis Studies (QUIPS) tool. RESULTS: Six studies were considered eligible for analysis. Five studies indicated that patient response to PIAI are associated to surgical outcomes for patients with FAIS, with a greater reduction in pain typically indicating a better surgical outcome. Additionally, the LHR ranged from 1.15 to 1.92 for patients with significant response to PIAI (I2 = 90.6%). For patients without a significant response, the LHR ranged from 0.18 to 0.65 (I2 = 87.5). An overall high risk of bias was observed for all studies included in the analysis. Study attrition, the prognostic factor measurement and the presence of confounding factors were the main sources of bias. CONCLUSIONS: Greater reductions in pain with preoperative intra-articular anesthetic injections were found to be associated to better outcomes after FAIS surgery, but all available studies contain a high risk of bias.

Use of Autogenous Tricorticocancellous Iliac Crest Graft for Large Hill-Sachs Lesion Associated with Anterior Glenohumeral Dislocation: A Case Report.

Introduction: Although Hill-Sachs lesions are frequently associated with recurrent anterior glenohumeral dislocation, understanding of biomechanics and the importance of having an engaging or non-engaging lesion has only been recently studied at more depth. It is now widely accepted that engaging lesions benefit from surgery due to the high risk of symptom recurrence if left untreated. Techniques that have been described include capsular shift procedures, rotational osteotomies of the humeral head, or even femoral or humeral head allografts. The authors describe an alternative treatment which involves autogenous tricorticocancellous iliac crest graft to treat the bony defect in a patient with recurrent anterior glenohumeral dislocation and a large, engaging Hill-Sachs lesion. Case Report: A 33-year-old male with clinical history of two anterior-inferior dislocations of the left shoulder presented with chronic instability and a large Hill-Sachs defect (about 30% of the humeral head) with an anterior labrum lesion but no glenoid bony lesion. The defect was treated with a tailored autogenous tricorticocancellous iliac crest graft and fixed with headless compression screws. The patient returned to every-day activities at 5 months postoperatively and has a complete range of motion no complications were observed. Conclusion: This appears to be a safe and painless technique with excellent functional results, that should, however, be validated in the future with prospective randomized controlled trials.

Prática esportiva em paciente com valva aórtica bivalvular: quando limitar? / Sports practice in a patient with bivalvular aortic valve: when to limit?

INTRODUÇÃO: A Válvula Aórtica Bicúspide (VAB) é a anomalia congênita cardíaca mais comum, podendo cursar com alterações valvares do tipo estenose ou insuficiência, assim como dilatação da aorta. Apesar de sua considerável prevalência, não há estudos que demonstrem o impacto da prática de atividade física competitiva na progressão de tais alterações. RELATO DE CASO: Paciente masculino, 27 anos, ciclista, percorrendo em média 20 quilômetros ao dia, 5 vezes por semana. Assintomático do ponto de vista cardiovascular em consultas de acompanhamento. Avaliado com teste cardiopulmonar considerado máximo, VO2 alcançando 47,6 e capacidade funcional normal; porém em ecocardiografia foi evidenciada válvula aórtica de abertura bivalvular com insuficiência aórtica moderada e ectasia de aorta ascendente de 38mm. Cavidades cardíacas de dimensões normais, com função ventricular preservada. Teste ergométrico sem alterações isquêmicas. Paciente foi liberado para prática de exercícios competitivos, com orientação de acompanhamento regular para avaliação valvar e do diâmetro da aorta. DISCUSSÃO: Presença de dilatação aórtica em atletas não é comum, não devendo ser considerada resposta fisiológica ao exercício. Segundo os guidelines da 36ª Conferência de Bethesda, pacientes sem dilatação aórtica e sem insuficiência ou estenose aórtica significativas, estão aptos a participar de esportes competitivos. Já aqueles com dilatação aórtica entre 40-45mm, podem participar de esportes competitivos leves e moderados. Pacientes portadores de VAB com dilatação aórtica > 45mm podem participar de esportes competitivos de baixa intensidade. Quanto ao grau de obstrução valvar, a prática de esportes deve ser liberada em pacientes assintomáticos com estenose leve; já naqueles com obstrução moderada, poderá participar de atividades leves a moderadas desde que não apresente grau importante de hipertrofia ventricular esquerda. Pacientes sintomáticos ou com obstrução moderada/grave devem ser afastados de práticas esportivas devido ao risco potencial de morte súbita e dissecção de aorta. CONCLUSÃO Pacientes atletas com VAB devem ter acompanhamento médico regular, com avaliação ecocardiográfica anual, a fim de avaliar competência valvar, além de diâmetros de segmentos aórticos. A presença de VAB não deve ser limitante quanto à elegibilidade de atividade esportiva em jovens com função valvar normal, sem dilatação significativa de aorta. Nos demais casos, os pacientes deverão ser individualizados quanto à presença de sintomas e grau de alteração valvar ou aórtica.

Fechamento espontâneo de comunicação interventricular em atleta de 51 anos / Spontaneous closure of a ventricular septal defect in a 51-year-old athlete

INTRODUÇÃO: As comunicações interventriculares (CIV) são um grupo comum de cardiopatia congênita, correspondendo cerca de 20 a 30% dos defeitos cardíacos congênitos. Dentre as CIV, as mais prevalentes são as que acometem o septo membranoso, chamadas de perimembranosas. Dentre elas, as CIV funcionalmente pequenas podem se fechar espontaneamente e são, geralmente, consideradas benignas, não necessitando de tratamento cirúrgico. O fechamento espontâneo ocorre, em aproximadamente 48% dos casos, nos primeiros 19 meses de vida4. A partir dessa idade, a taxa de fechamento reduz, chegando próximo de zero aos 7 anos de idade. As CIV funcionalmente pequenas evoluem em sua maioria sem complicações, mas podem apresentar complicações na vida adulta, como endocardite infecciosa, regurgitação aórtica, sobrecarga de câmaras e necessidade de correção cirúrgica. O fechamento cirúrgico das CIV é seguro, entretanto as principais complicações são bloqueio atrioventricular, síndrome pós-pericardiotomia, infecções e manutenção de CIV residual. RELATO: Paciente masculino, 51 anos, atleta amador de alta intensidade, portador de CIV perimembranosa funcionalmente pequena e sem outras comorbidades, assintomático do ponto de vista cardiovascular, em acompanhamento em ambulatório de Cardiologia do Esporte. Apresentava em ecocardiogramas prévios de seguimento anual, CIV perimembranosa com pequeno shunt esquerdo direito e dilatação biatrial moderada, evoluindo estudo ecocardiográfico de rotina com fechamento espontâneo de CIV sem shunt residual. Apesar de cardiopatia congênita, não apresentava limitação funcional e apresentou em teste ergométrico excelente aptidão cardiorrespiratória de 23 METs. DISCUSSÃO: No presenta caso, o paciente era atleta e assintomático, com poucas complicações estruturais secundárias à CIV perimembranosa, excelente capacidade funcional e evoluiu com fechamento espontâneo de CIV numa idade incomum para tal. Estudos prévios indicam que a maioria dos fechamentos espontâneos ocorrem na infância, chegando próximo de zero após os 7 anos de idade. CONCLUSÃO: O presente caso demonstra a importância do seguimento ambulatorial de atletas, muitas vezes com diagnóstico tardio e acidental de cardiopatias congênitas. Apesar da evolução benigna da CIV perimembranosa funcionalmente pequena, o fechamento espontâneo aos 51 anos de idade é incomum e sem relato descrito na pesquisa bibliográfica.

Type IX Superior Labrum Anterior and Posterior Lesion in a Professional Football Player: A Rare Pattern of Shoulder Instability in a Non-throwing Athlete.

Anterior shoulder instability is the most frequent type of glenohumeral instability, especially among young athletes. Superior labral anterior-posterior (SLAP) injuries involve the superior glenoid labrum where the long head of the biceps tendon (LHBT) inserts. There is still some debate regarding the pathogenesis, clinical presentation, and treatment of these lesions. We report a clinical case of an 18-year-old male professional football player with a rare type IX SLAP lesion. Given the recurrence of instability after prior nonoperative management, surgical treatment was seen as the best option, and a pan-labral arthroscopic repair suture anchor fixation was performed. Three months after undergoing a personalized postoperative rehabilitation program, he was able to return to full sport with the same competitive level, and no recurrent instability or other symptoms were reported throughout the 18-month follow-up period.

Poststroke psychosis: a case report.

BACKGROUND: Stroke is currently the second leading cause of death in the elderly population. Neuropsychiatric complications following stroke are common, can be overlooked, and are associated with low quality of life, increase in the burden of caregiving and impaired functional status. METHODS: We report a case of poststroke psychosis in a woman without prior psychiatric history. In addition, a brief, nonsystematic review of the pertinent literature was performed. RESULTS: Psychosis can present in almost 5% of stroke survivors. Many patients with poststroke psychosis have no previous psychiatric history and the most common lesion locations include the right frontal, temporal and parietal lobes, the white matter connecting those areas, as well as the right caudate nucleus. Compared to other stroke survivors, patients with poststroke psychosis are more likely to depend on assistance in their everyday lives, can have more difficulty coping with the sequelae of stroke, and have an increased 10-year mortality risk. Guidelines for diagnosing and managing poststroke psychosis are needed. CONCLUSION: Psychosis is a possible complication of stroke and is associated with impairment and increased mortality. Guidelines for diagnosing and managing poststroke psychosis are currently lacking. To assure evidence-based care, further research is needed.

Differences in hip torque ratios between individuals with femoroacetabular impingement syndrome and asymptomatic individuals: A cross-sectional study.

BACKGROUND: Hip torque ratios are considered a useful measure for patients with hip pain. However, evidence regarding this measure for patients with femoroacetabular impingement syndrome is scarce. The primary aim of this study was to compare hip external-internal rotation and abduction-adduction torque ratios between patients with femoroacetabular impingement syndrome and asymptomatic individuals. The secondary aim was to compare hip torque ratios between the asymptomatic group and femoroacetabular impingement syndrome patients grouped according to the severity of symptoms and functional limitations. METHODS: Hip abduction-adduction and external-internal rotation torque ratios of 134 individuals with femoroacetabular impingement syndrome and 134 asymptomatic matched controls was assessed through isokinetic testing. Severity of symptoms and functional limitations was assessed through the iHOT-33. Mann Whitney U and Kruskall-Wallis tests were used to compare hip torque ratios between asymptomatic individuals and patients with femoroacetabular impingement syndrome and to patients with femoroacetabular impingement syndrome with different severities of symptoms and functional limitations. FINDINGS: No differences were identified in hip abduction-adduction (U = 7659.5, p = 0.192) and external-internal rotation (U = 8787.5, p = 0.764) torque ratios between patients with femoroacetabular impingement syndrome and asymptomatic individuals. Hip abduction-adduction torque ratio was higher (p = 0.0127) in patients with a severe state (median = 1.80, IQR = 0.61) when compared to asymptomatic individuals (median = 1.52, IQR = 0.45) (moderate effect size, r = 0.45). INTERPRETATION: Patients with severe symptoms and functional limitations related to FAI syndrome presented greater hip abduction-adduction torque ratio than asymptomatic individuals, suggesting a decreased adduction torque capacity relative to abduction torque in this subgroup of femoroacetabular impingement.

Clinical Course, Genetic, and Immunohistochemical Characterization of Solid Pseudopapillary Tumor of the Pancreas (Frantz Tumors) in a Brazilian Cohort.

Frantz tumors or solid pseudopapillary pancreatic neoplasm (SPN) are rare exocrine neoplasms that carry a favorable prognosis; they represent up to 3% of all tumors located in the region of the pancreas and have specific age and gender predispositions. In recent years, the rising curve of diagnosis is entitled to the evolution and access of diagnostic imaging. In this paper, we have retrospectively reviewed and described the clinical course of 40 patients with SPN from three institutions in Brazil, who had their diagnosis between 2005 and 2020, and analyzed the clinicopathological, genetic, and surgical aspects of these individuals. In accordance with the literature, most patients were women, 60% with unspecified symptoms at diagnosis, with tumors mainly located in the body and tail of the pancreas, of whom 70% underwent a distal pancreatectomy with sparing splenectomy as a standard procedure, and none of the cases have experienced recurrence to date. Surgery still remains the mainstay of treatment given the low metastatic potential, but more conservative approaches as observed in this cohort are evolving to become the standard of care. Herein, we present an in-depth analysis of cases focusing on the latest literature and report some of the smallest tumor cases in the literature. To our knowledge, this is the first report evaluating germline genetic testing and presenting a case of detected Li-Fraumeni syndrome.

Looped Elastic Resistance during Squats: How Do Band Position and Stiffness Affect Hip Myoelectric Activity?

Looped elastic bands around the thigh are commonly used during squats and result in increased hip activation. Due to the closed kinetic chain nature of the squat exercise, one may expect that placing the elastic band on distal segments, close to the floor contact, may not result in the same increase in hip muscle activation as that achieved with a looped band around the thigh. We analyzed the effects of band position (thigh, lower leg, and forefoot) and band stiffness on the myoelectric activity of the tensor fascia latae, gluteus medius, gluteus maximus, biceps femoris, vastus medialis, and vastus lateralis during squats in 35 healthy subjects (18 men and 17 women). The greatest myoelectric activity of hip muscles was observed when the stiffest band was positioned around the forefeet with an increase in 24% for the tensor fascia latae, 83% for the gluteus medius, and 68% for the gluteus maximus compared to free (without resistance band) squatting. Contrary to previous thinking, the use of elastic bands around the forefeet during squats can elicit increased myoelectric activity of hip muscles, with a magnitude often greater than when the band is placed around the thigh segments.

Fístula coronária como causa de angina, um relato de caso / Coronary fistula as a cause of angina, a case report

RELATO DE CASO: EJA, feminino, 57 anos, previamente hipertensa e com história familiar positiva para Doença Arterial Coronariana, referia queixa de angina CCS III há dois anos, progressiva, associada a tontura e síncope. Realizada investigação ambulatorial com cateterismo cardíaco que evidenciou imagem sugestiva de fístula proveniente da Artéria Coronária Esquerda (ACE) para estrutura extra pericárdica, sugestivo de shunt para Artéria Pulmonar (AP), sem lesões coronarianas importantes. Realizada complementação da investigação com Cintilografia de Perfusão Miocárdica que mostrou hipocaptação transitória de pequena extensão em segmento apical da parede anterior do Ventrículo Esquerdo e carga isquêmica de 1,5%, além de Angiotomografia Coronariana com imagem de pequena fístula entre a ACE e AP, com diâmetro de 1,3mm. Paciente evoluiu com melhora do quadro de angina após ajuste de terapia medicamentosa. As fístulas coronárias são responsáveis por 0,2% a 0,4% das anomalias cardíacas, sendo a sua principal origem congênita (provável persistência de porções dos sinusoides coronários embrionários que conectam as artérias coronárias primitivas às câmaras cardíacas), existindo também as causas adquiridas (secundárias à infecção, trauma e iatrogenia). A fístula é definida como uma comunicação entre a terminação de uma artéria coronária e uma câmara cardíaca, um grande vaso ou outra estrutura vascular, sendo mais comum o envolvimento da artéria coronária direita (60% dos casos) e mais raramente da artéria circunflexa. A área mais comum de drenagem é o ventrículo direito, seguida pelo átrio direito, artéria pulmonar e seio coronário. A maioria dos pacientes apresentam-se assintomáticos, tendo o diagnóstico incidental ao realizarem algum exame invasivo. A evolução dos sintomas está relacionada ao envelhecimento e o aumento do shunt, sendo mais prevalente dispneia aos esforços, angina, fadiga, podendo apresentar alguma complicação como insuficiência cardíaca congestiva, infarto agudo do miocárdio, derrame pericárdico e arritmias. Dentre os exames complementares disponíveis para seu diagnóstico, destaca-se a Angiotomografia Coronariana, que representa o exame não invasivo de referência para visualização da árvore coronariana. Seu tratamento deve ser individualizado, sendo baseado na presença ou ausência de sintomas, isquemia miocárdica e disfunção ventricular, além do grau de sobrecarga de volume cardíaco, com evidências mais recentes recomendado o fechamento de grandes fístulas independente dos sintomas.

Knee and hip dynamic muscle strength in individuals with femoroacetabular impingement syndrome scheduled for hip arthroscopy: A case-control study.

Background The primary aim of this study was to compare knee and hip dynamic muscle strength of individuals with femoroacetabular impingement (FAI) syndrome scheduled for hip arthroscopy with healthy controls. Our secondary aim was to compare hip and knee muscle strength between male and female patients with FAI syndrome. Methods One hundred and thirty-four individuals with femoroacetabular impingement syndrome scheduled for hip arthroscopy and 134 healthy controls matched for sex and age (within 5 years range) underwent an isokinetic assessment of knee extension and flexion and hip abduction, adduction, external rotation and internal rotation dynamic muscle strength. Two MANOVAs were conducted to compare isokinetic peak torque and total work between groups and sexes. Findings Individuals with femoroacetabular impingement syndrome demonstrated lower values of all variables representing knee and hip isokinetic peak torque and total work measures when compared to healthy controls, with differences ranging from 0.09 Nm/kg (95%CI: 0.06-0.12 Nm/kg) to 0.64 Nm/kg (95%CI: 0.49-0.79 Nm/kg). Female participants from both FAI syndrome and control group showed less knee and hip muscle strength compared to male participants. There was no significant interaction between group and sex regarding knee or hip isokinetic peak torque and total work (p > 0.05). Interpretation Individuals with femoroacetabular impingement syndrome scheduled for hip arthroscopy present impairments in knee or hip dynamic muscle strength when compared to controls. Female participants present less knee and hip muscular strength compared to male participants, these between-sex differences are similar for both FAI syndrome and control group participants.

Building an IoT Platform Based on Service Containerisation.

IoT platforms have become quite complex from a technical viewpoint, becoming the cornerstone for information sharing, storing, and indexing given the unprecedented scale of smart services being available by massive deployments of a large set of data-enabled devices. These platforms rely on structured formats that exploit standard technologies to deal with the gathered data, thus creating the need for carefully designed customised systems that can handle thousands of heterogeneous data sensors/actuators, multiple processing frameworks, and storage solutions. We present the SCoT2.0 platform, a generic-purpose IoT Platform that can acquire, process, and visualise data using methods adequate for both real-time processing and long-term Machine Learning (ML)-based analysis. Our goal is to develop a large-scale system that can be applied to multiple real-world scenarios and is potentially deployable on private clouds for multiple verticals. Our approach relies on extensive service containerisation, and we present the different design choices, technical challenges, and solutions found while building our own IoT platform. We validate this platform supporting two very distinct IoT projects (750 physical devices), and we analyse scaling issues within the platform components.

Association between severity of hip chondrolabral injuries, dynamic hip muscle strength and quality of life: A cross-sectional study in patients with femoroacetabular impingement syndrome scheduled for hip arthroscopy.

BACKGROUND: We assessed the association between: the severity of hip chondral or labral pathology with dynamic hip muscle strength or quality of life in patients with femoroacetabular impingement syndrome scheduled for hip arthroscopy. We also assessed the association between dynamic hip muscle strength with quality of life. METHODS: Eighty-three participants with femoroacetabular impingement syndrome scheduled for hip arthroscopy were included. We measured dynamic hip abduction and adduction muscle strength with an isokinetic dynamometer (Nm/kg), and quality of life with the iHoT-33 questionnaire. The severity of hip chondrolabral pathologies was scored using the modified Beck classification. Linear regression analyses were conducted to assess the association between severity of hip chondral or labral pathology with dynamic hip muscle strength and quality of life. FINDINGS: The regression analyses showed no association between the (i) severity of hip chondral (adjusted r2: 0.14) or labral (adjusted r2: 0.08) pathology and quality of life (P > 0.05), (ii) between the severity of hip chondral or labral pathology and dynamic hip abduction and adduction muscle strength (P > 0.05). Significant correlation was observed for quality of life and hip abduction (adjusted r2:0.29; P < 0.001) or adduction (adjusted r2: 0.32; P < 0.001) muscle strength. INTERPRETATION: The severity of hip chondral or labral pathologies were not associated with quality of life or dynamic hip muscle strength in participants with femoroacetabular impingement syndrome. Greater dynamic hip abduction and adduction muscle strength were associated with better quality of life in participants with femoroacetabular impingement syndrome scheduled for hip arthroscopy.

Brazilian Group of Gastrointestinal Tumours' consensus guidelines for the management of oesophageal cancer.

Oesophageal cancer is among the ten most common types of cancer worldwide. More than 80% of the cases and deaths related to the disease occur in developing countries. Local socio-economic, epidemiologic and healthcare particularities led us to create a Brazilian guideline for the management of oesophageal and oesophagogastric junction (OGJ) carcinomas. The Brazilian Group of Gastrointestinal Tumours invited 50 physicians with different backgrounds, including radiology, pathology, endoscopy, nuclear medicine, genetics, oncological surgery, radiotherapy and clinical oncology, to collaborate. This document was prepared based on an extensive review of topics related to heredity, diagnosis, staging, pathology, endoscopy, surgery, radiation, systemic therapy (including checkpoint inhibitors) and follow-up, which was followed by presentation, discussion and voting by the panel members. It provides updated evidence-based recommendations to guide clinical management of oesophageal and OGJ carcinomas in several scenarios and clinical settings.

Arthroscopic-Assisted Acromioclavicular Joint Dislocation Repair: A Modified Technique for Horizontal Stabilization Using Suture Anchors.

Acromioclavicular (AC) dislocation is a common lesion often resulting from a sports injury. Nowadays, treatment is still controversial mainly in grade III lesions according to the Rockwood classification. For most surgically treated AC acute dislocations, treatment is performed with an arthroscopic procedure that anatomically reconstructs the coracoclavicular ligaments. Increasing knowledge about AC joint biomechanics has underlined the importance of its horizontal stability through the superior and inferior AC ligaments. Moreover, the pattern of lesion tends to repeat itself, with the superior AC ligament being torn most frequently from the clavicular side in a peeling fashion. Therefore, the purpose of this note is to describe the technical aspects of additional horizontal stability through superior AC ligament repair using suture anchors.