Impact of double stent retriever configuration on first-pass effect in stroke: a multicenter study.

BACKGROUND: Efficient recanalization of occluded cerebral arteries is crucial in the treatment of acute ischemic stroke. Double stent retrievers have shown the potential to enhance the rates of recanalization on the first pass. This study aims to evaluate the efficacy and safety of the double stent retriever technique and the predictors of achieving first-pass effect in patients with acute ischemic stroke. METHODS: This prospective multicenter study involved 209 patients from 16 comprehensive stroke centers in Spain. Patients with occlusions in the anterior circulation were treated using the Aperio Hybrid double stent retriever. The study examined various deployment techniques, including simultaneous and sequential deployment and stent configurations, comparing the Y-shaped and parallel configurations. RESULTS: The double stent retriever technique achieved a first-pass effect in 72.7% of cases and a final successful recanalization rate of 99.5%. The Y-shaped configuration was significantly associated with higher recanalization rates on the first pass (OR 2.59, 95% CI 1.18 to 5.68, P=0.02). Procedural complications were mild to moderate in 6.7% and severe in 1.5% of cases, with symptomatic intracranial hemorrhage occurring in 3.3% of patients. At 3 months follow-up, 57.2% of patients achieved a good clinical outcome, with a mortality rate of 15.1%. CONCLUSION: The findings support the efficacy of the double stent retriever technique, particularly the Y-shaped configuration, in achieving high recanalization rates on the first pass with an acceptable safety profile. This technique may offer clinical benefits for future acute ischemic stroke treatment protocols.

Endothelial extracellular vesicles enhance vascular self-assembly in engineered human cardiac tissues.

The fabrication of complex and stable vasculature in engineered cardiac tissues represents a significant hurdle towards building physiologically relevant models of the heart. Here, we implemented a 3D model of cardiac vasculogenesis, incorporating endothelial cells (EC), stromal cells, and human induced pluripotent stem cell (iPSC)-derived cardiomyocytes (CM) in a fibrin hydrogel. The presence of CMs disrupted vessel formation in 3D tissues, resulting in the upregulation of endothelial activation markers and altered extracellular vesicle (EV) signaling in engineered tissues as determined by the proteomic analysis of culture supernatant. miRNA sequencing of CM- and EC-secreted EVs highlighted key EV-miRNAs that were postulated to play differing roles in cardiac vasculogenesis, including the let-7 family and miR-126-3p in EC-EVs. In the absence of CMs, the supplementation of CM-EVs to EC monolayers attenuated EC migration and proliferation and resulted in shorter and more discontinuous self-assembling vessels when applied to 3D vascular tissues. In contrast, supplementation of EC-EVs to the tissue culture media of 3D vascularized cardiac tissues mitigated some of the deleterious effects of CMs on vascular self-assembly, enhancing the average length and continuity of vessel tubes that formed in the presence of CMs. Direct transfection validated the effects of the key EC-EV miRNAs let-7b-5p and miR-126-3p in improving the maintenance of continuous vascular networks. EC-EV supplementation to biofabricated cardiac tissues and microfluidic devices resulted in tissue vascularization, illustrating the use of this approach in the engineering of enhanced, perfusable, microfluidic models of the myocardium.

Return to Play After Arthroscopic Management of Rotator Cuff Tears in Professional Athletes of Contact Sports.

Background: Rotator cuff tears are rare injuries in professional athletes who participate in contact sports, and limited data exist to guide players and team physicians regarding outcomes after surgical management. Purpose: To report the outcomes and return-to-play rates of professional contact sport athletes who underwent arthroscopic management of rotator cuff tears. Study Design: Case series; Level of evidence, 4. Methods: All professional athletes of contact sports who underwent arthroscopic management of a rotator cuff tear between 2002 and 2019 at the institution were identified. Patient information collected were age, sport, position, date of injury, date of surgery, and time to return to play; surgical data included tear size, acuity, pattern, and procedure performed. The primary outcome measure was the ability to return to play and the number of games played after surgery. Results: Overall, 10 rotator cuff tears in 9 professional athletes (8 tears in football players and 2 tears in hockey players) were identified; 9 of the tears were full-thickness tears that underwent arthroscopic single-row repair, while 1 was a partial tear that was debrided. Of the 9 athletes, 8 were able to return to play at the same level, at a mean time of 9.5 ± 4.3 months. The mean playing time after surgery was 32 ± 25 games (2.7 ± 2 seasons) for the football players and 22 games (1 season) for the hockey player who returned. Postoperative imaging was available in 8 of the 10 tears, and 7 of 8 (88%) demonstrated a healed repair. One football player and 1 hockey player with large (>3 cm) full-thickness tears did not return to play. The mean age of these players was 34.5 years and both had >10 years of professional playing experience.≥. Conclusion: The study findings demonstrated that the majority (80%; n = 8) of the professional athletes in contact sports in this series were able to return to play at the same level after arthroscopic management of a symptomatic rotator cuff tear.

Tongue Tuberculosis as a Complication of Pott's Disease in a Patient on Systemic Steroid Therapy without Pulmonary Tuberculosis.

A 78-year-old man with a previous diagnosis of rheumatoid arthritis on prolonged treatment with corticosteroids presented with intense and progressive pain at the cervical level that prevented him from resting his head and walking, in addition to an ulcerative lesion covering 80% of the lingual area that was previously treated as oral candidiasis without improvement. On arrival, with no clinical or serological data of rheumatoid arthritis, immunosuppressive treatment was suspended, and a biopsy of the oral cavity was requested, confirming the diagnosis of lingual tuberculosis, an extremely rare disease, occurring in less than 1% of extrapulmonary cases. MRI of the cervical spine showed a crush fracture of the C6 and C7 bodies associated with spondylitis of probably infectious etiology that required surgical treatment, and histopathological studies confirmed Pott's disease. The patient displayed no evidence of pulmonary tuberculosis from arrival until the end of the follow-up.

Desenredando los nudos en cirugía: creando maestría con un simulador práctico en casa / Untangling the knots in surgery: Creating mastery with a practical at-home simulator

Introducción. Anudar es una de las habilidades quirúrgicas esenciales y de su correcta ejecución dependen procesos de vital importancia. La adquisición de estas competencias requiere trabajo motor, entornos amigables y realistas. Una estrategia para facilitar el aprendizaje de la técnica de anudado es generar instrumentos de simulación accesibles. Métodos. Se presenta un simulador de nudos quirúrgicos, construido con materiales de bajo costo y asequibles para la población en general, con un presupuesto de aproximadamente $5.000 COP (US$ 1,23). Resultados. Se desarrolló un simulador de nudos quirúrgicos que, al fijarse a la extremidad inferior desde una posición sentada, proporciona una superficie estable para llevar a cabo la práctica de anudado de manera efectiva. Conclusión. La cirugía moderna considera la seguridad del paciente como la principal prioridad, por lo que ya no es apropiado adoptar un método de formación de "ver uno, hacer uno, enseñar uno". Es la práctica constante mediante simuladores, el método más adecuado. Este trabajo presenta una alternativa de aprendizaje ininterrumpido de las técnicas quirúrgicas relacionadas con los nudos.

Introduction. Knotting is one of the essential surgical skills and vitally important processes that depends on its correct execution. The acquisition of these skills requires motor work, friendly and realistic environments. A strategy to facilitate learning the knotting technique is to generate accessible simulation instruments. Methods. A surgical knot simulator is presented, built with low-budget materials and affordable for the general population, with a budget of approximately $5,000 COP (US$ 1.23). Results. A surgical knot simulator has been developed in a way that, when attached to the thigh of a lower extremity from a seated position, provides a stable surface to effectively perform knot tying practice. Conclusion. Modern surgery considers patient safety as the top priority, so it is no longer appropriate to adopt a "see one, do one, teach one" training method. Constant practice using simulators is the most appropriate method. This work presents an alternative for uninterrupted learning of surgical techniques related to knots.

Explantador de Cabrera: un nuevo dispositivo para explantar endoprótesis aórticas después de reparo endovascular de aneurisma de aorta, un estudio experimental ex vivo / Cabrera explanter: a new device to explant aortic stents after endovascular aortic aneurysm repair, an ex vivo experimental study

Introducción. Las complicaciones posteriores a la reparación endovascular de aneurisma (EVAR) pueden resolverse con técnicas endovasculares. Sin embargo, cuando está indicada, la explantación de una endoprótesis es un procedimiento complejo, que se asocia a lesiones vasculares o viscerales, con alta morbimortalidad, en pacientes con edad avanzada y múltiples comorbilidades, y por lo tanto, alto riesgo quirúrgico. No existen dispositivos producidos por la industria para explantar las endoprótesis aórticas, por lo que el objetivo de este trabajo fue desarrollar un dispositivo para la explantación de endoprótesis aórticas. Métodos. Se llevó a cabo un estudio experimental, en fase preclínica, para desarrollar un dispositivo para la explantación de endoprótesis aórticas, con pruebas en modelos 3D y en un modelo animal porcino cadavérico. Resultados. Es factible desarrollar un modelo experimental de un nuevo dispositivo para explantar endoprótesis aórticas, denominado explantador de Cabrera, y comprobar su funcionamiento en un modelo animal cadavérico. El uso del explantador de Cabrera limitó el daño de la pared aórtica por parte de la endoprótesis en un 100 % al momento de su explantación en un modelo experimental ex vivo. Conclusión. Usando una jeringa septo, el explantador de Cabrera es superior a la técnica estándar de explantación de una endoprótesis al limitar la lesión de la pared aórtica, al colapsar y liberar los ganchos de fijación suprarrenal de forma controlada y segura al interior de la luz aórtica y, posteriormente, extraerla de forma rápida y efectiva, conservando la mayor cantidad de aorta sana para la posterior reconstrucción aorto-ilíaca.

Introduction. Complications after endovascular aneurysm repair (EVAR) can be resolved with endovascular techniques; however, when indicated, stent explantation is a complex procedure, which is associated with vascular or visceral injuries, with high morbidity and mortality in patients, with advanced age and multiple comorbidities, and therefore high surgical risk. There are no devices produced by the industry to explant aortic endoprostheses, so the objective of this work was to develop a device for the explantation of aortic endoprostheses. Methods. An experimental study was carried out, in the preclinical phase, to develop a device for the explantation of aortic endoprostheses, with tests in 3D models and in a cadaveric porcine animal model. Results. It is feasible to develop an experimental model of a new device for explanting aortic endoprostheses, called Cabrera explanter, and verify its operation in a cadaveric animal model. The use of the Cabrera explanter limited damage to the aortic wall by the endoprosthesis by 100% at the time of explantation in an ex vivo experimental model. Conclusions. Using a septum syringe, the Cabrera explanter is superior to the standard stent explantation technique by limiting injury to the aortic wall, collapsing and releasing the adrenal fixation hooks in a controlled and safe manner into the aortic lumen, and subsequently, extract it quickly and effectively, preserving the greatest amount of healthy aorta for the subsequent aorto-iliac reconstruction.

Decoding the mechanism governing the structural stability of wheat germ agglutinin and its isolated domains: A combined calorimetric, NMR, and MD simulation study.

Wheat germ agglutinin (WGA) demonstrates potential as an oral delivery agent owing to its selective binding to carbohydrates and its capacity to traverse biological membranes. In this study, we employed differential scanning calorimetry and molecular dynamics simulations to comprehensively characterize the thermal unfolding process of both the complete lectin and its four isolated domains. Furthermore, we present the nuclear magnetic resonance structures of three domains that were previously lacking experimental structures in their isolated forms. Our results provide a collective understanding of the energetic and structural factors governing the intricate unfolding mechanism of the complete agglutinin, shedding light on the specific role played by each domain in this process. The analysis revealed negligible interdomain cooperativity, highlighting instead significant coupling between dimer dissociation and the unfolding of the more labile domains. By comparing the dominant interactions, we rationalized the stability differences among the domains. Understanding the structural stability of WGA opens avenues for enhanced drug delivery strategies, underscoring its potential as a promising carrier throughout the gastrointestinal environment.

Skimmed, Lactose-Free Milk Ingestion Postexercise: Rehydration Effectiveness and Gastrointestinal Disturbances Versus Water and a Sports Drink in Physically Active People.

Postexercise hydration is fundamental to replace fluid loss from sweat. This study evaluated rehydration and gastrointestinal (GI) symptoms for each of three beverages: water (W), sports drink (SD), and skimmed, lactose-free milk (SLM) after moderate-intensity cycling in the heat. Sixteen college students completed three exercise sessions each to lose ≈2% of their body mass. They drank 150% of body mass loss of the drink assigned in randomized order; net fluid balance, diuresis, and GI symptoms were measured and followed up for 3 hr after completion of fluid intake. SLM showed higher fluid retention (∼69%) versus W (∼40%; p < .001); SD (∼56%) was not different from SLM or W (p > .05). Net fluid balance was higher for SLM (-0.26 kg) and SD (-0.42 kg) than W (-0.67 kg) after 3 hr (p < .001), resulting from a significantly lower diuresis with SLM. Reported GI disturbances were mild and showed no difference among drinks (p > .05) despite ingestion of W (1,992 ± 425 ml), SD (1,999 ± 429 ml), and SLM (1,993 ± 426 ml) in 90 min. In conclusion, SLM was more effective than W for postexercise rehydration, showing greater fluid retention for the 3-hr follow-up and presenting with low-intensity GI symptoms similar to those with W and SD. These results confirm that SLM is an effective option for hydration after exercise in the heat.

Efficacy and Safety of a Tetravalent Dengue Vaccine (TAK-003) in Children With Prior Japanese Encephalitis or Yellow Fever Vaccination.

BACKGROUND: We explored the impact of prior Yellow fever (YF) or Japanese encephalitis (JE) vaccination on the efficacy of Takeda's dengue vaccine candidate, TAK-003 (NCT02747927). METHODS: Children 4-16 years of age were randomized 2:1 to receive TAK-003 or placebo and were under active febrile surveillance. Symptomatic dengue was confirmed by serotype-specific RT-PCR. YF and JE vaccination history was recorded. RESULTS: Of the 20,071 children who received TAK-003 or placebo, 21.1% had a YF and 23.9% had a JE vaccination history at randomization. Fifty-seven months after vaccination, vaccine efficacy was 55.7% (95% CI, 39.7%-67.5%) in those with YF vaccination, 77.8% (70.8%-83.1%) for JE vaccination, and 53.5% (45.4%-60.4%) for no prior YF/JE vaccination. Regional differences in serotype distribution confound these results. The apparent higher vaccine efficacy in the JE vaccination subgroup could be largely explained by serotype-specific efficacy of TAK-003. Within 28 days of any vaccination, the proportions of participants with serious adverse events in the YF/JE prior vaccination population were comparable between the TAK-003 and placebo groups. CONCLUSIONS: The available data do not suggest a clinically relevant impact of prior JE or YF vaccination on TAK-003 performance. Overall, TAK-003 was well-tolerated and efficacious in different epidemiological settings.

Salud Mental en estudiantes universitarios en aislamiento social durante la pandemia COVID-19. Arequipa, Perú

Introducción: La Pandemia COVID-19, ha tenido impactos negativos en la salud física y mental de las personas, así como las medidas adoptadas por los gobiernos, para prevenir el contagio masivo de la población como el confinamiento, el aislamiento social, el trabajo y educación virtual. Dentro de los afectados por estos cambios, se encontrarían los estudiantes universitarios del área de la salud, que además de estudiar en estas condiciones de pandemia, no han podido hacer sus prácticas de los servicios de salud. Esta situación de exposición al aislamiento, podría afectar la salud mental de los jóvenes estudiantes universitarios. Objetivo: determinar los niveles de depresión, ansiedad y estrés en estudiantes universitarios y su relación con variables sociodemográficas y las características del aislamiento social durante la Pandemia COVID-19. Métodos: Se realizó un estudio descriptivo, observacional, de corte transversal y cuantitativo, con una muestra de 818 estudiantes universitarios de facultades de ciencias de la salud, mediante el cuestionario autoadministrado DASS-21. Resultados: Los principales hallazgos fueron: una mayor prevalencia en niveles altos (severos y extremadamente severos) en la ansiedad, alcanzado casi a 4 de cada 10 de los evaluados; por otro lado, en depresión y el estrés, 2 de cada 10 de los evaluados, se encontraron en los niveles mencionados. En relación con las variables sociodemográficas, las relacionadas con el COVID-19 y aislamiento social, se hallaron diferencias estadísticamente significativas con el género (mujeres > varones), el haber tenido COVID-19 (Sí > No) y vivir con familiares como antes de la pandemia (Sí > No) obtuvieron en promedio mayores puntajes en depresión, ansiedad y estrés. Conclusión: Los estudiantes que presentaron mayor depresión, ansiedad y estrés con una diferencia significativa fueron de género femenino, con antecedentes de haber tenido Covid-19, menor contacto con familiares y haber cumplido con aislamiento social total.

Introduction: The COVID-19 Pandemic has had negative impacts on the physical and mental health of people, as well as the measures adopted by governments to prevent the massive contagion of the population, such as confinement, social isolation, virtual work, and virtual education. Among those affected by these changes would be university students in the health area who, in addition to studying in these pandemic conditions, have been unable to do their health service practices. This situation of exposure to isolation could affect the mental health of young university students. Objective: To determine the levels of depression, anxiety, and stress in university students, their relationship with sociodemographic variables, and the characteristics of social isolation during the COVID-19 Pandemic. Methods: A descriptive, observational, cross-sectional, and quantitative study was carried out with a sample of 818 university students from health sciences faculties using the DASS-21 self-administered questionnaire. Results: The main findings were a higher prevalence of high levels (severe and highly severe) in anxiety, reaching almost 4 out of 10 of those evaluated; On the other hand, in depression and stress, 2 out of 10 of those evaluated were found at the mentioned levels. Concerning the sociodemographic variables, those related to COVID-19 and social isolation, statistically significant differences were found with gender (women > men), having had COVID-19 (Yes > No), and living with relatives as before. On average, the pandemic (Yes > No) obtained higher scores in depression, anxiety, and stress. Conclusion: The students who presented greater depression, anxiety, and stress with a significant difference were female, with a history of having had Covid-19, less contact with family members, and having complied with total social isolation

Bridging frontiers: The role of a Global Breast Research Working Group.

Breast cancer remains a significant cause of death for women globally, despite advancements in detection and treatment, low- and middle-income countries face unique obstacles. Role of Research Working Group (RWG) can expedite research progress by fostering collaboration between scientists, clinicians, and stakeholders. Benefits of a Global RWG include pooling resources and expertise to develop new research ideas, addressing disparities, and building local research capacity, with the potential to improve breast cancer research and outcomes.

Protective Role of NS1-Specific Antibodies in the Immune Response to Dengue Virus through Antibody-Dependent Cellular Cytotoxicity.

BACKGROUND: Dengue virus (DENV) non-structural protein 1 (NS1) has multiple functions within infected cells, on the cell surface, and in secreted form, and is highly immunogenic. Immunity from previous DENV infections is known to exert both positive and negative effects on subsequent DENV infections, but the contribution of NS1-specific antibodies to these effects is incompletely understood. METHODS: We investigated the functions of NS1-specific antibodies and their significance in DENV infection. We analyzed plasma samples collected in a prospective cohort study prior to symptomatic or subclinical secondary DENV infection. We measured binding to purified recombinant NS1 protein and to NS1-expressing CEM cells, antibody-mediated NK cell activation by plate-bound NS1 protein, and antibody-dependent cellular cytotoxicity (ADCC) of NS1-expressing target cells. RESULTS: We found that antibody responses to NS1 were highly serotype-cross-reactive and that subjects who experienced subclinical DENV infection had significantly higher antibody responses to NS1 in pre-infection plasma than subjects who experienced symptomatic infection. We observed strong positive correlations between antibody binding and NK activation. CONCLUSIONS: These findings demonstrate the involvement of NS1-specific antibodies in ADCC and provide evidence for a protective effect of NS1-specific antibodies in secondary DENV infection.

Long-term efficacy and safety of a tetravalent dengue vaccine (TAK-003): 4·5-year results from a phase 3, randomised, double-blind, placebo-controlled trial.

BACKGROUND: About half of the world's population lives in dengue-endemic areas. We aimed to evaluate the long-term efficacy and safety of two doses of the tetravalent dengue vaccine TAK-003 in preventing symptomatic dengue disease of any severity and due to any dengue virus (DENV) serotypes in children and adolescents. METHODS: In this ongoing double-blind, randomised, placebo-controlled trial, we enrolled healthy participants aged 4-16 years at 26 medical and research centres across eight dengue-endemic countries (Brazil, Colombia, Dominican Republic, Nicaragua, Panama, Philippines, Sri Lanka, and Thailand). The main exclusion criteria were febrile illness (body temperature ≥38°C) at the time of randomisation, hypersensitivity or allergy to any of the vaccine components, pregnancy or breastfeeding, serious chronic or progressive disease, impaired or altered immune function, and previous receipt of a dengue vaccine. Participants were randomly assigned 2:1 (stratified by age and region) using an interactive web response system and dynamic block assignment to receive two subcutaneous doses of TAK-003 or placebo 3 months apart. Investigators, participants, and their parents or legal guardians were blinded to group assignments. Active febrile illness surveillance and RT-PCR testing of febrile illness episodes were performed for identification of virologically confirmed dengue. Efficacy outcomes were assessed in the safety analysis set (all randomly assigned participants who received ≥1 dose) and the per protocol set (all participants who had no major protocol violations), and included cumulative vaccine efficacy from first vaccination to approximately 4·5 years after the second vaccination. Serious adverse events were monitored throughout. This study is registered with ClinicalTrials.gov, NCT02747927. FINDINGS: Between Sept 7, 2016, and March 31, 2017, 20 099 participants were randomly assigned (TAK-003, n=13 401; placebo, n=6698). 20 071 participants (10 142 [50·5%] males; 9929 [49·5%] females; safety set) received TAK-003 or placebo, with 18 257 (91·0%) completing approximately 4·5 years of follow-up after the second vaccination (TAK-003, 12 177/13 380; placebo, 6080/6687). Overall, 1007 (placebo: 560; TAK-003: 447) of 27 684 febrile illnesses reported were virologically confirmed dengue, with 188 cases (placebo: 142; TAK-003: 46) requiring hospitalisation. Cumulative vaccine efficacy was 61·2% (95% CI 56·0-65·8) against virologically confirmed dengue and 84·1% (77·8-88·6) against hospitalised virologically confirmed dengue; corresponding efficacies were 53·5% (41·6-62·9) and 79·3% (63·5-88·2) in baseline seronegative participants (safety set). In an exploratory analysis, vaccine efficacy was shown against all four serotypes in baseline seropositive participants. In baseline seronegative participants, vaccine efficacy was shown against DENV-1 and DENV-2 but was not observed against DENV-3 and low incidence precluded evaluation against DENV-4. During part 3 of the trial (approximately 22-57 months after the first vaccination), serious adverse events were reported for 664 (5·0%) of 13 380 TAK-003 recipients and 396 (5·9%) of 6687 placebo recipients; 17 deaths (6 in the placebo group and 11 in the TAK-003 group) were reported, none were considered study-vaccine related. INTERPRETATION: TAK-003 demonstrated long-term efficacy and safety against all four DENV serotypes in previously exposed individuals and against DENV-1 and DENV-2 in dengue-naive individuals. FUNDING: Takeda Vaccines. TRANSLATIONS: For the Portuguese, Spanish translations and plain language summary of the abstract see Supplementary Materials section.

Anterolateral Thoracotomy: A Novel and Simple Technique to Improve the Closure Using the Self Locking Knot.

Thoracotomy is defined as an incision made by the surgeon in the chest wall in order to allow visibility of the thoracic cavity content. This can be used by surgeons to treat thoracic cavity content diseases including the heart, lungs, esophagus, and other organs. Thoracic incision closure remains an item with no consensus. Therefore, we present an easy way and give a little tip for closure using the slipknot that will allow the correct approach of ribs and the successful closure of the intercostal space.

Ruptura de hematoma hepático secundario a terapia neural / Rupture of hepatic hematoma secondary to neural therapy

Objetivo: determinar si la terapia neural es una opción de tratamiento que pueda ser utilizada sin la aparición de efectos adversos. Presentación del caso: se presenta y analiza el caso de una paciente que ingresó a urgencias por dolor abdominal generalizado diagnosticándose hematoma hepático y realizándosele una revisión de la literatura científica. Resultados: se procedió a efectuar laparotomía con cirugía de control de daños, obteniendo resultados satisfactorios con egreso hospitalario sin complicaciones agregadas. Conclusiones: la terapia neural es un tratamiento del cual no se tiene suficiente evidencia científica que avale su seguridad en los pacientes

Objective: to determine whether neural therapy is a treatment option which can be used without the occurrence of adverse effects. Case report: we present and analyze the case of a female patient who was admitted to the emergency room for generalized abdominal pain. A hepatic hematoma was diagnosed, and a review of the scientific literature was conducted. Results: a laparotomy with damage control surgery was performed, obtaining satisfactory outcomes, with hospital discharge without any added complications. Conclusions: neural therapy is a treatment for which there is not enough scientific evidence to support its safety in patients

Las ecuaciones predictoras de frecuencia cardiaca máxima no superan prueba clave de validación externa / Maximum heart rate prediction equations fail key external validation test / Equações de predição da frequência cardíaca máxima não superam teste-chave de validação externa

Resumen Las ecuaciones de frecuencia cardiaca máxima (FCmax) se han utilizado por su fácil obtención y practicidad, en comparación con las pruebas de esfuerzo. Sin embargo, la ecuación más conocida "220 − edad" presenta baja fiabilidad y desviaciones de hasta 12 lat/min. Se han planteado nuevas fórmulas, pero estas no han sido correctamente validadas. El propósito de este estudio fue validar 7 ecuaciones de predicción utilizando una base de datos independiente. Se utiliza una base con datos de 634 sujetos (474 hombres y 160 mujeres) de 18-85 años, que fueron obtenidos como parte de un servicio de salud desarrollado en la Universidad de Michigan entre 1990-1992. Los sujetos realizaron una prueba de vO2max en banda sin fin, siguiendo un protocolo libre. Se utilizó la técnica de regresión lineal, en la que las ecuaciones adecuadas fueron aquellas que cumplieron con las dos hipótesis: pendiente = 1 y constante = 0. De acuerdo con los resultados, ninguna de las ecuaciones analizadas para toda la muestra aceptó ambas hipótesis. Al realizar el análisis de acuerdo con el sexo, seis de las ecuaciones cumplieron con las dos hipótesis para las mujeres, pero ninguna para los hombres; y, cuando se realizó de acuerdo con el grupo de edad, 4 de las ecuaciones cumplieron las hipótesis para el grupo de personas de 40 años o menos, pero no para el grupo de mayores de 40 años. La FCmax parece ser difícil de predecir por una única ecuación, por lo que se recomienda que, cuando se necesite una medida válida de esta variable, se recurra a una prueba directa.

Abstract Maximum heart rate equations (HRmax) have been used due to their easy availability and practicality, as compared to stress tests. However, the best-known equation, "220 - age", shows low reliability and deviations of up to 12 beats/min. New formulae have been proposed, but they have not been correctly validated. The purpose of this study was to validate 7 prediction equations by using and independent data base. A data base of 634 subjects (474 men and 160 women) from 18-85 years of age, obtained within a health service developed at the University of Michigan from 1990-1992, has been used. The subjects performed a vO2max test in a treadmill, following a free protocol. A linear regression technique was used in which the appropriate equations were those that met the two hypotheses: slope = 1 and constant = 0. According to the results, none of the equations analyzed for the full sample accepted both hypotheses. When doing the analysis by sex, six of the equations met the two hypotheses for the women, but none of them for the men; and when the analysis was done by age group, 4 of the equations met the hypotheses for the group 40 years old or younger, but not for those above 40. The HRmax seems to be difficult to predict through a single equation. Therefore, it is recommended that, when a valid measure for this variable is needed, a stress test be used.

Resumo As equações de predição da frequência cardíaca máxima (FCmax) têm sido utilizadas devido à sua facilidade de obtenção e praticidade, quando comparadas aos testes de esforço. No entanto, a equação mais conhecida "220 − idade" apresenta baixa confiabilidade e desvios de até 12 batimentos/min. Foram propostas novas fórmulas, entretanto não foram devidamente validadas. O objetivo deste estudo foi validar 7 equações de predição usando um banco de dados independente. Utiliza-se um banco de dados de 634 indivíduos (474 homens e 160 mulheres) com idades entre 18 e 85 anos, obtidos como parte de um serviço de saúde desenvolvido na Universidade de Michigan entre 1990-1992. Os sujeitos realizaram um teste de vO2máx em uma esteira, seguindo um protocolo livre. Utilizou-se a técnica de regressão linear, na qual as equações apropriadas foram aquelas que preencheram as duas hipóteses: inclinação = 1 e constante = 0. De acordo com os resultados, nenhuma das equações analisadas para toda a amostra aceitou ambas as hipóteses. Ao realizar a análise por sexo, seis das equações atenderam às duas hipóteses para as mulheres, mas nenhuma para os homens; e, quando realizadas de acordo com a faixa etária, 4 das equações atenderam às hipóteses para o grupo de pessoas com 40 anos ou menos, mas não para o grupo de pessoas com mais de 40 anos. A FCmax parece ser difícil de prever por uma única equação, por isso recomenda-se que, quando uma medida válida dessa variável for necessária, seja utilizado um teste direto.

Editorial: ¿Cuál es el idioma de la ciencia? Nuevas declaraciones de consenso en español / Editorial: What is the Language of Science? New Consensus Statements in Spanish / Editorial: Qual é a linguagem da ciência? Novas declarações de consenso em espanhol

Resumen Se presentan algunas reflexiones relacionadas con la publicación de las primeras dos declaraciones de consenso en español. Se plantea la importancia de divulgar información de este tipo para promover la práctica profesional en ciencias del movimiento humano basada en la evidencia.

Abstract Reflections are presented about the publication of the first two consensus statements in Spanish. Publication of this type of information is key to promote evidence-based practice in human movement science professionals.

Resumo Algumas reflexões são apresentadas em relação à publicação das duas primeiras declarações de consenso em espanhol. Aborda-se a importância da divulgação de informações desse tipo para promover a prática profissional baseada em evidências na ciência do movimento humano.

A novel validation approach shows new, solid reasons why vertical jump height should not be used to predict leg power / Uma nova abordagem de validação acrescenta fortes razões para não usar a altura do salto vertical como um indicador de potência das pernas / Un novedoso enfoque de validación añade sólidas razones para no utilizar la altura del salto vertical como predictor de la potencia de piernas

Abstract Jump height continues to be widely used to predict power in humans. Individual progress is often monitored on the basis of estimated power, but prediction equations are based on group data. The objective of the study was to show that vertical jump performance (vJP) and mechanical power are poorly associated, particularly within individuals. Two experiments are presented. First, 52 physically active male college students performed five maximal vertical jumps each. Second, three young male participants performed 50 maximal jumps each. Participants rested for 1 minute between jumps. vJP was calculated from kinematic data as peak body center of mass (BCOM) minus standing BCOM; peak power (PEAKPWR) was calculated from the vertical ground reaction force registered by a force plate, and average power (MEANPWR) during propulsion from the change in potential energy of BCOM. Regression analyses were performed using standardized vJP scores as the predictor variable and standardized power scores as the resulting variables, expecting an identity function of y = x (intercept = 0, slope = 1) and R2 = 1. In experiment 1, the model for zPEAKPWR R2 = 0.9707 (p < 0.0001) but slope (0.3452) ≠ 1 (p < 0.0001). The model for zMEANPWR R2 = 0.9239 (p < 0.0001); nevertheless, slope (0.4257) ≠ 1 (p < 0.0001). In experiment 2, all individual models for zPEAKPWR and zMEANPWR resulted in poor associations (R2 ≤ 0.21) and slopes ≠ 1 (p≤0.001). In conclusion, regression analysis for individuals, and even for groups, confirms that vJP is a poor predictor of mechanical power.

Resumo A altura do salto ainda é amplamente usada para prever a potência em humanos. O progresso individual é frequentemente monitorado usando a estimativa de potência, mas as equações de previsão são baseadas em dados de grupo. O objetivo do estudo é demonstrar que a altura do salto vertical (ASv) e a potência mecânica têm uma correlação débil, principalmente em um mesmo indivíduo. São apresentados dois experimentos: primeiro, 52 estudantes universitários fisicamente ativos realizaram cinco saltos verticais máximos cada um; segundo, três participantes do sexo masculino realizaram 50 saltos máximos cada um. Os participantes descansaram por 1 minuto entre os saltos. A ASv foi calculada a partir de dados cinemáticos como a posição mais alta do centro de massa corporal (CMC) menos o CMC em pé; a potência de pico (PEAKPWR) foi calculada a partir da força de reação vertical registrada por uma plataforma de força e a potência média (MEANPWR) durante a propulsão a partir da mudança na energia potencial do CMC. As análises de regressão foram realizadas usando os escores da ASv padronizados como variável preditora e os escores de potência padronizados como variáveis de resultado, com a expectativa de obter uma função de identidade y = x (interceptação = 0, inclinação = 1) e R2 = 1. No experimento 1, o modelo para zPEAKPWR produziu R2 = 0,9707(p < 0,0001), mas a inclinação (0,3452) ≠ 1 (p = 8,7x10-15). O modelo para zMEANPWR apresentou R2 = 0,9239 (p < 0,0001); no entanto, a inclinação (0,4257) ≠ 1 (p = 1,15x10-5). No experimento 2, todos os modelos individuais para zPEAKPWR e zMEANPWR apresentaram associações débeis (R2 ≤ 0,21) e inclinações ≠ 1(p ≤ 0,001). Em conclusão, a análise de regressão para indivíduos e até mesmo para grupos confirma que a ASv é um indicador débil da potência mecânica.

Resumen La altura del salto se sigue usando ampliamente para predecir la potencia en seres humanos. El progreso individual, a menudo, se monitorea usando una estimación de la potencia, pero las ecuaciones de predicción se basan en datos grupales. El estudio pretende demostrar que la altura del salto vertical (ASv) y la potencia mecánica tienen una pobre correlación, particularmente en un mismo individuo. Se presentan dos experimentos; primero, 52 estudiantes universitarios físicamente activos ejecutaron cinco saltos verticales máximos cada uno; segundo, tres participantes masculinos ejecutaron 50 saltos máximos cada uno. Los participantes descansaron 1 minuto entre saltos. ASv se calculó a partir de los datos cinemáticos como posición más alta del centro de masa corporal (CDM) menos CDM de pie; la potencia pico (PEAKPWR) se calculó a partir de la fuerza vertical de reacción registrada por una plataforma de fuerza y la potencia promedio (MEANPWR) durante la propulsión a partir del cambio en la energía potencial del CDM. Se realizaron análisis de regresión usando puntajes estandarizados de ASv como la variable predictora y puntajes estandarizados de potencia como las variables resultantes, con la expectativa de obtener una función de identidad y = x (intercepto = 0, pendiente = 1) y R2 = 1. En el experimento 1, el modelo para zPEAKPWR arrojó R2 = 0.9707 (p <.0001) pero la pendiente (0.3452) ≠ 1 (p = 8.7x10-15). El modelo para zMEANPWR dio R2 = 0.9239 (p < .0001); sin embargo, la pendiente (0.4257) ≠ 1 (p = 1.15x10-5). En el experimento 2, todos los modelos individuales para zPEAKPWR y zMEANPWR arrojaron asociaciones débiles (R2 ≤ 0.21) y pendientes ≠ 1 (p ≤ .001). En conclusión, el análisis de regresión para individuos y aún para grupos confirma que la ASv es un pobre predictor de la potencia mecánica.

Use of hand-held ultrasound to perform E-FAST by general surgery residents in a trauma reference center: First experience in the Colombian Caribbean region / Uso de ecografía portátil para realizar E-FAST por residentes de cirugía general en un centro de referencia en trauma: primera experiencia en la región del Caribe colombiano

Introduction. Extended focused assessment with sonography for trauma (E-FAST) can be performed with minimal training and achieve ideal results. It allows easy transport and use in austere environments such as the Colombian Caribbean, where many centers do not have 24-hour radiology services. The objective of this study was to determine the performance of the use of E-FAST in the evaluation of trauma by second-year general surgery residents in the emergency department. Methods. Retrospective observational study that evaluated the diagnostic performance of E-FAST with Butterfly IQ, in patients with thoracoabdominal trauma, who attended a referral center in the Colombian Caribbean between November 2021 and July 2022. Sensitivity, specificity, and positive and negative predictive values were evaluated, compared with intraoperative findings or conventional imaging. Results. A total of 46 patients were included, with a mean age of 31.2 ± 13.8 years, 87.4% (n=39) were male. The main mechanism of trauma was penetrating (n=32; 69.5%). It was found that 80.4% (n=37) of the patients had a positive E-FAST result, and of these, 97% (n=35) had a positive intraoperative finding. Sensitivity, specificity, positive predictive value and negative predictive value were 92.1%, 75%, 94.6%, and 66.6%, respectively. The positive likelihood ratio was 3.68, while the negative likelihood ratio was 0.10. Conclusion. General surgery residents have the competence to perform accurate E-FAST scans. The hand-held ultrasound device is an effective diagnostic tool for trauma and acute care surgery patients.

Introducción. La evaluación enfocada extendida con ecografía en trauma (E-FAST, extended focused assessment with sonography for trauma) puede realizarse con entrenamiento mínimo y lograr resultados ideales. Su fácil transporte permite usarla en entornos austeros, como el Caribe colombiano, donde muchos centros no disponen de servicio radiológico las 24 horas. El objetivo de este estudio fue determinar el rendimiento del uso de E-FAST por residentes de cirugía general de segundo año en la evaluación del paciente con trauma en urgencias. Métodos. Estudio observacional retrospectivo que evaluó el rendimiento diagnóstico de E-FAST con Butterfly IQ, en pacientes con trauma toracoabdominal que acudieron a un centro de referencia del Caribe colombiano, entre noviembre de 2021 y julio de 2022. Se evaluaron sensibilidad, especificidad, valores predictivos positivo y negativo, comparando la descripción de la ecografía con los hallazgos intraoperatorios o imagenología convencional. Resultados. Se incluyeron un total de 46 pacientes, con una media de edad de 31,2 ± 13,8 años, siendo el 87,4 % (n=39) hombres. El principal mecanismo de trauma fue penetrante (n=32; 69,5 %). Se encontró que el 80,4 % (n=37) de los pacientes tuvo resultado E-FAST positivo, y que, de estos, el 97 % (n=35) tuvo un hallazgo positivo intraoperatorio. Se calculó una sensibilidad de 92,1 %, especificidad de 75 %, valor predictivo positivo de 94,6 % y negativo de 66,6 %; la razón de verosimilitud positiva fue de 3,68 y la negativa de 0,10. Conclusión. Los residentes de cirugía general están capacitados para realizar exploraciones E-FAST precisas. El ecógrafo portátil es una herramienta de diagnóstico eficaz para pacientes traumatizados.