Vascularized adipose tissue engineering: moving towards soft tissue reconstruction.

Soft tissue defects are a common clinical challenge mostly caused by trauma, congenital anomalies and oncological surgery. Current soft tissue reconstruction options include synthetic materials (fillers and implants) and autologous adipose tissue transplantation through flap surgery and/or lipotransfer. Both reconstructive options hold important disadvantages to which vascularized adipose tissue engineering (VATE) strategies could offer solutions. In this review, we first summarized pivotal characteristics of functional adipose tissue such as the structure, function, cell types, development and extracellular matrix (ECM). Next, we discussed relevant cell sources and how they are applied in different state-of-the-art VATE techniques. Herein, biomaterial scaffolds and hydrogels, ECMs, spheroids, organoids, cell sheets, three dimensional printing and microfluidics are overviewed. Also, we included extracellular vesicles and emphasized their potential role in VATE. Lastly, current challenges and future perspectives in VATE are pointed out to help to pave the road towards clinical applications.

Relación entre la carga laboral de enfermería y la gravedad del paciente en unidades de cuidado intensivo de adultos / Relationship between the Nursing Workload and the Severity of the Patient's Condition in Adult Intensive Care Units / Relação entre carga de trabalho de enfermagem e estado grave do paciente em unidades de cuidados intensivos para adultos

Objetivo: determinar la relación entre la demanda de carga laboral de enfermería y la gravedad del paciente en unidades de cuidados intensivos de adultos en la ciudad de Cartagena, en el mes de julio de 2008. Método: investigación de corte longitudinal. Muestra de 42 pacientes, se obtuvieron registros TISS-28 y registros Apache II. Se realizó el cálculo de media aritmética, desviación estándar y proporciones, así como el cálculo del coeficiente de correlación de Pearson. Resultados: participaron 42 pacientes; la media para la edad fue 58,2 años (IC 95% 52,1-64,4). El 51,3% fueron mujeres. Se obtuvieron 42 calificaciones del Apache II al ingreso de los pacientes a la UCI con un promedio de 28,9, de los cuales el 66,7% (28) tienen un mal pronóstico, y 188 calificaciones de TISS-28, con un promedio de 28,7c (IC 95% 25,7-31,7). El promedio de TISS de egreso fue de 25,7 (IC 95% 22,4-28,9) por paciente. El 61,9% de los pacientes perteneció a la clase III. La razón enfermera/paciente clase IV fue de 0,57 inferior a 1:1(1). Se encontró una asociación entre el Apache II y TISS-28 de 0,55 (0,501-0,75) y un coeficiente de determinación de 0,38 (p<0,05). Conclusiones: existe una moderada correlación entre el TISS-28 y el Apache II dejando ver sobrecarga de trabajo de enfermería en las UCI, lo que repercute en la atención directa al paciente crítico.

Objective: To determine the relationship between the demands of the nursing workload and the severity of the patient's condition in adult intensive care units in the city of Cartagena during July 2008. Methodo: This is a longitudinal study with a sample comprised of 42 patients. TISS-28 (Therapeutic Intervention Scoring System) and Apache II (Acute Physiology and Chronic Health Evaluation) records were obtained. Arithmetic average, standard deviation and proportions were calculated, as was the Pearson correlation coefficient. Results: In this study involving a total of 42 patients, the average age was 58.2 years (IC 95% 52.1-64.4), and 51.3 percent of the patients in the sample were women. Forty-two (42) Apache II evaluations were obtained when the patients were admitted to the ICU, with an average of 28.9, and 66.7 percent if the patients (28) have a poor prognosis. There were 188 TISS-28 scores, with an average of 28.7 (IC 95% 25.7 - 31.7) per patient. The average TISS upon release from the ICU was 25.7 (95% CI 22.4 to 28.9) per patient. In all, 61.9 per cent of the patients were Class III. The nurse/ Class IV patient ratio was 0.57 less than 1:1. The study found a relationship of 0.55 between Apache II and TISS-28. (0.501-0.75) and a coefficient of determination equal to 0.38 (p<0.05). Conclusions: There is a moderate correlation between TISS-28 and Apache II that shows an overload of nursing work in intensive care units. This has repercussions on the direct care provided to critical patients.

Objetivo: determinar a relação entre a demanda por carga de trabalho de enfermagem e estado grave do paciente em unidades de cuidados intensivos para adultos na cidade de Cartagena em julho de 2008. Método: pesquisa longitudinal. Amostra de 42 pacientes. Lograram-se registros TISS-28 e Apache II. Calculou-se a média aritmética, o desvio padrao e proporções, o cálculo do coeficiente de correlação de Pearson. Resultados: 42 pacientes participaram. A idade média foi de 58,2 anos (IC 95%, 52,1-64,4). O 51,3% eram mulheres. Na UCI obtiveram-se 42 registros de APACHE II na admissão dos pacientes, com uma média de 28,9 no qual 66,7% (28) têm um mau prognóstico, e 188 do TISS-28 registros com uma média de 28,7 (IC 95%, 25,7-31,7). O TISS médio de saída foi de 25,7 (IC 95%, 22,4-28,9) por paciente. O 61,9% dos pacientes pertenciam à classe III. A relação enfermeira/paciente foi 0,57 de Classe IV, menos de 1:1 (1). Entre APACHE II e TISS-28 achou-se uma relação de 0,55 (0,501-0,75) e um coeficiente de determinação de 0,38 (p < 0,05). Conclusóes: existe correlação moderada entre o TISS-28 e II Apache, que mostra sobrecarga de trabalho de enfermagem nas UCI. Esta situação influência no atendimento direto de pacientes críticos.