The burden of major complications on failure to rescue after surgery for acute type A aortic dissection: Analysis of more than 19,000 patients.

BACKGROUND: The relationship between the number and type of postoperative complications and mortality in the setting for surgery for acute type A aortic dissection (ATAAD) remains underexplored despite its critical role in the failure-to-rescue (FTR) metric. METHODS: This retrospective study used data from the Society of Thoracic Surgeons Adult Cardiac Surgical Database on ATAAD surgeries performed between January 2018 and December 2022. Patients were categorized based on their number of major complications. The primary outcome was FTR. We used multilevel regression and classification and regression tree models. RESULTS: We included 19,243 patients (33% females), with a median age of 61 years. Regarding complications, 47.7% of patients had 0, 20.2% had 1, 12.7% had 2, and 19.4% experienced 3 or more. The most frequently reported complications were prolonged mechanical ventilation (30.3%), unplanned reoperation (19.5%), and renal failure (17.2%). Cardiac arrest occurred in 7.1% of cases. FTR increased from 13% in patients with 1 complication to >30% in those with 4 or more complications. Cardiac arrest (adjusted odds ratio [aOR], 10.9) and renal failure (aOR, 5.3) had the highest odds for mortality, followed by limb ischemia (aOR, 2.7), stroke (aOR, 2.6), and gastrointestinal complications (aOR, 2.4). Hospitals in the top performance quartile consistently showed lower FTR rates across all levels of complication. CONCLUSIONS: The study validates a dose-response association between postoperative complications and mortality in patients undergoing surgery for ATAAD. Top-performing hospitals consistently show lower FTR rates independent of the number of complications. Future research should focus on the timing of complications and interventions to reduce the burden of complications.

Volume-failure-to-rescue relationship in acute type A aortic dissections: An analysis of The Society of Thoracic Surgeons Database.

OBJECTIVE: To determine the relationship between volume of cases and failure-to-rescue (FTR) rate after surgery for acute type A aortic dissection (ATAAD) across the United States. METHODS: The Society of Thoracic Surgeons adult cardiac surgery database was used to review outcomes of surgery after ATAAD between June 2017 and December 2021. Mixed-effect models and restricted cubic splines were used to determine the risk-adjusted relationships between ATAAD average volume and FTR rate. FTR calculation was based on deaths associated with the following complications: venous thromboembolism/deep venous thrombosis, stroke, renal failure, mechanical ventilation >48 hours, sepsis, gastrointestinal complications, cardiopulmonary resuscitation, and unplanned reoperation. RESULTS: In total, 18,192 patients underwent surgery for ATAAD in 832 centers. The included hospitals' median volume was 2.2 cases/year (interquartile range [IQR], 0.9-5.8). Quartiles' distribution was 615 centers in the first (1.3 cases/year, IQR, 0.4-2.9); 123 centers in the second (8 cases/year, IQR, 6.7-10.2); 66 centers in the third (15.6 cases/year, IQR, 14.2-18); and 28 centers in the fourth quartile (29.3 cases/year, IQR, 28.8-46.0). Fourth-quartile hospitals performed more extensive procedures. Overall complication, mortality, and FTR rates were 52.6%, 14.2%, and 21.7%, respectively. Risk-adjusted analysis demonstrated increased odds of FTR when the average volume was fewer than 10 cases per year. CONCLUSIONS: Although high-volume centers performed more complex procedures than low-volume centers, their operative mortality was lower, perhaps reflecting their ability to rescue patients and mitigate complications. An average of fewer than 10 cases per year at an institution is associated with increased odds of failure to rescue patients after ATAAD repair.

La Economia Colaborativa: propuesta de bases conceptuales para su estudio / The Sharing Economy: a proposal of conceptual basis for its study / A Economia Colaborativa: uma proposta de base conceptual para o seu estudo

RESUMEN En este documento se presentan las bases conceptuales para el estudio de la Economia Colaborativa. Se plantean las diferencias entre las modalidades de intercambio econômico emergentes a partir de la mediación tecnológica, tales como la economia de conciertos y la economia digital. Para esto, se realizó una búsqueda bibliográfica a partir de la metodologia de revision sistemática de literatura para ciencias sociales y económicas en Scopus, WoS y Redalyc en el periodo 2008-2019. Este ejercicio permitió ubicar a la economia colaborativa como una nueva institución económica que posee cuatro subsectores: consumo, producción, educación y finanzas. La economía colaborativa se distingue por las soluciones particulares, la forma de solucionar las necesidades de las personas y en la creación de comunidad. El documento concluye que a) es importante que la academia y los estados miren con detenimiento las diferencias entre las modalidades estudiadas y b) la economia colaborativa es un mecanismo para el cambio social.

ABSTRACT This paper presents the conceptual bases for the study of the Sharing Economy. The differences between the modalities of economic exchange emerging from technological mediation, such as the gig economy and the digital economy are presented. For this purpose, a literature search was conducted using the systematic literature review methodology for social sciences and economics in Scopus, WoS and Redalyc in the period 2008-2019. This exercise allowed us to locate the Sharing Economy as a new economic institution with four subsectors: consumption, production, education and finance. The Sharing Economy is distinguished by particular solutions, the way of solving people's needs and in the creation of community. The document concludes that a) it is important for academia and states to look carefully at the differences between the modalities studied and b) the collaborative economy is a mechanism for social change.

RESUMO Este documento apresenta a base conceitual para o estudo da Economia Colaborativa. As diferenças entre os modos emergentes de intercâmbio econômico através da mediação tecnológica, como a economia gig e a economia digital, são discutidas. Para este fim, foi realizada uma pesquisa bibliográfica utilizando a metodologia de revisão sistemática de literatura para ciências sociais e economia em Scopus, WoS e Redalyc no periodo 2008-2019. Este exercício nos permitiu identificar a economia colaborativa como uma nova instituição econômica com quatro sub-setores: consumo, produção, educação e finanças. A economia colaborativa se distingue por soluções particulares na forma como as necessidades das pessoas são resolvidas e na criação de comunidade. O documento conclui que a) é importante para o meio acadêmico e os estados examinar de perto as diferenças entre as modalidades estudadas e b) a economia colaborativa é um mecanismo de mudança social.

Relación entre la cuenta de Twitter @ascolcirugia y las publicaciones de la Revista Colombiana de Cirugía durante la pandemia / Relationship between the Twitter account @ascolcirugia and the publications of the Colombian Journal of Surgery during the pandemic

Introducción. Indicadores alternativos basados en la web 2.0 han tomado importancia para medir el impacto de la producción científica. Previamente se han demostrado correlaciones positivas entre indicadores tradicionales y alternativos. El objetivo de este trabajo fue evaluar la relación de estos indicadores en el campo de la cirugía de nuestro país.Métodos. Análisis retrospectivo de las publicaciones de la Revista Colombiana de Cirugía y "tweets" de la cuenta @ascolcirugia entre marzo 2020 y julio 2021. Se evaluaron comparativamente los artículos con y sin publicación en la cuenta @ascolcirugia. Se determinó la correlación entre indicadores alternativos e indicadores tradicionales de las publicaciones de la revista. Resultados. En total se revisaron 149 artículos y 780 "tweets"; tan sólo el 13,4 % (n=20) de los artículos tuvieron visibilidad en la cuenta @ascolcirugia, con una mediana de 2 "tweets" (RIQ 1-2) por artículo, siendo la mayoría de estos sobre temas de COVID-19 (85 % vs 10 %; p<0,001). Los artículos publicados en @ascolcirugia tuvieron una mayor mediana de descargas (220 vs 116; p<0,001) y citaciones (3,5 vs 0; p<0,001) en comparación con los que no fueron publicados.Conclusión. El uso de las redes sociales tiene un efecto positivo en el número de lectores de la Revista Colombiana de Cirugía y el impacto académico de los autores. Aunque existe una buena correlación entre indicadores alternativos y tradicionales en el contexto nacional, la proporción de artículos de la Revista Colombiana de Cirugía publicados en la cuenta @ascolcirugia es baja.

Introduction. Alternative indicators based on web 2.0 have gained great relevance to measure the impact of scientific production. Positive correlations between traditional and alternative indicators have previously been shown. The objective of our article is to evaluate the relationship of these indicators in the field of surgery in our country.Methods. Retrospective analysis of the publications of the Colombian Journal of Surgery and tweets of the Twitter account (@ascolcirugia) during March 2020 and July 2021. Articles with and without tweets in the account @ascolcirugia were comparatively evaluated. The correlation between alternative indicators and traditional indicators of the journal's publications was determined. Results. A total of 149 articles and 780 tweets were reviewed; only 13.4% (n=20) of the articles had visibility at the @ascolcirugia account, with a median of 2 tweets (RIQ 1-2) per article, most of which were on COVID-19 issues (85% vs 10%; p<0.001). The articles published at the @ascolcirugia account had a higher median number of downloads (220 vs 116; p<0.001) and citations (3.5 vs 0; p<0.001) compared to the articles that were not published. Conclusions. The use of social media has a positive effect on the number of readers of the Colombian Journal of Surgery and the academic impact of the authors. Although there is a good correlation between alternative and traditional indicators, in the national context, the proportion of articles of the Colombian Journal of Surgery published at the @ascolcirugia account is low

The impact of prolonged mechanical ventilation after acute type A aortic dissection repair.

OBJECTIVE: Patients with type A aortic dissection have increased resource use. The objective of this study was to describe the relationship between prolonged mechanical ventilation and longitudinal survival in patients undergoing type A aortic dissection repair. METHODS: We conducted a retrospective analysis of patients with type A aortic dissection undergoing repair from 2010 to 2018; Kaplan-Meier function and adjusted Cox regression analysis were used to compare in-hospital mortality and longitudinal survival accounting for time on mechanical ventilatory support. RESULTS: A total of 552 patients were included. The study population was divided into 12 hours or less (n = 291), more than 12 to 24 or less hours (n = 101), more than 24 to 48 hours or less (n = 60), and more than 48 hours (n = 100) groups. Patients within the 12 or less hours group were the youngest (60.0 vs 63.5 years vs 63.6 vs 62.8 years; P = .03) and less likely to be female (31.6% vs 43.6% vs 46.7% vs 56.0%; P < .001). On the other hand, the more than 48 hours group presented with malperfusion syndrome at admission more often (24.4% vs 29.7% vs 28.3% vs 53.0%; P < .001) and had longer cardiopulmonary and ischemic times (P < .05). In-hospital mortality was significantly higher in the more than 48 hours group (5.2% vs 6.9% vs 3.3% vs 30.0%; P < .001). Multivariable analysis demonstrated worse longitudinal survival for the 24 to 48 hours group (hazard ratio, 1.94, confidence interval, 1.10-3.43) and more than 48 hours ventilation group (hazard ratio, 2.25, confidence interval, 1.30-3.92). CONCLUSIONS: The need for prolonged mechanical ventilatory support is prevalent and associated with other perioperative complications. More important, after adjusting for other covariates, prolonged mechanical ventilation is an independent factor associated with increased longitudinal mortality.

Central versus peripheral cannulation for acute type A aortic dissection.

OBJECTIVE: This study sought to evaluate the impact of central aortic versus peripheral cannulation on outcomes after acute type A aortic dissection repair. METHODS: This was an observational study using an institutional database of acute type A aortic dissection repairs from 2007 to 2021. Patients were stratified according to central, subclavian, or femoral cannulation. Kaplan-Meier survival estimation and multivariable Cox regression were performed. RESULTS: The study population consisted of 577 patients who underwent acute type A aortic dissection repair. Of these, central cannulation was used in 490 patients (84.9%), subclavian cannulation was used in 54 patients (9.4%), and femoral cannulation was used in 33 patients (5.7%). Rates of peripheral vascular disease, aortic insufficiency moderate or greater, and cerebral malperfusion differed significantly among the groups, but baseline characteristics were otherwise comparable (P > .05). Operative mortality was lowest in the central cannulation group (9.8%), but this did not differ significantly among the groups. Kaplan-Meier survival estimates were similar among the groups. On multivariable Cox regression, cannulation strategy was not significantly associated with long-term survival. CONCLUSIONS: Acute type A aortic dissection repair can be safely performed through central aortic cannulation, with outcomes comparable to those obtained with subclavian or femoral cannulation.

Fuentes de energía en apendicectomía laparoscópica en un programa académico de Cirugía general en Colombia / Energy sources in laparoscopic appendectomy in an academic program of General Surgery in Colombia

Introducción. La apendicectomía por laparoscopia se considera el patrón de oro en el tratamiento de la apendicitis aguda. Sin embargo, su disponibilidad es limitada en nuestro sistema de salud, principalmente por los costos asociados. El objetivo de este estudio fue evaluar la relación entre el uso de los diferentes tipos de energía y los métodos de ligadura de la base apendicular, con las complicaciones postoperatorias, al igual que describir los costos asociados. Métodos. Estudio observacional analítico de una cohorte retrospectiva de pacientes mayores de 15 años a quienes se les realizó apendicectomía por laparoscopia, en un hospital universitario entre los años 2014 y 2018. Se utilizaron modelos de regresión logística y lineal para evaluar la relación entre métodos de ligadura del meso y base apendicular, desenlaces operatorios y costos. Resultados. Se realizaron 2074 apendicectomías por laparoscopia, 58,2 % (n=1207) en mujeres, la edad mediana fue de 32 años. En el 71,5 % (n=1483) la apendicitis aguda no fue complicada. La energía monopolar para la liga-dura del meso apendicular fue la utilizada más frecuentemente en 57,2 % (n=1187) y el Hemolok® el más utilizado para la ligadura de la base apendicular en el 84,8 % (n=1759) de los pacientes. No se observaron diferencias estadísticamente significativas en la tasa de infección del sitio operatorio, reintervención o íleo. El uso de energía simple redujo los costos del procedimiento de manera significativa durante el período evaluado. Discusión. El uso de energía monopolar demostró ser una técnica segura, reproducible y de menor costo en comparación con el uso de energía bipolar, independientemente de la fase de la apendicitis aguda. Lo anterior ha permitido que se realicen más apendicectomías por laparoscopia y que los médicos residentes de cirugía general puedan realizar procedimientos laparoscópicos de forma más temprana

Introduction. Laparoscopic appendectomy is considered the gold standard in the treatment of acute appendicitis. However, its availability is limited in our health system mainly due to the associated costs. The objective of this study is to evaluate the relationship between the use of different types of energy and the methods of ligation of the appendicular base with postoperative complications, as well as to describe the associated costs. Methods. Retrospective observational study of a cohort of patients older than 15 years old who underwent laparoscopic appendectomy in a university hospital between 2014 and 2018. Logistic and linear regression models were used to evaluate the relationship between methods of ligation of the meso and appendicular base, operative outcomes and costs. Results: 2074 laparoscopic appendectomies were performed. Of those, 58.2% (n=1207) were women, median age was 32 years. In 71.5% (n=1483), acute appendicitis was uncomplicated. Monopolar energy for ligation was the most frequently used for ligation of the appendicular meso in 57.2% (n=1187) and Hem-o-lok® the most used for ligation of the appendicular base in 84.8% (n=1759) of the patients. There were no statistically significant differences in the rate of surgical site infection, reoperation, or ileus. The use of simple energy reduced the costs of the procedure significantly during the study period. Discussion. The use of monopolar energy proved to be a safe, reproducible and a lower cost technique compared to the use of bipolar energy, regardless of the phase of acute appendicitis. This has allowed more laparoscopic appendectomies to be performed and the general surgery residents to perform laparoscopic procedures earlier

The collateral impact of COVID19 among surgeonsand residents: Second cross-sectional survey about the Colombian perspective / El impacto colateral del COVID-19 entre cirujanos y residentes: Segunda encuesta transversal sobre la perspectiva colombiana

Introduction. The COVID-19 pandemic has led health services to adapt, surgical training has had to restructure, and personal life has had to thrive hardships. We aimed to describe the evolution of surgeons' and residents' per-ceptions about the impact COVID-19 has had on Colombia's surgical practice.Methods. Descriptive cross-sectional study using a structured electronic survey among general surgery residents, and graduated surgeons who have a clinical practice in Colombia.Results. 355 participants were included, with a median age of 37 years (IQR 30, 51), and 32.1% female. There were 28.7% residents, 43.3% general surgeons, and 27.8% subespecialist in surgery. Overall, 48.7% of respondents were from Bogotá, and 38.8% worked at academic private hospitals. Although almost all participants reported having used telemedicine platforms during the pandemic, 58% of the respondents did not view telemedicine as sufficient for follow-up consults. More than 80% of surgeons surveyed reported that their monthly incomes had been reduced. Discussion. The second survey showed a better-perceived adherence to safety protocols at their institutions than at the beginning of the pandemic. However, the toll on economic and academic domains are substantial among the surgical community. As the pandemic's effects are expected to last longer in our region, telemedicine services acceptance and healthcare providers' job stability need to be improved in Colombia

Introducción. La pandemia ha llevado a los servicios de salud a adaptarse, la formación quirúrgica ha tenido que reestructurarse y la vida personal ha tenido que prosperar en las dificultades. Nuestro objetivo fue describir la evolución de las percepciones de cirujanos y médicos residentes sobre el impacto que ha tenido el COVID-19 en la práctica quirúrgica de Colombia. Métodos. Estudio de corte transversal descriptivo mediante encuesta estructurada distribuida electrónica-mente a médicos residentes de cirugía general, cirujanos generales o sub-especialistas, con práctica clínica en Colombia. Resultados. Se incluyeron 355 participantes, con una mediana de edad de 37 años (RIC 30-51) y el 32,1 % fueron mujeres. El 28,7 % eran médicos residentes, el 43,3 % cirujanos generales y el 27,8 % subespecialistas en cirugía. El 48,7 % de los encuestados vivían en Bogotá y el 38,8 % trabajaba en hospitales académicos privados. Aunque la mayoría ha utilizado plataformas de telemedicina durante la pandemia, el 58 % de los encuestados no consideró que la telemedicina fuera suficiente para las consultas postoperatorias. Más del 80 % de los cirujanos encuestados informaron que sus ingresos mensuales se habían reducido. Discusión. La segunda encuesta mostró una mejor percepción de la adherencia a los protocolos de seguridad en sus instituciones que al comienzo de la pandemia. Sin embargo, el costo en los dominios económicos y académicos es considerable entre la comunidad quirúrgica. Dado que se espera que los efectos de la pandemia duren más en nuestra región, es necesario mejorar la aceptación de los servicios de telemedicina y la estabilidad laboral de los proveedores de atención médica en Colombia

The Impact of Donor Asphyxiation or Drowning on Pediatric Lung Transplant Recipients.

BACKGROUND: Donors with drowning or asphyxiation (DA) as a mechanism of death (MOD) are considered high risk in pediatric lung transplantation. We sought to evaluate whether recipients of DA donors had negatively impacted outcomes. METHODS: Pediatric recipients recorded in the United Network for Organ Sharing registry between 2000 and 2019 were included. Primary stratification was donor MOD. Propensity matching with a 1:1 ratio was performed to balance the DA and non-DA MOD donor cohorts. Cox multivariable regression was used to determine the risk-adjusted impact of donor MOD. A subanalysis of the effect of lung allocation score was also evaluated. RESULTS: A total of 1016 patients underwent bilateral lung transplantation during the study period, including 888 (85.6%) from non-DA donors and 128 (14.4%) from DA donors. Survival at 90 days, 1 year, and 2 years were similar in the matched and unmatched cohorts regardless of the donor MOD. Moreover, separate risk-adjusted analysis of drowning and asphyxiated donors was similar to other MOD donors at 30 days, 1 year, and 5 years. Similar survival findings persisted regardless of pretransplant lung allocation score. Although the rates of posttransplant stroke (1.0% versus 3.1%, P = 0.04) and the length of hospital stay (19 versus 22 d, P = 0.004) were elevated in the unmatched DA MOD recipients, these differences were mitigated after propensity matching. CONCLUSIONS: This study evaluated the impact of DA MOD donors in pediatric lung transplant recipients and found similar rates of complications and survival in a propensity-matched cohort. These data collectively support the consideration of DA MOD donors for use in pediatric lung transplantation.

Inteligencia emocional y práctica clínica en tiempos de pandemia / Emotional intelligence and clinical practice in pandemic times

Resumen Los cambios generados por la pandemia COVID-19 han significado innumerables retos en la práctica clínica, en los que el personal de salud ha tenido que adaptarse profesional y emocionalmente. Fortalecer la inteligencia emocional en los profesionales de la salud contribuye a su bienestar personal, previene el síndrome de burnout y ayuda a la creación de ambientes laborales seguros, objetivos fundamentales a la hora de enfrentar desafíos como la pandemia actual. Cuatro habilidades de la inteligencia emocional que son particularmente importantes en la práctica clínica (autoconciencia, autorregulación, conciencia social y manejo de relaciones) son objeto de reflexión en el presente artículo.

Abstract The changes generated by the COVID-19 pandemic have meant countless challenges in clinical practice, in which health personnel have had to adapt professionally and emotionally. Four skills in emotional intelligence that are particularly important in clinical practice (self-awareness, self-regulation, social awareness and relationship management) are the subject of reflection in this article. Strengthening emotional intelligence in health professionals contributes to their personal well-being, prevents burnout syndrome and helps create safe working environments, which are fundamental objectives when facing challenges such as the current pandemic.

Percepción de la pandemia COVID-19 en los servicios de cirugía en Colombia / Perception of the COVID-19 pandemic in the departments of surgery in Colombia

Introducción. La pandemia por COVID-19 ha llevado a modificar la estructura asistencial en los hospitales alrededor del mundo, buscando la mejor forma de adaptarse para responder al incremento de pacientes infectados por el virus, sin desatender las necesidades de los pacientes no afectados por el mismo. El objetivo de este trabajo es describir la percepción de la comunidad quirúrgica sobre el impacto que ha tenido la pandemia COVID-19 en los servicios de cirugía en Colombia.Métodos. Estudio de corte transversal descriptivo mediante encuesta estructurada compuesta por 10 preguntas de selección múltiple y 8 preguntas con ítems tipo Likert. Se distribuyó electrónicamente a residentes de cirugía general, cirujanos generales o sub-especialistas que tuvieran práctica clínica en Colombia. Resultados. Se incluyeron 464 participantes, 27.8 % fueron mujeres y 45.3 % cirujanos generales. Alrededor de la mitad residían en Bogotá (51.4 %) o trabajaban en un hospital universitario privado (48.3 %). El 78.8% de los encuestados consideraron que las recomendaciones de seguridad son efectivas y 76.6% se sienten seguros realizando procedimientos con ellas. Sin embargo, el 63% consideran que estas se cumplen parcialmente. Hasta el momento, 20% de los participantes reportó haber tenido contacto directo con pacientes COVID-19 positivos. Finalmente, la mayoría (93%) están de acuerdo con la cancelación de procedimientos electivos y están dispuestos a ser reubicados en otros servicios en caso de ser necesario. Conclusiones. Para el inicio de la fase de mitigación en Colombia existe consenso en la percepción del impacto de la pandemia COVID-19 en los servicios de cirugía. No se observó una variabilidad significativa respecto al nivel de entrenamiento ni al tipo de institución hospitalaria

Introduction: The COVID-19 pandemic has led to changes in the care structure in hospitals around the world, seeking the best way to adapt in response to the increase in patients infected with the virus, without neglecting the needs of patients not affected by it. The objective of this study is to describe the perception of the surgical community on the impact that the COVID-19 pandemic has had on the surgical services in Colombia.Methods: Descriptive cross-sectional study using a structured survey consisting of 10 multiple-choice questions and 8 questions with Likert-type items. It was distributed electronically to residents of general surgery, general surgeons, or sub-specialists who had clinical practice in Colombia.Results: 464 participants were included, 27.8% were women and 45.3% were general surgeons. About half resided in Bogotá (51.4%) or worked in a private university hospital (48.3%). 78.8% of the respondents considered that the safety recommendations are effective and 76.6% feel safe performing procedures with them. However, 63% con-sider that these are partially met. So far, 20% of participants reported having had direct contact with COVID-19 positive patients. Finally, the majority (93%) agree to the cancellation of elective procedures and are willing to be relocated to other services if necessary.Conclusions: There is a consensus in the perception of the COVID-19 pandemic impact in the surgery services without observing significant variability regarding the level of training or the type of hospital institution

Periodized Aerobic Interval Training Modifies Geometric Indices of Heart Rate Variability in Metabolic Syndrome.

Background: Metabolic syndrome (MetS) influences the autonomic modulation, increasing the risk of cardiovascular events, which demands the identification of effective treatments for this population. Considering this, the study has the objective of evaluating the effects of periodized aerobic interval training (AIT) on geometrical methods of heart rate variability (HRV) on individuals with MetS. Methods: 52 individuals with MetS were considered for analysis. They were divided into two groups: aerobic interval training group (AITG; n = 26) and control group (CG; n = 26). The AITG performed 16 weeks of periodized AIT. For HRV analysis, the heart rate was recorded beat-by-beat at the beginning and the end of the AIT program and geometrical methods were used for analysis. Results: significant increase was observed for triangular index (RRtri, -1.25 ± 0.58 vs. 1.41 ± 0.57), standard deviation of distances from diagonal to points (SD1, -0.13 ± 1.52 vs. 4.34 ± 1.49), and standard deviation of distances from points to lines (SD2, -2.14 ± 3.59 vs. 11.23 ± 3.52) on AITG compared to CG. Significant differences were not observed for triangular interpolation of normal heartbeats interval histogram (TINN, -4.05 ± 17.38 vs. 25.52 ± 17.03) and SD1/SD2 ratio (0.03 ± 0.02 vs. 0.00 ± 0.02). Qualitative analysis of the Poincaré plot identified increase on dispersion of both short and long-term intervals between successive heartbeats (RR interval) on AITG after the AIT program. Conclusion: geometric indices of HRV suggest an increase in cardiac autonomic modulation in individuals with MetS after 16 weeks of periodized AIT.

Experiencia y curva de aprendizaje de apendicectomía y colecistectomía laparoscópica de los residentes de cirugía general en un hospital latinoamericano / General Surgery Residents Experience and Learning Curve for Laparoscopic Appendectomy and Cholecystectomy in a Latin American Hospital

Introducción: La cirugía laparoscópica ha revolucionado el manejo quirúrgico de los pacientes y ha generado una necesidad de capacitación en el área. El rendimiento en la vida real es lo que permite una determinación global de las competencias en un procedimiento y establece un método de formación. El objetivo de este estudio es describir la evolución en la experiencia quirúrgica de un grupo de residentes de cirugía general. Metodología: Estudio observacional analítico de cohorte retrospectiva en el Hospital Universitario San Ignacio. Incluyó 4191 procedimientos realizados, divididos en 1045 apendicectomías laparoscópicas (AL) y 3146 colecistectomías laparoscópicas (CL), realizadas por un total de 52 residentes entre enero de 2008 y diciembre de 2014. Resultados: Tanto en AL como en CL se observó un aumento en el número de procedimientos anuales. Al comparar los tiempos promedios de AL por año de residencia, se observó una tendencia a la disminución en la mediana a medida que el residente era mayor. Las complicaciones intraoperatorias fueron del 0,77% para AL y del 1,9% para CL. La complicación postoperatoria más frecuente fue infección del sitio operatorio con una mortalidad menor al 0,5%. Conclusión: Los resultados evocan la necesidad de continuar con programas de residencia que proporcionen preparación adecuada en el abordaje laparoscópico, posiblemente con exposición cada vez más temprana a procedimientos mínimamente invasivos.

Introduction: Laparoscopic surgery has revolutionized the surgical management of patients, generating a need for training in the area. The performance in real life is what allows a global determination of the competences in a procedure and establishes a method of training. The objective of this study is to describe the evolution in the surgical experience of a group of residents of general surgery.Methodology: Observational analytical study of a retrospective cohort at the University Hospital San Ignacio. It included 4191 surgical procedures divided in 1045 laparoscopic appendectomies (LA) and 3146 laparoscopic cholecystectomies (LC) performed by a total of 52 residents between January 2008 and December 2014. Results: Both LA and LC showed an increase in the number of annual procedures. When comparing the average times of AL per year of residence, a tendency to decrease in the median was observed, as the resident was older. The intraoperative complications were 0.77% for LA and 1.9% for LC; being the most frequent postoperative complication ISO with mortality <0.5%. Conclusion: The results evoke the need to continue with residency programs that provide adequate preparation in the laparoscopic approach, possibly with increasingly early exposure to minimally invasive procedures.

Lesões musculares em atletas do sexo masculino atendidos no Centro de Estudos e Atendimento em Fisioterapia de Presidente Prudente - SP / Muscle injuries in male athletes at the Center of Studies and Physiotherapy Services of Presidente Prudente - SP / Lesiones musculares en atletas de sexo masculino atendidos en el Centro de Estudios y Atención en Fisioterapia de Presidente Prudente - SP

Resumo Objetivou-se caracterizar e determinar a frequência de lesões musculares (LM) de atletas atendidos em uma clínica universitária de fisioterapia. Foram feitas análises de prontuários e caracterizaram-se dados antropométricos, locais anatômicos, tratamentos usados, dentre outros. Foram identificados 47 casos de LM, distribuídas em grau I (n = 13) e grau II (n = 34). O segmento coxa foi o local anatômico mais acometido com 63,1% (p < 0,05) e 85,7% (p < 0,01) para modalidades coletivas e individuais, respectivamente. Aproximadamente 75% dos casos apresentaram alta por retorno ao esporte, onde observa-se terapias convencional (95,7%) e manual (70,2) os tratamentos mais frequentes. Conclui-se que LM acometem predominantemente o segmento coxa posterior, independentemente da modalidade esportiva e os tratamentos usados demonstraram-se efetivos no retorno ao esporte.

Abstract This study aimed to characterize and determine the frequency of muscle injuries (MI) in athletes assisted in a university service center in physical therapy. Analysis of medical records were made, characterizing anthropometric data, anatomic spots, treatments, among others. Forty-seven cases were identified, distributed in grade I (n=13) and grade II (n=34). The thigh segment was the anatomic spot with the higher prevalence, with 63.1% (p<0.05) and 85.7% (p<0.01) for collective and individual sports, respectively. The rate of return to sports was about 75%, in which conventional therapies (95,7%) and manual (70.2%) were the most common treatments. Thus, we conclude that MI predominantly affects the anatomical thigh segment, regardless of the sport, and that physiotherapy interventions used were effective to return to sports.

Resumen El objetivo de este estudio fue definir y determinar la frecuencia de las lesiones musculares (LM) de atletas atendidos en una clínica universitaria de fisioterapia. Se realizó un análisis de los registros, definición de datos antropométricos, espacios anatómicos y tratamientos utilizados, entre otros. Se identificaron 47 casos de LM, distribuidas en grado I (n = 13) y grado II (n = 34). El segmento del muslo fue el espacio anatómico más afectado con el 63,1% (p <0,05) y el 85,7% (p <0,01) en el caso de deportes colectivos e individuales, respectivamente. Hubo un 74,46% de altas para la vuelta a la práctica deportiva y se encontró que los tratamientos más frecuentes fueron las terapias convencionales (95,7%) y manuales (70,2%). Se concluye que las lesiones musculares afectan predominantemente al muslo, independientemente del tipo de deporte, y que los tratamientos utilizados fueron efectivos para la vuelta a la práctica deportiva.

High-Intensity Intermittent Exercise and Autonomic Modulation: Effects of Different Volume Sessions.

The aim of this study was to compare heart rate variability (HRV) recovery after 2 sessions of high-intensity intermittent exercise at different volumes (1.25 km [HIIE1.25] and 2.5 km [HIIE2.5]). 13 participants determined their maximal aerobic speed (MAS) and completed 2 HIIE (1:1 at 100% MAS) trials. The heart rate was recorded before and after each session. HRV indicators were calculated according to time (RMSSD and SDNN) and frequency (LF, HF and LF/HF ratio) domains. SDNN and RMSSD presented effect of test (F=20.97; p<0.01 and F=21.00; p<0.01, respectively) and moment (F=6.76; p<0.01 and F=12.30; p<0.01, respectively), without interaction. Even though we did not find an interaction effect for any HRV variables, the HIIE2.5 presented a delay of only 5 min in HRV recovery, when compared to HIIE1.25. However, the effects of the test (SDNN, RMSSD, LF-log, and HF-log) indicate higher autonomic stress during the entire recovery period. These findings may indicate that exercise volume interferes with HRV recovery. If so, physically active subjects may choose a lower volume exercise (i. e., HIIE1.25) in order to promote similar physical fitness adaptations with lower loading on autonomic modulation.

Inflammatory Cytokines and BDNF Response to High-Intensity Intermittent Exercise: Effect the Exercise Volume.

The purpose of this study was to compare the effects of two similar high-intensity intermittent exercises (HIIE) but different volume 1.25 km (HIIE1.25) and 2.5 km (HIIE2.5) on inflammatory and BDNF responses. Ten physically active male subjects (age 25.22 ± 1.74 years, body mass 78.98 ± 7.31 kg, height 1.78 ± 0.06 m, VO2peak 59.94 ± 9.38 ml·kg·min-1) performed an incremental treadmill exercise test and randomly completed two sessions of HIIE on a treadmill (1:1 min at vVO2max with passive recovery). Blood samples were collected at rest, immediately and 60-min after the exercise sessions. Serum was analyzed for glucose, lactate, IL-6, IL-10, and BDNF levels. Blood lactate concentrations was higher immediately post-exercise compared to rest (HIIE1.25: 1.69 ± 0.26-7.78 ± 2.09 mmol·L-1, and HIIE2.5: 1.89 ± 0.26-7.38 ± 2.57 mmol·L-1, p < 0.0001). Glucose concentrations did not present changes under the different conditions, however, levels were higher 60-min post-exercise than at rest only in the HIIE1.25 condition (rest: 76.80 ± 11.14-97.84 ± 24.87 mg·dL-1, p < 0.05). BDNF level increased immediately after exercise in both protocols (HIIE1.25: 9.71 ± 306-17.86 ± 8.59 ng.mL-1, and HIIE2.5: 11.83 ± 5.82-22.84 ± 10.30 ng.mL-1). Although both exercises increased IL-6, level percent between rest and immediately after exercise was higher in the HIIE2.5 than HIIE1.25 (30 and 10%; p = 0.014, respectively). Moreover, IL-10 levels percent increase between immediately and 60-min post-exercise was higher in HIIE2.5 than HIIE1.25 (37 and 10%; p = 0.012, respectively). In conclusion, both HIIE protocols with the same intensity were effective to increase BDNF and IL-6 levels immediately after exercise while only IL-10 response was related to the durantion of exercise indicanting the importance of this exercise prescription variable.

De lo convencional a lo alternativo en el manejo de las úlceras venosas / From conventional to alternative ways in the management of venous ulcers / A partir do convencional para a alternativa no tratamento de úlceras venosas

Objetivo: Analizar información bibliográfica sobre el uso de medidas alternativas y convencionales para el manejo de las ulceras venosas. Metodología: Se realizó una revisión de tipo documental, durante los meses de Junio y Julio de 2015, en varias fuentes bibliográficas, bases de datos y revistas indexadas nacionales e internacionales como: ScieLO, Proquest, Bireme, Elsevier, Biblioteca Virtual en Salud, Enfermería Global, Aquichan, Pubmed, Revista Mexicana, Guías de Práctica Clínica, Universidad Nacional de Colombia, Revista Cubana de Medicina General Integral, Instituto Nacional de Angiología y Cirugía Vascular. Se buscaron artículos originales de diferentes profesionales del área de la salud, publicados entre los años 2009 y 2015. Resultados: Se encontró que los métodos convencionales son: manejo con escleroterapia, presión negativa, plasma rico en plaquetas, larva terapia, bota de Unna, pasta de óxido de zinc, protocolos de cuidado de pie diabético, sellantes de fibrina, ácido ascórbico, vendajes compresivos, película de barrera no irritante, apósito de espuma polimérica y laser de baja potencia; los alternativos son: acupuntura, miel, aceite ozonizado, miel de Ulmo. Conclusiones: Pese a que cada institución tiene un protocolo diferente para el manejo de las úlceras venosas, la revisión bibliográfica demostró la similitud en muchas de las técnicas empleadas para el mismo fin: llegar rápidamente a la cicatrización de las heridas. En muchas instituciones consideran el uso de terapias alternativas como un método para reducir costos, pero queda claro que aunque pueden tener un valor económico inferior, el tiempo para la curación de las heridas es más prolongado, lo que implica la utilización de una mayor cantidad de materiales

Objective: Analyze bibliographic information on the use of alternative and conventional for the management of venous ulcers measures Methodology: A review of documentary by different professionals was conducted during the months of June and July 2015, the search was conducted in various literature sources, databases and national and international indexed journals as ScieLO, Proquest, Bireme, Elsevier, BVS, Global Nursing, Aquichan, Pubmed, Mexican journal, Clinical Practice Guidelines, National University of Colombia, Cuban Journal of General Medicine, National Institute of Angiology and Vascular Surgery. Results: It was found that conventional methods are: sclerotherapy, negative pressure, platelet rich plasma, larvae therapy, Unna boot, zinc oxide paste, fibrin sealants, ascorbic acid, bandage, non-irritating barrier film, polymeric foam dressing and Laser low power; alternative forms are: acupuncture, honey, ozonated oil, honey Ulmo. Conclusions: Although each institution has a different protocol for the management of venous ulcers, the literature review showed the similarity in many of the techniques used for the same purpose: to quickly get wound healing. In many institutions consider the use of alternative therapies as a method to reduce costs, but it is clear that although they may have a lowwer economic value, the time for wound healing is longer, involving the use of a greater amount of materials

Objetivo: analisar informação bibliográfica sobre o uso de medidas alternativas e convencionais para o manejo das úlceras venosas. Metodologia: foi realizada revisão documental nos meses de junho e julho de 2015, em várias fontes bibliográficas, bases de dados e revistas indexadas nacionais e internacionais como: ScieLO, Proquest, Bireme, Elsevier, Biblioteca Virtual em Saúde, Enfermería Global, Aquichan, Pubmed, Revista Mexicana, Guías de Práctica Clínica, Universidad Nacional de Colombia, Revista Cubana de Medicina General Integral, Instituto Nacional de Angiología y Cirugía Vascular. Foram pesquisados artigos originais de diversos profissionais da área de saúde, publicados entre 2009 e 2015. Resultados: encontrou que os métodos convencionais são: manejo com escleroterapia, pressão negativa, plasma rico em plaquetas, terapia larval, bota de Unna, pasta de óxido de zinco, protocolos de cuidado do pé diabético, selantes de fibrina, ácido ascórbico, curativos compressivos com gaze, filme de barreira não irritante, curativo de espuma de poliuretano e laser de baixa potência; os alternativos são: acupuntura, mel, óleo ozonizado, mel de Ulmo. Conclusões: apesar de que cada instituição tem um protocolo diferente para o manejo das úlceras venosas, a revisão bibliográfica demonstrou a semelhança de muitas das técnicas empregadas para o mesmo fim: chegar rapidamente à cicatrização das feridas. Em muitas instituições consideram o uso de terapias alternativas como um método para reduzir custos, mas é evidente que, embora tenham um valor econômico inferior, o tempo para a ferida se curar é mais longo, e implica em utilização de maior quantidade de materiais