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1.
Comput Methods Biomech Biomed Engin ; 23(10): 649-657, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32364804

RESUMO

Dislocation after total hip arthroplasty (THA) remains a major issue and an important post-surgical complication. Impingement and subsequent dislocation are influenced by the design (head size) and position (anteversion and abduction angles) of the acetabulum and different movements of the patient, with external extension and internal flexion the most critical movements. The aim of this study is to develop a computational tool based on a three-dimensional (3D) parametric finite element (FE) model and an artificial neural network (ANN) to assist clinicians in identifying the optimal prosthesis design and position of the acetabular cup to reduce the probability of impingement and dislocation. A 3D parametric model of a THA was used. The model parameters were the femoral head size and the acetabulum abduction and anteversion angles. Simulations run with this parametric model were used to train an ANN, which predicts the range of movement (ROM) before impingement and dislocation. This study recreates different configurations and obtains absolute errors lower than 5.5° between the ROM obtained from the FE simulations and the ANN predictions. The ROM is also predicted for patients who had already suffered dislocation after THA, and the computational predictions confirm the patient's dislocations. Summarising, the combination of a 3D parametric FE model of a THA and an ANN is a useful computational tool to predict the ROM allowed for different designs of prosthesis heads.


Assuntos
Artroplastia de Quadril/efeitos adversos , Impacto Femoroacetabular/diagnóstico , Impacto Femoroacetabular/etiologia , Luxações Articulares/diagnóstico , Luxações Articulares/etiologia , Redes Neurais de Computação , Adulto , Algoritmos , Impacto Femoroacetabular/fisiopatologia , Fêmur/cirurgia , Análise de Elementos Finitos , Articulação do Quadril/cirurgia , Humanos , Luxações Articulares/fisiopatologia , Amplitude de Movimento Articular , Reprodutibilidade dos Testes
2.
Rev. Esp. Cir. Ortop. Traumatol. (Ed. Impr.) ; 61(6): 375-382, nov.-dic. 2017. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-168632

RESUMO

El objetivo es conocer la duración de nuestras intervenciones, tiempos intermedios y rendimiento quirúrgico. Con ello elaborar una lista de espera virtual para aplicar un programa matemático que realice la programación con rendimiento idóneo máximo. Material y métodos. Revisión retrospectiva de 49 sesiones quirúrgicas obteniendo el retraso en la hora de comienzo, el tiempo intermedio y el rendimiento quirúrgico. Revisión retrospectiva de 4.045 intervenciones realizadas en los 3 últimos años para obtener la duración media de cada tipo de cirugía. Elaboración de una lista de espera virtual de 700 pacientes para realizar programaciones virtuales mediante el MIQCP-P hasta obtener el rendimiento óptimo. Resultados. Nuestro rendimiento quirúrgico con programación manual es del 75,9%, finalizando el 22,4% más tarde de las 15h. El rendimiento en las jornadas sin suspensiones es del 78,4%. El retraso en la hora de comienzo es de 9,7min. El rendimiento óptimo es del 77,5%, con una confianza de terminar antes de las 15h del 80,6%. La lista de espera se ha programado en 254 sesiones. Discusión. Nuestro rendimiento quirúrgico manual sin suspensiones (78,4%) es superior al idóneo (77,5%) generando jornadas finalizadas más tarde de las 15h y suspensiones. Las posibilidades de mejora son lograr la puntualidad en la hora de comienzo y ajustar la programación al rendimiento idóneo. La programación virtual nos ha permitido obtener nuestro rendimiento idóneo y conocer el número de quirófanos necesarios para resolver la lista de espera creada. Conclusiones. Los datos obtenidos en la programación matemática virtual son lo suficientemente fiables como para implantar este modelo con garantías (AU)


The objective is to establish the duration of our interventions, intermediate times and surgical performance. This will create a virtual waiting list to apply a mathematical programme that performs programming with maximum performance. Material and methods. Retrospective review of 49 surgical sessions obtaining the delay in start time, intermediate time and surgical performance. Retrospective review of 4,045 interventions performed in the last 3 years to obtain the average duration of each type of surgery. Creation of a virtual waiting list of 700 patients in order to perform virtual programming through the MIQCP-P until achieving optimal performance. Results. Our surgical performance with manual programming was 75.9%, ending 22.4% later than 3pm. The performance in the days without suspensions was 78.4%. The delay at start time was 9.7min. The optimum performance was 77.5% with a confidence of finishing before 15h of 80.6%. The waiting list has been scheduled in 254 sessions. Discussion. Our manual surgical performance without suspensions (78.4%) was superior to the optimal (77.5%), generating days finished later than 3pm and suspensions. The possibilities for improvement are to achieve punctuality at the start time and adjust the schedule to the ideal performance. The virtual programming has allowed us to obtain our ideal performance and to establish the number of operating rooms necessary to solve the waiting list created. Conclusions. The data obtained in virtual mathematical programming are reliable enough to implement this model with guarantees (AU)


Assuntos
Humanos , Planos e Programas de Saúde/tendências , Procedimentos Cirúrgicos Operatórios/métodos , Qualidade da Assistência à Saúde/tendências , Melhoria de Qualidade , Estudos Retrospectivos , Listas de Espera , Salas Cirúrgicas/organização & administração , Resultado do Tratamento
3.
Rev Esp Cir Ortop Traumatol ; 61(6): 375-382, 2017.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28890119

RESUMO

The objective is to establish the duration of our interventions, intermediate times and surgical performance. This will create a virtual waiting list to apply a mathematical programme that performs programming with maximum performance. MATERIAL AND METHODS: Retrospective review of 49 surgical sessions obtaining the delay in start time, intermediate time and surgical performance. Retrospective review of 4,045 interventions performed in the last 3 years to obtain the average duration of each type of surgery. Creation of a virtual waiting list of 700 patients in order to perform virtual programming through the MIQCP-P until achieving optimal performance. RESULTS: Our surgical performance with manual programming was 75.9%, ending 22.4% later than 3pm. The performance in the days without suspensions was 78.4%. The delay at start time was 9.7min. The optimum performance was 77.5% with a confidence of finishing before 15h of 80.6%. The waiting list has been scheduled in 254 sessions. DISCUSSION: Our manual surgical performance without suspensions (78.4%) was superior to the optimal (77.5%), generating days finished later than 3pm and suspensions. The possibilities for improvement are to achieve punctuality at the start time and adjust the schedule to the ideal performance. The virtual programming has allowed us to obtain our ideal performance and to establish the number of operating rooms necessary to solve the waiting list created. CONCLUSIONS: The data obtained in virtual mathematical programming are reliable enough to implement this model with guarantees.


Assuntos
Eficiência Organizacional/normas , Salas Cirúrgicas/organização & administração , Duração da Cirurgia , Procedimentos Ortopédicos/normas , Melhoria de Qualidade/organização & administração , Humanos , Garantia da Qualidade dos Cuidados de Saúde , Estudos Retrospectivos , Listas de Espera
4.
Equine Vet J ; 49(6): 767-769, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28502090

RESUMO

BACKGROUND: Lipid emulsion has been reported to be effective for the treatment of local anaesthetic overdoses in rats, dogs and man. OBJECTIVES: To describe the successful treatment of cardiovascular lidocaine toxicity in a foal with intravenous lipid administration. STUDY DESIGN: Observational study: case report. METHODS: An 8-month-old Arabian cross foal was anaesthetised for removal of the right alar fold and nasal plate. Anaesthesia was maintained with isoflurane in oxygen and lidocaine administered with a loading dose followed by a continuous rate infusion (CRI). The anaesthetic period was uneventful and 30 min before expected termination of the procedure lidocaine infusion was stopped. A sudden drop in mean arterial blood pressure was then observed. The ECG signal was lost, the end tidal CO2 tension dropped from 40 to 10 mmHg, corneal reflex was absent and asystole diagnosed. Cardiopulmonary resuscitation manoeuvres were immediately initiated, but epinephrine and atropine were unsuccessfully administered. Lipid emulsion was administered and the heart rate and arterial blood pressure gradually returned to normal. RESULTS: The foal recovered consciousness 3 h later, regained its sternal position, was responsive and 20 h later was able to stand up alone. MAIN LIMITATIONS: It will be necessary to evaluate a greater number of cases to determine the effectiveness of lipids in foals intoxicated with lidocaine. CONCLUSION: Intravenous lipid emulsion may be helpful in the treatment of potentially lethal cardiotoxicity attributable to lidocaine overdose in the foal.


Assuntos
Emulsões Gordurosas Intravenosas/uso terapêutico , Parada Cardíaca/veterinária , Doenças dos Cavalos/induzido quimicamente , Lidocaína/efeitos adversos , Administração Intravenosa , Animais , Parada Cardíaca/induzido quimicamente , Parada Cardíaca/tratamento farmacológico , Doenças dos Cavalos/tratamento farmacológico , Cavalos
5.
Int J Surg Case Rep ; 33: 97-98, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28288325

RESUMO

INTRODUCTION: Trochanteric hip fractures in elderly patients with osteoporosis are commonly caused by low energy trauma. The cardioversion therapy is an extremely rare cause of this type of fracture. PRESENTATION OF CASE: We report the case of a woman with hip fracture after cardioversion. DISCUSSION: We discuss the production mechanism of this injury and the importance of the care of the osteoporotic bone under these therapies. CONCLUSION: The propofol sedation should be complemented with skeletal muscle relaxants in the cardioversion therapy to avoid hip fracture in select patients with osteoporosis.

6.
Rev. Esp. Cir. Ortop. Traumatol. (Ed. Impr.) ; 61(1): 1-7, ene.-feb. 2017. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-159395

RESUMO

Objetivo. Estudiar las causas de producción y resultados en los pacientes tratados con fractura interprotésica femoral. Material y métodos. Revisión retrospectiva de 7 pacientes tratados entre 2010 y 2013. Las artroplastias de rodilla tenían al menos 5 años desde su implantación y las de cadera menos de un año siendo cementadas bipolares en 6 pacientes y total no cementada en un paciente, implantadas todas por una fractura desplazada del cuello femoral. Han sido tratadas mediante osteosíntesis con placa de estabilidad angular abarcando todo el segmento femoral interprotésico. Excepto un paciente, los demás han sido revisados 12 meses como mínimo. Resultados. Han sido 6 mujeres y un hombre con edad media de 84,7 años. La fractura, siempre por baja energía, se ha producido entre 2 y 8 meses tras la de cadera sin encontrarse movilizados los implantes, estando localizadas 4 de ellas a nivel diafisario y 3 a nivel supracondíleo, sin relación con el tipo de implante de rodilla. Se ha producido la consolidación en todos los pacientes a los 4,5 meses de media sin reintervención en ninguno de ellos y sin mortalidad en el tiempo que han sido controlados. Todos los pacientes deambulaban en carga en el momento de producirse la fractura y todos ellos han conseguido volver a deambular en carga, habiendo perdido como media 20° de flexión de rodilla en los casos de fractura supracondílea. Conclusiones. Los factores más importantes en nuestros pacientes con respecto a la producción de la fractura han sido la alteración de la capacidad de deambulación tras la artroplastia de cadera y la fragilidad ósea. La placa de estabilidad angular concede buenos resultados en el tratamiento de las fracturas interprotésicas femorales (AU)


Objective. To study the causes and outcomes of patients with interprosthetic femoral fractures. Material and methods. A retrospective review conducted on 7 patients treated between 2010 and 2013. The knee arthroplasties had been implanted for at least 5 years, and those of the hip less than a year. They were bipolar cemented in 6 patients and totally non-cemented in one patient, all of them implanted due to a displaced femoral neck fracture. They were treated using osteosynthesis with angular stability plate covering the whole interprosthetic femoral segment. Except for one patient, all have been reviewed at least 12 months. Results. The patients included 6 women and one man, with a mean age of 84.7. The fracture, always by low energy, occurred between 2 and 8 months after that of the hip without the implants being mobilized. Four of them were located at diaphyseal level, and 3 at supracondylar level, and unrelated to the type of knee implant. There was consolidation in all patients at a mean of 4.5 months, without a re-operation in any of them, and with no mortality during the follow-up period. All patients walked independently at the time of the fracture, and all of them have managed to return to walking independently, having lost as average 20° of knee flexion in cases of supracondylar fracture. Conclusions. The most important factors in our patients regarding the producing of the fracture have been the changes in the ability to walk after knee replacement and bone fragility. Angular stability plates give good results in the treatment of interprosthetic femoral fractures (AU)


Assuntos
Humanos , Masculino , Feminino , Idoso de 80 Anos ou mais , Fraturas do Fêmur/etiologia , Fraturas do Fêmur/cirurgia , Fraturas do Fêmur , Fraturas do Fêmur/classificação , Artroplastia/métodos , Fixação Interna de Fraturas/métodos , Estudos Retrospectivos , Expectativa de Vida/tendências , Grupos de Risco , Raquianestesia , Fraturas do Fêmur/complicações , Fraturas Ósseas/complicações , Fraturas Ósseas
7.
Reproduction ; 153(3): 293-304, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-27965398

RESUMO

The reduced lifespan of cryopreserved spermatozoa in the mare reproductive tract has been attributed to both capacitative and apoptotic changes. However, there is a lack of studies investigating both phenomena simultaneously. In order to improve our knowledge in this particular point, we studied in raw and frozen-thawed samples apoptotic and capacitative markers using a wide battery of test based in flow cytometry. Apoptotic markers evaluated were caspase 3 activity, externalization of phosphatidylserine (PS), and mitochondrial membrane potential. Markers of changes resembling capacitation were membrane fluidity, tyrosine phosphorylation, and intracellular sodium. Conventional and computational flow cytometry using nonlinear dimensionally reduction techniques (t-distributed stochastic neighbor embedding (t-SNE)) and automatic classification of cellular expression by nonlinear stochastic embedding (ACCENSE) were used. Most of the changes induced by cryopreservation were apoptotic, with increase in caspase 3 activation (P < 0.01), PS translocation to the outer membrane (P < 0.001), loss of mitochondrial membrane potential (P < 0.05), and increase in intracellular Na+ (P < 0.01). Average values of markers of capacitative changes were not affected by cryopreservation; however, the analysis of the phenotype of individual spermatozoa using computational flow cytometry revealed the presence of subpopulations of spermatozoa experiencing capacitative changes. For the first time advanced computational techniques were applied to the analysis of spermatozoa, and these techniques were able to disclose relevant information of the ejaculate that remained hidden using conventional flow cytometry.


Assuntos
Biomarcadores/metabolismo , Biologia Computacional/métodos , Criopreservação/veterinária , Citometria de Fluxo/métodos , Preservação do Sêmen/veterinária , Capacitação Espermática , Espermatozoides/patologia , Animais , Membrana Celular/metabolismo , Cavalos , Masculino , Fluidez de Membrana/fisiologia , Potencial da Membrana Mitocondrial , Fosforilação , Preservação do Sêmen/métodos , Motilidade dos Espermatozoides/fisiologia , Espermatozoides/metabolismo
8.
Rev Esp Cir Ortop Traumatol ; 61(1): 1-7, 2017.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-27818190

RESUMO

OBJECTIVE: To study the causes and outcomes of patients with interprosthetic femoral fractures. MATERIAL AND METHODS: A retrospective review conducted on 7 patients treated between 2010 and 2013. The knee arthroplasties had been implanted for at least 5 years, and those of the hip less than a year. They were bipolar cemented in 6 patients and totally non-cemented in one patient, all of them implanted due to a displaced femoral neck fracture. They were treated using osteosynthesis with angular stability plate covering the whole interprosthetic femoral segment. Except for one patient, all have been reviewed at least 12 months. RESULTS: The patients included 6 women and one man, with a mean age of 84.7. The fracture, always by low energy, occurred between 2 and 8 months after that of the hip without the implants being mobilized. Four of them were located at diaphyseal level, and 3 at supracondylar level, and unrelated to the type of knee implant. There was consolidation in all patients at a mean of 4.5 months, without a re-operation in any of them, and with no mortality during the follow-up period. All patients walked independently at the time of the fracture, and all of them have managed to return to walking independently, having lost as average 20° of knee flexion in cases of supracondylar fracture. CONCLUSIONS: The most important factors in our patients regarding the producing of the fracture have been the changes in the ability to walk after knee replacement and bone fragility. Angular stability plates give good results in the treatment of interprosthetic femoral fractures.


Assuntos
Placas Ósseas , Fixação Interna de Fraturas/instrumentação , Fraturas do Quadril/cirurgia , Fraturas Periprotéticas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/instrumentação , Feminino , Seguimentos , Fixação Interna de Fraturas/métodos , Fraturas do Quadril/etiologia , Prótese de Quadril , Humanos , Masculino , Fraturas Periprotéticas/etiologia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
9.
Vet Rec ; 178(18): 450, 2016 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-27044651

RESUMO

In order to know reproduction-related complications due to standing laparoscopic peritoneal flap hernioplasty, histological characteristics of the testicles from five stallions one year after surgery were compared with seven testicles from four healthy stallions. Moreover, the daily sperm output (DSO) was determined before (T0) and one year after surgery (T12). DSO did not show significant differences between T0 and T12. The diameter of the seminiferous tubules was significantly decreased in the samples from the hernioplasty group. The percentage of tubules with full spermatogenesis was smaller in the hernioplasty group, but the difference was not significant. It can be concluded that standing laparoscopic peritoneal flap hernioplasty produced mild histological changes in the testicular parenchyma, epididymis and pampiniform plexus after one year follow-up.


Assuntos
Herniorrafia/veterinária , Doenças dos Cavalos/cirurgia , Laparoscopia/veterinária , Espermatozoides/fisiologia , Testículo/anatomia & histologia , Animais , Seguimentos , Herniorrafia/métodos , Cavalos , Laparoscopia/métodos , Masculino , Peritônio/cirurgia , Postura , Retalhos Cirúrgicos/veterinária , Resultado do Tratamento
10.
Reprod Domest Anim ; 49(6): 1043-8, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25307792

RESUMO

Laparoscopic hernioplasty techniques have been developed in the recent years to avoid the recurrence of inguinal hernias and to spare the testicles for breeding purposes in stallions. However, there have been no previous comprehensive and systematic studies of the reproductive outcomes and prognoses for stallions after inguinal hernioplasty. Therefore, the objective of this study was to assess the possible effects of one of these techniques (standing laparoscopic peritoneal flap hernioplasty) on the sperm production and motility characteristics of six healthy stallions that received this procedure based on 1-year follow-ups. There were no significant differences in the measured sperm variables (assessments based on the DSO, MOT, PMOT, VSL, VCL and VAP) during 1-year follow-ups.


Assuntos
Herniorrafia/veterinária , Cavalos/fisiologia , Cavalos/cirurgia , Análise do Sêmen/veterinária , Espermatogênese/fisiologia , Animais , Herniorrafia/métodos , Masculino , Sêmen/fisiologia , Motilidade dos Espermatozoides/fisiologia , Espermatozoides/fisiologia
11.
Vet Rec ; 171(4): 98, 2012 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-22781342

RESUMO

Horses (n=35) underwent orchidectomy in a single institution with a re-sterilised LSA as sole means of haemostasis. During the surgery, the gross quality of the seal, the stickiness of the forceps to the tissues, bleeding/oozing from the stump and the need for a subsequent application in already severed spermatic cord were assessed for haemostasis quality. After surgery, physical parameters (appearance of the mucous membranes, quality of the peripheral pulse, heart rate, respiratory rate, rectal temperature and blood dripping from the incisions), haematology or packed cell volume and total protein were monitored to assess signs of bleeding or any other condition. For cleanliness and asepsis assessment, signs of surgical infection were recorded. Complications during surgery were mild degree of sticking of the LSA forceps to the tissues and dulling of the blade. There was no need to reapply LSA a second time except in one horse. This means a haemostasis complication rate of 2.85 per cent of the horses. No postoperative bleeding was detected. Only two horses with fever had associated signs of surgical site infection. This means an infection rate of 5.71 per cent of the horses.


Assuntos
Hemostasia Cirúrgica/veterinária , Cavalos/cirurgia , Complicações Intraoperatórias/veterinária , Orquiectomia/veterinária , Infecção da Ferida Cirúrgica/veterinária , Animais , Hemorragia/epidemiologia , Hemorragia/prevenção & controle , Hemorragia/veterinária , Hemostasia Cirúrgica/instrumentação , Hemostasia Cirúrgica/métodos , Complicações Intraoperatórias/epidemiologia , Masculino , Orquiectomia/efeitos adversos , Orquiectomia/métodos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/veterinária , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/epidemiologia , Resultado do Tratamento
12.
Rev. esp. cir. ortop. traumatol. (Ed. impr.) ; 56(3): 188-196, mayo-jun. 2012.
Artigo em Espanhol | IBECS | ID: ibc-100220

RESUMO

Introducción. La conveniencia de establecer una prueba que acredite la formación de los especialistas en Cirugía Ortopédica y Traumatología (COT) al término de su período de formación como médicos internos residentes es objeto de controversia. Con la intención de favorecer y estimular el desarrollo de esta prueba, los actuales vocales de la Comisión Nacional de la Especialidad (CNE) han realizado una revisión de los datos obtenidos en las pasadas ediciones. Material y métodos. Resultados de las pruebas de evaluación voluntaria de final de residencia y de las encuestas de valoración rellenadas por los participantes de la prueba entre los años 2006 y 2011. Resultados. En total han intervenido 231 personas en la evaluación, incrementándose el número de participantes desde 19 en 2005, hasta 71 en 2011. La media de puntuación global a lo largo del período analizado (2006-2011) es de 6,72 puntos. Los no aptos en estos 6 años han sido 9 participantes (4,25%). La media de puntuación en el test es de 7,57 puntos. La puntuación global media de las mesas es de 6,57. Generalidades es la mesa que obtiene peores resultados. La mesa de miembro inferior reconstructivo no ha sido suspendida nunca. La mesa de miembro superior es la que obtiene los mejores resultados medios. Discusión. La prueba está arraigada en la estructura de la formación especializada de la COT en nuestro país. Debemos reconocer favorablemente a aquellos candidatos que optan por presentarse. Este reconocimiento será el mejor estímulo para las futuras promociones (AU)


Introduction. The idea of establishing an examination that accredits the training of the specialists in orthopaedic surgery at the end of their educational period as residents is subject to controversy. With the aim of encouraging the development of this examination, the present members of the National Commission of the Specialty of Orthopaedics (CNE) have reviewed the results obtained in previous examination. Materials and Methods. The results of the voluntary final exam for Orthopaedics residents, and of the surveys of participant opinions for the years 2006 to 2011 are presented. Results. The total number of participants was 231, growing from 19 in 2005, to 71 in 2011. The overall mean score in the period reviewed (2006-2011) was 6.72 out of 10 points. In these 6 years, 9 participants failed (4.25%). The mean score for the test was 7.57. The overall mean score of the oral exam was 6.57. The worst results were obtained in the general knowledge section of the oral examination. Nobody has ever failed the section on reconstruction of the lower extremity. The upper extremity section in the oral examination achieves the best average results. Discussion. The examination has established its place in the structure of orthopaedic resident training in our country, even without making it official by the Administration. We must positively acknowledge those candidates who chose to take the examination and be evaluated by their peers in order to prove their qualification and distinction. This recognition will be the best encouragement for future generations (AU)


Assuntos
Adulto , Humanos , Ortopedia , Internato e Residência/ética , Internato e Residência/métodos , Conhecimentos, Atitudes e Prática em Saúde , Especialização/normas , Especialização/tendências , Ortopedia/educação , Ortopedia/organização & administração , Ortopedia/normas , Internato e Residência , Internato e Residência/organização & administração , Internato e Residência/normas , /instrumentação
13.
Rev Esp Cir Ortop Traumatol ; 56(3): 188-96, 2012.
Artigo em Espanhol | MEDLINE | ID: mdl-23594805

RESUMO

INTRODUCTION: The idea of establishing an examination that accredits the training of the specialists in orthopaedic surgery at the end of their educational period as residents is subject to controversy. With the aim of encouraging the development of this examination, the present members of the National Commission of the Specialty of Orthopaedics (CNE) have reviewed the results obtained in previous examination. MATERIALS AND METHODS: The results of the voluntary final exam for Orthopaedics residents, and of the surveys of participant opinions for the years 2006 to 2011 are presented. RESULTS: The total number of participants was 231, growing from 19 in 2005, to 71 in 2011. The overall mean score in the period reviewed (2006-2011) was 6.72 out of 10 points. In these 6 years, 9 participants failed (4.25%). The mean score for the test was 7.57. The overall mean score of the oral exam was 6.57. The worst results were obtained in the general knowledge section of the oral examination. Nobody has ever failed the section on reconstruction of the lower extremity. The upper extremity section in the oral examination achieves the best average results. DISCUSSION: The examination has established its place in the structure of orthopaedic resident training in our country, even without making it official by the Administration. We must positively acknowledge those candidates who chose to take the examination and be evaluated by their peers in order to prove their qualification and distinction. This recognition will be the best encouragement for future generations.


Assuntos
Avaliação Educacional/estatística & dados numéricos , Internato e Residência , Ortopedia/educação , Traumatologia/educação , Programas Voluntários , Atitude do Pessoal de Saúde , Competência Clínica/estatística & dados numéricos , Avaliação Educacional/métodos , Feminino , Humanos , Masculino , Ortopedia/normas , Espanha , Traumatologia/normas
14.
Educ. méd. (Ed. impr.) ; 12(1): 47-53, mar. 2009. ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-61646

RESUMO

Objetivo. Presentar el diseño y los resultados obtenidos enana práctica sobre metacognición en Fisiología Humana(Facultad de Medicina). Sujetos y métodos. Ciento diecinueveestudiantes (95 mujeres y 24 varones) asistieron a una práctica sobre metacognición en la asignatura de Fisiología Humana (Facultad de Medicina). La práctica se dividió en dos partes: en la primera, los estudiantes se determinaron el estilo de aprendizaje (test de Kolb) para poner de manifiesto que no todos aprenden de la misma manera, y se les hizo reflexionar sobre las características esenciales de cada estilo encontrado; en la segunda, escribieron las recomendaciones que harían a su mejor amigo/a sobre cómo estudiar fisiología y, posteriormente, las expusieron ante el resto. Resultados y conclusiones. Los resultados respecto a los modos de aprender mostraron dos hechos: uno, que la mayor puntuación se obtuvo en la conceptualización abstracta, tanto para varones como para mujeres, y, otro, referente a la segunda opción, que las mujeres señalaron la experimentación activa (significativamente mayor que en los varones), mientras que para éstos fue la observación reflexiva. Los estilos de aprendizaje de los estudiantes fueron convergentes y asimiladores, con escasa diferencia entre ambos. Por sexos, se observó que en los varones predominó el estilo asimilador (13 frente a 8),mientras que en las mujeres fue más frecuente el convergente(44 frente a 36). En la segunda parte de la práctica(metacognición) ambos grupos manifestaron utilizar las mismas estrategias, con independencia del estilo al que pertenecían. Determinadas estrategias fueron utilizadas por los estudiantes con niveles de sofisticación diferentes (AU)


Aim. To present the design and results found in a practical lecture on met cognition in the subject of Human Physiology(School of Medicine). Subjects and methods. The practical lecture was attended by 119 students (95 women and 24men). This one was divided into two parts: in the first, students determined by themselves their learning style (Kolb test) in orderto show that not everyone learns the same way and makes them reflect on the essential features of each style found; in the second, they wrote on the recommendations made to his/her best friend on how to study the Physiology and then put them to rest. Results and conclusions. The results respect to the learning modes showed two facts: one, the highest score was obtained by abstract conceptualization, for both men and women; and another, in relation to the second option the active experimentation was reported by women (significantly greater than men) versus reflective observation indicated by men. Regarding learning styles of students, these were assimilator and converger, with little difference between them. By gender, the following fact was found: in men predominated assimilator style (13 versus 8), whereas women were the most converge one (44 versus 36). In the second part of the practical lecture(metacognition) both groups expressed to use the same learning strategies, independently of the learning style. Some strategies were used by students with different sophistication levels (AU)


Assuntos
Humanos , Fisiologia/educação , Estágio Clínico/métodos , Aprendizagem , Educação Médica/tendências , Faculdades de Medicina/tendências , Modelos Educacionais
15.
Br J Pharmacol ; 154(5): 1009-15, 2008 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-18587446

RESUMO

BACKGROUND AND PURPOSE: Leptin regulates energy expenditure and body weight by acting both on the hypothalamus and on peripheral targets. Central actions of leptin are enhanced by cholecystokinin (CCK). The interaction between leptin and CCK makes physiological sense, as rats lacking CCK1 receptors are resistant to peripheral leptin but not to leptin directly infused into the brain. We have recently reported that CCK enhances leptin effects by increasing the entry of leptin into the CNS. The aim of this work was to further characterize the effect of CCK (10 microg kg(-1)) on leptin kinetics as well as the CCK receptor subtype involved in the interaction between CCK and leptin. EXPERIMENTAL APPROACH: Experiments were carried out both in free-feeding and in fasted rats receiving a single dose of leptin (100 microg kg(-1); i.p.). Parameters analysed over the next 6 h were plasma and cerebrospinal fluid concentrations of leptin. KEY RESULTS: We observed that CCK-8 depressed the increase in plasma leptin that followed the i.p. injection and simultaneously increased leptin concentration in the cerebrospinal fluid from 92+/-25 to 230+/-24 pg mL(-1) (P<0.05). The effect of CCK-8 was totally prevented by the CCK1 receptor antagonist, SR-27,897 (0.3 mg kg(-1), s.c.), but not by the CCK2 receptor antagonist, L-365,260 (1 mg kg(-1)). CONCLUSIONS AND IMPLICATIONS: These results show that CCK plays a role in regulating the access of leptin to the brain and suggest that CCK analogues, acting on CCK1 receptors, might be useful drugs in improving leptin actions within the brain.


Assuntos
Barreira Hematoencefálica/metabolismo , Permeabilidade da Membrana Celular , Leptina/metabolismo , Receptores da Colecistocinina/metabolismo , Sincalida/metabolismo , Animais , Benzodiazepinonas/farmacologia , Glicemia/metabolismo , Barreira Hematoencefálica/efeitos dos fármacos , Permeabilidade da Membrana Celular/efeitos dos fármacos , Ingestão de Alimentos , Ácidos Indolacéticos/farmacologia , Injeções Intraperitoneais , Insulina/sangue , Cinética , Leptina/administração & dosagem , Leptina/sangue , Leptina/líquido cefalorraquidiano , Masculino , Compostos de Fenilureia/farmacologia , Ratos , Ratos Sprague-Dawley , Receptores da Colecistocinina/agonistas , Proteínas Recombinantes/metabolismo , Sincalida/administração & dosagem , Tiazóis/farmacologia
17.
J Am Vet Med Assoc ; 219(7): 941-5, 2001 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-11601789

RESUMO

OBJECTIVE: To determine the effects of prolonged anesthesia with desflurane in dogs undergoing laparotomy or abdominal laparoscopy. DESIGN: Randomized prospective study. ANIMALS: 20 adult mixed-breed dogs. PROCEDURE: Dogs were randomly assigned to 1 of 2 groups with 10 dogs/group. Anesthesia was induced with propofol and maintained with desflurane and fentanyl, and pyloroplasty was performed. In 10 dogs, a ventral midline laparotomy was performed; in the other 10, abdominal laparoscopy was performed. Dogs were monitored for cardiovascular and respiratory responses (ECG, oxygen saturation [SpO2], arterial blood pressure, rectal temperature, end-tidal partial pressure of carbon dioxide [PETCO2], and expired desflurane concentration). Recovery times were recorded. RESULTS: Mean +/- SD duration of anesthesia was 201 +/- 25 minutes for dogs undergoing laparotomy and 287 +/- 15 minutes for dogs undergoing laparoscopy. Anesthesia was accompanied by hypotension that was less severe in dogs undergoing laparoscopy. Heart rate did not vary significantly during anesthesia. The SpO2 was > 97% in all dogs at all times, and PETCO2 remained within reference limits. Recovery times for dogs that underwent laparotomy were not significantly different from those for dogs that underwent laparoscopy. Mean +/- SD time to standing was 13.6 +/- 2.4 minutes for dogs that underwent laparotomy and 12.5 +/- 2.9 minutes for dogs that underwent laparoscopy. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that induction of anesthesia with propofol and maintenance with desflurane and fentanyl is safe in dogs undergoing abdominal surgery.


Assuntos
Anestésicos Combinados , Anestésicos Inalatórios , Anestésicos Intravenosos , Cães/fisiologia , Fentanila , Isoflurano , Abdome/cirurgia , Período de Recuperação da Anestesia , Anestésicos Combinados/efeitos adversos , Anestésicos Combinados/farmacologia , Anestésicos Inalatórios/efeitos adversos , Anestésicos Inalatórios/farmacologia , Anestésicos Intravenosos/efeitos adversos , Anestésicos Intravenosos/farmacologia , Animais , Pressão Sanguínea/efeitos dos fármacos , Desflurano , Cães/cirurgia , Feminino , Fentanila/efeitos adversos , Fentanila/farmacologia , Frequência Cardíaca/efeitos dos fármacos , Isoflurano/efeitos adversos , Isoflurano/análogos & derivados , Isoflurano/farmacologia , Laparoscopia/veterinária , Laparotomia/veterinária , Masculino , Propofol , Estudos Prospectivos , Respiração/efeitos dos fármacos , Segurança
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