First Robotic Roux-en-Y Gastric Bypass for the Treatment of Refractory Gastroesophageal Reflux Disease in a Patient With Systemic Sclerosis.

Systemic sclerosis (SSc) is an immune-mediated disease that results in fibrosis of the skin and internal organs. Refractory gastroesophageal reflux disease (GERD) associated with severe esophageal dysmotility is common in SSc patients, and surgical treatment with usual anti-reflux procedures such as fundoplications is associated with dismal symptomatic relief and postoperative dysphagia. We report the first robotic short-limb Roux-en-Y gastric bypass (RYGB) with a short Roux limb for the treatment of GERD in a patient with SSc with intense esophageal dysmotility. The operative time was two hours. The procedure and postoperative course were uneventful. The patient presented complete relief of gastroesophageal reflux symptoms and no postoperative dysphagia in a two-year follow-up. Therefore, short-limb RYGB is a safe and very effective alternative for the treatment of severe GERD in patients with SSc. The robotic surgical platform may have some advantages compared to conventional laparoscopy.

Instructional Cues in Futsal Teaching, Coaching and Matches / Pistas de instrucción en la enseñanza, entrenamiento y partidos de fútbol sala

This study investigated what are the verbal cues provided in futsal contexts of teaching-learning, training, and official matches, and what are their attentional foci. A cue refers is a short instruction that constrains the students/athletes to direct their attention to critical elements for successful performance. 1543 instructional cues were collected from Physical Education (PE) classes, futsal training sessions and futsal matches of an official championship. Data were analysed based on content analysis method and categorized through the Systematic Analysis of Pedagogical Content Interventions. Inferential analyses were run by the Trend Module (Trend Analysis and Multiple Comparisons) of PEPI software. The results showed that the category offensive technique (passing) was the one with the highest number of instructions in the classes, training and matches. It was also observed that rules and violations were similar between curricular classes and futsal training sessions. The findings allowed to verify (i) the primary cues physical education teachers and coaches provided, (ii) about which critical aspects they referred to and (iii) their specificity regarding the context specificity (classes, training and matches). The findings provide useful insights into the design of instructional tasks as the instructional cues allow students/athletes to gain knowledge about the learning task and to direct their attention to critical elements for successful performance. (AU)

El objetivo de este estudio fue investigar cuáles son las pistas instructivas proporcionadas por los profesores de educación física (EF) en el contexto escolar de enseñanza-aprendizaje. entrenamientos y partidos oficiales del futsal, y sus respectivos focos de atención. Se recogieron 1543 pistas instructivas de las clases curriculares centradas en la enseñanza-aprendizaje de fútbol sala, entrenamientos de fútbol sala y partidos de fútbol sala de un campeonato escolar oficial, en los que participaron cuatro profesores de educación física. Los datos fueron analizados con base en el método de análisis de contenido y categorizados a través del Análisis Sistemático de Intervenciones de Contenido Pedagógico. Los análisis inferenciales fueron ejecutados por el Módulo de Tendencias (Análisis de Tendencias y Comparaciones Múltiples) del software PEPI. Los resultados mostraron que las pistas instructivas de la categoría técnica ofensiva (pases) fueron las más utilizadas en las clases, entrenamientos y partidos. También se observó que las reglas y las violaciones eran similares entre las clases curriculares y los entrenamientos. Los hallazgos permitieron verificar (i) las principales pistas instructivas utilizadas por los profesores de EF, (ii) sobre los aspectos críticos a los que se referían y (iii) su especificidad con respecto al contexto de enseñanza (clases, entrenamientos y partidos). Estos hallazgos brindan información útil sobre el diseño de tareas de instrucción, ya que las pistas instructivas permiten a los estudiantes adquirir conocimientos sobre la tarea de aprendizaje. (AU)

A perceptual cue on a moving opponent improves the learning of a motor skill from aikido / Uma dica perceptiva sobre um oponente em movimento melhora a aprendizagem de uma habilidade motora do aikido

ABSTRACT The effect of different instructional foci on the learning of a motor skill of aikido was investigated. Sixty participants from both sexes with an average age of 14 practiced choku tsuki task, which consisted of hitting a target on the chest of an attacking opponent with a stick. They were divided into four groups: relaxation, with a cue about the relaxed way in which the task should be performed; low hip, with a cue about maintaining hip displacement as low as possible; perceptive, with a cue at the circular target located on the chest of the opponent as they raised their sword to attack; and control, without cues. The dependent variables included measures related to the task goals, movement pattern relative to the task components and kinematic features. Only the perceptive and low hip groups learned the motor skill. The perceptive group obtained better overall performance than the other groups. Learning choku tsuki was improved by the instructional cue "strike target as soon as sword is raised", establishing the learner's perceptive attunement to the moving opponent. Learning was also enhanced by the cue "keep hips as low as possible"; however, at a lower level than that of the perceptive cue.

RESUMO O efeito de diferentes dicas sobre a aprendizagem de uma habilidade motora do aikido foi investigado. Sessenta participantes, de ambos os sexos, com idade média de 14 anos, praticaram a tarefa choku tsuki, que consistia em acertar um alvo no peito de um oponente atacante com um bastão. Eles foram divididos em quatro grupos: relaxamento, com dica sobre a maneira relaxada como a tarefa deveria ser executada; quadril baixo, com dica sobre manter o quadril o mais baixo possível; perceptiva, com dica sobre o alvo circular localizado no peito do oponente enquanto ele levantava a espada para atacar; e controle, sem dicas. As variáveis dependentes incluíram medidas relacionadas aos objetivos da tarefa, padrão de movimento em relação aos componentes da tarefa e características cinemáticas. Apenas os grupos perceptivo e quadril baixo aprenderam a habilidade motora. Ainda, o grupo perceptivo obteve melhor desempenho que os demais grupos. A aprendizagem do choku tsuki foi aprimorada pela dica "estocar o alvo assim que levantar a espada", estabelecendo a sintonia perceptiva do aprendiz com o oponente em movimento. A aprendizagem também foi aprimorada pela dica "mantenha o quadril o mais baixo possível"; no entanto, em um nível inferior ao da dica perceptiva.

Totally robotic caudate lobe liver resection: Bridge over troubled water.

BACKGROUND: Minimally invasive hepatectomy has well-known advantages over the traditional open approach. Inherent limitations of laparoscopy make major hepatectomies and the resection of upper and posterior segments a great technical challenge. The robotic approach overcomes most of these limitations, and this technology is most useful in the resection of the deeply located caudate lobe. METHODS: We describe the robotic caudate lobe resection technical aspects, using the first robotic resection of the caudate lobe to treat a biphenotypic hepatocholangiocarcinoma to illustrate the procedure. We also performed a literature review on the current status of the robotic approach to segment (Sg) 1. RESULTS: Technical approach to the robotic caudate lobe resection is described in a patient with uneventful post-operative recovery. Literature review demonstrated only four previous authors reporting the use of this technique. CONCLUSION: We present a step-by-step approach to the hepatic Sg 1 resection by robotic approach.

Long-term survival after surgical treatment followed by adjuvant systemic therapy for primary duodenal melanoma.

Primary mucosal malignant melanomas of the gastrointestinal tract are rare tumors associated to poor prognosis. Primary duodenal involvement by pigmented lesions is even more uncommon, and only a few reports exist in the literature. We report the case of a patient with large primary duodenal melanoma that presented with upper intestinal obstruction and bleeding that was submitted to urgent pancreaticoduodenectomy followed by adjuvant systemic therapy with an oral alkylating agent (temozolomide) plus intravenous cisplatin. The patient presents no signs of recurrence 3 years after the surgery. We consider that radical surgical resection followed by systemic therapy is a safe and effective treatment strategy option for primary mucosal gastrointestinal melanomas.

Memory deficit, toxic effects and activity of Na(+), K(+)-ATPase and NTPDase in brain of Wistar rats submitted to orally treatment with alpha-terpinene.

The neurotoxic effects and activity of Na(+), K(+)-ATPase and NTPDase in Wistar rats after treatment with α-terpinene (daily oral administration of 0.5, 0.75 and 1.0mLkg(-1) for 10days) were examined. Results of the inhibitory avoidance task showed a memory deficit (p<0.05) in rats treated with all doses of α-terpinene. The evaluation of DNA damage in brain tissue revealed an increase (p<0.05) on frequency of damage and damage index in all concentrations. According to the cytotoxicity assay, doses of 0.5, 0.75 and 1.0mLkg(-1) increase the lactate dehydrogenase levels, and doses of 1.0mLkg(-1) also decrease (p<0.05) cell viability in brain cells. A decrease (p<0.05) on Na(+), K(+)-ATPase activity in brain tissue and on NTPDase activity in serum were observed in all concentrations of α-terpinene. These results suggest that the α-terpinene was cytotoxic and genotoxic to the brain cells by inducing loss of cell viability and DNA damage, as well as causing alterations in Na(+), K(+)-ATPase and NTPDase activity, what may contribute to the memory deficit of treated animals. Thus, α-terpinene cannot be consumed by the population at the doses studied.

Effects of treatment with the anti-parasitic drug diminazene aceturate on antioxidant enzymes in rat liver and kidney.

Diminazene aceturate (DA) is the active component of some trypanocidal drugs used for the treatment of animals infected with trypanosomosis and babesiosis. Residues of DA may cause hepatotoxic and nephrotoxic effects. Therefore, the purpose of this study was to investigate the occurrence of oxidative stress, i.e., changes in the antioxidant defense system of rats treated with a single dose of 3.5 mg kg(-1) of DA. All treatments were intramuscularly administered, and evaluations were performed on days 7 and 21 post-treatment (PT). Liver and kidney samples were collected and evaluated by histopathology and oxidative stress parameters (thiobarbituric acid-reactive species, catalase, superoxide dismutase, carbonyl, non-protein thiols, and reduced glutathione). Finally, blood was collected to determine seric DA concentration. Superoxide dismutase (SOD) and catalase (CAT) activities in liver and kidney of rats were dramatically inhibited (p < 0.05) compared to the control group on day 21 PT. This difference is related to the concomitant increase (p < 0.05) in malondialdehyde (MDA) content, which was identified by an increase in thiobarbituric acid-reactive species (TBARS) levels. The carbonyl levels did not differ between groups (p > 0.05). Both non-protein thiols (NPSH) and glutathione (GSH) levels in liver and kidney decreased (p < 0.05) on day 21 PT. Chromatographic analyses showed lower levels of DA on day 21 PT compared to day 7 PT. A negative correlation was observed between DA concentration in serum and lipid peroxidation in liver and kidney tissues on 21 days PT. Histopathology revealed vacuolar degeneration in liver and kidney samples on day 21 PT. Our findings indicate that DA could cause oxidative damage to liver and kidney of rats.

Interações públicas, censura privada: o caso do Facebook / Public interactions, private censorship: the case of Facebook

Resumo O Facebook é apresentado como uma plataforma de relacionamento social on-line transnacional em que ocorrem debates e interações públicas. O texto traz um levantamento sobre o controle privado das expressões culturais e políticas realizadas pelos gestores da plataforma, que pode ser definido como censura privada. Casos de remoção de conteúdo são apresentados, e são expostas as políticas de controle do Facebook. O texto mostra ainda que as regras do Facebook trazem fortes componentes discricionários e uma estética que pode ser apresentada como um tipo de biopolítica da sociedade informacional.

Abstract Facebook is examined as a transnational online social networking platform where public discussions and interactions take place. The study surveys the private control of cultural and political expressions exercised by the platform’s managers, which can be defined as private censorship. Cases of removal of content are presented and Facebook’s political control policies discussed. The article also shows how Facebook rules display highly discretionary components and an aesthetic that can be portrayed as a kind of biopolitics of the information-age society.

[Public interactions, private censorship: the case of Facebook]. / Interações públicas, censura privada: o caso do Facebook.

Facebook is examined as a transnational online social networking platform where public discussions and interactions take place. The study surveys the private control of cultural and political expressions exercised by the platform's managers, which can be defined as private censorship. Cases of removal of content are presented and Facebook's political control policies discussed. The article also shows how Facebook rules display highly discretionary components and an aesthetic that can be portrayed as a kind of biopolitics of the information-age society.

Avaliação do controle da asma em pacientes acompanhados em dois ambulatórios de pneumologia vinculados à Estratégia Saúde da Família em Tubarão, Santa Catarina, Brasil / Assessment of asthma control in patients monitored at two pulmonology outpatient clinics linked to the Family Health Strategy in Tubarão, Santa Catarina state, Brazil / Evaluación del control del asma en pacientes asistidos en dos ambulatorios de neumología vinculados a la Estrategia de Salud Familiar en Tubarão, Santa Catarina, Brasil

Introdução: A asma é uma doença crônica debilitante, que pode gerar restrições diretamente ligadas a um mau controle da doença. O controle da asma pode ser avaliado por instrumentos padronizados. Objetivo: Determinar o controle da asma por meio do Questionário de Controle da Asma (QCA) e do Teste de Controle da Asma (TCA) e a classificação de acordo com as Diretrizes para o Manejo da Asma, de 2012. Métodos: Estudo observacional transversal com pacientes atendidos em ambulatórios de referência vinculados à Estratégia Saúde da Família em Tubarão-SC. A população foi composta por todos os pacientes asmáticos adultos que recorreram a consultas médicas durante o período de janeiro a novembro de 2010. Os dados foram compilados em uma planilha Excel e analisados pelo programa INSTAT 3. Foi realizada análise descritiva e aplicado teste quiquadrado para verificar associação entre respostas do TCA e QCA. Resultados: Foram avaliados 49 pacientes, tendo, a maioria deles, asma intermitente ou persistente leve (51%). Na avaliação do controle da asma o TCA mostrou que 69,3% dos pacientes não estavam controlados. Em relação ao QCA, foram considerados fora do alvo 75,5% dos pacientes. Houve associação significativa entre o TCA e QCA (p<0,05). Quanto às Diretrizes para o Manejo da Asma, 2012, 57,14% dos pacientes foram considerados não controlados; 30,6% estavam parcialmente controlados; e 12,2%, controlados. Conclusão: Os asmáticos estavam, em sua maioria, não controlados. Torna-se necessário identificar os fatores ligados ao descontrole e buscar estratégias, visando melhorar os escores para redução da morbimortalidade associada à asma.

Introduction: Asthma is a chronic debilitating disease which can generate constraints directly associated with poor disease control. Asthma control can be evaluated using standardized instruments. Objective: To determine asthma control through the Asthma Control Questionnaire (ACQ) and Asthma Control Test (ACT), and to classify it according to the Guidelines for the Management of Asthma, 2012. Methods: This is a cross-sectional observational study with patients of two pulmonology outpatient clinics linked to the Family Health Strategy in the municipality of Tubarão, Santa Catarina state. The population consisted of all adult asthmatic patients who resorted to medical appointments from January to November 2010. The data were compiled in Excel and analyzed by INSTAT 3 software. We performed descriptive analysis and applied the chi-square test to assess the association between ACT and ACQ answers. Results: We evaluated 49 patients, most of them presenting intermittent or mild persistent asthma (51%). In the assessment of asthma control, ACT showed that 69.3% of patients were considered uncontrolled, while ACQ showed that 75.5% of patients were considered off-target. Significant association was found between ACT and ACQ (p<0.05). Regarding the 2012 Guidelines for the Management of Asthma, 57.14% of patients were considered uncontrolled; 30.6% were partially controlled; and 12.2% were controlled. Conclusion: Most asthmatics were uncontrolled. It is necessary to identify the factors related to uncontrolled patients and search strategies to improve health scores for reduction of morbimortality caused by asthma.

Introducción: El asma es una enfermedad crónica debilitante, que puede generar restricciones directamente relacionadas con el mal control de la enfermedad. El control del asma puede ser evaluado utilizando instrumentos estandarizados. Objetivo: Determinar el control del asma a través del Cuestionario de Control del Asma (CCA) y la Prueba de Control del Asma (PCA) y la clasificación de acuerdo con la Guía para el Manejo del Asma, de 2012. Métodos: Estudio observacional transversal con pacientes atendidos en ambulatorios de referencia vinculados a la Estrategia de Salud Familiar en Tubarão-SC. La población estaba compuesta por todos los pacientes asmáticos adultos que recurrieron a citas médicas durante el período de enero a noviembre de 2010. Los datos se recopilaron en una hoja de cálculo Excel y se analizaron con el software INSTAT 3. Se realizó un análisis descriptivo y se aplicó el test chi-cuadrado para evaluar la asociación entre respuestas del PCA y CCA. Resultados: Se evaluaron 49 pacientes, la mayoría de ellos con asma intermitente o persistente leve (51%). En la evaluación del control del asma, el PCA mostró que el 69,3% de los pacientes no estaban bajo control. En el CCA se consideró fuera de objetivo al 75,5% de los pacientes. Se encontró una asociación significativa entre PCA y CCA (p <0,05). En cuanto a la Guía para el Manejo del Asma, de 2012, se consideró al 57,14% de los pacientes fuera de control; el 30,6% estaban parcialmente bajo control; y el 12,2% bajo control total. Conclusión: La mayoría de los asmáticos no estaban bajo control. Es necesario identificar los factores relacionados con el descontrol y buscar estrategias con el objetivo de mejorar los puntajes para reducir la morbimortalidad asociada al asma.

O ensino de habilidades motoras esportivas na escola e o esporte de alto rendimento: discurso, realidade e possibilidades / The teaching of sport motor skills in the school and the high performance sport: discourse, reality and possibilities

A massificação da prática esportiva começando pela escola tem sido sugerida como uma forma eficaz para transformar o Brasil numa potência no esporte de alto rendimento. O objetivo deste ensaio é analisar e refletir sobre o discurso, a realidade e as possiblidades de ensino do esporte na escola, tendo como pano de fundo a relação entre a Educação Física Escolar e o esporte de alto rendimento. Em outras palavras, fazer uma análise crítica para qualificar a vinculação escola-esporte de alto rendimento com o intuito de deixar claro o papel social da escola e a sua eventual contribuição para a formação de atletas, e para discutir as possibilidades reais de se ensinar o esporte na escola, particularmente as habilidades motoras, consideradas as condições em que ela se encontra...

The amplification of mass sport practice starting from school physical education has been suggested as an effective way to transform Brazil in a powerful high performance sport country. The objective of this essay is to analyze and reflect on discourse, reality and possibilities of teaching sport in the schools having as a background the relationship between school physical education and high performance sport. In other words, to carry out a critical analysis to qualify the link school-high performance sport in order to make clear the social role of the school and its eventual contribution to the formation of athletes, and to discuss the real possibilities to teach sport in the schools, particularly motor skills, considering the conditions in which they now are...

Aquisição da habilidade motora rebater na educação física escolar: um estudo das dicas de aprendizagem como conteúdo de ensino / The acquisition of striking motor skill in school physical education: a study of learning cues as educational con

O objetivo do estudo foi investigar o efeito das dicas verbais na aquisição da habilidade rebater na Educação Física Escolar (EFE), com foco de atenção no seu aspecto perceptivo e motor. Participaram do estudo 84 alunos de três turmas de uma escola (faixa etária entre seis a oito anos). Cada turma correspondeu a um grupo: sem dicas, com dica perceptiva e com dica motora. O experimento teve três fases: pré-teste, aulas de EFE e pós-teste. O grupo com dica perceptiva apresentou melhores resultados. Portanto, verificou-se o efeito das dicas relacionado com a especificidade da tarefa no que se refere às suas demandas de processamento. Assim concluiu-se que a dica de aprendizagem relacionada à especificidade da tarefa mostrou o seu potencial como um conhecimento que orienta os alunos em direção à melhoria da qualidade do movimento, confirmando a possibilidade de sua inclusão como conteúdo de ensino da EFE.

The purpose of this study was to investigate the effects of verbal cues on the acquisition of a striking skill, focusing on their perceptual and motor aspects. The sample of this study was made of 84 public school students aged between six to eight years old from three classrooms of the same school. Each classroom constituted a group: no cue, perceptual cue and motor cue group. The experiment was carried out in three phases: pre-test, classes with specific cue and post-test. The group which received perceptual cue showed better results. Thus, it was verified that the effects of cues depend on the specificity of the task concerning its information processing demands. It was concluded that task´s specificity related cue demonstrated its potential as knowledge for the students to guide them towards improvement of the quality of movement and confirms the possibility of its inclusion as a content to be taught in the school physical education.

Therapeutic cold: An effective kind to modulate the oxidative damage resulting of a skeletal muscle contusion.

Muscular contusions affect the function of the skeletal muscle system. This study investigated the oxidative damage as well as the main morphological changes related to a skeletal muscle contusion in the gastrocnemius muscle of rats and also the capacity of therapeutic cold to modulate these parameters. The therapeutic cold modulated the increase of oxidative stress markers and also modulated the reduction in the antioxidants levels in the injured muscle. In enzyme assays, therapeutic cold was also effective in normalizing the muscle Na(+)/K(+) and Ca(2+) ATPases, lactate dehydrogenase and myeloperoxidase activities. Similarly, the lesioned non-treated animals presented evident impairments in the mitochondrial functions and in the muscle morphology which were diminished by the cold treatment. The therapeutic cold was able to modulate the oxidative damage possibly by its capacity to limit the inflammatory response intensity, to attenuate the impairment of the mitochondrial function and also to preserve the skeletal muscle morphology.

Desfechos hospitalares em pacientes submetidos a intervenção coronária percutânea na vigência de síndromes coronárias agudas atendidos em unidades de pronto atendimento (UPAs) - Resultados de um centro de cardiologia terciário / In-hospital outcomes in patients with acute coronary syndromes undergoing coronary percutaneous intervention primarily assisted in the Emergency Care Units (ECUs): results from a Tertiary Cardiology Center

INTRODUÇÃO: A criação das Unidade de Pronto Atendimento (UPAs) veio atender a uma necessidade urgente do governo brasileiro em melhorar o atendimento à população carente. Rapidamente as UPAs se tornaram centros de referência para tratamento da dor torácica nessa população, em decorrência da agilidade do atendimento, da disponibilidade de medicamentos de última geração e da existência de pessoal treinado. Este estudo visa a descrever o perfil e a evolução hospitalar de pacientes com sindrome coronária aguda atendidos nessas unidades e posteriormente encaminhados a um hospital terciário, onde foram tratados por angioplastia com implante de stent. Método: No período de julho a dezembro de 2009, 300 pacientes foram encaminhados das UPAs para o hospital Santa Helena (Cabo Frio, RJ). Desses pacientes, 164 (2002 lesões) foram submetidos a implante de stent e divididos em dois grupos: grupo I, formado por 86 pacientes com síndrome coronária aguda...

BACKGROUND: Emergency Care Units (ECUs) were created to meet an urgent need of the Brazilian government to improve health care to low-income population. ECUs quickly became reference centers to treat chest pain in this population, due to their ability to provide prompt medical care, availability of last generation drugs and well trained staff. This study is aimed at describing the profile and inhospital follow-up of patients with acute coronary syndromes seen in these units and later referred to a tertiary hospital, where they were treated by percutaneous coronary intervention with stent implantation. METHOD: Three hundred patients were referred from ECUs to Santa Helena Hospital (Cabo Frio, RJ) from July to December, 2009. One hundred and sixty four patients (202 lesions) were treated by percutaneous intervention with stent and were divided in two groups: group I included 86 patients with acute coronary syndromes with ST segment elevation and group II included 78 patients with acute coronary syndromes without ST segment elevation. Clinical and angiographic characteristics and in-hospital major adverse cardiac events were compared between the two groups. RESULTS: Clinical and angiographic characteristics were similar in both groups except for smoking. Angiographic success was obtained in 99% of the procedures. Mean hospitalization time (ECU + tertiary hospital) was 6 days. There were 6 in-hospital major adverse cardiac events, 5 in group I and 1 in group II (5.8% vs. 1.3%; P = 0.60). CONCLUSION: Late percutaneous revascularization of patients with acute coronary syndromes seen at ECUs is a safe and effective procedure, with high success and low complication rates.