Translational Approach for Percutaneous Interventions for the Treatment of Cardiac Arrhythmias

Abstract New translational concepts on cellular and tissue substrate of cardiac arrhythmias have been responsible for the development of non-pharmacological interventions, with important achievements compared to the conventional approach with antiarrhythmic drugs. In addition, the increasing knowledge of anatomical and electrophysiological studies, sophisticated mapping methods, special catheters, and controlled clinical trials have favored the progression of ablation of tachyarrhythmias, particularly of ventricular tachyarrhythmias and atrial fibrillation.

Medicina Traslacional en el Perú, generación de políticas y mejoras basadas en la evidencia / Translational medicine in Peru, policy making and evidence-based improvement

Introducción: la investigación traslacional es una rama de la ciencia de reciente creación, su objetivo principal es la aplicación del conocimiento que se genera de las investigaciones, que no quede formando parte de la literatura gris, en el papel o para unos pocos, sino que pueda servir a la mayor cantidad posible de individuos y/o poblaciones. Objetivo: determinar los avances que se han dado a lo largo de los últimos años en la aplicación de la medicina traslacional en Perú. Métodos: se realizó una búsqueda por conveniencia en bases de datos (Google Scholar, Pubmed). Se han brindado ejemplos de cómo la investigación traslacional en Perú puede aportar en gran medida a la mejora de realidades y problemáticas específicas, esto refuerza la necesidad de que las decisiones políticas deben basarse en la medicina basada en la evidencia. Resultados: la medicina traslacional en Perú enfrenta muchas dificultades, como lo son los recursos limitados, tiempo escaso para implementar la investigación formativa, carencia de modelos pedagógicos actualizados, docentes preparados en escuelas antiguas y con capacidad limitada para la educación médica continua; obstáculos que deben de superarse para poder asegurar que la ciencia -y por ende la sociedad- progresen. Conclusiones: en Perú, el avance de la medicina traslacional ha derivado en la generación de personal de salud más capacitado que ha proporcionado los medios para el desarrollo de múltiples políticas públicas. Dichas políticas en muchos casos han terminado plasmadas en normas, reglamentos y hasta leyes en el país(AU)

Introduction: translational research is a branch of science of recent creation. Its main aim is the application of the knowledge generated by research so that it will not become grey literature printed on paper or for the use of a chosen few, but serve as many people and/or populations as possible. Objective: determine the progress made in recent years in the application of translational medicine in Peru. Methods: a convenience search was conducted in the databases Google Scholar and PubMed. Examples are offered of the way in which translational research may greatly contribute to improve specific realities and problems in Peru. This reinforces the need that political decisions be based on evidence-based medicine. Results: translational medicine is faced with many difficulties in Peru, such as limited resources, scant time to implement training research, lack of updated pedagogical models, and teachers trained in old schools and with a limited capacity for continuing medical education. These hurdles should be overcome to ensure the progress of science and therefore of society as well. Conclusions: progress of translational medicine in Peru has resulted in the training of more skilled health personnel, providing the means for the development of multiple public policies. In many cases those policies have been included in standards, regulations and even laws in the country(AU)

Perspectiva Latinoamericana del Modelo Conceptual Conocimiento en Acción de Knowledge Translation / Latin-American Perspective about the Conceptual Model Knowledge in Action of Knowledge Translation

Introducción: El vacío entre lo que se sabe y lo que se hace es complejo para la toma de decisiones ante las demandas de la práctica diaria de atención a la salud de las personas, familias y comunidades. En ese sentido, la traducción del conocimiento puede ser una estrategia de transformación del conocimiento en acción con la participación del usuario del sistema de salud. Objetivo: Reflexionar acerca del significado, las potencialidades y límites de aplicación del modelo conceptual conocimiento en acción de la estrategia de traducción del conocimiento para transferir conocimientos científicos al campo de la salud y la enfermería. Métodos: Análisis teórico-reflexivo del modelo conceptual de traducción del conocimiento en acción, editado por expertos del área de la salud, de acuerdo con la definición del Instituto Canadiense de Investigación en Salud y adoptado por la OMS y EVIPNET, con aplicación en países latinoamericanos. Esa reflexión fue dividida en tres ejes: significado; modelo conceptual y aplicación en la práctica. Conclusiones: Algunas propuestas de transformación del conocimiento en acción y justicia social han empezado a considerarse en América Latina, tanto en la política como en la práctica clínica. En el campo de la enfermería hay una creciente aplicación del modelo de traducción del conocimiento a la acción, con la utilización de diferentes enfoques de investigación para integrar a los participantes para la producción de nuevas prácticas más eficiente, efectiva, eficaz y segura(AU)

Introduction: The gap between what is known and what is done is complex for decision-making in the face of daily-practice demands of the healthcare of individuals, families and communities. In that respect, knowledge translation can be a strategy of knowledge transformation in action with the participation of the health system user. Objective: To reflect on the meaning, potentialities and limits of applying the conceptual model knowledge in action of the knowledge translation strategy to transfer scientific knowledge to the field of health and nursing. Methods: Theoretical-reflexive analysis of the conceptual model of translation of knowledge in action, edited by experts in the health area​​, in accordance with the definition of the Canadian Institutes for Health Research and adopted by WHO and EVIPNET, with application in Latin American countries. That reflection was divided into three axes: meaning, conceptual model, and application in practice. Conclusions: Some proposals for the transformation of knowledge into action and social justice have started to be considered in Latin America, both in politics and in clinical practice. In the field of nursing, there is a growing application of the model of translation of knowledge into action, with the use of different research approaches to integrate participants for the production of new practices that are more efficient, effective, and safer(AU)

Investigación traslacional en microbioma (InTraMic): un área de interés común y creciente en el IMTIB, Hospital Italiano e Instituto Universitario / Translational research in microbiome (InTraMic): an area of common and growing interest at IMTIB, Hospital Italiano and Instituto Universitario

Se estima que aproximadamente 100 trillones de microorganismos (incluidos bacterias, virus y hongos) residen en el intestino humano adulto y que el total del material genético del microbioma es 100 veces superior al del genoma humano. Esta comunidad, conocida como microbioma se adquiere al momento del nacimiento a través de la flora comensal de la piel, vagina y heces de la madre y se mantiene relativamente estable a partir de los dos años desempeñando un papel crítico tanto en el estado de salud como en la enfermedad. El desarrollo de nuevas tecnologías, como los secuenciadores de próxima generación (NGS), permiten actualmente realizar un estudio mucho más preciso de ella que en décadas pasadas cuando se limitaba a su cultivo. Si bien esto ha llevado a un crecimiento exponencial en las publicaciones, los datos sobre las poblaciones Latinoamérica son casi inexistentes. La investigación traslacional en microbioma (InTraMic) es una de las líneas que se desarrollan en el Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB). Esta se inició en 2018 con la línea de cáncer colorrectal (CCR) en una colaboración con el Colorectal Cancer Research Group del Leeds Institute of Medical Research en el proyecto Large bowel microbiome disease network: Creation of a proof of principle exemplar in colorectal cancer across three continents. A fines de 2019 se cumplió el objetivo de comprobar la factibilidad de la recolección, envío y análisis de muestras de MBF en 5 continentes, incluyendo muestras provenientes de la Argentina, Chile, India y Vietnam. Luego de haber participado de capacitaciones en Inglaterra, se ha cumplido con el objetivo de la etapa piloto, logrando efectivizar la recolección, envío y análisis metagenómico a partir de la secuenciación de la región V4 del ARNr 16S. En 2019, la línea de enfermedad de hígado graso no alcohólico se sumó a la InTraMic iniciando una caracterización piloto en el marco de una colaboración con el laboratorio Novartis. Los resultados de ese estudio, así como el de cáncer colorrectal, están siendo enviados a publicación. En 2020, con la incorporación de la línea de trasplante alogénico de células progenitoras hematopoyéticas, fue presentado un proyecto para un subsidio del CONICET que ha superado la primera etapa de evaluación. En el presente artículo se brinda una actualización sobre la caracterización taxonómica de microbioma y se describen las líneas de investigación en curso. (AU)

It is estimated that approximately 100 trillion microorganisms (including bacteria, viruses, and fungi) reside in the adult human intestine, and that the total genetic material of the microbiome is 100 times greater than that of the human genome. This community, known as the microbiome, is acquired at birth through the commensal flora of the mother's skin, vagina, and feces and remains relatively stable after two years, playing a critical role in both the state of health and in disease. The development of new technologies, such as next-generation sequencers (NGS), currently allow for a much more precise study of it than in past decades when it was limited to cultivation. Although this has led to exponential growth in publications, data on Latin American populations is almost non-existent. Translational research in microbiome (InTraMic) is one of the lines developed at the Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB). This started in 2018 with the Colorectal Cancer Line (CRC) in a collaboration with the Colorectal Cancer Research Group of the Leeds Institute of Medical Research in the project "Large bowel microbiome disease network: Creation of a proof of principle exemplar in colorectal cancer across three continents". At the end of 2019, the objective of verifying the feasibility of collecting, sending and analyzing MBF samples on 5 continents, including samples from Argentina, Chile, India and Vietnam, was met. After having participated in training in England, the objective of the pilot stage has been met, achieving the collection, delivery and metagenomic analysis from the sequencing of the V4 region of the 16S rRNA. In 2019, the non-alcoholic fatty liver disease line joined InTraMic, initiating a pilot characterization in the framework of a collaboration with the Novartis laboratory. The results of that study, as well as that of colorectal cancer, are being published. In 2020, with the incorporation of the allogeneic hematopoietic stem cell transplantation line, a project was presented for a grant from the CONICET that has passed the first stage of evaluation. This article provides an update on the taxonomic characterization of the microbiome and describes the lines of ongoing research. (AU)

How to translate scientific knowledge into practice? Concepts, models and application / ¿Cómo traducir el conocimiento científico a la práctica? Conceptos, modelos y aplicación / Como traduzir o conhecimento científico à prática? Conceitos, modelos e aplicação

ABSTRACT Objectives: to present the concept of Knowledge Translation and Exchange as it has been used in the international literature and in Canada, particularly. Next, to describe a renowned conceptual model to guide its implementation, entitled Knowledge-to-Action Cycle. Results: we described the use of the model in the context of the municipal primary health care system in southern Brazil for the implementation of pain management strategies during vaccination. Conclusions: in this theoretical reflection, we argue that in order to promote health equity and quality of care in the Unified Health System (Brazilian SUS) it is important to translate scientific knowledge to various practice settings and create opportunities for exchange with users of this knowledge, such as health professionals, managers, policy makers, patients, family members and other stakeholders.

RESUMEN Objetivos: presentar el concepto de Traducción e Intercambio de Conocimiento tal como se ha utilizado en la literatura internacional y, en particular, en Canadá. A continuación, describir un modelo conceptual reconocido para guiar su implementación, titulado Ciclo del Conocimiento a la Acción. Resultados: ilustramos el uso del modelo en el contexto del sistema municipal de atención primaria de salud en el sur de Brasil para implementar estrategias de manejo del dolor durante la vacunación. Conclusiones: en esta reflexión teórica, argumentamos sobre la importancia de traducir el conocimiento científico a los diversos contextos de práctica y de crear oportunidades de intercambio con los usuarios de este conocimiento, como profesionales sanitarios, gerentes, formuladores de políticas públicas, pacientes, familias y otros grupos de interés para promover la equidad y la calidad de los cuidados en el Sistema Único de Salud.

RESUMO Objetivos: apresentar o conceito de Tradução e Intercâmbio do Conhecimento tal como vem sendo utilizado na literatura internacional e, em particular, no Canadá. A seguir, descrever um renomado modelo conceitual para orientar a sua implementação, intitulado Ciclo do Conhecimento à Ação. Resultados: ilustramos a utilização do modelo no contexto do sistema municipal de atenção básica à saúde no sul do Brasil, na implementação de estratégias de manejo da dor durante a vacinação. Conclusões: nesta reflexão teórica, argumentamos sobre a importância de se traduzir o conhecimento científico aos diversos contextos de prática e criar oportunidades de intercâmbio com os usuários desse saber, como profissionais de saúde, gestores, formuladores de políticas públicas, pacientes, familiares e demais grupos de interesse, para promover equidade e qualidade dos cuidados no Sistema Único de Saúde.

Development of middle-range theories in nursing / Desarrollo de las teorías de medio alcance en enfermería / Desenvolvimento das teorias de médio alcance na enfermagem

ABSTRACT Objective: To identify in the literature how Middle-Range Theories (MRT) are being developed in Nursing. Method: Integrative review on the databases Lilacs (Latin American and Caribbean Literature in Health Sciences), Scopus, Cinahl (Cumulative Index to Nursing and Allied Health Literature), Web of Science and PubMed portal, using the keywords middle range theory and nursing, as well its Portuguese correspondents (Lilacs), and the Boolean operator AND. The sample included 25 articles. Results: All articles presented concepts related to MRT. Most developed a synthesis picture. Some theories have formulated specific propositions, hypotheses, and names. Only 16 articles cited the methodological framework, while 22 used theories or models for theoretical foundation and 11 carried out literature reviews. Final considerations: The development of MRT included the presentation of fundamental concepts, synthesis, propositions, hypotheses and specific name. The MRT is recognized as a way of developing knowledge to guide the nursing practice.

RESUMEN Objetivo: Identificar en la literatura cómo las Teorías de Medio Alcance (TMA) se están desarrollando en enfermería. Método: Revisión integrativa en las bases de datos: LILACS (Literatura Latinoamericana y del Caribe en Ciencias de la Salud), Scopus, Cinahl (Cumulative Index to Nursing and Allied Health Literature), Web of Science y PubMed, utilizando la palabra clave middle range theory, el descriptor nursing y sus equivalentes en portugués (LILACS) y el operador booleano AND. La muestra constó de 25 artículos. Resultados: Todos los artículos presentaron conceptos relacionados con las TMA. La mayoría desarrolló un cuadro resumen. Algunas teorías presentaron proposiciones, plantearon hipótesis y nombres específicos. Solamente 16 artículos citaban el referencial metodológico, mientras que 22 utilizaban teorías o modelos en la fundamentación teórica y 11 hicieron revisión de la literatura. Consideraciones finales: El desarrollo de las TMA incluyó la presentación de conceptos fundamentales, de cuadro resumen, de proposiciones, hipótesis y nombre específico. Se reconocen las TMA como forma de desarrollar conocimiento para orientar la práctica en enfermería.

RESUMO Objetivo: Identificar na literatura como as Teorias de Médio Alcance (TMA) têm sido desenvolvidas na enfermagem. Método: Revisão integrativa nas bases Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde), Scopus, Cinahl (Cumulative Index to Nursing and Allied Health Literature), Web of Science e portal PubMed, utilizando a palavra-chave middle range theory, o descritor nursing, seus correspondentes em português (Lilacs) e o operador booleano AND. A amostra incluiu 25 artigos. Resultados: Todos os artigos apresentaram conceitos relacionados às TMA. A maioria desenvolveu quadro síntese. Algumas teorias formularam proposições, hipóteses e nomes específicos. Apenas 16 artigos citavam o referencial metodológico, enquanto 22 usavam teorias ou modelos para fundamentação teórica e 11 utilizavam revisão na literatura. Considerações finais: O desenvolvimento das TMA incluiu apresentação de conceitos fundamentais, quadro síntese, proposições, hipóteses e nome específico. Reconhece-se as TMA como forma de desenvolver conhecimento para orientar a prática de enfermagem.

El biomodelo porcino en la investigación médica traslacional: del biomodelo al humano en trasplante pulmonar / The porcine biomodel in translational medical research: From biomodel to human lung transplantation

Resumen Introducción. La anatomía humana y porcina son comparables. En consecuencia, el biomodelo porcino tiene el potencial de ser implementado para entrenar al profesional quirúrgico en áreas como el trasplante de órganos sólidos. Objetivo. Describir los procedimientos y hallazgos obtenidos mediante experimentos de medicina respiratoria traslacional con biomodelos porcinos realizados en un laboratorio de experimentación animal, y hacer una revisión comparativa entre el pulmón humano y el porcino. Materiales y métodos. El experimento se llevó a cabo en nueve cerdos de raza híbrida en un laboratorio de cirugía experimental. Se estudiaron la anatomía y la histología de las vías respiratorias mediante fibrobroncoscopia, biopsia bronquial y lavado broncoalveolar. El lavado broncoalveolar se estudió con citología en base líquida y se evaluó con las coloraciones de Papanicolau y hematoxilina y eosina. Se utilizaron técnicas de patología molecular, como inmunohistoquímica, citometría de flujo y microscopía electrónica. Los cerdos se sometieron a neumonectomía izquierda con posterior implante del injerto en otro cerdo experimental. Resultados. Los estudios histopatológicos y moleculares evidenciaron un predominio de macrófagos alveolares (98 %) y linfocitos T (2 %) en el lavado broncoalveolar porcino. En los estudios del parénquima pulmonar porcino se encontró tejido linfoide hiperplásico asociado a las paredes bronquiales. La microscopía electrónica evidenció linfocitos T dentro del epitelio y el diámetro de las cilias porcinas fue similar al de las humanas. Conclusiones. El biomodelo porcino es viable en la investigación traslacional para el entendimiento de la anatomía del sistema respiratorio y el entrenamiento en trasplante pulmonar. La implementación de este modelo experimental podría fortalecer los grupos que planean implementar un programa institucional de trasplante pulmonar en humanos.

Abstract Introduction: Human and porcine anatomy are comparable. In consequence, the porcine biomodel has the potential to be implemented in the training of surgical professionals in areas such as solid organ transplantation. Objectives: We described the procedures and findings obtained in the experiments of translational respiratory medicine with the porcine biomodel, within an experimentation animal laboratory, and we present a comparative review between human and porcine lung. Materials and methods: The experiment was done in nine pigs of hybrid race within a laboratory of experimental surgery. The anatomy and histology of the respiratory tract were studied with fibrobronchoscopy, bronchial biopsy and bronchoalveolar lavage. The bronchoalveolar lavage was studied with liquid-based cytology and assessed with Papanicolau and hematoxylin-eosin staining. Molecular pathology techniques such as immunohistochemistry, flow cytometry, and electronic microscopy were implemented. The pigs were subjected to left pneumonectomy with posterior implantation of the graft into another experimental pig. Results: Histopathologic and molecular studies evidenced predominance of alveolar macrophages (98%) and T-lymphocytes (2%) in the porcine bronchoalveolar lavage. Studies on the porcine lung parenchyma revealed hyperplasic lymphoid tissue associated with the bronchial walls. Electronic microscopy evidenced the presence of T-lymphocytes within the epithelium and the cilia diameter was similar to the human. Conclusions: The porcine biomodel is a viable tool in translational research applied to the understanding of the respiratory system anatomy and the training in lung transplantation. The implementation of this experimental model has the potential to strength the groups who plan to implement an institutional program of lung transplantation in humans.

Musical educational technology for lactation physiology learning: knowledge translation / Tecnología educativa musical para el aprendizaje de la fisiología de la lactancia: traducción del conocimiento / Tecnologia educativa musical para aprendizagem da fisiologia da lactação: tradução do conhecimento

ABSTRACT Objective: create and validate a musical educational technology for lactation physiology learning for professional training in health. Method: methodological study with application of a conceptual framework of Knowledge Translation. In the creation cycle, the knowledge of the physiology of lactation was synthetized in key points to create the lyrics and the melody. In the action cycle, the content of the musical educational technology was validated by judges experts in breast feeding, in the period from September to December 2017. Results: 18 judges from all Brazilian regions participated in the validation. The content of the technology obtained a global Content Validity Index of 0.94 with one round of validation. Conclusion: the musical educational technology is validated to introduce the content of the physiology of lactation in the learning process of students, mediated by the teacher.

RESUMEN Objetivo: crear y validar una tecnología educativa musical para el aprendizaje de la fisiología de la lactancia en la formación profesional en salud. Método: estudio metodológico con aplicación del Modelo Conceptual de Traducción del Conocimiento. En el ciclo de creación, el conocimiento de la fisiología de la lactancia fue sintetizado en puntos clave con los que se crearon la letra y la melodía. En el ciclo de acción, el contenido de la tecnología educativa musical fue validado por jueces expertos en lactancia materna, en el período de septiembre a diciembre de 2017. Resultados: 18 jueces de todas las regiones brasileñas participaron de la validación. El contenido de la tecnología obtuvo un Índice de Validez de Contenido global de 0.94 con una ronda de evaluación. Conclusión: se validó la tecnología educativa musical para introducir el contenido de la fisiología de la lactancia en el proceso de aprendizaje del alumno, mediado por el profesor.

RESUMO Objetivo: criar e validar uma tecnologia educativa musical para a aprendizagem da fisiologia da lactação na formação profissional em saúde. Método: estudo metodológico com aplicação de Modelo Conceitual de Tradução do Conhecimento. No ciclo de criação foi sintetizado o conhecimento da fisiologia da lactação em pontos-chave, com os quais foram criadas a letra e a melodia. No ciclo de ação foi validado o conteúdo da tecnologia educativa musical por juízes experts em aleitamento materno, no período de setembro a dezembro de 2017. Resultados: 18 juízes de todas as regiões brasileiras participaram da validação. O conteúdo da tecnologia obteve Índice de Validade de Conteúdo global de 0,94 com uma rodada de avaliação. Conclusão: a tecnologia educativa musical está validada para introduzir o conteúdo da fisiologia da lactação no processo de aprendizagem de estudantes, mediado pelo docente.

New trends in translational microsurgery

Abstract Technological advances such as optical instruments and surgical tools have enabled the considerable contributions of microsurgery to surgical therapies. Accordingly, surgical therapeutics has provided the latest information across a wide range of medical specialties, including immunology and pharmacology, despite specialization according to organs and organ systems. The International Society for Experimental Microsurgery, an academic organization, has utilized experimental microsurgery technology in the identification of curative concepts for diseases that remain difficult to treat. For this publication to mark the 32nd anniversary of the Brazilian Surgical Society, I introduced the following types of technology related to the further development of microsurgical technological innovations in the future: high-resolution three-dimensional (3D) video and touch-sensitive microsurgery robots.

Medicina traslacional e innovación en salud: mecanismos y perspectivas / Translational medicine and innovation in health: mechanisms and perspectives

Many new discoveries in Life Sciences cannot be translated into products, services or new applications to improve human health. Translational medicine, defined as "from bench to bedside", refers to the transfer of results or new knowledge achieved in the laboratory into health innovation. We aim to review the state of art of translational medicine, its relationship with innovation processes and the different perspectives to consider. Finally, we contextualize the situation of Research and Development (R&D) in Chile and the main issues of the biotechnology market in the country.

Insuficiência cardíaca - fisiopatologia atual e implicações terapêuticas / Heart failure - current pathophysiology and terapeutic implications

Conhecer a fisiopatologia da insuficiência cardíaca propiciou uma evolução terapêutica em seu manejo, que se traduziu em melhora de desfechos clínicos relevantes, incluindo redução da mortalidade. O conceito do remodelamento ventricular, associado à ativação neuro-humoral descrita inicialmente, via ativação do sistema renina-angiotensina-aldosterona, e posteriormente via ativação simpática, levou ao uso de inibidores da ECA e de betabloqueadores, respectivamente, que mudaram o curso da história da insuficiência cardíaca. Ainda na categoria farmacológica, mais recentemente a modulação da rota da neprilisina, através do uso do composto sacubitril/valsartan, trouxe impacto adicional de redução de mortalidade em pacientes com insuficiência cardíaca. Por fim, dispositivos que também interfiram no processo de remodelamento ventricular, como marcapassos de ressincronização biventricular, demonstraram benefícios clínicos significativos. Novos alvos moleculares, microRNAs ou moléculas de sinalização intracelular, devem crescer como potenciais áreas de investigação na progressão da doença e, potencialmente, se transformarem em alvos terapêuticos

Knowledge of the pathophysiology of heart failure has led to a therapeutic evolution in its management that has resulted in improved clinical outcomes, including a reduction in mortality. The concept of ventricular remodeling associated with neurohumoral activation, initially described via activation of the renin-angiotensin-aldosterone system and later, via sympathetic activation, led to the use of ACE inhibitors and beta blockers, respectively, altering the course of history of heart failure. Also in the pharmacological category, more recently, modulation of the neprilysin route, through the use of the compound sacubitril/valsartan, brought additional impacts in reducing mortality in patients with heart failure. Finally, devices that also interfere in the process of ventricular remodeling, such as biventricular resynchronization pacemakers, have demonstrated significant clinical benefits. New molecular targets, microRNAs, or intracellular signaling molecules should increase as potential areas of research on disease progression, and could potentially become therapeutic targets

The future of psychiatric research / O futuro da pesquisa em psiquiatria

Abstract Psychiatric disorders place considerable burden on individuals and on public health. Funding for research in psychiatry is less than ideal, but even so high quality research is being conducted at many centers. However, these studies have not impacted clinical practice as much as expected. The complexity of psychiatric disorders is one of the reasons why we face difficulties in translating research results to patient care. New technologies and improved methodologies are now available and must be incorporated to deal with this complexity and to accelerate the translational process. I discuss the application of modern techniques for data acquisition and analysis and also the new possibilities for performing trials in virtual models of biological systems. Adoption of new technologies is necessary, but will not reduce the importance of some of the fundamentals of all psychiatry research, such as the developmental and translational perspectives. Psychiatrists wishing to integrate these novelties into their research will need to work with contributors with whom they are unaccustomed to working, such as computer experts, a multidisciplinary team, and stakeholders such as patients and caregivers. This process will allow us to further understand and alleviate the suffering and impairment of people with psychiatric disorders.

Resumo Os transtornos psiquiátricos são responsáveis por uma significativa carga de doença tanto no nível individual quanto na saúde pública. Mesmo com financiamento abaixo do ideal, muitas pesquisas de alta qualidade vêm sendo executadas em vários centros. Entretanto, o impacto desses estudos na prática clínica é menor que o esperado. A complexidade dos transtornos psiquiátricos é uma das razões pelas quais enfrentamos tanta dificuldade na translação dos resultados das pesquisas para a prática clínica. Novas tecnologias e metodologias aperfeiçoadas já estão disponíveis e devem ser incorporadas para lidar com esta complexidade e acelerar o processo translacional. Discuto, neste artigo, a aplicação de técnicas modernas para a coleta e análise de dados e as novas possibilidades para a realização de testes em modelos virtuais dos sistemas biológicos. A adoção das novas tecnologias é necessária, mas não reduzirá a importância de fundamentos da pesquisa em psiquiatria, como as perspectivas desenvolvimental e translacional. Os psiquiatras que desejarem integrar essas novas tecnologias à suas pesquisas terão que trabalhar com colaboradores com os quais não estão acostumados, como especialistas em informática, equipes multidisciplinares e representantes de partes interessadas nos resultados, como pacientes e provedores de cuidados assistenciais. Esse processo permitirá um avanço no conhecimento e no alívio do sofrimento e da incapacidade das pessoas com transtornos psiquiátricos.

Translational microsurgery. A new platform for transplantation research

ABSTRACT PURPOSE: Clinical microsurgery has been introduced in many fields, while experimental microsurgery has the cross-disciplinary features of the sciences and techniques for growth of medicine, pharmacology, veterinary, engineering etc. Training protocol, proposing a new name as Translational Microsurgery, was introduced. METHODS: Reconstructive skills of hepatic artery in pediatric living donor liver transplantation were summarized. Ex vivo training protocol using artificial blood vessel for surgeons was proposed. RESULTS: Clinical microsurgery requires anastomosis with delicate arteries and limited field of view. Our training protocol revealed that the relation between the score and speed was seen, while not all the surgeons with enough experience got high score. This training led to muster clinical skills and to apply excellent experimental works. CONCLUSIONS: Our microsurgical training protocol has been planned from the points of clinical setting. Training for vascular anastomosis led to rodent transplantation models. These models were used for immunology and immunosuppressant research. Microsurgical techniques led to master catheter technique and to inject various drugs or gene vectors.

Contribuições do programa de doutorado sanduíche nas abordagens metodológicas: relato de experiência / Contribuciones del programa de doctorado sándwich con los abordajes metodológicos: relato de experiencia / Contributions of the sandwich doctoral program to methodological approaches: an experience report

RESUMO Objetivo Compartilhar experiências e insights teóricos e metodológicos que os pesquisadores obtiveram ao trabalhar juntos durante um programa de doutorado sanduíche. Método Trata-se de um estudo descritivo do tipo relato de experiência. Resultados Incorporou-se o pensamento restaurativo no estudo da cultura de segurança do paciente e espera-se implementar o plano de knowledge translation utilizando os princípios do diálogo deliberativo como uma estratégia para aumentar a aplicabilidade dos resultados da pesquisa. Conclusão A incorporação de novas metodologias nas pesquisas da enfermagem brasileira possui um papel fundamental para o alcance de visibilidade e participação internacional nas diferentes áreas de conhecimento da enfermagem.

RESUMEN Objetivo Compartir experiencias e introspecciones teóricas y metodológicas que los investigadores obtuvieron al trabajar juntos durante un programa de doctorado sándwich. Método Estudio descriptivo del tipo relato de experiencia. Resultados Se ha incorporado el pensamiento restaurador en el estudio de la cultura de seguridad del paciente y se espera implementar el plan de traducir conocimientos usando los principios del diálogo deliberativo como una estrategia para aumentar la aplicabilidad de los resultados de la investigación. Conclusión La incorporación de nuevas metodologías en las investigaciones de enfermería brasileña tiene un rol fundamental para el alcance de visibilidad y participación internacional en las diferentes áreas de conocimiento de enfermería.

ABSTRACT Objective To share our experience on theoretical and methodological insights we have gained as researchers working together during the Sandwich Doctoral Program. Method This is a descriptive experience report. Results We have incorporated restoration thinking into a study on patient safety culture and will enhance knowledge translation by applying principles of deliberative dialogue to increase the uptake and implementation of research results. Conclusion Incorporating new approaches in Brazilian nursing research plays a key role in achieving international participation and visibility in different areas of nursing knowledge.

Thyroid function, autoimmunity and nodules in hematological malignancies

Objective Hematological malignancies encompass a large spectrum of disease entities whose treatment by chemo/radiotherapy could lead to thyroid complications. To the best of our knowledge, no study has simultaneously addressed thyroid function, autoimmunity and nodularity. Therefore, we decided to conduct one.Materials and methods We evaluated 82 Caucasian patients (36 women and 46 men), who were treated at our Oncology division for hematological malignancies (multiple myeloma, chronic myeloid leukemia, chronic lymphatic leukemia, non-Hodgkin lymphoma and polycythemia vera) and compared them with a control group of 104 patients. Patients who had received or were receiving external head/neck radiotherapy were excluded. All oncological patients and control individuals underwent thyroid ultrasonography and thyroid function and autoimmunity tests.Results A lower prevalence of enlarged thyroid and nodules were found in patients with respect to controls. The rate of thyroid nodules was the highest in multiple myeloma and polycythemia vera, and the lowest in chronic lymphatic leukemia. Non-Hodgkin lymphoma patients had the smallest thyroid nodules while men with multiple myeloma the biggest ones. No patient had hypothyroidism, while 5.6% of patients had subclinical hyperthyroidism. In contrast, within the control group the rates of hypothyroidism and hyperthyroidism, overt and subclinical, were 3.8%, 20.2%, 0% and 0% respectively. Moreover, the overall rate of thyroid autoantibody positiveness in patients was significantly lower than controls.Conclusion In our experience, we found a significantly lower prevalence of thyroid abnormalities in hematologic patients who underwent chemotherapy, but not radiotherapy, with respect to controls. Arch Endocrinol Metab. 2015;59(3):236-44.

La investigación científica como misión académica de los hospitales públicos universitarios / Scientific research as academic mission of the public university hospitals

En un hospital universitario, la asistencia, la educación y la investigación están ligadas entre sí. Es propósito de este trabajo destacar la significación de la investigación científica como misión académica de los hospitales públicos universitarios. La integración de la investigación con la práctica clínica garantiza mayor calidad en los servicios de salud, mejor implantación de los avances médicos en la prevención y tratamiento de las enfermedades y un cuidado más ético y eficiente para los pacientes. Lograr tal integración implica una asistencia médica de excelencia, unos profesionales mejor formados y más reconocidos en su quehacer investigativo, un financiamiento suficiente y claro, la integridad del sistema institucional que da soporte a la actividad investigativa y la incorporación sostenida de investigadores jóvenes. Son necesarios cambios en la enseñanza de la medicina, en la organización de la investigación y en la organización hospitalaria. A esta última le corresponde afrontar el reto de la investigación traslacional. El hospital universitario reúne las características para nuclear la investigación traslacional y brindar una alternativa de acción efectiva a la compleja relación existente entre la investigación en salud y la toma de decisiones a nivel político, para lograr finalmente el acercamiento entre la asistencia y la investigación. Los responsables hospitalarios han de tomar conciencia de que la investigación biomédica es también un producto hospitalario. Los hospitales universitarios y otros, de menor o mayor complejidad, deben realizar actividades asistenciales, docentes y de investigación, para brindar una asistencia de calidad haciendo uso de la mejor evidencia científica disponible(AU)

Assistance, education and research are mutually linked in a university hospital. The objective of this paper is to underline the meaning of the scientific research as an academic mission of the public university hospitals. The integration of research with the clinical practice assures higher quality of health services, better implementation of medical advances in the prevention and treatment of diseases and more ethical and efficient care to patients. Reaching such integration involves medical assistance of excellence, better prepared and more acknowledged professionals in their research work, adequate financing and the integrity of the institutional system that supports the research activity, without ignoring the sustained involvement of young researchers. The abovementioned involves changes in medical education, in the organization of the research activity and of the hospitals as well. The university hospital has the right characteristics to face the translational research challenge, to serve as a core and to provide effective alternative to the complex relationship between health research and decision taking at the political level, so that assistance and research can finally get closer. The hospital officials must be aware of the fact that biomedical research is also a hospital product. The university hospitals, either more or less complex, should perform assistance, teaching and research activities to offer quality care and to make the best use of the scientific evidence at its disposal(AU)

Asian Society of Gynecologic Oncology International Workshop 2014 / 부인종양

The Asian Society of Gynecologic Oncology International Workshop 2014 on gynecologic oncology was held in Asan Medical Center, Seoul, Korea on the 23rd to 24th August 2014. A total of 179 participants from 17 countries participated in the workshop, and the up-to-date findings on the management of gynecologic cancers were presented and discussed. This meeting focused on the new trends in the management of cervical cancer, fertility-sparing management of gynecologic cancers, surgical management of gynecologic cancers, and recent advances in translational research on gynecologic cancers.

Proposta conceitual de telessaúde no modelo da pesquisa translacional / Proposal for a telehealth concept in the translational research model

OBJETIVO Rever relação conceitual entre telessaúde e pesquisa translacional. MÉTODOS Realizou-se busca bibliográfica sobre telessaúde nas bases Scopus, Cochrane BVS, Lilacs e Medline com a finalidade de encontrar experiências de telessaúde conjugadas com a discussão da pesquisa translacional em saúde. A busca recuperou oito estudos, que basearam a análise dos modelos das cinco etapas da pesquisa translacional com os múltiplos fluxos de política pública no contexto brasileiro da telessaúde. Esses modelos foram aplicados às atividades de telessaúde da Rede de Bancos de Leite Humano, na Rede Universitária de Telemedicina. RESULTADOS O ciclo da pesquisa translacional do leite humano coletado, armazenado e distribuído apresentou iniciativas de telessaúde integradas, tais como videoconferências, softwares e portais de síntese do conhecimento, compondo elementos de um ecossistema de informação, mediado por tecnologias da informação e comunicação no sistema de saúde. CONCLUSÕES A telessaúde deve ser compreendida como conjunto de atividades em rede mediadas por computação e que promovem a translação do conhecimento entre pesquisa e serviços de saúde. .

OBJECTIVE To review the conceptual relationship between telehealth and translational research. METHODS Bibliographical search on telehealth was conducted in the Scopus, Cochrane BVS, LILACS and MEDLINE databases to find experiences of telehealth in conjunction with discussion of translational research in health. The search retrieved eight studies based on analysis of models of the five stages of translational research and the multiple strands of public health policy in the context of telehealth in Brazil. The models were applied to telehealth activities concerning the Network of Human Milk Banks, in the Telemedicine University Network. RESULTS The translational research cycle of human milk collected, stored and distributed presents several integrated telehealth initiatives, such as video conferencing, and software and portals for synthesizing knowledge, composing elements of an information ecosystem, mediated by information and communication technologies in the health system. CONCLUSIONS Telehealth should be composed of a set of activities in a computer mediated network promoting the translation of knowledge between research and health services. .