Progresión de los componentes de la presión arterial y la correlación con las medidas antropométricas y laboratoriales en adultos jóvenes / Progression of blood pressure components and correlation with anthropometric and laboratory measurements in young adults

Introducción: La presencia de hipertensión arterial en población joven aumenta el riesgo de eventos cardiovasculares en la mediana edad y como consecuencia una morbimortalidad prematura. El propósito de este estudio es evaluar la progresión de los componentes de la presión arterial y la correlación con las medidas antropométricas y laboratoriales en estudiantes de la Universidad Nacional de Asunción- Paraguay. Materiales y métodos: Se realizó un estudio descriptivo correlacional, longitudinal, prospectivo, desde el año 2013 hasta el año 2017 evaluando al inicio 284 universitarios y 240 al final de las carreras. Se midieron variables sociodemográficas, antropométricas, presión arterial, determinaciones bioquímicas. La progresión de los componentes de la presión arterial, de las variables antropométricas y clínicas se calcularon mediante la prueba T de muestras relacionadas. La correlación de la presión arterial sistólica y presión arterial diastólica con las variables antropométricas y laboratoriales con la correlación de Pearson. Resultados: La progresión de los componentes de la presión arterial presentó una diferencia estadísticamente significativa en la presión arterial sistólica, presión arterial diastólica y presión de pulso. En relación con las características antropométricas y clínicas de los estudiantes se encontró una diferencia estadísticamente significativa entre la medición inicial y final en el peso, perímetro abdominal, glicemia, insulina, colesterol total, colesterol de alta densidad, colesterol de baja densidad, triglicéridos y proteína C reactiva. La correlación más importante encontrada entre las medidas antropométricas con la presión arterial sistólica y presión arterial diastólica fue la circunferencia abdominal. Conclusión: Se encontró aumento de la tendencia de la presión arterial y de otros factores de riesgo cardiovascular en universitarios.

Introduction: The presence of arterial hypertension in young population increases the risk of cardiovascular events in middle age and as a consequence premature morbimortality. The purpose of this study was to evaluate the progression of blood pressure components and the correlation with anthropometric and laboratory measurements in students of the National University of Asuncion, Paraguay. Materials and methods: A descriptive correlational, longitudinal, prospective, descriptive study was conducted from 2013 to 2017 evaluating at the beginning 284 undergraduates and 240 at the end of the careers. Sociodemographic variables, anthropometric variables, blood pressure, biochemical determinations were measured. The progression of blood pressure components, anthropometric and clinical variables were calculated using the related samples t-test. The correlation of systolic blood pressure and diastolic blood pressure with anthropometric and laboratory variables was correlated with Pearson's correlation. Results: The progression of blood pressure components presented a statistically significant difference in systolic blood pressure, diastolic blood pressure and pulse pressure. In relation to the anthropometric and clinical characteristics of the students, a statistically significant difference was found between the initial and final measurements in weight, abdominal perimeter, glycemia, insulin, total cholesterol, high-density cholesterol, low-density cholesterol, triglycerides, and C-reactive protein. The most important correlation found between anthropometric measurements with systolic blood pressure and diastolic blood pressure was abdominal circumference. Conclusion: An increase in the trend of blood pressure and other cardiovascular risk factors was found in university students.

Experimental study of the response of articular cartilage surface roughness to load / 生物医学工程学杂志

Cartilage surface fibrosis is an early sign of osteoarthritis and cartilage surface damage is closely related to load. The purpose of this study was to study the relationship between cartilage surface roughness and load. By applying impact, compression and fatigue loads on fresh porcine articular cartilage, the rough value of cartilage surface was measured at an interval of 10 min each time and the change rule of roughness before and after loading was obtained. It was found that the load increased the roughness of cartilage surface and the increased value was related to the load size. The time of roughness returning to the initial condition was related to the load type and the load size. The impact load had the greatest influence on the roughness of cartilage surface, followed by the severe fatigue load, compression load and mild fatigue load. This article provides reference data for revealing the pathogenesis of early osteoarthritis and preventing and treating articular cartilage diseases.

Assessment of apical pressures at different automated irrigant flow rates: an ex vivo study based on computational fluid dynamic analysis / Avaliação de pressões apicais em diferentes taxas de fluxo irrigante automatizadas: um estudo ex vivo baseado em análise dinâmica de fluidos computacionais

Objective: The current study aimed at assessing the induced apical pressure at various simulated irrigant flow rates. Materials and Methods: Forty eight freshly extracted single-rooted premolars were decoronated and prepared to size 30 0.04 taper using HY-Flex CM rotary file system and were scanned using cone-beam computed tomography (CBCT). The scanned images were reconstructed to three-dimensional Computer-aided design models (CAD) and the 3D needle was also reconstructed. Finally, simulations were done by placing the 30 gauge open-ended needle 3 mm short of the working length. Results: There was a statistically significant difference (p<0.05) among the different groups compared. 1 ml/min flow rate induced the least apical pressures (p<0.05) as compared to the other types. Conclusion: 1 ml/min flow rates induced the least apical pressures when open-ended needles are used for irrigation.(AU)

Objetivo: O presente estudo teve como objetivo avaliar a indução de pressão apical em várias taxas de fluxo irrigante simuladas. Material e Métodos: Quarenta e oito raízes de pré-molares unirradiculares recém extraídos tiveram suas coroas removidas, foram preparados para uma conicidade de tamanho 30 0.04 através de um sistema rotatório de limas HYFlex CM e foram escaneados via tomografia computadorizada cone-beam (CBCT). As imagens escaneadas e as agulhas para irrigação foram reconstruídas em modelos tridimensionais de design assistido por computador (CAD). Ao final, foram feitas simulações através de agulhas de calibre 30 e 3 mm a menos que o comprimento de trabalho. Resultados: Houve diferença estatisticamente significativa (p<0.05) entre os diferentes grupos. A taxa de fluxo de 1 ml/min induziu as menores pressões apicais (p<0.05) quando comparada às demais taxas. Conclusão: Taxas de fluxo de 1 ml/min induziram as menores pressões apicais quando agulhas de ponta aberta foram utilizadas para irrigação (AU)

Relação entre perfil, hábitos, vivências acadêmicas e resiliência de universitários / Relationship between profile, habits, academic experiences and resilience of university students / Relación entre el perfil, los hábitos, las experiencias académicas y la resiliencia de los estudiantes universitarios

A falta de recursos para lidar com situações desafiadoras pode dificultar o ajuste do estudante à universidade e aumentar o risco de fracasso acadêmico. Pensando nisso, o objetivo deste estudo foi verificar se há relação entre o perfil, os hábitos de vida, as vivências acadêmicas e a resiliência de graduandos das áreas da saúde e Psicologia. Trata-se de um estudo transversal e inferencial. Participaram 361 graduandos dos cursos de Biomedicina, Educação Física, Enfermagem, Farmácia, Fisioterapia, Medicina, Nutrição, Terapia Ocupacional e Psicologia, matriculados em três instituições federais de Ensino Superior do interior de Minas Gerais. Utilizou-se um questionário sociodemográfico e de hábitos de vida, a Escala de Resiliência e o Questionário de Vivências Acadêmicas - versão reduzida -, respondidos de forma on-line pelos universitários, bem como análises descritivas e correlacionais. Os resultados mostraram resiliência média para a maioria dos universitários e boa adaptação ao contexto universitário, além de relações entre a resiliência e o período cursado, estar em psicoterapia, avaliar positivamente a própria saúde e todas as dimensões das vivências acadêmicas. Conclui-se que a resiliência é uma capacidade importante para enfrentar as demandas da graduação e que é possível desenvolvê-la, especialmente durante o começo da graduação e com a adoção de intervenções focadas no autoconhecimento, na autoeficácia e em boas estratégias de enfrentamento. Desenvolver a resiliência nos estudantes pode colaborar para a promoção da saúde desta população e a redução da evasão no Ensino Superior.(AU)

The lack of resources to deal with challenging situations may hinder the student's adjustment to the university and increase the risk of academic failure. With this in mind, this study aimed to verify whether there is a relationship between the profile, life habits, academic experiences, and resilience of undergraduate students in the areas of Health and Psychology. This is a cross-sectional and inferential study. A total of 361 undergraduate students of Biomedicine, Physical Education, Nursing, Pharmacy, Physical Therapy, Medicine, Nutrition, Occupational Therapy, and Psychology, registered in three Federal Institutions of Higher Education in the interior of Minas Gerais participated in the study. We used a sociodemographic and lifestyle questionnaire, the Resilience Scale, and the Questionnaire of Academic Experiences - short version, answered online by the undergraduates, and descriptive and correlational analyses. The results showed average resilience for most university students and good adaptation to the university context, as well as showing relationships between resilience and the study period, being in psychotherapy, positively evaluating their own health, and all dimensions of academic experiences. We conclude that resilience is an important capacity to face the demands of undergraduate courses and that developing it is possible, especially during the beginning of undergraduate life and by adopting interventions focused on self-knowledge, self-efficacy, and good coping strategies. Developing the resilience of students can contribute to promote health in this population and reduce dropout rates in higher education.(AU)

La falta de recursos para afrontar situaciones desafiantes puede dificultar la adaptación del estudiante a la universidad y aumentar el riesgo de fracaso académico. Con esto en mente, el objetivo de este estudio fue verificar si existe una relación entre el perfil, los hábitos de vida, las experiencias académicas y la resiliencia de los estudiantes de grado en las áreas de Salud y Psicología. Se trata de un estudio transversal e inferencial. Participaron 361 estudiantes de pregrado de Biomedicina, Educación Física, Enfermería, Farmacia, Fisioterapia, Medicina, Nutrición, Terapia Ocupacional y Psicología, matriculados en tres Instituciones Federales de Educación Superior del interior de Minas Gerais. Se utilizó un cuestionario sociodemográfico y de hábitos de vida, la Escala de Resiliencia y el Cuestionario de Vivencias Académicas - Versión Reducida, que los universitarios respondieron en línea, y se realizaron análisis descriptivos y correlativos. Los resultados mostraron una resiliencia media para la mayoría de los estudiantes universitarios y una buena adaptación al contexto universitario, además mostraron relaciones entre la resiliencia y el periodo estudiado, estar en psicoterapia, evaluar positivamente su propia salud y todas las dimensiones de las experiencias académicas. Concluimos que la resiliencia es una capacidad importante para afrontar las exigencias de la graduación y que es posible desarrollarla, especialmente durante el inicio de esta y con la adopción de intervenciones centradas en el autoconocimiento, la autoeficacia y las buenas estrategias de afrontamiento. Desarrollar la resiliencia de los estudiantes puede contribuir a promover la salud de esta población y a reducir el abandono escolar en la enseñanza superior.(AU)

Notificações de incidentes relacionados à segurança do paciente em hospital universitário sentinela / Notificaciones de incidentes relacionados con la seguridad del paciente en un hospital universitario centinela / Notifications of incidents related to patient safety in a sentinel university hospital

RESUMO Objetivo: analisar as notificações de incidentes relacionados à segurança do paciente em hospital universitário público sentinela. Método: Pesquisa retrospectiva, quantitativa, realizada em hospital universitário localizado no Sul do Brasil. Foram analisadas 760 notificações de incidentes ocorridos nos anos de 2015 a 2017 encaminhadas ao setor de gerência de risco da instituição. Os dados foram coletados de maio a agosto de 2018. A análise estatística descritiva se realizou com o auxílio do Statistical Package for the Social Sciences versão 20.0. Resultados: os incidentes notificados foram lesão por pressão (64,0%), seguida de quedas (25,0%), erro de medicação (9,7%), identificação incorreta do paciente (1,0%) e incidentes nos procedimentos cirúrgicos (0,3%). O período matutino, profissional enfermeiro e a unidade de terapia intensiva adulto foram os que mais realizaram as notificações. O evento adverso mais notificado estava relacionado ao erro de medicação (50,7%) seguido de quedas (26,8%). Conclusão: os resultados deste estudo contribuem para aumentar o interesse na análise dos dados de incidentes e eventos adversos, bem como para definir ou refinar as estratégias de melhoria da segurança do paciente.

RESUMEN Objetivo: analizar las notificaciones de incidentes relacionados con la seguridad del paciente en hospital universitario público centinela. Método: investigación retrospectiva, cuantitativa, realizada en hospital universitario ubicado en el Sur de Brasil. Se analizaron 760 notificaciones de incidentes ocurridos en los años 2015 a 2017 dirigidas al sector de gestión de riesgos de la institución. Los datos se recopilaron de mayo a agosto de 2018. El análisis estadístico descriptivo se realizó con la ayuda del Statistical Package for the Social Sciences versión 20.0. Resultados: los incidentes notificados fueron lesión por presión (64,0%), seguida de caídas (25,0%), error de medicación (9,7%), identificación incorrecta del paciente (1,0%) e incidentes en los procedimientos quirúrgicos (0,3%). Los que más realizaron las notificaciones fueron el profesional enfermero, período matutino y la unidad de cuidados intensivos adulto. El evento adverso más notificado estaba relacionado con el error de medicación (50,7%) seguido de caídas (26,8%). Conclusión: los resultados de este estudio contribuyen a aumentar el interés en el análisis de los datos de incidentes y eventos adversos, así como para definir o refinar las estrategias de mejora de la seguridad del paciente.

ABSTRACT Objective: to analyze the notifications of incidents related to patient safety in a sentinel public university hospital. Method: retrospective, quantitative research conducted in a university hospital located in southern Brazil. It analyzed 760 notifications of incidents that occurred in the years 2015 to 2017 forwarded to the risk management sector of the institution. Data was collected from May to August 2018. Descriptive statistical analysis was performed using the Statistical Package for the Social Sciences version 20.0. Results: the incidents reported were pressure ulcers (64.0%), followed by falls (25.0%), medication errors (9.7%), incorrect patient identification (1.0%) and incidents in surgical procedures (0.3%). The morning period, nursing professionals and adult intensive care unit were the ones that made the most notifications. The most reported adverse event was related to medication error (50.7%) followed by falls (26.8%). Conclusion: the results of this study contribute to increasing interest in the analysis of incident and adverse event data, and to defining or refining strategies to improve patient safety.

Respostas pressóricas faringeana, esofágica e do esfíncter esofagiano a tarefas vocais à luz da manometria de alta resolução / Pharyngeal, upper esophageal sphincteric and esophageal pressures responses related to vocal tasks at the light of high resolution manometry

ABSTRACT BACKGROUND: High-resolution manometry (HRM) represents a potential tool for measuring pharyngoesophageal phonation pressures. OBJECTIVE: This study aims to evaluate pharyngeal, esophageal upper sphincteric and esophageal pressures during different phonation tasks. METHODS: 12 (six males, mean age 27 years) professional singers underwent HRM and produced four different vocal tasks at low, medium and high vocal loudness: vowel /ae/, ascending five note scale, word /hey/ and word /go/. Pressures were measured at pharynx, upper esophageal sphincter (UES) and esophagus. Visual analysis of the HRM topographic plots were performed. RESULTS: Esophageal pressures are higher during vocalization than at rest. Pharyngeal and UES phonation pressures does not differ significantly from rest pressures. Visual analysis of the topographic plots showed an important UES pressure increasement during phonation. CONCLUSION: HRM is a valuable tool for measuring pharyngoesophageal pressures during phonation. Esophageal pressures are higher during phonation than at rest and tend to increase with vocal loudness increment. The topographic plot provides additional data about phonatory mechanism physiology, especially at the UES region.

RESUMO CONTEXTO: A manometria de alta resolução (MAR) é uma ferramenta de grande potencial para mensuração das pressões faringoesofágicas durante a fonação. OBJETIVO: O estudo visa avaliar pressões faringianas, do esfíncter esofagiano superior e do esôfago durante manobras fonatórias. MÉTODOS: Doze (seis homens, idade média 27 anos) cantores profissionais foram submetidos à MAR e produziram quatro tarefas vocais em intensidade baixa, média e alta: vogal / ae /, escala ascendente de cinco notas, palavras /hey/ e /go/. Pressões aos níveis da faringe, esfíncter esofagiano superior e esôfago foram aferidas além de análise visual dos traçados. RESULTADOS: Pressões esofágicas foram maiores na vocalização que no repouso. Pressões da faringe e esfíncter esofagiano superior durante a fonação não foram diferentes que no repouso. Análise visual dos traçados mostrou importante incremento da pressão do esfíncter durante a fonação. CONCLUSÃO: MAR é uma ferramenta valiosa para mensurar as pressões faringoesofágicas durante a fonação. Pressões esofágicas são maiores durante a fonação que no repouso e tendem a aumentar com maior intensidade sonora. Análise visual dos traçados mostram dados adicionais sobre a fisiologia do mecanismo da fonação, especialmente na região do esfíncter esofagiano superior.

EndoFLIP: una nueva tecnología / EndoFLIP: a new technology

Resumen Mediante la distensión de un balón con líquido conductor, la sonda de imagen luminal funcional endoluminal (EndoFLIP) evalúa las propiedades biomecánicas como la distensibilidad, volumen, presión e inclusive diámetros de regiones esfinterianas como la unión gastroesofágica, píloro y ano. La mayor evidencia en la utilidad clínica de la EndoFLIP está en los trastornos de motilidad esofágica, principalmente para identificar acalasia cuando la manometría esofágica de alta resolución y otras imágenes no logran diagnosticarla e inclusive, mediante el programa de FLIP 2.0, caracteriza la acalasia en subtipos a partir de patrones de motilidad del esófago distal en respuesta a la distensión. Se ha demostrado recientemente que la EndoFLIP tiene un rol diagnóstico, pronóstico o terapéutico en otras patologías como la esofagitis eosinofílica, reflujo gastroesofágico, gastroparesia, durante la fundoplicatura y dilatación esofágica.

Abstract EndoFLIP evaluates biomechanical properties such as distensibility, volume, pressure, and even diameters of sphincter regions like the gastroesophageal junction, pylorus, and anus, by distending a balloon with a conductive medium. The best evidence of the clinical utility of EndoFLIP is observed in esophageal motility disorders, mainly when identifying achalasia when high-resolution esophageal manometry and other images fail to diagnose it. Even EndoFLIP 2.0 characterizes achalasia into subtypes based on distal esophageal motility patterns in response to distention. Recently, it has been shown that this system has a diagnostic, prognostic and/or therapeutic role in other diseases such as eosinophilic esophagitis, gastroesophageal reflux, and gastroparesis, and during fundoplication and esophageal dilation.

High pressure endoscopic irrigation: impact on renal histology

ABSTRACT Purpose: High intra-renal pressures during flexible ureteroscopy have been associated with adverse renal tissue changes as well as pyelovenous backflow. Our objective was to investigate the effect of various intra-renal pressures on histologic changes and fluid extravasation during simulated ureteroscopy. Materials and Methods: Twenty-four juvenile pig kidneys with intact ureters were cannulated with an Olympus flexible ureteroscope with and without a ureteral access sheath and subjected to India ink-infused saline irrigation for 30 minutes at constant pressures ranging from sphygmomanometer settings of 50mm, 100mm and 200mmHg. Renal tissue samples were collected, processed and stained, and were evaluated by a blinded pathologist for depth of ink penetration into renal parenchyma as a percentage of total parenchymal thickness from urothelium to renal capsule. Results: The mean percentage of tissue penetration for kidneys with ink present in the cortical tubules at sphygmomanometer pressure settings of 50, 100, and 200mm Hg without a ureteral access sheath was 33.1, 31.0 and 99.3%, respectively and with ureteral access sheath was 0, 0 and 18.8%, respectively. Overall, kidneys with an access sheath demonstrated a smaller mean tissue penetration among all pressure compared to kidneys without a sheath (6.3% vs. 54.5%, p=0.0354). Of kidneys with sheath placement, 11% demonstrated any ink compared to 56% of kidneys without sheath placement. Conclusions: Pressurized endoscopic irrigation leads to significant extravasation of fluid into the renal parenchyma. Higher intra-renal pressures were associated with increased penetration of irrigant during ureteroscopy in an ex-vivo porcine model.

Presión en la reparación de manguito rotador con suturas transóseas y Mason-Allen modificado / Pressure on the rotator cuff repair with transosseous sutures and modified Mason-Allen

OBJETIVO:Comparar el promedio de curva de presión de contacto y el porcentaje de presión de contacto residual final en la interfase tendón-huella de una reparación transósea (TO) realizada con nudos cruzados y una configuración Mason-Allen modificada (MAM). MÉTODOS: Se utilizaron ocho hombros de cordero para simular una rotura de manguito rotador. Se midió la presión con un sensor digital. Se registró la presión basal durante la aplicación de carga cíclica y al final de la intervención. Se compararon dos reparaciones: dos túneles TOs con nudos cruzados (TOCs) (n » 4) y dos puntos MAMs (n » 4) utilizando suturas MaxBraid #2 (Zimmer Biomet, Warsaw, IN, EEUU). Se realizaron 1.000 ciclos, con una frecuencia de 2 Hz y una carga de 30 N. Se utilizó el test de t de Student, y se consideraron significativos valores de p < 0,05. RESULTADOS: El promedio de curva de presión de contacto en las piezas que fueron reparadas con suturas TOCs fue de 86,01 8,43%, mientras que con MAM fue de 73,28 12,01% (p < 0,0004). El promedio del porcentaje residual al final del ciclado fue de 71,57% para suturas TOCs y de 51,19% para MAM (p < 0,05). CONCLUSION: La reparación TOC presenta mayor promedio de curva de presión de contacto y mayor porcentaje de presión de contacto residual final en la interfase tendón-huella que la reparación con sutura MAM luego de carga cíclica estandarizada, lo que podría traducirse en una mejor cicatrización del tendón. NIVEL DE EVIDENCIA: Estudio de ciencia básica.

OBJECTIVE: To compare the average contact pressure curve and the percentage of final residual contact pressure at the tendon-footprint interphase of a transosseous (TO) repair performed with crossover sutures or a modified Mason-Allen (MMA) configuration. METHODS: Eight lamb shoulders were used to simulate a rotator cuff tear. The pressure was measured with a digital sensor. The baseline pressure was recorded during the application of the cyclic load and at the end of the intervention. Two repairs were compared: 2 crossover TO (CTO) sutures (n » 4) and 2 MMA sutures MMA (n » 4), using MaxBraid #2 (Zimmer Biomet, Warsaw, IN, US) sutures. A thousand cycles were performed, with a frequency of 2 Hz and a 30-N load. The Student t-test was used, and significance was set at p < 0.05. RESULTS: The average contact pressure curve was of 86.01 8.43% for parts repaired with CTO sutures, and of 73.28 12.01% for those repaired with MMA sutures (p < 0.0004). The mean residual percentage at the end of cycling was of 71.57% for CTO sutures, and of 51.19% for MMA sutures (p < 0.05). CONCLUSION: The CTO repair shows a higher average contact pressure curve and a higher percentage of final residual contact pressure at the tendon-footprint interphase than the MMA suture repair after standardized cyclic loading, potentially resulting in improved tendon healing. LEVEL OF EVIDENCE: Basic Science Study.

Abordaje holístico de las lesiones por presión en la persona mayor: Caso clínico / Holistic approach to pressure injuries in the elderly: Clinical case

Se expone un caso clínico de una paciente de 88 años cursando una hospitalización domiciliaria de larga estadía, por múltiples lesiones por presión, tras su seguimiento presenta una merma en su recuperación, por lo que un profesional de enfermería de hospitalización domiciliaria realiza una visita domiciliaria integral que evidencia múltiples elementos que precisan un abordaje holístico de la situación. Para su abordaje se utilizó el marco teórico de Virginia Henderson, que facilitó la elección del diagnóstico en la cuidadora de Cansancio del rol de cuidador, lo cual permitió que la situación lograra ser abordada satisfactoriamente. CONCLUSIÓN: se relevó la importancia de un manejo holístico en las lesiones por presión, que debe considerar la dimensión social en la que está inmerso el paciente, junto a un manejo interdisciplinario, preparación profesional y abordaje precoz del probable impacto económico en estos pacientes.

A clinical case of an 88-year-old patient undergoing a long-term home hospitalization due to multiple pressure injuries is presented. After follow-up, she presents a decline in her recovery, so a home hospitalization nursing professional performs a comprehensive home visit that shows multiple elements that require a holistic approach to the situation. For its approach, the theoretical framework of Virginia Henderson was used, which facilitated the choice of the diagnosis in the caregiver of Tiredness from the caregiver role, which allowed the situation to be satisfactorily addressed. CONCLUSION: the importance of a holistic management of pressure injuries was highlighted, which must consider the social dimension in which the patient is immersed, together with an interdisciplinary management, professional preparation, and an early approach to the probable economic impact on these patients.

Biomecânica da língua durante a deglutição após laringectomia total: revisão integrativa / Biomechanics of the tongue during swallowing after total laryngectomy: an integrative review

RESUMO Objetivo Sintetizar o estado do conhecimento científico sobre biomecânica da língua durante a deglutição após laringectomia total. Estratégia de pesquisa Formulou-se a questão PICO e combinações de descritores e termos livres para busca nas bases de dados PubMed/Medline, EMBASE, LILACS e SciELO. Critérios de seleção incluíram-se artigos nos idiomas português, inglês ou espanhol; sem limite de tempo; com resultados sobre a biomecânica da língua durante a deglutição em laringectomizados totais; e estudos do tipo ensaio clínico randomizado ou não randomizado, coorte, caso controle, transversal, série de casos e estudos de caso. Análise dos dados analisou-se ano, país, população, objetivo, delineamento do estudo, instrumentos de avaliação, principais desfechos e qualidade metodológica. Resultados Foram incluídos quatro estudos realizados nos Estados Unidos, um na Austrália e um no Brasil, publicados entre 1986 e 2014. Em todos os estudos incluídos a biomecânica da língua foi um desfecho secundário. A maioria dos artigos teve baixa qualidade metodológica, com amostras pequenas, predomínio do sexo masculino e desenho transversal prevalente. Os instrumentos de avaliação foram videofluoroscopia, manometria, acelerômetro ou dispositivo para captar pressão de língua. Resultados principais indicaram mais força de propulsão da base de língua para superar a alta resistência da neofaringe ao fluxo do bolo alimentar; redução do contato e pressão entre base de língua e parede posterior da faringe; resíduo em base de língua após deglutição; pressão aumentada e resistência reduzida da língua oral. Conclusão Existem indícios de movimentos compensatórios de língua durante a deglutição após laringectomia total, porém, as evidências científicas são insuficientes.

ABSTRACT Purpose To synthesize the state of scientific knowledge about biomechanics of the tongue during swallowing after total laryngectomy. Research strategy The PICO question and combinations of descriptors and single terms were formulated in the PubMed/Medline, EMBASE, LILACS, and SciELO databases. Selection criteria Articles in Portuguese, English, or Spanish were included, without time limit, with results on the biomechanics of the tongue during swallowing and total laryngectomy, and studies on randomized or non-randomized clinical trials, cohort, case control, cross-sectional, case series, and case studies. Data analysis year, country, population, objective, study design, assessment methods, main outcomes, and methodological quality were analyzed. Results There were four studies in the United States, one in Australia, and one in Brazil, all published between 1986 and 2014. In all studies, the biomechanics of the tongue was the secondary outcome. Most articles had low methodological quality, small samples, predominance of the male gender, and a prevalent cross-sectional design. The assessment instruments were fluoroscopy, manometry, accelerometer or a device to capture tongue pressure. Main results indicated a higher propulsion force of the tongue base to overcome the high resistance of the neopharynx to the bolus flow, reduced contact and pressure between the base of the tongue and the posterior pharyngeal wall, residues in the tongue base after swallowing, increased pressure, and reduced resistance of the oral tongue. Conclusion There are indications of compensatory tongue movements during swallowing after total laryngectomy; however, the scientific evidence is insufficient.

Fisiología respiratoria mecánica de la respiración / Mechanics breathing

El trabajo respiratorio se ejerce en una estructura cerrada donde se encuentran los pulmones, estos son sometidos a cambios de presiones determinados por la musculatura pulmonar en las diferentes fases del ciclo respiratorio, lo que generará gradientes y permite la entrada y salida de aire. Se suman a ello el calibre de las vías aéreas, el tipo de flujo, las características de las vías aéreas y del surfactante pulmonar, que determinan un menor o mayor trabajo respiratorio según la condición fisiológica.

The work of breathing is exerted in a closed structure where the lungs are located. These are subjected to pressure changes determined by the pulmonary musculature in the different phases of the respiratory cycle, which will generate gradients and allow the entry and exit of air. In addition to the aforesaid, airway calibre, type of flow, airway characteristics and pulmonary surfactant determine less or more work of breathing depending on the physiological condition.

Do papel do treinador ao ambiente competitivo no futebol infantil: o que está em jogo? / From coaches' roles to the competitive environment in children's football: what's at play? / Del papel del entrenador al entorno competitivo en el fútbol infantil: ¿qué está en juego?

Resumo Esta pesquisa teve como objetivo averiguar a percepção dos treinadores sobre o papel do treinador e o ambiente competitivo no futebol da categoria sub-10. Foram realizadas entrevistas semiestruturadas com 12 treinadores e observadas cinco partidas das fases finais da competição. Os resultados evidenciam que os treinadores reconhecem o seu papel formador, mas não orientam as suas intervenções para valores e competências mais adequados para essa etapa de formação. Os treinadores percebem a competição como um ambiente de aprendizagem, reconhecendo o jogo e a competição como ambientes de pressão inerentes a outras tarefas da vida, mas salientam que em muitas situações esse ambiente de pressão se torna excessivo, por conta do comportamento dos adultos. Assim, os propósitos dos adultos são sobrepostos às possibilidades de experiência e aprendizado das crianças na competição.

Abstract This study examines coaches' views about their role in the U-10 football competitive environment. Semi-structured interviews were conducted with 12 coaches, and 5 matches of the final stages of the competition were observed. The results show that coaches recognize their educational role but do not focus on values and the most appropriate skills in that stage of training. Coaches perceive competition as a learning environment, recognizing the game and competition as a pressure environment inherent to other tasks in life, but they stress that this pressure environment often becomes excessive due to the behavior of adults. Thus, adults' purposes are often superimposed on children's possibilities for experiencing and learning in competition.

Resumen La investigación tuvo como objetivo conocer la percepción de los entrenadores sobre su papel y el ambiente competitivo en el fútbol de la categoría sub-10. Se realizaron entrevistas semiestructuradas con 12 entrenadores y se observaron cinco partidos de la fase final de una competición en nivel estatal. Los resultados muestran que los entrenadores reconocen su papel como formadores, pero no orientan sus intervenciones hacia el desarrollo de valores y habilidades más apropiados en esta etapa de formación deportiva. Los entrenadores perciben la competición como un ambiente de aprendizaje, así como reconocen los partidos como un ambiente de presión inherente a otras tareas de la vida, pero destacan que en muchas situaciones ese ambiente de presión se vuelve excesivo, debido al comportamiento de los adultos. Así, los propósitos de los adultos a menudo se superponen a las posibilidades de experiencia y aprendizaje de los niños en la competición.

Biomechanical evaluation of a new femoral stem design for total hip replacement in a canine model

ABSTRACT Purpose To evaluate the biomechanical properties of a novel total hip replacement femoral stem. Methods Eight pairs of femurs from dog cadavers were used. The femurs were separated into different groups. A novel femoral stem with a convex proximal portion (Stem B) was biomechanically evaluated and compared to awell-known veterinary collared stem (Stem A). Femoral stems were inserted into the contralateral femurs from the same dog, forming 16 constructs. A flexo-compression load was applied on the axial axis of each sample. Maximum strength, deflection, stiffness, and energy absorption were analysed. Results Group B constructs showed significantly higher values (p ? 0.05) for the variables, except stiffness. The mean maximum strength was 1,347 ± 357 N for Group A and 1,805 ± 123 N for Group B (p ? 0.0069). The mean deflection was5.54 ± 2.63 mm for Group A and 10.03 ± 3.99 mm for Group B (p ? 0.0056). For the energy variable, the force was 6,203 ± 3,488 N/mm for Group A and 12,885 ± 5,056 N/mm for Group B (p ? 0.0054). Stem B had greater maximum strength, deflection, and energy. Conclusions The new stem was effective in neutralizing the impact of axial flexion-compression stresses during biomechanical tests in cadaveric models.

Design of combined lower limb elastic compression device and comparative study with elastic bandage / 中国骨伤

OBJECTIVE@#To compared with the modified Robert Jones bandage of 3M elastic bandage, to evaluate the fitness, convenience, safety and comfort of the modular combination lower limb elastic compression device.@*METHODS@#Forty healthy adult college students, including 28 males and 12 females, aged 16 to 25 (20.3±2.2) years old and weighing 40 to 81 (60.4±20.2) kg, were randomly divided into two groups with 40 samples in each group. According to the body surface parameters of Chinese lower limbs and guided by the concept of modularization, a group of modular combined lower limb elastic compression device was designed. Each module was combined to evaluate the fitness of the modular combined compression device in thelength and circumference of the lower limbs. The left and right lower limbs were randomly paired and divided into groups, with 40 samples in each group. The convenience of the operation time, adjustment times and required time were compared between two groups. The safety of the two groups after 24 hours of application of pressure injury was compared. The subjective pain feeling changes within 24 hours were recorded by visual analogue scale (VAS) to evaluate the comfort.@*RESULTS@#The device was composed of several elastic compression outer lining modules with different length and width of 15 cm, an inner lining module for buffering, positioning and attaching the main body, and an elastic ankle compression module. The length of the elastic compression outer lining module covers the circumference of the human lower limbs. The length of a single outer lining module increased from 15 cm to 80 cm every 5 cm interval, and the length of a single inner lining module increased from 62 cm to 83 cm every 3 cm interval. After the modules were selected and combined, the length and circumference of the lower limbs can reach 100% fitness. The operation time of the first placement(118.23±7.33) s and re operation(60.08±5.88) s of experimental group were significantly shorter than those of control group (164.68±8.93) s and re operation (131.23±7.91) s. The adjustment times (3) and operation time (3.50±0.71) s of experimental group were significantly shorter than those of control group(11)and operation time(139.00±5.66) s (@*CONCLUSION@#The modular combined elastic compression device has good fitness, better placement and flexible adjustment, convenience and safety, and better comfort than modified Robert Jones bandage of 3M elastic bandage.

Effects of visual restoration on dynamic plantar pressure features in elder individuals / 北京大学学报(医学版)

OBJECTIVE@#To analyze the effects of visual restoration after cataract surgery on plantar pressure and biomechanics of foot in elder individuals.@*METHODS@#Thirty-two patients [male/female 5/27, (70.1±5.2) years old] with age-related cataract were recruited between October 2016 and December 2019. The footscan system was employed to record the data of plantar pressure during level walking before and 1-month after the cataract surgery. Parameters of peak pressure (PP), impulse (I), pressure-time integral (PTI) and time to peak pressure (TPP) from the regions of the 1st toe (T1), 2nd to 5th toes (T2-5), 1st to 5th metatarsal heads (M1-M5), midfoot (MF), medial hindfoot (HM) and lateral hindfoot (HL) were analyzed respectively.@*RESULTS@#Post-operatively, the visual function was effectively reconstructed with improved visual acuity in both eyes (Z=-4.878, -4.801; P < 0.001). The PP (t=2.266, P=0.031) and I (t=2.152, P=0.039) values in M2 region on the dominant side (right foot) increased statistically at post-operative phase, while the changes of pressure and temporal para-meters in other regions remained stable. There was laterality in plantar pressure at pre-operative phase, manifested as greater PP values in M1, M2, MF, and HM regions on the dominant sides (t=-2.414, -2.478, -2.144, -5.269; P < 0.05), greater PP values in T1, M3, M5 and HL regions on the non-dominant sides (t=4.830, 3.155, 2.686, 3.683; P < 0.05), greater I values in M1, MF, and HM regions on the dominant sides (t=-2.380, -2.185, -5.320; P < 0.05) and greater I values in T1, M3, M5 and HL regions on the non-dominant sides (t=4.489, 2.247, 2.838, 3.992; P < 0.05). post-operatively, the pressure tended to be compatible between the two sides in regions of M3 and MF, while the magnitude of laterality in regions of M1 (ZPP△= -2.721, P=0.007; ZI△=-2.581, P=0.010), M2 (ZPP△=-2.674, P=0.007; ZI△=-2.375, P=0.018) and M5 (ZPP△=1.991, P=0.046; ZI△=2.150, P=0.032) was further increased.@*CONCLUSION@#Changes in plantar pressure after cataract surgery were characterized as increased pressure in the 2nd metatarsal head area on the dominant side. Visual restoration might intensify the laterality in the medial of forefoot on the dominant side and the lateral of forefoot on the non-dominant side.

Hipertensión portal secundario a trombosis de la vena porta y várices esofágicas / Secondary portal hypertension to portal venous thrombosis and esophageal varices

Resumen La hipertensión portal se define como la alteración patológica en el gradiente de presión a nivel del sistema portal, es decir, la diferencia entre la presión de la vena porta y la vena cava inferior. El valor normal es entre 1-5 mm Hg y se considera hipertensión cuando es mayor de 10 mm Hg. En este artículo, se describe el caso de una paciente de 5 años con un cuadro de hipertensión portal secundario a várices esofágicas y trombosis de la vena porta, confirmado por endoscopia de vías digestivas alta y angioresonancia magnética. La paciente fue atendida en la Fundación Clínica Infantil Club Noel de la ciudad de Cali, Colombia, entre los meses de diciembre del 2018 y febrero del 2019.

Abstract Portal hypertension is defined as the pathological increase in the portal pressure gradient, which is the difference between the pressure of the portal vein and the inferior vena cava. Normally portal vein pressure ranges between 1-5 mmHg and is considered hypertension when it is higher than 10 mmHg. In this study the case of a 5-year-old patient that suffers from secondary portal hypertension to portal venous thrombosis and esophageal varices is presented. The diagnostic is confirmed by an endoscopy of the upper gastrointestinal tract and by a magnetic angioresonance. The patient was treated at the Fundacion Clinica Infantil Club Noel located in Cali, Colombia, between the months of December 2018 and February 2019.

Relación de las medidas de mecánica ventilatoria y radiográficas con el tiempo de conexión a ventilación mecánica en pacientes COVID-19: un análisis preliminar / Relations of ventilatory mechanical and radiographic measures with the connection time to mechanical ventilation in patients COVID-19: a preliminary analysis

RESUMEN: Los pulmones son el sitio predominante en la infección por COVID-19. Esta puede conducir al síndrome distrés respiratorio agudo (SDRA). Frente a su sintomatología severa, la ventilación mecánica (VM), y sus valores de mecánica ventilatoria aparecen como una herramienta fundamental. Un complemento, para analizar el estado de avance de esta patología es la radiografía de tórax (RT), aunque en ocasiones esta depende de la experiencia del equipo de salud. Así el objetivo de esta investigación fue explorar la relación de las medidas de mecánica ventilatoria y radiográficas con el tiempo de conexión a VM en pacientes COVID-19. Estudio retrospectivo, que incluyó a 23 pacientes en VM. Se recolectó información de variables de mecánica ventilatoria; PEEP, presión plateau, presión de distensión y compliance estática. Desde la RT se midió, altura y ancho pulmonar, ángulo costodiafragmático y espacio intercostal. Los resultados indicaron que las variables de mecánica ventilatoria tales como el PEEP y el plateau se relacionaron significativamente con el tiempo de conexión a VM (r=0,449; p=0,035 y r=0,472; p=0,026), mientras que las variables radiográficas construidas en base al ángulo costodiafragmático y el espacio intercostal presentaron similares comportamientos (r= 0,462; p=0,046 y r=-0,543; p=0,009). En conclusión, la presión resultante de la programación del ventilador mecánico junto a cambios estructurales observados en la RT, se relacionan con el tiempo de conexión a VM.

SUMMARY: The lungs are the predominant site of COVID-19 infection. This can lead to severe acute respiratory síndrome (ARDS). In view of its severe symptoms, mechanical ventilation (MV) and its ventilatory mechanics values appear as a fundamental tool. Chest radiography (CR) is a complement to analyze the state of progress of this pathology, although this sometimes depends on the experience of the health team. Thus, the aim of this research was to explore the relationship of ventilatory mechanics and radiographic measures with connection time to MV in COVID-19 patients. Retrospective study, which included 23 patients on MV. Information on ventilatory mechanics variables was collected; PEEP, plateau pressure, distension pressure and static compliance. And from CR, lung height and width, costodiaphragmatic angle and intercostal space were measured. The results indicated that ventilatory mechanics variables such as PEEP and plateau were significantly related to connection time to MV (r = 0.449; p = 0.035 and r = 0.472; p = 0.026), while the radiographic variables Constructed on the basis of the costodiaphragmatic angle and the intercostal space, they showed similar behaviors (r = 0.462; p = 0.046 and r = -0.543; p = 0.009). In conclusion, the pressure resulting from mechanical ventilator programming, together with the structural changes observed in CR, are related to the connection time to MV.

Proceso enfermero aplicado a un paciente con úlceras por presión / Nursing process applied to a patient with pressure ulcers / Processo de enfermagem aplicado a um paciente com úlcera por pressão

Resumen Las escaras (también llamadas úlceras por presión y úlceras de decúbito) son lesiones en la piel y el tejido inferior, resultan de una presión prolongada sobre la misma. En la mayoría de los casos, se manifiestan en la piel que recubre las partes óseas del cuerpo, como talones, tobillos, caderas y coxis. Las personas que corren mayor riesgo de tener escaras tienen limitada su capacidad para cambiar de posición o pasan la mayor parte del tiempo en una cama o una silla de ruedas. Pueden desarrollarse en el transcurso de horas o días, la mayoría se curan con tratamiento, pero algunas nunca se curan completamente. El proceso enfermero es una herramienta metodológica a través del cual Enfermería puede apoyar al paciente y/o familiar en brindar cuidados y educación en la prevención y atención de las úlceras por presión. En México, dos estudios metacéntricos reportan que la prevalencia cruda de UPP es del 12,94% y del 17%, respectivamente. El presente caso se trata de una mujer adulto mayor, en edad extrema (81 años), atendida por su familiar, con regular adherencia a su tratamiento terapéutico y de cuidados, pasa la mayor parte del tiempo en cama, movilización regular aunque con buena higiene, con una escara de región sacra limpia en estadio ll, la paciente y familiar muestra disponibilidad y motivación para aprender acciones de cuidado y prevención adoptar cambios en los hábitos de vida, ser más saludable además mejorar la salud familiar.

Abstract Bedsores (also called pressure ulcers and pressure sores) are lesions on the skin and lower tissue, resulting from prolonged pressure on it. In most cases, they manifest on the skin that covers the bony parts of the body, such as heels, ankles, hips and coccyx. People who are most at risk for bedsores have limited ability to change position or spend most of their time in a bed or wheelchair. They can develop over the course of hours or days, most heal with treatment, but some are never completely cured. The nursing process is a methodological tool through which Nursing can support the patient and / or family in providing care and education in the prevention and care of pressure ulcers. In Mexico, two metacentric studies report that the crude prevalence of PU is 12.94% and 17%, respectively. The present case is about an elderly woman, (81 years), cared for by her relative, with regular adherence to her therapeutic and care treatment, spends most of the time in bed, regular mobilization although with good hygiene, with a clean sacral region eschar in stage II, the patient and family member show availability and motivation to learn care and prevention actions, adopt changes in life habits, be healthier and improve family health.

Resumo Escaras (também chamadas de úlceras de pressão e escaras) são lesões na pele e nos tecidos inferiores, resultantes de pressão prolongada sobre ela. Na maioria dos casos, eles se manifestam na pele que cobre as partes ósseas do corpo, como calcanhares, tornozelos, quadris e cóccix. Pessoas com maior risco de escaras têm capacidade limitada de mudar de posição ou de passar a maior parte do tempo em uma cama ou cadeira de rodas. Eles podem se desenvolver ao longo de horas ou dias, a maioria cura com tratamento, mas alguns nunca estão completamente curados. O processo de enfermagem é uma ferramenta metodológica por meio da qual a Enfermagem pode apoiar o paciente e / ou família na prestação de cuidados e educação na prevenção e cuidado das úlceras por pressão. No México, dois estudos metacêntricos relatam que a prevalência bruta de UP é de 12,94% e 17% 4, respectivamente. O presente caso se refere a uma idosa, em extrema idade (81 anos), cuidada por seu familiar, com adesão regular ao seu tratamento terapêutico e assistencial, passa a maior parte do tempo acamada, mobilização regular, porém, com boa higiene com uma escara limpa da região sacral em estágio II, o paciente e seu familiar demonstram disponibilidade e motivação para aprender ações de cuidado e prevenção, adotar mudanças de hábitos de vida, ter mais saúde e melhorar a saúde da família.