Surgical complications in the first and second semesters of the general surgery medical residence. A study of 14063 cases.

OBJECTIVE: To evaluate whether the rate of surgical complications is higher during the first semester of the General Surgery residency in the largest hospital complex in Latin America. During this period, students are expected to have less experience in carrying out procedures. METHODS: During a period of two years, all General Surgery resident doctors at the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo, made a notification of all the procedures they performed (n = 14.063), containing information such as name of the procedure, date, who participated, complications, among others. These data were analyzed with the purpose of evaluating the variation in the rate of complications throughout the year. RESULTS: There was a 52 % increase in the rate of complications in the first academic semester when compared to the second semester. This phenomenon was observed in resident doctors in the first and second years of residency. Furthermore, it was observed that second-year residents remain with high rates of complications, in some procedures, for a longer time than first-year residents. Furthermore, the first three months (March, April and May) seem to have the highest complication rates of the entire year. CONCLUSION: The impact of these complications can affect several health services and the increase in surgical complications in the first half of the year must be monitored by institutions, in order to control this phenomenon.

Surgical complications in the first and second semesters of the general surgery medical residence. A study of 14063 cases

Abstract Objective: To evaluate whether the rate of surgical complications is higher during the first semester of the General Surgery residency in the largest hospital complex in Latin America. During this period, students are expected to have less experience in carrying out procedures. Methods: During a period of two years, all General Surgery resident doctors at the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo, made a notification of all the procedures they performed (n = 14.063), containing information such as name of the procedure, date, who participated, complications, among others. These data were analyzed with the purpose of evaluating the variation in the rate of complications throughout the year. Results: There was a 52 % increase in the rate of complications in the first academic semester when compared to the second semester. This phenomenon was observed in resident doctors in the first and second years of residency. Furthermore, it was observed that second-year residents remain with high rates of complications, in some procedures, for a longer time than first-year residents. Furthermore, the first three months (March, April and May) seem to have the highest complication rates of the entire year. Conclusion The impact of these complications can affect several health services and the increase in surgical complications in the first half of the year must be monitored by institutions, in order to control this phenomenon.

Epidemiological and Clinical Characteristics of Young Patients With Breast Cancer in Brazil: A Retrospective Study.

PURPOSE: Understanding the epidemiological profile of young patients with breast cancer (BC) is crucial for devising effective control strategies. However, data on Brazilian patients with BC, particularly concerning the association with pathogenic germline mutations, are limited. This retrospective cross-sectional study seeks to shed light on the epidemiological and genetic profiles of young patients with BC in Brazil, with a specific focus on the correlation between germline mutations and clinical outcomes. METHODS: We analyzed medical records from two institutions in Minas Gerais, Brazil, focusing on young patients with BC diagnosed from January 2012 to December 2020. The collected variables included sociodemographic profile, tumor characteristics, mutational status, follow-up duration, and time from diagnosis to death. RESULTS: The findings highlight high rates of genetic mutations, more aggressive tumor characteristics, and the necessity for more radical surgical interventions in patients with mutations. CONCLUSION: In general, young patients with BC in Brazil present an unfavorable prognosis, emphasizing the need for early diagnosis and personalized treatment strategies.

N-Substituted Benzene-1-Urea-3,5-Biscarboxamide (BUBA): Easily Accessible C2 -Symmetric Monomers for the Construction of Reversible and Chirally Amplified Helical Assemblies.

Non-C3 -symmetric supramolecular helices are gaining interest for the design of hierarchical assemblies, for the compartmentalisation or the self-assembly of polymer chains and for application in asymmetric catalysis. Herein, N-substituted benzene-1-urea-3,5-biscarboxamide (BUBA) monomers, which consist of one urea and two carbon-connected amide functions linked to an aromatic ring, are introduced as an easily accessible class of C2 -symmetric supramolecular synthons. In apolar solvents, BUBA monomers assemble into long helical assemblies by means of hydrogen-bonding and aromatic interactions, as assessed by several analytical techniques. To probe the influence of the urea function, BUBA and related benzene-1,3,5-tricarboxamide (BTA) helical polymers have been compared, in terms of their thermodynamics of formation, stability, reversibility and chiral amplification properties. Similar to BTA, BUBA monomers form long helices reversibly through a highly cooperative mechanism and the helicity of their assemblies is governed by chiral amplification effects. However, precise quantification of their properties reveals that BUBA monomers assemble in a more cooperative manner. Also, chiral amplification operates to a higher extent in BUBA helices, as probed by both sergeants-and-soldiers and majority-rules experiments. Compatibility between urea and amide functions also allows the formation of co-assemblies that incorporate both BUBA and BTA monomers. Importantly, a small amount of chiral BUBA monomers in these co-assemblies is sufficient to obtain single-handed helices; thus paving the way towards the development of functional supramolecular helices.

Preliminary Feasibility Study to Measure the Immediate Changes of Bilateral Asymmetry After Lumbar Spinal Manipulative Therapy in Asymptomatic Athletes.

OBJECTIVE: The purpose of this preliminary study was to assess the feasibility of a study to measure the immediate changes in bilateral asymmetry on physical performance tests before and after lumbar spinal manipulative therapy (SMT). METHODS: Thirteen asymptomatic athletes participated in this study. Each participant underwent a clinical and physical evaluation for inclusion according to eligibility criteria. Assessments were performed in all participants and included a physical test symmetry sequence (static standing position, squat, and countermovement jump) before and after lumbar SMT intervention. The immediate changes were quantitatively measured from before to after intervention by statistical calculations. RESULTS: All recruited participants completed the study, and none of them reported complaints during participation. Statistically significant differences between before and after lumbar SMT were found only for static symmetry (respectively, mean = 14.4% and 3.7%), not for squatting or the countermovement jump. CONCLUSION: According our sample characteristics, asymptomatic athlete participants, presented initially bilateral asymmetry values, such as described in the literature, and after lumbar SMT, these values decreased significantly in static posture. This preliminary study demonstrates the feasibility to measure the pre-to-post changes in symmetry after lumbar SMT intervention. The results showed a great decrease in bilateral symmetry on static symmetry percentage, but none in dynamic tests, which deserves further investigation. Nevertheless, this preliminary study demonstrated the feasibility of measuring the immediate changes in symmetry produced by lumbar SMT, and of a larger study to measure whether lumbar SMT changes symmetry.

The effects of a single session of lumbar spinal manipulative therapy in terms of physical performance test symmetry in asymptomatic athletes: a single-blinded, randomised controlled study.

BACKGROUND AND AIM: Musculoskeletal disorders in athletes, including spinal biomechanical dysfunctions, are believed to negatively influence symmetry. Spinal manipulative therapy (SMT) is recognised as a safe and effective treatment for musculoskeletal disorders, but there is little evidence about whether it can be beneficial in symmetry. Therefore, this study aimed to measure the effects of lumbar SMT in symmetry. METHODS: Forty asymptomatic athletes participated in the study. The randomisation procedure was performed according to the following group allocation: group 1 (SMT) and group 2 (SHAM). Each participant completed a physical activity questionnaire, and also underwent clinical and physical evaluation for inclusion according to eligibility criteria. Statistical significance (P<0.05) between groups and types of therapy were calculated by physical performance tests symmetry (static position, squat and counter movement jump (CMJ), pre- and post-SMT and SHAM. There were 14 trials of three symmetry tests for each participant, for a total of 560 trials. RESULTS: Lumbar SMT produced immediate effects in symmetry in the static position; however, the same effects were not found in squat and CMJ on symmetry 1. Therefore, our results showed a significant difference in pre- (mean 16.3%) and post-lumbar SMT (mean 3.7%) in static symmetry. However, symmetry 2 showed no statistical significant differences for any of the tests and intervention groups. No statistically significant effects in symmetry pre- to post-SHAM were found in any of the tests. CONCLUSIONS: Statistically significant differences were found in lumbar SMT, but only for static symmetry. These findings suggest that SMT was effective in producing immediate effects in symmetry in the static position, but none in dynamic tests. Future studies could address our study's limitations. CLINICAL TRIALS REGISTER NUMBER: NCT03361592.

Two different pathways for assembling bis-urea in benzene and toluene.

The thermodynamic stability of assemblies formed by a bis-urea-based supramolecular polymer, 2,4-bis(2-ethylhexylureido)toluene (EHUT), was investigated in solutions using either benzene or toluene as the solvent. Starting from a higher temperature in which EHUT was soluble in both solvents, molecules spontaneously self-organized into tubular assemblies upon cooling and these assemblies were stable in a wide range of temperatures. However, the systems followed different paths below a specific temperature: while the supramolecular polymer remained stable in toluene, EHUT molecules underwent precipitation in benzene. The causes for these different behaviors were explored by molecular dynamics simulations, which provided support for stronger enthalpic stabilization of the tubular assemblies in toluene as compared to benzene. This stabilization was due mainly to the better interaction energy of trapped toluene molecules instead of benzene ones. For both cases, lowering the temperature makes the solvent penetration inside the tubes less favorable, which reduces the stability of supramolecular structures upon cooling. Graphical abstract Different EHUT solubilities.

Spinal Manipulative Therapy and Sports Performance Enhancement: A Systematic Review.

OBJECTIVE: The purpose of this study was to review the literature regarding the relationship between spinal manipulative therapy (SMT) and sports performance. METHODS: PubMed and Embase databases were searched for original studies published up to July 2016. Inclusion criteria were if SMT has been applied to athletes and if any sports performance-related outcome was measured. RESULTS: Of the 581 potential studies, 7 clinical trials were selected. Most studies had adequate quality (≥6/11) when assessed by the PEDro scale. None of those studies assessed performance at an event or competition. Four studies revealed improvement in a sports performance test after SMT. Meta-analysis could not be performed because of the wide differences in methodologies, design, and outcomes measured. Spinal manipulative therapy influences a wide range of neurophysiological parameters that could be associated with sports performance. Of the 3 studies where SMT did not improve test performance, 2 used SMT not for therapeutic correction of a dysfunctional vertebral joint but to an arbitrary previously set joint. CONCLUSIONS: Although 4 of 7 studies showed that SMT improved sports performance tests, the evidence is still weak to support its use. Spinal manipulative therapy may be a promising approach for performance enhancement that should be investigated with more consistent methodologic designs.

Tuning the nature and stability of self-assemblies formed by ester benzene 1,3,5-tricarboxamides: the crucial role played by the substituents.

As the benzene 1,3,5-tricarboxamide (BTA) moiety is commonly used as the central assembling unit for the construction of functionalized supramolecular architectures, strategies to tailor the nature and stability of BTA assemblies are needed. The assembly properties of a library of structurally simple BTAs derived from amino dodecyl esters (ester BTAs, 13 members) have been studied, either in the bulk or in cyclohexane solutions, by means of a series of analytical methods (NMR, DSC, POM, FT-IR, UV-Vis, CD, ITC, high-sensitivity DSC, SANS). Two types of hydrogen-bonded species have been identified and characterized: the expected amide-bonded helical rods (or stacks) that are structurally similar to those formed by BTAs with simple alkyl side chains (alkyl BTAs), and ester-bonded dimers in which the BTAs are connected by means of hydrogen bonds linking the amide N-H and the ester C[double bond, length as m-dash]O. MM/MD calculations coupled with simulations of CD spectra allow for the precise determination of the molecular arrangement and of the hydrogen bond pattern of these dimers. Our study points out the crucial influence of the substituent attached on the amino-ester α-carbon on the relative stability of the rod-like versus dimeric assemblies. By varying this substituent, one can precisely tune the nature of the dominant hydrogen-bonded species (stacks or dimers) in the neat compounds and in cyclohexane over a wide range of temperatures and concentrations. In the neat BTAs, stacks are stable up to 213 °C and dimers above 180 °C whilst in cyclohexane stacks form at c* > 3 × 10-5 M at 20 °C and dimers are stable up to 80 °C at 7 × 10-6 M. Ester BTAs that assemble into stacks form a liquid-crystalline phase and yield gels or viscous solutions in cyclohexane, demonstrating the importance of controlling the structure of these assemblies. Our systematic study of these structurally similar ester BTAs also allows for a better understanding of how a single atom or moiety can impact the nature and stability of BTA aggregates, which is of importance for the future development of functionalized BTA supramolecular polymers.

Pioderma gangrenoso após quadrantectomia de mama com radioterapia intraoperatória: relato de caso / Pyoderma gangrenosum after quadrantectomy with intraoperative radiotherapy: a case report

Pioderma gangrenoso é uma doença inflamatória imunomediada e rara da pele, de diagnóstico extremamente desafiador. A evolução clínica é a base para o diagnóstico, cursando com lesões pustulosas superficiais, halo eritematoso doloroso, rápida progressão para ulcerações dolorosas e estéreis, sem resposta a antibióticos ou a novas intervenções cirúrgicas e, finalmente, com pronta melhora com uso de imunossupressores. O atraso no diagnóstico pode acarretar numerosas internações e terapias prolongadas, sendo que seu reconhecimento precoce, por outro lado, evita a progressão dessas ulcerações e sua morbidade. Relatou-se um caso de pioderma gangrenoso que evoluiu após cirurgia associada à radioterapia intraoperatória no tratamento conservador do câncer de mama, fazendo-se uma revisão de casos relatados na literatura e suas possibilidades terapêuticas. Questiona-se, também, se a radioterapia intraoperatória estaria relacionada com algum estímulo imunomediado, o que poderia ter facilitado o desencadeamento do quadro.

Pyoderma gangrenosum is an immune-mediated inflammatory and rare skin disease with an extremely challenging diagnosis. The clinical evolution of the disease is the basis for the diagnosis that involves pustular superficial lesions, painful erythematous halo, rapid progression to painful and sterile ulcerations, unresponsiveness to antibiotics or new surgical interventions, and finally, ready improvement with the use of immunosuppressive drugs. Delayed diagnosis may cause numerous hospitalizations and prolonged therapy, whereas early recognition can prevent the progression of the ulcerations and their morbidities. We report a case of pyoderma gangrenosum that evolved after surgery and was associated with intraoperative radiotherapy for the conservative treatment of breast cancer. In addition, we reviewed reported cases in the literature and therapeutic options. It is conjectured that intraoperative radiotherapy might be related to some immune-mediated stimuli that could trigger the clinical condition.

Most of the patients presenting myocardial infarction would not be eligible for intensive lipid-lowering based on clinical algorithms or plasma C-reactive protein.

OBJECTIVE: The study we assessed how often patients who are manifesting a myocardial infarction (MI) would not be considered candidates for intensive lipid-lowering therapy based on the current guidelines. METHODS: In 355 consecutive patients manifesting ST elevation MI (STEMI), admission plasma C-reactive protein (CRP) was measured and Framingham risk score (FRS), PROCAM risk score, Reynolds risk score, ASSIGN risk score, QRISK, and SCORE algorithms were applied. Cardiac computed tomography and carotid ultrasound were performed to assess the coronary artery calcium score (CAC), carotid intima-media thickness (cIMT) and the presence of carotid plaques. RESULTS: Less than 50% of STEMI patients would be identified as having high risk before the event by any of these algorithms. With the exception of FRS (9%), all other algorithms would assign low risk to about half of the enrolled patients. Plasma CRP was <1.0mg/L in 70% and >2mg/L in 14% of the patients. The average cIMT was 0.8±0.2mm and only in 24% of patients was ≥1.0mm. Carotid plaques were found in 74% of patients. CAC ≥100 was found in 66% of patients. Adding CAC ≥100 plus the presence of carotid plaque, a high-risk condition would be identified in 100% of the patients using any of the above mentioned algorithms. CONCLUSION: More than half of patients manifesting STEMI would not be considered as candidates for intensive preventive therapy by the current clinical algorithms. The addition of anatomical parameters such as CAC and the presence of carotid plaques can substantially reduce the CVD risk underestimation.