Operating on A Bias: A Review of Cultural Competency Curricula in Surgical Residencies and a Call for Systemic Change.

BACKGROUND: Several factors contribute to surgical outcome disparities, including structural racism and implicit bias. Research into how surgical residency programs intervene on Cultural Complications via education remains sparse. We review the literature for how surgical residency programs use education to combat staff and patient exposure to Cultural Complications. METHODS: We searched PubMed, SCOPUS, and Google Scholar for curricula aimed at improving cultural competency in surgical residencies. OBGYN curricula were included. Non-US studies were excluded. RESULTS: Studies were organized by intervention type: Didactic, Grand Rounds, and M&M. The most common interventions were Didactics, with Grand Rounds being the least common. Target measures improved anywhere from 20-88%. CONCLUSIONS: The common types of cultural competency curricula are clear, and certain interventions show improvement in trainees' education. Scarcity of data on these curricula does not necessarily indicate their lack of existence but does suggest additional research is needed into curricular interventions and how they may address cultural complications.

Dissecting Diversity: A Comprehensive Look at the Present Landscape and Future Challenges in Surgical Specialties.

BACKGROUND: As the US demographic evolves, surgical fields must adapt to ensure equitable healthcare. Healthcare disparities notably affect minority populations, with communities of color often facing physician shortages and higher rates of diseases such as coronary disease, stroke, and cancer. Research shows that minority physicians significantly improve patient satisfaction and outcomes in underserved communities, highlighting the need for increased physician diversity to enhance cultural competency and patient centered care. Data from the Association of American Medical Colleges (AAMC) reveals minimal increases in underrepresented minorities (URM) in surgical residency and academic careers over the past thirty-six years, with little change URM applicants and matriculants in the nine surgical specialties recognized by the American College of Surgeons from 2010 to 2018. OBJECTIVE: This review aims to critically evaluate the current landscape of racial and gender diversity in six out of the nine defined surgical specialties (general surgery, plastic surgery, neurosurgery, orthopedic surgery, cardiothoracic surgery, and vascular surgery) in the US. DESIGN: We conducted a comprehensive literature review to assess of the state of diversity within surgical specialties in the United States. By analyzing the benefits of diversity in surgical fields, evaluating the effectiveness of various diversity programs and initiatives, examining the comparative diversity between surgical subspecialties, and assessing the impact of diversity on patient outcomes, our aim is to highlight the critical importance of enhancing diversity in surgical fields. RESULTS: While nuances in representation and diversity vary across surgical specialties, all fields persistently exhibit underrepresentation of certain racial/ethnic groups and persistent gender disparities. These disparities manifest throughout various phases, including in residency, and in the recruitment and retention of URM individuals in surgery and surgical subspecialties. While interventions over the past decade have contributed to improving diversity in surgical fields, significant disparities persist. Limitations include the time required for recent interventions to show significant impacts and the inability of established interventions to eliminate disparities. CONCLUSIONS: Despite the clear benefits, diversity within surgical specialties remains an uphill battle. Addressing the diversity gap in surgical fields is crucial for improving patient outcomes, healthcare access, and workplace environments, requiring strategies such as targeted recruitment, mentorship programs, and addressing systemic biases. This review highlights the undeniable imperative for change and serve a call to action.

Imaging of pediatric skull lytic lesions: A review.

Skull lesions in pediatric population are common findings on imaging and sometimes with heterogeneous manifestations, constituting a diagnostic challenge. Some lesions can be misinterpreted for their aggressiveness, as with larger lesions eroding cortical bone, containing soft tissue components, leading to excessive and, in some cases, invasive inappropriate etiological investigation. In this review, we present multiple several conditions that may present as skull lesions or pseudolesions, organized by groups (anatomic variants, congenital and development disorders, traumatic injuries, vascular issues, infectious conditions, and tumoral processes). Anatomic variants are common imaging findings that must be recognized by the neuroradiologist. Congenital malformations are rare conditions, such as aplasia cutis congenita and sinus pericranii, usually seen at earlier ages, the majority of which are benign findings. In case of trauma, cephalohematoma, growing skull fractures, and posttraumatic lytic lesions should be considered. Osteomyelitis tends to be locally aggressive and may mimic malignancy, in which cases, the clinical history can be the key to diagnosis. Vascular (sickle cell disease) and tumoral (aneurismal bone cyst, eosinophilic granuloma, metastases) lesions are relatively rare lesions but should be considered in the differential diagnosis, in the presence of certain imaging findings. The main difficulty is the differentiation between the benign and malignant nature; therefore, the main objective of this pictorial essay is to review the main skull lytic lesions found in pediatric age, describing the main findings in different imaging modalities (CT and MRI), allowing the neuroradiologist greater confidence in establishing the differential diagnosis, through a systematic and simple characterization of the lesions.

Advances in diffuse glial tumors diagnosis / Avanços no diagnóstico dos gliomas difusos

Abstract In recent decades, there have been significant advances in the diagnosis of diffuse gliomas, driven by the integration of novel technologies. These advancements have deepened our understanding of tumor oncogenesis, enabling a more refined stratification of the biological behavior of these neoplasms. This progress culminated in the fifth edition of the WHO classification of central nervous system (CNS) tumors in 2021. This comprehensive review article aims to elucidate these advances within a multidisciplinary framework, contextualized within the backdrop of the new classification. This article will explore morphologic pathology and molecular/genetics techniques (immunohistochemistry, genetic sequencing, and methylation profiling), which are pivotal in diagnosis, besides the correlation of structural neuroimaging radiophenotypes to pathology and genetics. It briefly reviews the usefulness of tractography and functional neuroimaging in surgical planning. Additionally, the article addresses the value of other functional imaging techniques such as perfusion MRI, spectroscopy, and nuclear medicine in distinguishing tumor progression from treatment-related changes. Furthermore, it discusses the advantages of evolving diagnostic techniques in classifying these tumors, as well as their limitations in terms of availability and utilization. Moreover, the expanding domains of data processing, artificial intelligence, radiomics, and radiogenomics hold great promise and may soon exert a substantial influence on glioma diagnosis. These innovative technologies have the potential to revolutionize our approach to these tumors. Ultimately, this review underscores the fundamental importance of multidisciplinary collaboration in employing recent diagnostic advancements, thereby hoping to translate them into improved quality of life and extended survival for glioma patients.

Resumo Nas últimas décadas, houve avanços significativos no diagnóstico de gliomas difusos, impulsionados pela integração de novas tecnologias. Esses avanços aprofundaram nossa compreensão da oncogênese tumoral, permitindo uma estratificação mais refinada do comportamento biológico dessas neoplasias. Esse progresso culminou na quinta edição da classificação da OMS de tumores do sistema nervoso central (SNC) em 2021. Esta revisão abrangente tem como objetivo elucidar esses avanços de forma multidisciplinar, no contexto da nova classificação. Este artigo irá explorar a patologia morfológica e as técnicas moleculares/genéticas (imuno-histoquímica, sequenciamento genético e perfil de metilação), que são fundamentais no diagnóstico, além da correlação dos radiofenótipos da neuroimagem estrutural com a patologia e a genética. Aborda sucintamente a utilidade da tractografia e da neuroimagem funcional no planejamento cirúrgico. Destacaremos o valor de outras técnicas de imagem funcional, como ressonância magnética de perfusão, espectroscopia e medicina nuclear, na distinção entre a progressão do tumor e as alterações relacionadas ao tratamento. Discutiremos as vantagens das diferentes técnicas de diagnóstico na classificação desses tumores, bem como suas limitações em termos de disponibilidade e utilização. Além disso, os crescentes avanços no processamento de dados, inteligência artificial, radiômica e radiogenômica têm grande potencial e podem em breve exercer uma influência substancial no diagnóstico de gliomas. Essas tecnologias inovadoras têm o potencial de revolucionar nossa abordagem a esses tumores. Em última análise, esta revisão destaca a importância fundamental da colaboração multidisciplinar na utilização dos recentes avanços diagnósticos, com a esperança de traduzi-los em uma melhor qualidade de vida e uma maior sobrevida.

Advances in diffuse glial tumors diagnosis.

In recent decades, there have been significant advances in the diagnosis of diffuse gliomas, driven by the integration of novel technologies. These advancements have deepened our understanding of tumor oncogenesis, enabling a more refined stratification of the biological behavior of these neoplasms. This progress culminated in the fifth edition of the WHO classification of central nervous system (CNS) tumors in 2021. This comprehensive review article aims to elucidate these advances within a multidisciplinary framework, contextualized within the backdrop of the new classification. This article will explore morphologic pathology and molecular/genetics techniques (immunohistochemistry, genetic sequencing, and methylation profiling), which are pivotal in diagnosis, besides the correlation of structural neuroimaging radiophenotypes to pathology and genetics. It briefly reviews the usefulness of tractography and functional neuroimaging in surgical planning. Additionally, the article addresses the value of other functional imaging techniques such as perfusion MRI, spectroscopy, and nuclear medicine in distinguishing tumor progression from treatment-related changes. Furthermore, it discusses the advantages of evolving diagnostic techniques in classifying these tumors, as well as their limitations in terms of availability and utilization. Moreover, the expanding domains of data processing, artificial intelligence, radiomics, and radiogenomics hold great promise and may soon exert a substantial influence on glioma diagnosis. These innovative technologies have the potential to revolutionize our approach to these tumors. Ultimately, this review underscores the fundamental importance of multidisciplinary collaboration in employing recent diagnostic advancements, thereby hoping to translate them into improved quality of life and extended survival for glioma patients.

Nas últimas décadas, houve avanços significativos no diagnóstico de gliomas difusos, impulsionados pela integração de novas tecnologias. Esses avanços aprofundaram nossa compreensão da oncogênese tumoral, permitindo uma estratificação mais refinada do comportamento biológico dessas neoplasias. Esse progresso culminou na quinta edição da classificação da OMS de tumores do sistema nervoso central (SNC) em 2021. Esta revisão abrangente tem como objetivo elucidar esses avanços de forma multidisciplinar, no contexto da nova classificação. Este artigo irá explorar a patologia morfológica e as técnicas moleculares/genéticas (imuno-histoquímica, sequenciamento genético e perfil de metilação), que são fundamentais no diagnóstico, além da correlação dos radiofenótipos da neuroimagem estrutural com a patologia e a genética. Aborda sucintamente a utilidade da tractografia e da neuroimagem funcional no planejamento cirúrgico. Destacaremos o valor de outras técnicas de imagem funcional, como ressonância magnética de perfusão, espectroscopia e medicina nuclear, na distinção entre a progressão do tumor e as alterações relacionadas ao tratamento. Discutiremos as vantagens das diferentes técnicas de diagnóstico na classificação desses tumores, bem como suas limitações em termos de disponibilidade e utilização. Além disso, os crescentes avanços no processamento de dados, inteligência artificial, radiômica e radiogenômica têm grande potencial e podem em breve exercer uma influência substancial no diagnóstico de gliomas. Essas tecnologias inovadoras têm o potencial de revolucionar nossa abordagem a esses tumores. Em última análise, esta revisão destaca a importância fundamental da colaboração multidisciplinar na utilização dos recentes avanços diagnósticos, com a esperança de traduzi-los em uma melhor qualidade de vida e uma maior sobrevida.

Subacute Partially Reversible Leukoencephalopathy Expands the Aicardi-Goutières Syndrome Phenotype.

OBJECTIVE: To report a series of atypical presentations of Aicardi-Goutières syndrome. METHODS: Clinical, neuroimaging, and genetic data. RESULTS: We report a series of six unrelated patients (five males) with a subacute loss of developmental milestones, pyramidal signs, and regression of communication abilities, with onset at ages ranging from 7 to 20 months, reaching a nadir after 4 to 24 weeks. A remarkable improvement of lost abilities occurred in the follow-up, and they remained with residual spasticity and dysarthria but preserved cognitive function. Immunization or febrile illness occurred before disease onset in all patients. CSF was normal in two patients, and in four, borderline or mild lymphocytosis was present. A brain CT scan disclosed a subtle basal ganglia calcification in one of six patients. Brain MRI showed asymmetric signal abnormalities of white matter with centrum semi-ovale involvement in five patients and a diffuse white matter abnormality with contrast enhancement in one. Four patients were diagnosed and treated for acute demyelinating encephalomyelitis (ADEM). Brain imaging was markedly improved with one year or more of follow-up (average of 7 years), but patients remained with residual spasticity and dysarthria without cognitive impairment. Demyelination relapse occurred in a single patient four years after the first event. Whole-exome sequencing (WES) was performed in all patients: four of them disclosed biallelic pathogenic variants in RNASEH2B (three homozygous p.Ala177Thr and one compound heterozygous p.Ala177Thr/p.Gln58*) and in two of them the same homozygous deleterious variants in RNASEH2A (p.Ala249Val). CONCLUSIONS: This report expands the phenotype of AGS to include subacute developmental regression with partial clinical and neuroimaging improvement. Those clinical features might be misdiagnosed as ADEM.

Neurocysticercosis: diagnosis via metagenomic next-generation sequencing.

A 68-year-old Brazilian woman had 3 months of progressive fatigue, difficulty walking and 18 kg weight loss. On examination, there was gait apraxia and executive dysfunction. MR scan of brain showed communicating hydrocephalus and a cerebrospinal fluid showed 105 white cells/µL (≤5), predominantly lymphocytes, protein of 1.35 g/L (0.15-0.45) and the glucose content of 0.06 mmol/L (3.3-4.4). We suspected an infective cause and used of metagenomic next-generation sequencing to diagnose neurocysticercosis. This case highlights the challenge of diagnosing chronic meningitis and the relevance of genetic approaches in diagnosing neurological infections.

Intracranial vessel wall magnetic resonance imaging features of infectious vasculitis.

Vasculitis is a complication of several infectious diseases affecting the central nervous system, which may result in ischemic and/or hemorrhagic stroke, transient ischemic attack, and aneurysm formation. The infectious agent may directly infect the endothelium, causing vasculitis, or indirectly affect the vessel wall through an immunological mechanism. The clinical manifestations of these complications usually overlap with those of non-infectious vascular diseases, making diagnosis challenging. Intracranial vessel wall magnetic resonance imaging (VWI) enables the evaluation of the vessel wall and the diseases that affect it, providing diagnostic data beyond luminal changes and enabling the identification of inflammatory changes in cerebral vasculitis. This technique demonstrates concentric vessel wall thickening and gadolinium enhancement, associated or not with adjacent brain parenchymal enhancement, in patients with vasculitis of any origin. It permits the detection of early alterations, even before a stenosis occurs. In this article, we review the intracranial vessel wall imaging features of infectious vasculitis of bacterial, viral, and fungal etiologies.

Emerging precision neoadjuvant systemic therapy for patients with resectable non-small cell lung cancer: current status and perspectives.

Over the past decade, targeted therapy for oncogene-driven NSCLC and immune checkpoint inhibitors for non-oncogene-driven NSCLC, respectively, have greatly improved the survival and quality of life for patients with unresectable NSCLC. Increasingly, these biomarker-guided systemic therapies given before or after surgery have been used in patients with early-stage NSCLC. In March 2022, the US FDA granted the approval of neoadjuvant nivolumab and chemotherapy for patients with stage IB-IIIA NSCLC. Several phase II/III trials are evaluating the clinical efficacy of various neoadjuvant immune checkpoint inhibitor combinations for non-oncogene-driven NSCLC and neoadjuvant molecular targeted therapies for oncogene-driven NSCLC, respectively. However, clinical application of precision neoadjuvant treatment requires a paradigm shift in the biomarker testing and multidisciplinary collaboration at the diagnosis of early-stage NSCLC. In this comprehensive review, we summarize the current diagnosis and treatment landscape, recent advances, new challenges in biomarker testing and endpoint selections, practical considerations for a timely multidisciplinary collaboration at diagnosis, and perspectives in emerging neoadjuvant precision systemic therapy for patients with resectable, early-stage NSCLC. These biomarker-guided neoadjuvant therapies hold the promise to improve surgical and pathological outcomes, reduce systemic recurrences, guide postoperative therapy, and improve cure rates in patients with resectable NSCLC.

Dscam1 overexpression impairs the function of the gut nervous system in Drosophila.

BACKGROUND: Down syndrome (DS) patients have a 100-fold increase in the risk of Hirschsprung syndrome of the colon and rectum (HSCR), a lack of enteric neurons in the colon. The leading DS candidate gene is trisomy of the Down syndrome cell adhesion molecule (DSCAM). RESULTS: We find that Dscam1 protein is expressed in the Drosophila enteric/stomatogastric nervous system (SNS). Axonal Dscam1 phenotypes can be rescued equally by diverse isoforms. Overexpression of Dscam1 resulted in frontal and hindgut nerve overgrowth. Expression of dominant negative Dscam1-ΔC led to a truncated frontal nerve and increased branching of the hindgut nerve. Larval locomotion is influenced by feeding state, and we found that the average speed of larvae with Dscam1 SNS expression was reduced, whereas overexpression of Dscam1-ΔC significantly increased the speed. Dscam1 overexpression reduced the efficiency of food clearance from the larval gut. CONCLUSION: Our work demonstrates that overexpression of Dscam1 can perturb gut function in a model system.

Racial Health Disparities Research in Cardiothoracic Surgery Under-represented in Major Meetings.

INTRODUCTION: Black/African Americans and Latinos face significant health disparities and systemic inequities. Heart and lung disease are leading factors affecting morbidity and mortality in these groups. Given this disparity, we sought to determine how often this topic is presented at the most relevant United States annual cardiothoracic surgery meetings. METHODS: Specialty-specific annual meeting abstract books were queried between 2015 and 2021. We included the Society of Thoracic Surgeons, American Association for Thoracic Surgery, Western Thoracic Surgical Association, and the Southern Thoracic Surgical Association. Scientific abstract titles and content were searched for the following keywords and phrases: "racial health disparities," "race," "racism," "racial bias," "institutional racism," and "health disparities". If an abstract included a keyword or phrase, it was counted as a racial health disparity abstract. We calculated the proportion of racial health disparity abstracts and abstracts published as manuscripts in the meeting-associated journals. RESULTS: A total of 3664 abstracts were presented between 2015 and 2021. Of those, 0.90% (33/3664) abstracts presented contained at least one of the keywords or phrases. Of these abstracts, the percentage that went on to publication represented 0.38% (14/3664) of the total number of abstracts presented. CONCLUSIONS: Abstracts on racial health disparities in cardiothoracic surgery represent a very small fraction of total meeting peer-reviewed content. There is a significant gap in research to identify and develop best practice strategies to address these disparities and mitigate structural racism within the care of underserved patients with cardiothoracic diseases.

Tem palhaço na Educação Física escolar? Tem, sim Senhor! / Is there a clown in school Physical Education? Yes, sir! / ¿Hay payasos en la Educación Física escolar? ¡Sí, señor

Neste estudo relatamos a implementação do ensino do palhaço como conteúdo nas aulas de Educação Física numa turma de 8.º ano de Ensino Fundamental de uma escola pública, na qual participaram 30 alunos de 12-17 anos (13 meninas e 17 meninos). As aulas ocorreram duas vezes por semana, num total de dez, ministradas por dois professores monitores, orientados por um professor orientador local e um professor orientador especialista em palhaçaria. Nas aulas pesquisou-se o imaginário dos alunos sobre circo e palhaço; foram propostos jogos que buscaram o riso, exposições sobre quatro palhaços brasileiros, atividades que buscaram a conexão entre os participantes do estudo, acrobacias cômicas e uma avaliação final com desenhos. Essa experiência aponta que é possível ensinar a palhaçaria nas aulas de Educação Física.

In this study we report the implementation of clowning as a content in Physical Education classes in an 8th grade class in a public school, in which 30 students aged 12-17 years (13 girls and 17 boys) participated. The classes took place twice a week, in a total of ten, taught by two monitors, guided by a local mentor teacher and a mentor teacher specialized in clowning. In the classes we researched the students' imaginary about circus and clown; we proposed games that sought laughter, exhibitions about four Brazilian clowns, activities that sought connection among the participants of the study, comical acrobatics and a final evaluation with drawings. This experience points out that it is possible to teach clowning in Physical Education classes.

En este estudio relatamos la implementación de la enseñanza del payaso como contenido en clases de Educación Física en una clase de 8º de Primaria de un colegio público, en la que participaron 30 alumnos con edades comprendidas entre los 12 y los 17 años (13 chicas y 17 chicos). As clases ocorreram duas vezes por semana, em um total de dez, ministradas por dois monitores, orientados por um professor mentor local e um professor mentor especializado em payaso. En las clases, se investigó el imaginario de los alumnos sobre el circo y el payaso; se propusieron juegos que buscaban la risa, exposiciones sobre cuatro payasos brasileños, actividades que buscaban la conexión entre los participantes del estudio, acrobacias cómicas y una evaluación final con dibujos. Esta experiencia señala que es posible enseñar clown en las clases de Educación Física.

Circo nas aulas de Educação Física: para além do domínio motor / Circus in Physical Education classes: beyond the motor domain / Circo en las clases de Educación Física: más allá del dominio motor

O presente artigo relata a prática pedagógica de docentes de Educação Física Escolar que desenvolveram dois projetos relacionados ao circo, sendo um com discentes do Ensino Fundamental e, outro, com os do Ensino Médio. Objetiva-se, inicialmente, discorrer sobre a importância do compromisso ético-político-pedagógico dos professores frente às disparidades sociais, a fim de estabelecer uma ação didática situada com vistas à emancipação coletiva, na acepção freireana. Em seguida, apresentam-se as potencialidades artísticas, afetivas, estéticas, críticas e socioculturais da tematização do circo nas aulas de Educação Física através do relato dos projetos "O circo chegou -o fazer coletivo das acrobacias" e "Circo: entre o espetáculo e o cotidiano". Os resultados evidenciam um rompimento com a visão tecnicista e projetam a potencialidade de tematizar o circo na educação básica como forma de possibilitar trocas humanizadoras provenientes de relações que se constituem a partir de um diálogo com o outro, com o mundo.

This article reports the pedagogical practice of Physical Education teachers who developed two projects related to the circus, one with elementary school students and the other with high school students. The objective is, initially, to discuss the importance of the ethical-political-pedagogical commitment of teachers in face of social disparities, in order to establish a didactic action situated with a view to collective emancipation, in the Freirean perspective. Then, the artistic, affective, aesthetic, critical and sociocultural potentials of the circus theme in Physical Education classes are presented through the report of the projects "The circus has arrived -the collective doing of acrobatics" and "Circus: between the spectacle and the everyday". The results show a break with the technicist view and project the potential to thematize the circus in basic education to enable humanizing exchanges arising from relationships that are constituted from a dialogue with the other, with the world.

Este artículo relata la práctica pedagógica de docentes de Educación Física que desarrollaron dos proyectos relacionados con el circo, uno con el alumnado de la Educación Primaria y otro de la Educación Secundaria. Inicialmente se buscó discutir la importancia del compromiso ético-político-pedagógico de los docentes frente a las desigualdades sociales, para establecer una acción didáctica situada que posibilite la emancipación colectiva, en la perspectiva freireana. A continuación, se presentan las potencialidades artísticas, afectivas, estéticas, críticas y socioculturales de abordar el circo en las clases de Educación Física, a través del relato de los proyectos "El circo llegó -la realización colectiva de acrobacias" y "Circo: entre el espectáculo y la vida cotidiana". Los resultados muestran una ruptura con la visión tecnicista y proyectan la potencialidad de tematizar el circo en la educación básica para posibilitar intercambios humanizadores que surgen de relaciones que se constituyen a partir del diálogo con el otro, con el mundo.

Do macrojogo ao microjogo: os vários jogos que compõem o jogo / From macro-game to micro-game: the various games that make up the game / Del macro-juego al micro-juego: los distintos juegos que componen el juego

Com o presente artigo pretendemos problematizar e explorar o conceito de jogo, entendendo-o como algo amplo, rizomático e não fechado em uma única forma de interpretação. Além do que, o conceito de jogo pode já ter sido cristalizado em decorrência da sua consolidação, assim, seu desenvolvimento só se torna possível na medida em que se há um arruinamento para devir novas potencialidades. Foi, então, a partir dos pensamentos de Deleuze e Guattari sobre: conceito e rizoma, de onde partimos para desenvolver o conceito de macro-jogo e microjogo, em uma tentativa de potencializar as discussões por um viés interdisciplinar e de cunho filosófico. Diante de tais questões, foi possível compreender a importância do olhar interdisciplinar para a resolução de problemas provenientes de áreas distintas do conhecimento, rompendo com a dicotomia entre teoria e prática tão evidente e presente em diversas áreas do conhecimento, entre elas, a Educação Física e as artes

Our intend with this article is to question and explore the concept of game, understanding it as something broad, rhizomatic and not closed in a single form of interpretation. In addition, the game concept may have already been crystallized as a result of its consolidation, thus, its development only becomes possible as long as new potentialities are ruined. It was, then, from the thoughts of Deleuze and Guattari on concept and rhizome, from which we started to develop the concept of macro-game and micro-game, in an attempt to enhance the discussions through an interdisciplinary and philosophical approach. Facing these questions, it was possible to understand the importance of the interdisciplinary look to solve problems coming from different areas of knowledge, breaking the dichotomy between theory and practice so evident and present in several areas of knowledge, including Physical Education and the arts.

Con el presente artículo pretendemos problematizar y explorar el concepto de juego, entendiéndolo como algo amplio, rizomático y no cerrado en una única forma de interpretación. Además, el concepto de juego puede haber sido ya cristalizado como resultado de su consolidación, por lo que su desarrollo sólo se hace posible en la medida en que hay una ruína para idear nuevas potencialidades. Se basó, pues, en las reflexiones de Deleuze y Guattari sobre el concepto y el rizoma, a partir de las cuales desarrollamos el concepto de macro-juego y micro-juego, en un intento de enriquecer los debates mediante un enfoque interdisciplinario y filosófico. Ante estas cuestiones, se pudo comprender la importancia de la mirada interdisciplinaria para resolver los problemas que surgen de las diferentes áreas del conocimiento, rompiendo la dicotomía entre teoría y práctica tan evidente y presente en várias áreas del conocimiento, incluyendo la Educación Física y las artes.