RESUMO
INTRODUCTION AND OBJECTIVES: Epicardial and mediastinal adipose tissue (EAT, MAT) are linked to metabolic syndrome and coronary artery disease. Patients with chronic kidney disease (CKD) have thicker EAT. We assessed if EAT and MAT could be associated with increased mortality and cardiovascular events in patients with advanced CKD and haemodialysis therapy. METHODS: A post-hoc study was performed. We analyzed a prospective series of 104 cases. EAT thickness was quantified by a multislice synchronized computed tomography (MSCT). RESULTS: The follow-up period was 112.68 (109.94-115.42) months. The optimal cut-off point of EAT for prediction of total mortality was 11.45 mm (92.86% and 43.75%). EAT thickness was associated with serum albumin levels, serum triglyceride levels, phosphorus and calcium phosphate product. The EAT was greater in haemodialysis patients compared to those with advanced CKD (P < .001). Patients with diabetes mellitus had greater EAT and MAT thickness (P = .018). At the end of follow up, the survival average time of patients with EAT thickness <11.45 mm was 97.48 months vs. 76.65 months for thickness > 11.45 mm (P = .007). CONCLUSIONS: A higher EAT and MAT thickness was associated with increased mortality. Furthermore, EAT was associated with lower free survival time to fatal and non-fatal cardiovascular events. The measurement of EAT and MAT by MSCT could be a prognostic tool to predict cardiovascular events and mortality risk in advanced CKD patients.
RESUMO
El aula invertida es un modelo de enseñanza-aprendizaje en el que los alumnos tienen el primer contacto con la información a ser aprendida fuera de clase, mediante documentos (textos y videos) que el docente les hace llegar por medios electrónicos. El tiempo de clase así ahorrado se dedica a actividades de aula que consolidan la asimilación de ese conocimiento y lo aplican a la resolución de cuestiones, casos y problemas. Este modelo de aprendizaje reduce el tiempo de instrucción directa en clase y aumenta el dedicado al aprendizaje activo. Se transfiere al alumno la responsabilidad de esforzarse inicialmente para alcanzar un nivel de comprensión básico y comunicar sus dificultades y dudas al docente. Así, el docente recibe información sobre cuáles son las dificultades y necesidades de sus alumnos y podrá adaptar las actividades que realizará en el aula para resolver las dudas manifestadas por ellos. Denominamos a esta metodología 'aula invertida adaptativa'. El aula invertida logra un mayor grado de implicación de los alumnos con su aprendizaje, mejoras en la valoración de su percepción sobre la docencia recibida y, sobre todo, mejoras en sus resultados académicos. En este artículo también se sopesan los beneficios y los costes del cambio desde la metodología expositiva tradicional al aula invertida adaptativa y, finalmente, se aportan recomendaciones para la puesta en práctica del aula invertida en el contexto de una enseñanza tradicional de las ciencias sanitarias
Flipped classroom means that students have the first exposure to new information to be learned outside the classroom by mean of electronic documents (texts and videos). Next, class time is devoted to class activities which reinforce the assimilation of that knowledge by applying it to answer questions and solving cases and problems. This learning model reduces the class time devoted to direct instruction and increases the time used in active learning. It transfers to the student the responsibility of initially striving to reach a basic understanding and communicate their difficulties and doubts to the teacher. Thus, the teacher receives information about the difficulties and needs of their students and can adapt the activities they will carry out in the classroom to solve the doubts expressed by their students. We named this teaching methodology as adaptive fl ipped classroom. The fl ipped classroom achieves a greater degree of involvement of students with their learning, improvements in academic results and in their assessment of the teaching received. In this report, the benefits and costs of the change are weighed from the traditional expositive methodology to the adaptive flipped classroom and, finally, recommendations are given for the implementation of the flipped classroom in the context of a traditional teaching of health sciences
