Virtual reality navigation system for prostate biopsy

Prostate cancer is the most common non-cutaneous cancer in America. Tumor detection involves non-invasive screening tests, but positive results must be confirmed by a prostate biopsy. About twelve random samples are obtained during the biopsy, which is a systematic procedure traditionally performed with trans-rectal ultrasound (TRUS) guidance to determine prostate location. Recently, methods of fusion between TRUS and preoperative MRI have been introduced in order to perform targeted biopsies aimed to reduce the number of samples to few suspicious areas. Since the TRUS displaces the prostate during the procedure, the preoperative MRI does not match patient anatomy. Therefore, complex MRI deformation algorithms are needed. However, despite the substantial increase in complexity and cost, there is no strong evidence that the TRUS-MRI fusion actually improves accuracy and surgical outcomes. This paper presents an innovative virtual reality surgical navigation system for performing targeted prostate biopsies, without the need of the uncomfortable TRUS. Both biopsy needle and patient anatomy are constantly tracked by an electromagnetic tracking system that provides their 3D position and orientation with respect to the surgical bed. Multiple fiducial markers are placed on the patient skin (at the iliac crest and pubic bone) during MRI scanning. Once in the operative room, the surgeon is presented a stereoscopic 3D volumetric rendering and multiple orthogonal views of the patient anatomy, as well as a virtual representation of the tracked needle. After a simple registration process between the MRI and the tracker coordinate system, the navigation system guides the needle insertion in the patient perineum through several anatomical layers towards the biopsy targets

Viability Criteria during Liver Ex-Situ Normothermic and Hypothermic Perfusion

With the increased use of extended-criteria donors, machine perfusion became a beneficial alternative to cold storage in preservation strategy for donor livers with the intent to expand donor pool. Both normothermic and hypothermic approach achieved good results in terms of mid- and long-term outcome in liver transplantation. Many markers and molecules have been proposed for the assessment of liver, but no definitive criteria for graft viability have been validated in large clinical trials and key parameters during perfusion still require optimization.In this review, we address the current literature of viability criteria during normothermic and hypothermic machine perfusion and discuss about future steps and evolution of these technologies

An evaluation of the professional, social and demographic profile and quality of life of physicians working at the Prehospital Emergency Medical System (SAMU) in Brazil

OBJECTIVE: To describe the profile of physicians working at the Prehospital Emergency Medical System (SAMU) in Brazil and to evaluate their quality of life.METHODS: Both a semi-structured questionnaire with 57 questions and the SF-36 questionnaire were sent to research departments within SAMU in the Brazilian state capitals, the Federal District and inland towns in Brazil.RESULTS: Of a total of 902 physicians, including 644 (71.4%) males, 533 (59.1%) were between 30 and 45 years of age and 562 (62.4%) worked in a state capital. Regarding education level, 45.1% had graduated less than five years before and only 43% were specialists recognized by the Brazilian Medical Association. Regarding training, 95% did not report any specific training for their work at SAMU. The main weaknesses identified were psychiatric care and surgical emergencies in 57.2 and 42.9% of cases, respectively; traumatic pediatric emergencies, 48.9%; and medical emergencies, 42.9%. As for procedure-related skills, the physicians reported difficulties in pediatric advanced support (62.4%), airway surgical access (45.6%), pericardiocentesis (64.4%) and thoracentesis (29.9%). Difficulties in using an artificial ventilator (43.3%) and in transcutaneous pacing (42.2%) were also reported. Higher percentages of young physicians, aged 25-30 years (26.7 vs 19.0%; p48 h per week (12.8 vs 8.6%; p<0.001), and were non-specialists with the shortest length of service (<1 year) at SAMU (30.1 vs 18.2%; p<0.001) who were hired without having to pass public service exams* (i.e., for a temporary job) (61.8 vs 46.2%; p<0.001). Regarding quality of life, the pain domain yielded the worst result among physicians at SAMU.CONCLUSIONS: The doctors in this sample were young and within a few years of graduation, and they had no specific training in prehospital emergencies. Deficiencies were mostly found in pediatrics and psychiatry, with specific deficiencies in the handling of essential equipment and in the skills necessary to adequately attend to prehospital emergencies. A disrespectful labor scenario was also found; the evaluation of quality of life showed a notable presence of pain on the SF-36 among physicians at SAMU and especially among doctors who had worked for a longer length of time at SAMU.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina (UNIFESP/EPM) Departamento de CirurgiaFaculdade de Medicina de São José do Rio Preto Departamento de CirurgiaDuke University School of Medicine Division of CardiologyUNIFESP, EPM, (UNIFESP/EPM) Depto. de CirurgiaSciEL

Development and validation of a questionnaire to assess the knowledge of mechanical ventilation in urgent care among students in their last-year medical course in Brazil

OBJECTIVE: To develop and validate a questionnaire to assess the knowledge of mechanical ventilation among final-year medical students in Brazil. METHODS: A cross-sectional study conducted between October 2015 and October 2017 involving 554 medical students was carried out to develop a questionnaire for assessing knowledge on mechanical ventilation. Reproducibility was evaluated with the intraclass correlation coefficient, internal consistency was evaluated with Cronbach’s alpha, and construct validation was evaluated with a tetrachoric exploratory factor analysis. To compare the means of the competences among the same type of assessment tool, the nonparametric Friedman test was used, and the identification of the differences was obtained with Dunn-Bonferroni tests. RESULTS: The final version of the questionnaire contained 19 questions. The instrument presented a clarity index of 8.94±0.83. The value of the intraclass correlation coefficient was 0.929, and Cronbach’s alpha was 0.831. The factor analysis revealed five factors associated with knowledge areas regarding mechanical ventilation. The final score among participants was 24.05%. CONCLUSION: The instrument has a satisfactory clarity index and adequate psychometric properties and can be used to assess the knowledge of mechanical ventilation among final-year medical students in Brazil

A SÍNDROME DE BURNOUT NAS ORGANIZAÇÕES

O presente artigo tem por objetivo apresentar a importância que existe em promover uma melhor qualidade de vida dos indivíduos dentro das organizações. Ao direcionar as atenções à saúde ocupacional dos colaboradores dentro da organização, a empresa acaba por implantar uma fórmula para o sucesso nesse ambiente tão competitivo do mundo globalizado. Trata-se de uma pesquisa bibliográfica de natureza qualitativa onde chegou-se à conclusão de que é de muita importância levar à prática as teorias estudadas sobre a saúde organizacional. Buscou-se apresentar também algumas sugestões teóricas para amenizar os efeitos do estresse afim de melhorar a qualidade de vida dos indivíduos dentro das organizações

Midiologia, linguagem e poesia

As novas possibilidades abertas pela comunicação em rede, no que diz respeito a sua produção, circulação e consumo, e as instigantes possibilidades que a cultura digital abre para a literatura em suas diversas formas, na medida em que implicam modificações significativas nos seus usos, necessitam de novos aportes teórico-metodológicos. Cremos, contudo, que uma tal necessidade, diríamos crítica em toda amplitude, deve estar articulada a uma reflexão sobre os processos técnicos que agiram diretamente sobre a literatura ao longo de todos estes séculos de sua existência. Pensamos ainda que a poesia, exatamente por ter dialogado sem interrupção com tais processos, tenha muito a nos dizer a respeito do que consideramos, na esteira de Régis&nbsp;Debray (1995) e&nbsp;Lévy (1997), as três idades da inteligência, centradas na voz, na escrita e no vídeo digital

Autobiographical narrative: Practices of writing and memory performances in the literary work of Tatiana Belinky (São Paulo/Rio de Janeiro, anos 1930)

O presente trabalho tem como objetivo propor uma reflexão sobre as representações contidas na narrativa autobiográfica da escritora russa Tatiana Belinky, tratando especificamente sobre as práticas de escrita e as performances da memória que tecem suas experiências sociais na São Paulo e no Rio de Janeiro da década de 1930, registradas no livro Transplante de Menina. É justamente nesta ideia de “transplante” que o referido livro caracteriza-se como uma experiência de deslocamento e de adaptação social infanto-juvenil, tendo a cidade como espaço privilegiado dos conflitos, das negociações e, de destacada importância, da constituição de memórias.This paper aims to propose a reflection on the representations contained in the autobiographical narrative of Russian writer Tatiana Belinky, dealing specifically with writing practices and memory performances that weave her social experiences in São Paulo and Rio de Janeiro during the 1930s, recorded in the book Girl Transplant. It is precisely in this idea of "transplant" that said book features a children's social displacement and adjustment experience, taking the city as a privileged space of conflicts, negotiations and, more importantly, of memories formation

UMA VIAGEM AO MUNDO (NEO) FANTÁSTICO DAS CRÔNICAS DE NÁRNIA, DE C. S. LEWIS

Esse artigo tem como objetivo fazer uma leitura dos elementos do (neo) fantástico e como estes estão inseridos no romance O leão, a feiticeira e o guarda-roupa, publicado originalmente em 1950 pelo autor C. S. Lewis. O romance nos convida a uma viagem pelo reino da fantasia onde acontecimentos sobrenaturais ocorrem dentro do mundo imaginário de Nárnia. Desde tempos imemoráveis, a literatura, assim também como as outras artes, têm representado mundos irreais, situações e ações improváveis, que ultrapassam a realidade; seja pela presença de objetos mágicos, seres encantados ou eventos que estão fora da realidade, o fantástico está presente. Assim, nos basearemos nas teorias de Tzvetan Todorov (2010), Remo Ceserani (2006) e David Roas (2013), para discutir os diferentes pontos de vista que cercam o fantástico no romance de Lewis

Cardiovascular Toxicity of Immune Checkpoint Inhibitors: A Guide for Clinicians

Immune checkpoint inhibitors (ICIs) have revolutionized the treatment and care of patients with cancer owing to unique features, including the occurrence of the so-called immune-related adverse events (irAEs). A multidisciplinary team, possibly including a cardio-oncology specialist, is warranted to achieve a favorable patient outcome. Cardiovascular toxicity, especially myocarditis, emerged as a life-threatening irAE in the real-word setting, and the European Society of Cardiology has recently published the first guideline on cardio-oncology to increase awareness and promote a standardized approach to tackle this complex multimodal issue, including diagnostic challenges, assessment, treatment, and surveillance of patients with cancer receiving ICIs. In this article, through a question &amp; answer format made up of case vignettes, we offer a clinically oriented overview on the latest advancements of ICI-related cardiovascular toxicity, focusing on myocarditis and associated irAEs (myositis and myasthenia gravis within the so-called overlap syndrome), with the purpose of assisting clinicians and healthcare professionals in daily clinical practice