Fisioterapia intrahospitalaria para pacientes con isquemia crítica de miembro inferior: consenso de especialistas

La isquemia crítica de miembro inferior (ICMI) afecta a los sistemas de salud y la calidad de vida y funcionalidad de los individuos diagnosticados. Sin embargo, hay poca evidencia científica que fundamente la intervención fisioterapéutica para pacientes internados por ICMI. El objetivo de este estudio fue elaborar un consenso de especialistas sobre la fisioterapia intrahospitalaria para pacientes con ICMI. Para ello, se utilizó el método Delphi. Se formó un panel de expertos con 18 fisioterapeutas que representaban el 85,7% del equipo de un hospital de referencia en cirugía vascular. Se consideraron, para el consenso, las respuestas con un valor mínimo de concordancia del 70% y media o mediana ≥3,1 en la escala Likert. Los cuestionarios abordaron ítems de evaluación, objetivos y conductas fisioterapéuticas en las fases pre y poscirugía de revascularización. Se definieron como elementos esenciales la evaluación de síntomas y las funciones cognitiva, musculoesquelética y cardiorrespiratoria. En el preoperatorio, control del dolor, reducción de edemas, ganancia de amplitud de movimiento, deambulación y educación en salud son los objetivos; en la fase posoperatoria, la ganancia de fuerza muscular. Los ejercicios pasivos, asistidos, activos libres y circulatorios, incluidos los miembros superiores, se indican antes y después de las cirugías. La educación en salud y la deambulación con reducción de peso en el área de lesión plantar son esenciales en todo el período de internación. La electroanalgesia fue preconizada en el preoperatorio; y, en el postoperatorio, elevación del miembro inferior y ejercicios resistidos.Critical limb ischemia (CLI) is a disease with a great burden for the healthcare system, patient’s functionality and quality of life. However, there is little evidence to guide intrahospital physical therapy programs for patients with CLI. Thus, this study aimed to provide an expert consensus on intrahospital physiotherapeutic care for CLI patients. An expert panel was made up with 18 experienced physical therapists, which represented 85.7% of physical therapists from the vascular surgery team, a reference group in a university hospital. The Delphi method was used to produce a consensus, considering a minimum agreement of 70% and a mean or median score in the Likert scale ≥3.1. The questionnaires included items related to assessment, goals and physiotherapeutic interventions prior and after revascularization. A consensus was reached on assessing symptoms, cognitive, articular, musculoskeletal and cardiorespiratory functions. Pain control, edema drainage, range of motion gain, walking incentive and health education are goals in the pre-operatory and the muscular strengthening in postoperatory phase. In both phases there was a consensus on the use of passive, active-assisted and active exercises, including upper limb exercises. Walking and therapeutic education are essential during the hospitalization period with offloading practices in area of plantar ulcer. Electroanalgesia should be used in preoperative phase and resisted exercises and lower limb elevation at postoperatory.A isquemia crítica de membro inferior (ICMI) gera impacto nos sistemas de saúde, na qualidade de vida e funcionalidade dos indivíduos diagnosticados. Entretanto, há pouca evidência científica que permita fundamentar a intervenção fisioterapêutica para pacientes internados por ICMI. O objetivo desse estudo foi elaborar um consenso de especialistas sobre a fisioterapia intra-hospitalar para pacientes com ICMI. Para tal, foi utilizado o método Delphi. Um painel de especialistas foi formado por 18 fisioterapeutas que representavam 85,7% da equipe de um hospital de referência em cirurgia vascular. Foram consideradas, para o consenso, as respostas com valor mínimo de concordância de 70% e média ou mediana ≥3,1 na escala Likert. Os questionários abordaram itens da avaliação, objetivos e condutas fisioterapêuticas nas fases pré e pós-cirurgia de revascularização. Definiram-se como itens essenciais a avaliação de sintomas, função cognitiva, musculoesquelética e cardiorrespiratória. Controle da dor, redução de edemas, ganho de amplitude de movimento, deambulação e educação em saúde são objetivos no pré-operatório e o ganho de força muscular na fase pós-operatória. Exercícios passivo, assistido, ativo livre e circulatório, incluindo os membros superiores, estão indicados antes e após as cirurgias. Educação em saúde e deambulação com redução de peso em área de lesão plantar são essenciais em todo o período de internação. A eletroanalgesia foi preconizada no pré-operatório e a elevação do membro inferior e exercícios resistidos no pós-operatório

Measurement of transverse momentum relative to dijet systems in PbPb and pp collisions at sNN=2.76\sqrt{s_{NN}} = 2.76 TeV

An analysis of dijet events in PbPb and pp collisions is performed to explore the properties of energy loss by partons traveling in a quark-gluon plasma. Data are collected at a nucleon-nucleon center-of-mass energy of 2.76 TeV at the LHC. The distribution of transverse momentum (pT) surrounding dijet systems is measured by selecting charged particles in different ranges of pT and at different angular cones of pseudorapidity and azimuth. The measurement is performed as a function of centrality of the PbPb collisions, the pT asymmetry of the jets in the dijet pair, and the distance parameter R used in the anti-kt jet clustering algorithm. In events with unbalanced dijets, PbPb collisions show an enhanced multiplicity in the hemisphere of the subleading jet, with the pT imbalance compensated by an excess of low-pT particles at large angles from the jet axes

Measurement of the top quark mass using proton-proton data at (s){\sqrt{(s)}} = 7 and 8 TeV

A new set of measurements of the top quark mass are presented, based on the proton-proton data recorded by the CMS experiment at the LHC at s=8 TeV corresponding to a luminosity of 19.7 fb-1. The top quark mass is measured using the lepton+jets, all-jets and dilepton decay channels, giving values of 172.35±0.16(stat)±0.48(syst) GeV, 172.32±0.25(stat)±0.59(syst) GeV, and 172.82±0.19(stat)±1.22(syst) GeV, respectively. When combined with the published CMS results at s=7 TeV, they provide a top quark mass measurement of 172.44±0.13(stat)±0.47(syst) GeV. The top quark mass is also studied as a function of the event kinematical properties in the lepton+jets decay channel. No indications of a kinematic bias are observed and the collision data are consistent with a range of predictions from current theoretical models of tt¯ production

Measurement of t-tbar production with additional jet activity, including b quark jets, in the dilepton channel using pp collisions at s\sqrt s = 8TeV

Jet multiplicity distributions in top quark pair (t-tbar) events are measured in pp collisions at a centre-of-mass energy of 8 TeV with the CMS detector at the LHC using a data set corresponding to an integrated luminosity of 19.7 inverse-femtobarns. The measurement is performed in the dilepton decay channels (e+ e-, mu+ mu-, and e+/- mu-/+). The absolute and normalized differential cross sections for t-tbar production are measured as a function of the jet multiplicity in the event for different jet transverse momentum thresholds and the kinematic properties of the leading additional jets. The differential t-tbar-b and t-tbar-b-bbar cross sections are presented for the first time as a function of the kinematic properties of the leading additional b jets. Furthermore, the fraction of events without additional jets above a threshold is measured as a function of the transverse momenta of the leading additional jets and the scalar sum of the transverse momenta of all additional jets. The data are compared and found to be consistent with predictions from several perturbative quantum chromodynamics event generators and a next-to-leading order calculation

Measurement of the ttˉ\bar t Production Cross Section in the All-Jets Final State in pp Collisions at s\sqrt{s}=8 TeV

The cross section for $\mathrm{t \bar{t}}$ production in the all-jets final state is measured in pp collisions at a centre-of-mass energy of 8 TeV at the LHC with the CMS detector, in data corresponding to an integrated luminosity of 18.4 fb$^{-1}$. The inclusive cross section is found to be 275.6 $\pm$ 6.1 (stat) $\pm$ 37.8 (syst) $\pm$ 7.2 (lum) pb. The normalized differential cross sections are measured as a function of the top quark transverse momenta, $p_{\mathrm{T}}$, and compared to predictions from quantum chromodynamics. The results are reported at detector, parton, and particle levels. In all cases, the measured top quark $p_{\mathrm{T}}$ spectra are significantly softer than theoretical predictions

Measurement of t-tbar production with additional jet activity, including b quark jets, in the dilepton channel using pp collisions at sqrt(s) = 8TeV

Jet multiplicity distributions in top quark pair (t-tbar) events are measured in pp collisions at a centre-of-mass energy of 8 TeV with the CMS detector at the LHC using a data set corresponding to an integrated luminosity of 19.7 inverse-femtobarns. The measurement is performed in the dilepton decay channels (e+ e-, mu+ mu-, and e+/- mu-/+). The absolute and normalized differential cross sections for t-tbar production are measured as a function of the jet multiplicity in the event for different jet transverse momentum thresholds and the kinematic properties of the leading additional jets. The differential t-tbar-b and t-tbar-b-bbar cross sections are presented for the first time as a function of the kinematic properties of the leading additional b jets. Furthermore, the fraction of events without additional jets above a threshold is measured as a function of the transverse momenta of the leading additional jets and the scalar sum of the transverse momenta of all additional jets. The data are compared and found to be consistent with predictions from several perturbative quantum chromodynamics event generators and a next-to-leading order calculation