Avanços nas técnicas minimamente invasivas na abordagem de hérnias abdominais: uma revisão dos procedimentos, inovações e resultados clínicos

A reparação de hérnias abdominais é uma prática comum em cirurgia geral, com a abordagem minimamente invasiva sendo cada vez mais preferida por suas vantagens em termos de recuperação pós-operatória e resultados clínicos. Esta revisão buscou avaliar os avanços e resultados clínicos das técnicas minimamente invasivas, incluindo a laparoscopia, cirurgia assistida por robótica (RAS) e abordagens laparoscópicas (TEP e TAPP). Cada uma dessas técnicas apresenta vantagens distintas, como a diminuição da dor pós-operatória, menores taxas de infecção do sítio cirúrgico e menor tempo de recuperação. No entanto, o treinamento especializado e o alto custo dos equipamentos necessários são barreiras que precisam ser enfrentadas. A pesquisa continua a avaliar e aprimorar essas técnicas, com inovações promissoras como novos materiais de malha e técnicas de fixação sem sutura. Embora essas técnicas mostrem resultados promissores, mais estudos são necessários para avaliar sua eficácia em hérnias complexas ou de grande tamanho

Abordagens multidisciplinares no tratamento da dor crônica: perspectivas e desafios

A dor crônica é uma condição complexa e debilitante que afeta milhões de pessoas em todo o mundo. Esta revisão destaca a importância das abordagens multidisciplinares para o tratamento da dor crônica, enfocando a eficácia e os desafios dessas intervenções. Foram analisadas várias bases de dados, incluindo PubMed, PsycINFO e CINAHL, para identificar estudos que avaliaram a eficácia das abordagens multidisciplinares, incluindo intervenções físicas, psicológicas e farmacológicas. Embora estas sejam geralmente eficazes, a implementação na prática clínica é muitas vezes inconsistente devido a barreiras ao acesso e falta de coordenação entre os provedores de cuidados. Os tratamentos devem ser personalizados para atender às necessidades individuais dos pacientes e requerem uma abordagem coordenada entre várias disciplinas. A pesquisa futura deve se concentrar em aprimorar a compreensão dos mecanismos subjacentes à dor crônica, desenvolver novas intervenções e superar as barreiras ao acesso ao tratamento

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For schoolaged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit

Probing the nature of the χc1(3872)\chi_{c1}(3872) state using radiative decays

International audienceThe radiative decays $\chi_{c1}(3872)\rightarrow\psi(2S)\gamma$ and $\chi_{c1}(3872)\rightarrow J/\psi\gamma$ are used to probe the~nature of the~$\chi_{c1}(3872)$ state using proton-proton collision data collected with the LHCb detector, corresponding to an~integrated luminosity of~9fb$^{-1}$. Using the~$B^+\rightarrow \chi_{c1}(3872)K^+$decay, the $\chi_{c1}(3872)\rightarrow \psi(2S)\gamma$ process is observed for the first time and the ratio of its partial width to that of the $\chi_{c1}(3872)\rightarrow J/\psi\gamma$ decay is measured to be $$\frac{\Gamma_{\chi_{c1}(3872)\rightarrow \psi(2S)\gamma}} {\Gamma_{\chi_{c1}(3872)\rightarrow J/\psi\gamma}} = 1.67 \pm 0.21 \pm 0.12 \pm0.04 ,$$ where the first uncertainty is statistical, the second systematic and the third is due to the uncertainties on the branching fractions of the $\psi(2S)$ and $J/\psi$ mesons. The measured ratio makes the interpretation of the $\chi_{c1}(3872)$ state as a~pure $D^0\bar{D}^{*0}+\bar{D}^0D^{*0}$ molecule questionable and strongly indicates a sizeable compact charmonium or tetraquark component within the $\chi_{c1}(3872)$ state

Amplitude analysis of B+→ψ(2S)K+π+π−B^+ \to \psi(2S) K^+ \pi^+ \pi^- decays

International audienceThe first full amplitude analysis of $B^+ \to \psi(2S) K^+ \pi^+ \pi^-$ decays is performed using proton-proton collision data corresponding to an integrated luminosity of $9\,\text{fb}^{-1}$ recorded with the LHCb detector. The rich $K^+ \pi^+ \pi^-$ spectrum is studied and the branching fractions of the resonant substructure associated with the prominent $K_1(1270)^+$ contribution are measured. The data cannot be described by conventional strange and charmonium resonances only. An amplitude model with 53 components is developed comprising 11 hidden-charm exotic hadrons. New production mechanisms for charged charmonium-like states are observed. Significant resonant activity with spin-parity $J^P = 1^+$ in the $\psi(2S) \pi^+$ system is confirmed and a multi-pole structure is demonstrated. The spectral decomposition of the $\psi(2S) \pi^+ \pi^-$ invariant-mass structure, dominated by $X^0 \to \psi(2S) \rho(770)^0$ decays, broadly resembles the $J/\psi \phi$ spectrum observed in $B^+ \to J/\psi \phi K^+$ decays. Exotic $\psi(2S) K^+ \pi^-$ resonances are observed for the first time

Probing the nature of the χc1(3872)\chi_{c1}(3872) state using radiative decays

International audienceThe radiative decays $\chi_{c1}(3872)\rightarrow\psi(2S)\gamma$ and $\chi_{c1}(3872)\rightarrow J/\psi\gamma$ are used to probe the~nature of the~$\chi_{c1}(3872)$ state using proton-proton collision data collected with the LHCb detector, corresponding to an~integrated luminosity of~9fb$^{-1}$. Using the~$B^+\rightarrow \chi_{c1}(3872)K^+$decay, the $\chi_{c1}(3872)\rightarrow \psi(2S)\gamma$ process is observed for the first time and the ratio of its partial width to that of the $\chi_{c1}(3872)\rightarrow J/\psi\gamma$ decay is measured to be $$\frac{\Gamma_{\chi_{c1}(3872)\rightarrow \psi(2S)\gamma}} {\Gamma_{\chi_{c1}(3872)\rightarrow J/\psi\gamma}} = 1.67 \pm 0.21 \pm 0.12 \pm0.04 ,$$ where the first uncertainty is statistical, the second systematic and the third is due to the uncertainties on the branching fractions of the $\psi(2S)$ and $J/\psi$ mesons. The measured ratio makes the interpretation of the $\chi_{c1}(3872)$ state as a~pure $D^0\bar{D}^{*0}+\bar{D}^0D^{*0}$ molecule questionable and strongly indicates a sizeable compact charmonium or tetraquark component within the $\chi_{c1}(3872)$ state

Study of the rare decay J/ψ→μ+μ−μ+μ−J/\psi \to \mu^+\mu^-\mu^+\mu^-

International audienceThe rare electromagnetic $J/\psi \to \mu^+\mu^-\mu^+\mu^-$ decay is observed with a significance greatly exceeding the discovery threshold, using proton-proton collision data collected by the LHCb experiment during 2016-2018 at a center-of-mass energy of 13 TeV, corresponding to an integrated luminosity of $5.4\,\text{fb}^{-1}$. The rate of this decay is measured relative to that of the $J/\psi \to \mu^+\mu^-$ mode. Using the QED model for the four-muon decay in the efficiency estimation, its branching fraction is determined to be \begin{equation*} {\mathcal{B}}(J/\psi \to \mu^+\mu^-\mu^+\mu^-) = (1.13\pm0.10\pm0.05\pm0.01)\times 10^{-6}, \end{equation*} where the uncertainties are statistical, systematic and due to the uncertainty on the branching fraction of the $J/\psi \to \mu^+\mu^-$ decay

Amplitude analysis of B+→ψ(2S)K+π+π−B^+ \to \psi(2S) K^+ \pi^+ \pi^- decays

International audienceThe first full amplitude analysis of $B^+ \to \psi(2S) K^+ \pi^+ \pi^-$ decays is performed using proton-proton collision data corresponding to an integrated luminosity of $9\,\text{fb}^{-1}$ recorded with the LHCb detector. The rich $K^+ \pi^+ \pi^-$ spectrum is studied and the branching fractions of the resonant substructure associated with the prominent $K_1(1270)^+$ contribution are measured. The data cannot be described by conventional strange and charmonium resonances only. An amplitude model with 53 components is developed comprising 11 hidden-charm exotic hadrons. New production mechanisms for charged charmonium-like states are observed. Significant resonant activity with spin-parity $J^P = 1^+$ in the $\psi(2S) \pi^+$ system is confirmed and a multi-pole structure is demonstrated. The spectral decomposition of the $\psi(2S) \pi^+ \pi^-$ invariant-mass structure, dominated by $X^0 \to \psi(2S) \rho(770)^0$ decays, broadly resembles the $J/\psi \phi$ spectrum observed in $B^+ \to J/\psi \phi K^+$ decays. Exotic $\psi(2S) K^+ \pi^-$ resonances are observed for the first time

Probing the nature of the χc1(3872)\chi_{c1}(3872) state using radiative decays

International audienceThe radiative decays $\chi_{c1}(3872)\rightarrow\psi(2S)\gamma$ and $\chi_{c1}(3872)\rightarrow J/\psi\gamma$ are used to probe the~nature of the~$\chi_{c1}(3872)$ state using proton-proton collision data collected with the LHCb detector, corresponding to an~integrated luminosity of~9fb$^{-1}$. Using the~$B^+\rightarrow \chi_{c1}(3872)K^+$decay, the $\chi_{c1}(3872)\rightarrow \psi(2S)\gamma$ process is observed for the first time and the ratio of its partial width to that of the $\chi_{c1}(3872)\rightarrow J/\psi\gamma$ decay is measured to be $$\frac{\Gamma_{\chi_{c1}(3872)\rightarrow \psi(2S)\gamma}} {\Gamma_{\chi_{c1}(3872)\rightarrow J/\psi\gamma}} = 1.67 \pm 0.21 \pm 0.12 \pm0.04 ,$$ where the first uncertainty is statistical, the second systematic and the third is due to the uncertainties on the branching fractions of the $\psi(2S)$ and $J/\psi$ mesons. The measured ratio makes the interpretation of the $\chi_{c1}(3872)$ state as a~pure $D^0\bar{D}^{*0}+\bar{D}^0D^{*0}$ molecule questionable and strongly indicates a sizeable compact charmonium or tetraquark component within the $\chi_{c1}(3872)$ state

Study of the rare decay J/ψ→μ+μ−μ+μ−J/\psi \to \mu^+\mu^-\mu^+\mu^-

International audienceThe rare electromagnetic $J/\psi \to \mu^+\mu^-\mu^+\mu^-$ decay is observed with a significance greatly exceeding the discovery threshold, using proton-proton collision data collected by the LHCb experiment during 2016-2018 at a center-of-mass energy of 13 TeV, corresponding to an integrated luminosity of $5.4\,\text{fb}^{-1}$. The rate of this decay is measured relative to that of the $J/\psi \to \mu^+\mu^-$ mode. Using the QED model for the four-muon decay in the efficiency estimation, its branching fraction is determined to be \begin{equation*} {\mathcal{B}}(J/\psi \to \mu^+\mu^-\mu^+\mu^-) = (1.13\pm0.10\pm0.05\pm0.01)\times 10^{-6}, \end{equation*} where the uncertainties are statistical, systematic and due to the uncertainty on the branching fraction of the $J/\psi \to \mu^+\mu^-$ decay