Cirurgia robótica em pacientes com tumor testicular

Introdução: o tumor testicular é a neoplasia mais comum entre homens jovens de 15 a 35 anos de idade. Nos últimos anos, a incidência dessa patologia tem aumentado, o que torna necessária a adoção de tratamentos mais eficazes e menos invasivos. Nesse sentido, a cirurgia robótica é uma realidade, mais ágil e mais segura do que os métodos tradicionais, para um bom prognóstico dessa doença. Objetivo: o trabalho teve como objetivo avaliar a eficácia da cirurgia robotizada em casos de tumor testicular. Material e método: o presente estudo trata de uma revisão de literatura a partir de vinte artigos redigidos em língua inglesa, obtidos das bases de dados do PubMed, selecionados utilizando-se os Descritores em Ciência da Saúde (DeCS): “surgery”, “robotic”, “cancer” e “testicular”, com critério de data de publicação entre 2014 e 2019. Foram selecionados artigos que relataram a cirurgia robótica para o tratamento do câncer de testículo. Resultados: os resultados se basearam na comparação da cirurgia robótica com a laparoscopia tradicional, ambas realizadas com o objetivo de dissecção de linfonodo retroperitoneal pós-quimioterapia, para tratamento de câncer testicular. O primeiro procedimento citado, apesar de ainda ser considerado o padrão, é tecnicamente difícil, e acarreta maior perda de sangue (uma média de 500Ml), tempo de operação (200 a 350 minutos) e complicações. Em contrapartida, a cirurgia robotizada tem perda de sangue mínima (50mL a 200mL) e demanda menos horas de centro cirúrgico (uma variação de 150 a 200 minutos). Quase todos os pacientes submetidos à robotização receberam alta no 1º dia de pós-operatório, pouco se queixando de dor ou desconforto. Além disso, após uma média de sete meses de acompanhamento, os indivíduos operados apresentaram-se assintomáticos. A taxa de complicação também foi mínima, bem como os valores de morbimortalidadedade, o que demonstra a efetividade da cirurgia robotizada.. Conclusão: diante do exposto, constatou-se que a cirurgia robotizada para tratamento de câncer testicular é um procedimento viável e oncologicamente seguro, com morbidade e riscos mínimos. Nesse sentido, é uma estratégia bastante eficaz, e vem sendo introduzida cada vez mais nos centros hospitalares. Contudo, é imprescindível ter uma tecnologia avançada e profissionais mais especializados e capacitados para a realização dessa técnica, visando a segurança máxima do paciente

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

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Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Process mining based approach to performance evaluation in computer-aided examinations

A considerable part of educational systems tends to be online and computer oriented. However, online examination may create some difficulties during the evaluation of student performance. Process mining which arises as a new concept presents various powerful techniques for processing and analyzing different types of data by making use of some advanced information technologies. This paper proposes a novel approach based on process mining for evaluating the performance of students that should follow certain tasks on the computer. The proposed approach is composed of two main phases which are process mining and similarity analysis. Automatic assessment is performed totally in six steps in order to obtain students' final grades. In addition, cheat control is possible in the last step thanks to the similarity analysis. A real-life application in an Enterprise Resource Planning (ERP) course is performed in order to present usefulness, validity and practicality of the proposed approach. Furthermore, to evaluate the performance of the assessment system, we compared the assessment mechanism against instructor. A total of 15 students' answers belonging to computer-aided exam are assessed by instructor and the results showed a very good agreement between the automatic assessment system and instructor

Role of cell adhesion molecules in leukocyte recruitment in the liver and gut

This article reviews the evidence that adhesion molecules are critical in leukocyte recirculation and pathogenesis of diseases affecting the closely related tissues of the liver and gut, which offer novel opportunities for treatment