3D-Printed Models Applied in Medical Research Studies

The aim of this chapter is to show experiments in cardiology and fetal medicine, two specialties of medicine, through the development of three dimensional (3D) physical models produced on additive manufacturing (AM) technologies, also known as 3D printing, from files acquired on noninvasive-imaging technologies (NITs) as 3D ultrasound (3DUS), magnetic resonance imaging (MRI), computed tomography (CT), and micro-computed tomography (micro-CT). The presentation of eight different experiments demonstrates that the combination of AM technologies and files obtained from NITs may improve our understanding of medical anatomical characteristics for medical research, simulation procedures, and educational purposes

Velocimetria por imagens de partículas em ultrassonografia cardiovascular utilizando contraste espontâneo

desenvolvida recentemente, capaz de medir a velocidade do fluxo sanguíneo com resolução espacial superior à ecocardiografia DOPPLER. Esta técnica baseia-se no processamento digital de imagens ecocardiográficas adquiridas utilizando-se contraste venoso ultra-sonográfico (microbolhas com recobrimento lipídico). No presente trabalho foi estudada a aplicação desta técnica utilizando-se o contraste espontâneo (remora) como marcador do fluxo sanguíneo, um desenvolvimento original na literatura. O objetivo do presente trabalho é avaliar a aplicabilidade da técnica de velocimetria por imagens de partículas em ecocardiografia, em seres humanos, utilizando imagens que contenham contraste espontâneo. Pela técnica ECO-PIV, a obtenção da velocidade do fluxo sanguíneo torna-se viável em imagens ecocardiográficas que contenham contraste espontâneo devido à característica deste tipo de contraste de movimentar-se, acompanhando fielmente o escoamento sanguíneo. Para tal, após a aquisição de um exame ecocardiográfico, é implementado um processamento de imagens, onde um procedimento de análise estatística (correlação-cruzada) é aplicado a pares sucessivos de imagens fornecendo o deslocamento do contraste em toda a região de interesse. O conhecimento do intervalo de tempo entre as imagens permite a determinação da velocidade do escoamento de sangue. Neste trabalho, dez pacientes foram selecionados da rotina clínica de investigação diagnóstica dos serviços de ecocardiografia do Hospital Procordis e do Hospital Universitário Antônio Pedro, pertencente à Universidade Federal Fluminense, Niterói, RJ. Os exames foram selecionados durantes os anos de 2009 e 2010. Foram incluídos no estudo pacientes que possuíam exames ecocardiográficos com imagens apresentando contraste espontâneo em uma quantidade classificada como médio-moderada (2+), moderada (3+) e grave (4+). Utilizaram-se exames ecocardiográficos transesofágicos de artéria aorta torácica e átrio esquerdo obtidos com o transdutor GE 6T – 8.0 MHz do aparelho Vivid 3®, GE, EUA. Os exames das veias tibiais anteriores foram obtidos com o transdutor linear GE 10L – 8.0 MHz do aparelho Vivid 3®, GE, EUA. A presença de contraste espontâneo nas imagens obtidas possibilitou a aplicação do processo de análise de correlaçãocruzada proposto e a medição do campo instantâneo de velocidade. A partir do campo de velocidade, foi possível o cálculo das taxas de cisalhamento e campos de vorticidade do fluxo sanguíneo. Através da análise dos resultados foi possível constatar a aplicabilidade da técnica de velocimetria por imagens de partículas em ecocardiografia (ECO-PIV) em seres humanos, utilizando imagens que contenham contraste espontâneo. Estudos futuros deverão avaliar a validação, reprodutibilidade e o significado clínico do emprego da técnica ECO-PIV com contraste espontâneoParticle image velocimetry applied to echocardiographic images (ECHO-PIV) is a technique recently developed, capable of measuring blood flow velocity with a higher spatial resolution than DOPPLER echocardiography. This technique is based on digital image processing of echocardiographic images acquired with ultra-sonographic contrast (micro-bubbles with lipidic shell). In the present work a novel implementation of the technique was tested, whereby spontaneous echocardiographic contrast provided by the blood was used as flow tracers, which constitutes, seemingly, an original contribution to the literature. The focus of this study was to test the feasibility of the application of particle image velocimetry in echocardiography, in humans, using echocardiographic images displaying spontaneous echocardiographic contrast. It was verified that spontaneous contrast faithfully follows the blood flow, a characteristic which allows its use as tracer for the determination of the instantaneous blood velocity field using the ECHO-PIV technique. After the acquisition of echocardiographic images, statistical analysis (cross-correlation) was applied to a successive pair of images, yielding the displacement of the contrast in the complete field of view. The knowledge of the image acquisition frame rate and the displacement of the tracers allow the determination of the desired blood flow velocity. In the present study, ten patients were selected from clinical routine of diagnostic investigation of the echocardiographic laboratory of Procordis Hospital and Antônio Pedro University Hospital, from Federal Fluminense University, Niterói, RJ. The echocardiographic exams were obtained during 2009 and 2010 and were selected among those patients displaying spontaneous echocardiographic contrast classified as medium-moderate (2+), moderate (3+) and severe (4+). The images of thoracic aorta artery and left atrium were acquired with GE 6T – 8.0 MHz transducer from Vivid 3®, GE, USA. Tibial anterior veins were studied with GE 10L – 8.0 MHz transducer from Vivid 3®, GE, USA The presence of spontaneous echocardiographic contrast in the analyzed images allowed the cross-correlation of image pairs and the measurements of instantaneous velocity fields. Shear rate and vorticity fields for the blood flow were then calculated from the measured velocity fields. The analysis of the results proved the feasibility of the particle image velocimetry technique in echocardiography in humans, using echocardiographic images with spontaneous echocardiographic contrast. Future studies are necessary to assess the validity, reproducibility and clinical significance of this methodology107f

Tuberculose e leite: elementos para a história de uma polêmica Tuberculosis and milk: elements of a polemic

Pode o ser humano contrair tuberculose pela ingestão do leite de vacas tuberculosas? São efetivos o diagnóstico e o controle da tuberculose bovina para a proteção da população humana? Questões como estas estiveram em pauta no pensamento médico paulistano no início do século XX. O presente estudo procurou reconstituir elementos da polêmica travada em São Paulo, com o intuito de incentivar a divulgação de dados suplementares sobre a matéria. Aqui são apresentadas indicações sintéticas das posições em confronto: de um lado, as preocupações em intensificar as ações de controle do gado tuberculoso; de outro, o cuidado de não prejudicar os criadores nacionais com a demanda de precauções adicionais, as quais se temia serem lesivas à comercialização do produto. O acompanhamento das intervenções sobre o tema na imprensa médica permitiu identificar a preponderância da primeira posição, com conseqüências para o controle sanitário de alimentos.<br>Can human beings get tuberculosis from the milk taken from cows infected with tuberculosis? Are the diagnosis and control of cattle tuberculosis effective for the protection of human populations? Questions such as these were the main concern of doctors from São Paulo at the beginning of the twentieth century. The present study tried to recover elements from the polemic that took place in São Paulo, in order to encourage the coming up of complementary facts about such matter. The article presents some indicators of confronting positions: on one hand, the goal of intensifying the control of tuberculosis among the cattle; on the other hand, the attempt not to bring up any loss to national cattle raisers through the demand of additional precaution measures, which would affect the production and distribution of their products. Medical publications kept records of the interventions, which have allowed the author to identify the first position as the stronger one, which has brought up relevant consequences for the sanitary food control

NEOTROPICAL ALIEN MAMMALS: a data set of occurrence and abundance of alien mammals in the Neotropics

Biological invasion is one of the main threats to native biodiversity. For a species to become invasive, it must be voluntarily or involuntarily introduced by humans into a nonnative habitat. Mammals were among first taxa to be introduced worldwide for game, meat, and labor, yet the number of species introduced in the Neotropics remains unknown. In this data set, we make available occurrence and abundance data on mammal species that (1) transposed a geographical barrier and (2) were voluntarily or involuntarily introduced by humans into the Neotropics. Our data set is composed of 73,738 historical and current georeferenced records on alien mammal species of which around 96% correspond to occurrence data on 77 species belonging to eight orders and 26 families. Data cover 26 continental countries in the Neotropics, ranging from Mexico and its frontier regions (southern Florida and coastal-central Florida in the southeast United States) to Argentina, Paraguay, Chile, and Uruguay, and the 13 countries of Caribbean islands. Our data set also includes neotropical species (e.g., Callithrix sp., Myocastor coypus, Nasua nasua) considered alien in particular areas of Neotropics. The most numerous species in terms of records are from Bos sp. (n = 37,782), Sus scrofa (n = 6,730), and Canis familiaris (n = 10,084); 17 species were represented by only one record (e.g., Syncerus caffer, Cervus timorensis, Cervus unicolor, Canis latrans). Primates have the highest number of species in the data set (n = 20 species), partly because of uncertainties regarding taxonomic identification of the genera Callithrix, which includes the species Callithrix aurita, Callithrix flaviceps, Callithrix geoffroyi, Callithrix jacchus, Callithrix kuhlii, Callithrix penicillata, and their hybrids. This unique data set will be a valuable source of information on invasion risk assessments, biodiversity redistribution and conservation-related research. There are no copyright restrictions. Please cite this data paper when using the data in publications. We also request that researchers and teachers inform us on how they are using the data

NEOTROPICAL XENARTHRANS: a data set of occurrence of xenarthran species in the Neotropics

Xenarthrans—anteaters, sloths, and armadillos—have essential functions for ecosystem maintenance, such as insect control and nutrient cycling, playing key roles as ecosystem engineers. Because of habitat loss and fragmentation, hunting pressure, and conflicts with domestic dogs, these species have been threatened locally, regionally, or even across their full distribution ranges. The Neotropics harbor 21 species of armadillos, 10 anteaters, and 6 sloths. Our data set includes the families Chlamyphoridae (13), Dasypodidae (7), Myrmecophagidae (3), Bradypodidae (4), and Megalonychidae (2). We have no occurrence data on Dasypus pilosus (Dasypodidae). Regarding Cyclopedidae, until recently, only one species was recognized, but new genetic studies have revealed that the group is represented by seven species. In this data paper, we compiled a total of 42,528 records of 31 species, represented by occurrence and quantitative data, totaling 24,847 unique georeferenced records. The geographic range is from the southern United States, Mexico, and Caribbean countries at the northern portion of the Neotropics, to the austral distribution in Argentina, Paraguay, Chile, and Uruguay. Regarding anteaters, Myrmecophaga tridactyla has the most records (n = 5,941), and Cyclopes sp. have the fewest (n = 240). The armadillo species with the most data is Dasypus novemcinctus (n = 11,588), and the fewest data are recorded for Calyptophractus retusus (n = 33). With regard to sloth species, Bradypus variegatus has the most records (n = 962), and Bradypus pygmaeus has the fewest (n = 12). Our main objective with Neotropical Xenarthrans is to make occurrence and quantitative data available to facilitate more ecological research, particularly if we integrate the xenarthran data with other data sets of Neotropical Series that will become available very soon (i.e., Neotropical Carnivores, Neotropical Invasive Mammals, and Neotropical Hunters and Dogs). Therefore, studies on trophic cascades, hunting pressure, habitat loss, fragmentation effects, species invasion, and climate change effects will be possible with the Neotropical Xenarthrans data set. Please cite this data paper when using its data in publications. We also request that researchers and teachers inform us of how they are using these data

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally