ESTADO NUTRICIONAL PRÉ-OPERATÓRIO E COMPLICAÇÕES CIRÚRGICAS EM DOENTES COM CANCRO DIGESTIVO E DA CABEÇA E PESCOÇO

Introduction: Malnutrition is present in 40-50% of surgical patients upon hospital admission and is one of the most important factors influencing post-surgical morbidity and mortality. It is important to establish routines to identify and monitor patients at nutritional risk nutritional, to start early nutritional therapy, ideally in the pre-surgical phase. The aim of this study was to evaluate the association between pre-surgical nutritional status and postoperative complications and assess the nutritional assessment tool with the best prognostic value for post-surgical complications, in patients referred to surveillance in intermediate and intensive care units during surgical planning. Methods: We recruited patients at the Digestive Pathology and Head and Neck Units, referred for surgery and signaled at the anesthesia consultation for post-surgical surveillance in Intermediate or Intensive Care, from August to December 2016, at the Portuguese Institute of Oncology of Porto, Francisco Gentil, EPE. Clinical and demographic data were collected from the clinical process of the patients. Risk and nutritional status assessment was performed in the first 24 hours of patient’s admission to hospital using the PG-SGA and NRI. Data analysis was performed using the SPSS 23.0 statistical program. Results: We included 97 patients, 62 with digestive malignancies and 35 with head and neck malignant tumors. The prevalence of pre-surgical malnutrition was 51.2% and 33%, as assessed by NRI and PG-SGA, respectively. Nutritional status, as assessed by NRI was associated with postoperative complications and length of hospital stay. Nutritional status and lack of nutritional support were also associated with greater odds of prolonged hospitalizations (>10 days). Conclusion: The odds of developing post-surgical complications was about 3 times higher if the patient is malnourished or at risk of malnutrition, as assessed by NRI.Introdução: A desnutrição está presente em 40-50% dos doentes cirúrgicos no momento da admissão hospitalar, sendo considerada um dos fatores que mais influencia a morbimortalidade pós-cirúrgica. É importante estabelecer rotinas para identificar e monitorizar os doentes em risco nutricional, para iniciar a terapia nutricional precocemente, idealmente na fase pré-cirúrgica. O objetivo do presente trabalho foi avaliar a associação entre estado nutricional pré-cirúrgico e as complicações pós-cirúrgicas e verificar qual o instrumento de avaliação nutricional com melhor valor prognóstico para complicações pós-cirúrgicas, em doentes encaminhados para vigilância para as unidades de cuidados intermédios e intensivos durante o planeamento cirúrgico. Métodos: Foram recrutados doentes nas Unidades de Patologia Digestiva e de Cabeça e Pescoço, que tinham sido encaminhados para cirurgia e sinalizados na consulta de anestesia para vigilância pós-cirúrgica em Terapia Intermediária ou Intensiva, de agosto a dezembro de 2016, no Instituto Português de Oncologia do Porto, Francisco Gentil, EPE. Dados clínicos e demográficos foram recolhidos através de consulta ao processo clínico. A avaliação do risco e do estado nutricional foi realizada através do PG-SGA e do NRI, nas primeiras 24 horas da admissão do doente para internamento hospitalar. A análise dos dados foi realizada através do programa estatístico SPSS 23.0. Resultados: Foram incluídos 97 doentes, 62 com neoplasias digestivas e 35 com neoplasias malignas de cabeça e pescoço. A prevalência de desnutrição pré-cirúrgica avaliada foi de 51,2% e 33%, avaliada pelo NRI e PG-SGA, respetivamente. O estado nutricional, avaliado pelo NRI, foi associado a complicações pós-operatórias e maior tempo de hospitalização. O estado nutricional e a falta de suporte nutricional também foram associados a maior risco de hospitalização prolongada (> 10 dias). Conclusão: O risco de desenvolver complicações pós-cirúrgicas foi cerca de 3 vezes maior em doentes desnutridos ou em risco de desnutrição avaliados pelo NRI

Impact of a 10 km race on inflammatory and cardiovascular markers: comparison between trained and untrained recreational adults

Previous studies have found that trained athletes had lower changes in circulating levels of inflammatory biomarkers and cardiovascular stress than untrained athletes, upon prolonged or exhausting exercise. Particularly, recreational runners with less training showed higher risk of cardiac injury and dysfunction after a marathon. Presently, we are observing a steadily growing number of young and older adults engaging in running events without having a professional orientation or training, emphasizing the need to assess biochemical markers that allow the evaluation of the acute changes imposed in these recreational athletes. To compare the immediate and 24-hour effects of a 10-km run on inflammatory and cardiovascular biomarkers between recreational athletes, with and without specific running training.info:eu-repo/semantics/publishedVersio

PRÉ-HABILITAÇÃO E PROGNÓSTICO PÓS-OPERATÓRIO EM DOENTES ONCOLÓGICOS DE ALTO RISCO: UMA REVISÃO SISTEMÁTICA E META-ANÁLISE

Introduction. Prehabilitation aims to optimize patients before surgical treatment in order to improve postsurgical recovery. While its efficacy to improve major postoperative clinical outcomes have been recognized for the broader low-risk surgical population, it remains unclear if the high-risk surgical population also benefits. This meta-analysis assessed the impact of prehabilitation on postoperative outcomes in high-risk surgical cancer patients Methodology: We searched for experimental (randomized and non- randomized) and observational studies investigating the impact of prehabilitation in the frequency and/or severity (e.g minor and major complications) of post-surgical complications (primary outcome), type of complications, functional capacity, hospital readmissions, length of hospital stay and 30 day post-surgical mortality (secondary outcomes). High-risk patients for adverse surgical events were defined as frail and / or age ≥70 years and / or with an ASA score of >III. Results: 136 articles were found, of which only 6 were eligible for qualitative and quantitative evaluation (3 randomized and 3 observational studies). The analysis resulted in a total of 674 participants, with an average age of 78 years, mostly male. Prehabilitation resulted in a lower risk of major complications (risk difference –0.09, 95% CI: –0.15, – 0.03, p = 0.005; i2 = 27%, p = 0.24) and surgical complications (RR 0.62, 95% CI 0.43 to 0.89, p=0.01; I2 = 33%, p = 0.22) in comparison to patients receiving standard care. Also, prehabilitation reduced the length of hospital stay (mean difference of – 2.7, 95% CI: –5.37 to –0.17, p = 0.04) and improved functional recovery as assessed by the distance covered in the 6 MWT (mean difference 29.06 meters, 95% CI 26.55 to 31.57, I2 = 42%, p < 0.001). No differences were observed for the rate of overall complications, medical complications 30-day postoperative mortality or hospital readmission. Conclusion: Our work suggests that prehabilitation is effective in reducing postoperative burden in high-risk cancer patients. Future randomized controlled trials for the high-risk surgical patients, using well-established and clinically relevant outcome measures, and with appropriate sample size calculation are needed.Introdução: A pré-habilitação visa otimizar os doentes antes do tratamento cirúrgico, com o objetivo de melhorar a sua recuperação pós-cirúrgica. Embora a eficácia desta intervenção para melhorar os principais desfechos clínicos pós-operatórios tenha sido reconhecida para a população cirúrgica de baixo risco, ainda não está claro até que ponto estes benefícios serão extensíveis também para doentes considerados de alto risco. Esta meta-análise avaliou o impacto da pré-habilitação em desfechos pós-operatórios de doentes oncológicos cirúrgicos de alto risco. Metodologia: Procuramos estudos experimentais (randomizados e não randomizados) e observacionais que avaliaram o impacto da pré-habilitação na frequência e / ou gravidade (major e minor) das complicações pós-cirúrgicas (desfecho primário), tipo de complicações, capacidade funcional, readmissões hospitalares, tempo de hospitalização e mortalidade pós-cirúrgica até 30 dias (desfechos secundários). Doentes de alto risco para eventos cirúrgicos adversos foram definidos como frágeis e / ou com idade ≥70 anos e / ou com score ASA> III. Resultados: foram encontrados 136 artigos, dos quais apenas 6 foram elegíveis para avaliação qualitativa e quantitativa (3 estudos randomizados e 3 estudos observacionais). A análise global incluiu um total de 674 participantes, com idade média de 78 anos, a maioria do sexo masculino. A pré-habilitação reduziu o risco de complicações major (diferença do risco –0,09, IC 95%: –0,15, – 0,03, p = 0,005; i2 = 27%, p = 0,24) e de complicações cirúrgicas (RR 0,62, IC 95% 0,43 a 0,89, p = 0,01; I2 = 33%, p = 0,22) em comparação com doentes que receberam o tratamento habitual. Além disso, a pré-habilitação reduziu o tempo de hospitalização (diferença média de – 2,7, IC 95%: –5,37 a –0,17, p = 0,04) e melhorou a recuperação funcional avaliada pela distância percorrida no teste de marcha de 6 minutos (diferença média de 29,06 metros, IC de 95% 26,55 a 31,57, I2 = 42%, p <0,001). Não foram observadas diferenças para as complicações gerais, complicações médicas, mortalidade pós-operatória até 30 dias ou na readmissão hospitalar. Conclusão: O nosso trabalho sugere que a pré-habilitação é eficaz na melhoria do prognóstico pós-operatório de doentes oncológicos considerados de “alto risco” para complicações cirúrgicas. Ficou evidente a necessidade de desenvolver ensaios clínicos randomizados especialmente focados em doentes cirúrgicos de alto risco, usando medidas de desfecho bem estabelecidas e clinicamente relevantes, e com cálculo de tamanho amostral adequado

Teachers' training handbook: tangible programming and inclusion in educational context

Resumo indisponível.publishe

Localization and navigation of an omnidirectional mobile robot: the robot@factory case study

The Robot@Factory competition was recently included in Robotica, the main Portuguese Robotics Competition. This robot competition takes place in an emulated factory plant, where Automatic Guided Vehicles (AGVs) must cooperate to perform tasks. To accomplish their goals, the AGVs must deal with localization, navigation, scheduling and cooperation problems that must be solved autonomously. This robot competition can play an important role in education due to its inherent multidisciplinary approach, which can motivate students to bridge different technological areas. It can also play an important role in research and development, because it is expected that its outcomes will later be transferred to real-world problems in manufacturing or service robots. By presenting a scaled-down factory shop floor, this competition creates a benchmark that can be used to compare different approaches to the challenges that arise in this kind of environments. The ability to alter the environment, in some restricted areas, can usually promote the test and evaluation of different localization mechanisms, which is not possible in other competitions. This paper presents one of the possible approaches to build a robot capable of entering this competition. It can be used as a reference to current and new teams.info:eu-repo/semantics/publishedVersio

Effect of exercise training on lymphocyte subpopulations in chemically and hormonally induced prostate cancer: flow cytometry analysis

Introduction: Long-term and regular exercise training is suggested to have an immunomodulatory effect, protecting against several diseases. This work aimed to analyse the effect of exercise training on peripheral lymphocyte subpopulations in a model of prostate cancer (PCa) chemically and hormonally induced. Methods: Fifty-five male Wistar Unilever rats of 4 weeks of age were randomly divided into four experimental groups as follow: control sedentary group (SED+CONT; n=10), control exercised group (EX+CONT; n=10), induced sedentary group (SED+PCa; n=15) and induced exercised group (EX+PCa; n=20). Prostate lesions were induced through the sequential administration of flutamide (50 mg/kg, TCI Chemicals, USA), testosterone propionate (100 mg/kg, TCI Chemicals, Portland, USA) and N-methyl-N-nitrosourea (30 mg/kg, Sigma Chemical, Spain), and subcutaneous implantation of tubes filled with crystalline testosterone (Sigma Chemical, Spain). At eight weeks of age, exercised animals started the training in a treadmill (Treadmill Control LE 8710, USA), 5 days/weeks, for 53 weeks. Animals were sacrificed at 61 weeks of age through an intraperitoneal injection of ketamine (75 mg/kg, Imalgene® 1000, Merial S.A.S., France) and xylazine (10 mg/kg, Rompun® 2%, Bayer Healthcare S.A., Germany), followed by exsanguination by cardiac puncture. Peripheral blood of all animals was collected by intracardiac puncture and transferred into tubes containing EDTA salt as an anticoagulant for flow cytometry analysis. The following conjugated monoclonal antibodies were used: cyCD3-BV421, CD3-FITC, CD25-APC, CD45-BV510, CD127-PE, CD161-FITC, CD4-PE/Cy7, CD45RA-APC/Cy7, OX-82-PE and CD8a-PerCP. The flow cytometry immunophenotyping was performed in a BD FACSCantoTM II cytometer (BD Biosciences, USA) and data were analysed with InfinicytTM, flow cytometry software 1.7 version. The prostate was collected and stained with H&E for histopathological analysis. Statistical analysis was performed using SPSS 25. The differences were considered statistically significant at p<0.05. Results: A higher level of CD161+NK cells were observed in EX+PCa group when compared with SED+PCa group (p0.05). Conclusion: These results reinforce the beneficial role of exercise in anti-tumour immune response. Additional studies are warranted to better understand these results

Teachers handbook: a guide for understanding tangible programming and the implementation of the TangIn toolbox of resources

Sem resumo disponível.publishe

EXPERIÊNCIA RELATADA PELOS DOENTES COM CANCRO COLORRETAL SOBRE OS CUIDADOS RECEBIDOS AO LONGO DO TEMPO. COMO TRADUZI-LOS NUM PROGRAMA DE APOIO A DOENTES E FAMILIARES?

Background: Patient-focused interventions recognize the role of patients as active participants in the process of delivering effective, safe and responsible healthcare. When equipped with appropriate knowledge, patients can play an important role in their own care by early diagnosing self-limiting conditions and establishing a beneficial relationship with the healthcare team. The purpose of this study was to identify the main changes in bodily processes and their impact on dependency and self-care during colorectal cancer multimodal treatment to further develop a consistent patient-focused intervention protocol. Methods: A prospective longitudinal design was chosen to describe the evolution of the health condition of colorectal cancer patients during multimodal treatment. Patients were assessed (N = 129) in three separate moments, namely: T1 – after multi-disciplinary-team treatment decision; T2 – three months after T1; and T3 – six months after T1. Results: The results of this study show that, during treatment, patients with colon or rectal cancer experience significant changes in their health condition. They present a negative evolution on health status related with impairment in the gastrointestinal, circulatory and nervous systems and in psychological, neurovascular and resting processes. Chemotherapy adverse effects significantly reduce the ability to self-care. These patients reveal a higher dependency level in self-care areas, such as: instrumental activities of daily life (IADL) “bathing”, “to dress and undress”, “rising”, “taking medication” and “colostomy”. Conclusion: The results of this study pose a challenge to health care providers in the sense that these professionals are in a privileged position to help with an appropriate program, patients with colorectal cancer and their family in transition from dependence to supported self-care.Introdução: Os doentes quando munidos do conhecimento necessário podem desempenhar um papel importante no seu percurso terapêutico, quer pelo reconhecimento precoce das alterações na sua condição de saúde, quer pela relação que podem estabelecer com os profissionais de saúde. Assim, a prescrição de intervenções focadas no doente e nas suas necessidades individuais torna-os mais participativos no processo de prestação de cuidados, tornando-os mais eficazes e seguros. O objetivo deste estudo foi identificar as principais alterações nos processos corporais e o seu impacto na dependência para o autocuidado durante o tratamento do cancro coloretal para desenvolver um protocolo de intervenção consistente com foco no doente. Métodos: Estudo prospetivo longitudinal. Os doentes foram avaliados (N = 129) em três momentos distintos, a saber: T1 – após decisão do tratamento da equipe multidisciplinar; T2 – três meses após T1; e T3 – seis meses após T1. Resultados: Os resultados deste estudo mostram que, durante o tratamento, os doentes com cancro do cólon ou reto experienciam mudanças significativas no seu estado de saúde. Apresentam uma evolução negativa da condição de saúde de saúde relacionada com compromissos nos sistemas gastrointestinal, circulatório, nervosa, nos processos psicológicos, neurovasculares e regulador. Os efeitos adversos da quimioterapia reduzem significativamente a capacidade para o autocuidado. Esses doentes revelam maior grau de dependência nas áreas de autocuidado, tais como: atividades instrumentais de vida diária (AIVD) “tomar banho”, “vestir-se e despir-se”, “levantar-se”, “tomar medicamentos” e “colostomia”. Conclusão: Os resultados deste estudo representam um desafio para os profissionais de saúde no sentido de que esses profissionais estão numa posição privilegiada para ajudar com um programa de intervenção, adequado aos doentes com cancro coloretal e sua família na transição da dependência para o autocuidado com suporte

Finding parameters around the abdomen for a vibrotactile system: healthy and patients with Parkinson’s disease

Freezing of Gait (FOG) is one of the most disabling gait disorders in Parkinson’s Disease (PD), for which the efficacy of the medication is reduced, highlighting the use of non-pharmacological solutions. In particular, patients present less difficulties in overcoming FOG when using feedback and especially with Biofeedback Systems. In this study it is intended to detect the frequency threshold and the minimum interval of perception of the vibrotactile feedback, through a proposed wearable system, a waistband. Experimental tests were carried out that considered a temporal, spatial and spatiotemporal context, for which 15 healthy and 15 PD patients participated. It was detected as threshold frequency 180 Hz and for minimum interval of vibration perception 250 ms. The identification of this threshold frequency and this interval will allow us to select the frequency and the minimum interval of vibration to be used in a Vibrotactile Biofeedback Device for patients with PD, in order to help them to overcome FOG.This work was supported by the FCT – Fundação para a Ciência e Tecnologia - with the reference project UID/EEA/04436/ 2013, by FEDER funds through the COMPETE 2020 – Programa Operacional Competitividade e Internacionalização (POCI) - with the reference project POCI-01-0145-FEDER-006941