A novel adjustable pulmonary artery banding system for hypoplastic left heart syndrome

OBJECTIVE: Hypoplastic left heart syndrome remains a challenge for worldwide surgeons. Initial palliation employing bilateral pulmonary artery banding along with ductal stent implantation and atrial septostomy has been proposed as an alternative approach. However, the surgically placed bands are fixed and may become inadequate after sternum closure or with somatic growth of the patient. We describe the first case in which a neonate with hypoplastic left heart syndrome was initially managed using a mini banding system that allows for fine percutaneous adjustments of pulmonary blood flow. METHOD: Through a mid sternotomy, a 5 day-old neonate underwent bilateral pulmonary artery banding using this new system combined with placement of a main pulmonary artery to innominate artery shunt. RESULTS: The patient had an uneventful postoperative course. Three percutaneous adjustments of the banding system were necessary to keep the arterial oxygen saturation in the 75%-85% range. On the 48th day of life, she was submitted to stent placement (6 mm) within the atrial septum to treat a restrictive atrial septal defect. The Norwood operation and the bidirectional Glenn shunt were carried out on the 106th day of life. The bands were removed with no distortion of the pulmonary arteries. CONCLUSIONS: The clinical use of this innovative pulmonary artery banding system was feasible, safe and effective. It allowed for customization of the pulmonary blood flow according to the underlying clinical needs, resulting in a more precise balance between the pulmonary and systemic circulations.OBJETIVO: A Síndrome de Hipoplasia de Câmaras Esquerdas representa um grande desafio para cirurgiões do mundo inteiro. Atualmente, tem sido proposto procedimento paliativo alternativo, por meio da bandagem bilateral das artérias pulmonares associada à colocação de stent no canal arterial e atrioseptostomia. No entanto, as bandagens utilizadas são fixas, podendo tornar-se inadequadas após o fechamento do esterno ou com o rápido crescimento somático do paciente. Descrevemos a primeira aplicação clínica do novo dispositivo miniaturizado de bandagem ajustável das artérias pulmonares em neonato portador da síndrome de hipoplasia de câmaras esquerdas, o qual permitiu ajustes percutâneos precisos do fluxo sangüíneo pulmonar. MÉTODO: Através de esternotomia mediana, neonato de 5 dias de vida foi submetido à bandagem pulmonar bilateral, usando este novo dispositivo, combinada com interposição de tubo de PTFE entre o tronco pulmonar e o tronco braquiocefálico. RESULTADOS: O paciente apresentou boa evolução pós-operatória. Três ajustes percutâneos das bandagens foram necessários para manter a saturação arterial de oxigênio entre 75-85%. No 48º dia de vida, o paciente foi submetido a atrioseptostomia com colocação de stent (6 mm) para tratamento de comunicação interatrial restritiva. No 106º dia de vida, realizou-se operação de Norwood associada à anastomose cavopulmonar bilateral. As bandagens foram removidas, sem distorção das artérias pulmonares. CONCLUSÕES: O uso clínico deste sistema inovador de bandagem ajustável das artérias pulmonares mostrou-se factível, seguro e eficaz. Permitiu o ajuste fino do fluxo pulmonar de acordo com as necessidades clínicas, proporcionando um equilíbrio preciso entre as circulações pulmonar e sistêmica.Universidade de São Paulo Faculdade de MedicinaChildren's HospitalHospital Samaritano de São PauloUSP FM HCUniversidade Federal de São Paulo (UNIFESP)UNIFES Curso de Rastreamento Pré-Natal das Malformações CardíacasUniversidade de São Paulo Faculdade de Medicina Instituto do CoraçãoInstituto do Coração de IpatingaInstituto do Coração de Juiz de ForaHospital for Sick ChildrenInstituto Dante Pazzanese de CardiologiaInstituto Dante Pazzanese de Cardiologia Seção Médica de Intervenção em Cardiopatias CongênitasHospital Samaritano de São Paulo Laboratório de CateterismoAssociação Sanatório Sírio Hospital do CoraçãoUNIFESP, EPMSciEL

Modalidad virtual sincrónica y competencias investigativas en los estudiantes del curso Introducción a la Salud Comunitaria del II ciclo de Enfermería de una universidad privada de Lima, durante el periodo 2021-II

El objetivo de la presente investigación es explicar la contribución de la modalidad virtual sincrónica en el desarrollo de las competencias investigativas de los estudiantes del curso Introducción a la Salud Comunitaria del segundo ciclo de enfermería de una Universidad Privada de Lima. La población está constituida por treinta y nueve participantes de ambos sexos, de los cuales dieciséis de ellos, cuyas edades oscilan de dieciocho a veintitrés años, constituyeron la muestra. Se sigue la metodología que contempla un enfoque cualitativo, de alcance explicativo, y con diseño fenomenológico. Las evidencias alcanzadas muestran a los participantes utilizando la plataforma Blackboard y sus respectivas funciones, además como usan sus recursos para buscar, obtener, analizar, compartir y almacenar información. Sin embargo, se evidencia escaso uso de la biblioteca virtual, repositorios y fuentes confiables. En consecuencia, se percibe una limitada capacidad de síntesis, generación de contenidos y divulgación de información. Se concluye que, desde las percepciones de los estudiantes, la modalidad virtual sincrónica contribuye de manera favorable en el desarrollo de la competencia investigativa, considerando como un factor clave las estrategias y orientaciones que el docente facilita a los estudiantes.Escuela de Postgrad

Tetraciclinas e glicilciclinas: uma visão geral

Tetracyclines exhibits activity to a broad range of Gram-negative and Gram-positive bacteria and this fact allied to the low toxicity, low cost, and the advantage of administration by oral route led to their indiscriminate use, which caused the appearance of bacterial resistance to these agents, wich has restricted its clinical utility, though new applications have emerged. On the other hand, the glycylcyclines, semi-synthetic products are similar to tetracyclines, which are active against many bacteria resistant to tetracycline and other classes of antibiotics. The purpose of this paper is to give an overview of this important class of antibiotics focusing on its coordination chemistry and possible applications

Gaia Data Release 1. Astrometry: one billion positions, two million proper motions and parallaxes

Context. Gaia Data Release 1 (DR1) contains astrometric results for more than 1 billion stars brighter than magnitude 20.7 based on observations collected by the Gaia satellite during the first 14 months of its operational phase. Aims. We give a brief overview of the astrometric content of the data release and of the model assumptions, data processing, and validation of the results. Methods. For stars in common with the Hipparcos and Tycho-2 catalogues, complete astrometric single-star solutions are obtained by incorporating positional information from the earlier catalogues. For other stars only their positions are obtained, essentially by neglecting their proper motions and parallaxes. The results are validated by an analysis of the residuals, through special validation runs, and by comparison with external data. Results. For about two million of the brighter stars (down to magnitude ∼11.5) we obtain positions, parallaxes, and proper motions to Hipparcos-type precision or better. For these stars, systematic errors depending for example on position and colour are at a level of ±0.3 milliarcsecond (mas). For the remaining stars we obtain positions at epoch J2015.0 accurate to ∼10 mas. Positions and proper motions are given in a reference frame that is aligned with the International Celestial Reference Frame (ICRF) to better than 0.1 mas at epoch J2015.0, and non-rotating with respect to ICRF to within 0.03 mas yr−1 . The Hipparcos reference frame is found to rotate with respect to the Gaia DR1 frame at a rate of 0.24 mas yr−1 . Conclusions. Based on less than a quarter of the nominal mission length and on very provisional and incomplete calibrations, the quality and completeness of the astrometric data in Gaia DR1 are far from what is expected for the final mission products. The present results nevertheless represent a huge improvement in the available fundamental stellar data and practical definition of the optical reference frame