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World Journal of Cardiovascular Diseases 2012年第2期2卷 90-94页

作者： Angela Sansone Francesca Bonura Fabiana Castellano Rosanna Iacona Dario Mancuso Giuseppina novo Pasquale Assennato Salvatore novo Department of Internal Medicine Cardiovascular and Nephro-Urological Disease Unit of Cardiology University of Studies “P. Gi-accone” Palermo Palermo Italy

The occurrence of left bundle branch block (LBBB) is quite common in clinical practice. The changes in cardiac repolarization, caused by this disorder of electric conduction, may mask the presence of an acute myocardial infarction (AMI), delaying the diagnostic-therapeutic iter, with an important impact on prognosis. We describe the case of a woman of 59 years with LBBB, came to our observation for a constrictive chest pain associated with dyspnea. The diagnostic workup for suspected acute coronary syndrome (ACS), initially conducted only on the analysis of the electrocardiogram (negative TnI at entry), showed the presence of coronary arteries free of stenosis. However, the diagnostic confirmation of AMI was completed after the rise of cardiac markers and the electrocardiographic changes. This case confirm the difficulty about the diagnosis of AMI in patients with LBBB and stresses, however, as the use of some criteria proposed in the literature [1-3] can guide to its identification, directing patient to an appropriate treatment.

关键词： Left Bundle Branch Block (LBBB) Myocardial Infarction Electrocardiogram.

Evaluation of a Modified Scleral Contact Lens as a Riboflavin Delivery Device for Corneal Collagen Crosslinking

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Open Journal of Ophthalmology 2017年第4期7卷 273-280页

作者： Ricardo Torres Soares Neil F.novo Willy Marcus Franca Faculty of Medical and Health Science Catholic University of Sao PauloSao PauloBrazil

Introduction: Keratoconus is a complex corneal disease that reduces visual acuity by progressively modifying the corneal shape and thickness, usually producing myopia and irregular astigmatism. Corneal collagen crosslinking with riboflavin + ultraviolet-A radiation (CXL) has become a widely accepted treatment for progressive keratoconus. During CXL, riboflavin administration is performed by repeated manual instillation of solution drops on the cornea for 30 minutes, a procedure that is often uncomfortable for many patients and that consumes surgical facilities and staff resources. In this study, especially modified scleral contact lenses (MSCL) were employed for delivering riboflavin to the cornea during CXL. Objective: The study aimed at evaluating the safety and efficacy of MSCL as a drug delivery system, verifying if anterior chamber flare confirms riboflavin penetration and describes the impact on patient comfort and optimization of surgical staff and facility resources. Material and Method: This study included 8 eyes of 6 patients aged 16 - 25 years old with history of progressive keratoconus. After mechanical removal of corneal epithelium, the concave surface of the modified scleral contact lens was filled with riboflavin solution and the lens was placed on the patient’s eye during 30 minutes. The lens design allows the formation of a riboflavin layer between the lens and the exposed corneal stroma to facilitate riboflavin penetration. Patients with lens were allowed to stand up and wait for the second UVA phase outside the surgical room. Riboflavin diffusion was confirmed by biomicroscopic examination of the corneal stroma and anterior chamber with the lens in place. Patients returned and the lens was removed before UV-A irradiation at 3 mW/cm2 for 30 minutes. Statistical analysis was performed by comparing the following parameters of each patient pre- and post-CXL: Spherical equivalent (***.), Mean simulated keratometry (SimK-m) and corrected distance vis

关键词： Keratoconus Riboflavin UVA Rigid Contact Lens Cross-Linking

Robotic4all project:Results of a hands-on robotic surgery training program

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Laparoscopic, Endoscopic and Robotic Surgery 2023年第1期6卷 1-8页

作者： Mario Rui Gonçalves Jose novo de Matos Antonio Oliveira Ricardo Marinho Irene Cadime Palmira Carlos Alves Salvador Morales-Conde Miguel Castelo-Branco Faculty of Health Sciences University of Beira InteriorCovilha 6200-506Portugal Centro Hospitalar Universitario Lisboa Central Hospital de Sao JoseLisboa 1150-199Portugal Centro Hospitalar de Tras-os-Montes e Alto Douro Vila Real 5000-508Portugal Centro Hospitalar de Leiria Hospital de Santo AndreLeiria 2410-197Portugal Centro de Investigaçao em Psicologia Escola de Psicologia-Universidade do MinhoBraga 4710-057Portugal Departamento de Estudos Curriculares e Tecnologia Educativa Instituto de Educaçao-Universidade do MinhoCampus de GualtarBraga 4710-093Portugal Unit of Innovation in Minimally Invasive Surgery University Hospital Virgen del RocioUniversity of SevillaSeville 41013Spain

Objective Although robotic surgery adoption and its indications are growing worldwide,for multiple factors,including costs,there is a lack of training and *** aim was to study the impact of a robotic introduction training program on gesture performance,such as suturing,in robot-naive *** Using the DaVinci robot,a 2-hour program was based on virtual reality and anatomical model *** participants performed 3 repetitions of virtual reality exercises on the virtual simulator,and then performed and were assessed on 2 tests,ie robot and laparoscopic training *** the course,the participants were surveyed for this training *** Twenty-seven residents and surgeons were enrolled in the training *** only 2 hours of training,all of the participants were able to complete the training program,thus learning generic and specific skills in robotic *** virtual reality exercise,the scores of the 3 exercises increased significantly with every repetition(p<0.001)and the size of the increase was *** completion time on the robot platform was 2.6 times faster(169.33±28.28 s vs.447.96±156.55 s,p<0.001)than that in the laparoscopic box,and the difference between both types of tests was large(pη2=0.797).The centralization and passage of the needle were significantly better on the robot platform(5 vs.3,p<0.001,r=0.47;5 vs.4,p<0.001,r=0.59)than in the laparoscopic *** the intracorporeal stitch+knot test,every participant was able to perform the exercise on the robot but only 85.2%(23/27)in the laparoscopic ***-one participants answered the survey,and 13(61.9%)of them considered robotic performance independent of laparoscopic *** Surgeons are interested and seek training in robotic *** implemented the first hands-on robotic surgery training program in Portugal and participants considered it was important and adequate for its *** participants,even without robotic experience,lear

关键词： Simulation Education Laparoscopic suture Laparoscopy Robotic surgery

Comparative Study of Bovine Pericardium and Gore-Tex in Tissual Interaction with Wistar Rats Diaphragm

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Surgical Science 2016年第9期7卷 381-389页

作者： Artur Fracassi Guerra Mauro Razuk Filho Neil Ferreira novo Willy Marcus França Medical Science and Health Faculty Catholic University of Sao Paulo Sao Paulo Brazil Department of Medicine—Service of Statistical Studies Sao Paulo Brazil Department of Medicine Catholic University of Sao Paulo Sao Paulo Brazil

Introduction: Simple suture isn’t always possible in large congenital diaphragmatic hernia (cdh) defects. Synthetic materials are used for correction such as Silastic®, Gore-Tex® (GT), Teflon® or biological, such as autologous muscle patches. It was shown that bovine pericardium (bp) was effective to correct those large defects with many positive outcomes when compared with syntactic materials. Aim: This study aims to establish an experimental model of correction for large diaphragmatic defect with PB and GT patches to compare histologically the tissue interaction between them and diaphragm in young Wistar rats. Materials & Methods: 15 wistar rats were divided in 3 groups: Rats that used BP was named G1;Rats that used GT was named G2;and rats with only scraping in the diphragm, named G3 (control). Animals were submited to a laparotomy and fixed pathces to diaphragms and harvested 3 weeks later. Area between normal diaphragm and patches were isolated and separated for histological analysis, such as lymphocytic infiltration (inflammation), neovascularization and fibrosis. Results: G1 presented inflammation between BP and Diaphragm In 5 Samples. G2 Presented Neovascularization In 5 Samples, But No inflammation. Fibrotic tissue overlapping GT patches occurred in 3 samples in G2. Comparing G1 with G2 there was a significant statistical difference concerning inflammation (P = 0.0079), in G1. Comparing neovascularization there is no significant statistical difference (P = 0.4444), despite a slight higher incidence in G2. Fibrosis in both groups presented no significant statistical difference (P = 0.4444), despite a slight higher incidence in G2. There were no alterations in G3. Discussion: Despite the statistical difference in the inflammatory process was more frequent in G1 (P = 0.0079), neovascularization and fibrosis were more frequent in G2. Conclusion: The proposed experimental model was satisfactory to reproduce suture of patches in the diaphragm. These resu

关键词： Diaphragm Hernia Bovine Pericardium Gore-Tex Tissue Interaction and Wistar Rat

Timing of Surgery and Complications of Acute Appendicitis:A Retrospective Study

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Surgical Science 2019年第5期10卷 147-153页

作者： Ricardo Purchio Galletti Vinicius Oliveira Fernandes Neil Ferreira novo Willy Marcus Franca Faculty of Medical Science and Health PUC/SP(FCMSPUC/SP)SorocabaBrazil Department of Medicine Service of Statistical Studies of PUC/SPSorocabaBrazil Laboratory of Surgery Technique and Experimental Surgery of FCMS PUC/SPFaculty of Medical Science and HealthSorocabaBrazil

Introduction: Acute appendicitis (AA) is the most frequent surgical condition of the abdomen during childhood. Its clinical presentation in children under 5 may be atypical and thus causes a delay in diagnosis, which often leads to complications such as perforation and peritonitis. Patients with unperforated AA at hospital admission may have their surgery postponed up to 24 hours while antibiotics are initiated without significant increase in complications, instead of undergoing immediate surgery. Immediate surgery to prevent complications has been questioned. Delaying surgery in patients admitted to hospital with AA has not increased the risk of perforation. Objective: To determine the impact of timing of surgery of patients with AA admitted to our Pediatric Surgery Ward of the Sorocaba Hospital Complex of the Medical Science and Health Faculty (CHS-PUC/SP) on the rate of complications (perforation, peritoneal drainage and infection of the surgical wound). Methods: We reviewed the records of 195 children aged 4 to 12 years, admitted between 2010 and 2014. They were separated in 2 groups according to timing of surgery under 7 hours (group A) and 7 to 24 hours (group B) and had their rate of complications (infection of the surgical wound, drainage and perforation (grade IV) assessed. Results: Ninety-seven children underwent surgery less than 7 hours after admission (group A) and 98 children were operated between 7 and 24 hours after admission (group B). Groups A and B had no significant difference regarding the rates of wound infection (p = 0.2277), peritoneal drain insertion (p = 0.4085) or perforation (p = 0.7125). Conclusions: In our study, timing of surgery for AA had no impact on the occurrence of complications, such as infection of the surgical wound, peritoneal drainage or perforation.

关键词： Acute Appendicitis Intrabdominal Abscess Antibiotic Therapy Appendix Perforation

Are Fetuses Affected by Gastroschisis Benefited from Prenatal Maternal Corticosteroid Use and Early Parturition?

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Surgical Science 2019年第5期10卷 154-163页

作者： Mateus Guimaraes Massimo Anna Paula Auada Kopaz Neil Ferreira novo Willy Marcus Franca Medical Science and Health Faculty PUC/SP(FCMSPUC/SP)SorocabaBrazil Department of Medicine Service of Statistical Studies of PUC/SPSorocabaBrazil Medical Science and Health Faculty The Laboratory of Surgery Technique and Experimental Surgery of FCMSPUC/SPSorocabaBrazil

Introduction: Gastroschisis (G) is a congenital defect of the abdominal walls through which intestinal herniation and permanent exposure to amniotic liquid (AL) and its components are developed at the end of gestation. G affects mostly fetuses from young mothers under 25 - 29 years old, but it occurs more often in fetuses of mothers’ ages between 12 - 15 years old. Some authors assert that it is not the low weight, nor the low gestational age that influences mortality. In addition to morphological alterations, histological alterations are characterized by disorganization, distribution and the degree of ganglia maturity and myenteric plexuses. The literature describes parturition anticipation of G disease carriers to minimize damages to intestinal loops. There are studies suggesting corticosteroids at the end of gestation in order to avoid morphological and histological damages to the intestinal loop. Objective: Identify if live newborn infants delivery anticipation, that is, gestational date less than 37 weeks and prenatal maternal use of corticosteroid were benefited from early enteral diet, namely, less than 10 post-surgery days. Material and Method: From 33 newborns researched in the period from 2010 to 2014;28 newborns full records were included in the study with 15.2% mortality rate. These newborns were divided in 3 groups according to maternal age: 6 newborns from mothers’ age between 16 - 20 years old (Group 1);14 newborns from mothers’ age between 21 - 25 years old (Group 2) and 8 newborns from mothers’ age between 26 - 29 years old (Group 3). Gestational age at birth and prenatal maternal usage of corticosteroid and beginning oral feeding were assessed. Results: From 28 newborns, 19 mothers ingested prenatal corticosteroid and 16 newborns received the first enteric diet 10 days before and 3 days later. The mothers of the other 9 newborns were not treated with corticosteroid;only 3 newborns were fed before 10 days and 6 were fed later (p = 0.0016). Regarding

关键词： Gastroschisis Preterm Delivery Maternal Use of Corticosteroid First Enteral Feeding

Satellite Images Applied to Assess the Influence of Amazon River Seasonal Dynamic on the Floodplain Lake Morphology

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Open Journal of Ecology 2014年第13期4卷 820-831页

作者： Andreia M.S.Franca Teresa G.Florenzano Evlyn M.L.M.novo Instituto Federal de Brasilia Campus SamambaiaBrasiliaBrazil Instituto Nacional de Pesquisas Espaciais Divisao de Sensoriamento RemotoSao Jose dos CamposBrazil

The objective of this study is to assess the influence of the Amazon River seasonal dynamic on floodplain lake morphology. The study area includes the Amazon River floodplain reach encompassed by the Madeira and Tapajós River confluences. Products from the Global Rain Forest Mapping (GRFM) and Moderate Resolution Imaging Spectroradiometer (MODIS) were used to derive variables such as lake size, shape and number. The main steps in the research were: data base implementation, legend definition, image processing (merge, segmentation, classification and edition), morphological mapping and quantitative assessment. Four classes of lacustrine morphology were defined in this study: circular/elliptical, elongated, composite, and dendritic. The result showed that 1) the lake class increased 18.38% from the low- to high-water period;2) there was a reduction in the total number of lakes from low to high water;3) the most common lake type was the circular/elliptical;and 4) better results were obtained integrating SAR and optical sensors.

关键词： Amazon River Floodplain Seasonal Dynamic Morphological Lakes Remote Sensing SAR-JERS-1/GRFM MOD09-TERRA

Epidemiological Study of Pediatric Surgery at Regional Hospital of Sorocaba between 2008 and 2012 by a Single Surgeon

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Surgical Science 2017年第8期8卷 375-383页

作者： Raíssa Teixeira Rosalino Natália Iwakura Martelli Neil F. novo Willy Marcus Franç a Medical Science and Health Faculty Pontifical Catholic University of S&atilde o Paulo (PUC-SP) S&atilde o Paulo Brazil Department of Medicine Service of Statistical Studies of Pontifical Catholic University of S&atilde o Paulo (PUC-SP) S&atilde o Paulo Brazil Medical Science and Health Faculty Pontifical Catholic University of S&atilde o Paulo (PUC-SP) S&atilde o Paulo Brazil

Introduction: volume increase of Pediatric Surgery (PedSur) due to factors not yet fully clarified contrast with the scarcity of pediatric surgeons in Brazil and globally. Geographic distribution, surgical care costs, and graduation period might contribute to this dearth. In Brazil, vacancy occupation rate in PedSur is below 43% (162 vacancies/year). Aim: analyze the volume of procedures performed on 0 - 12 year-old patients in PedSur by a single Specialist at Hospital Regional (HR);compare with the literature and propose the outset of a PedSur Medical Residence program. Material & Method: 1912 attendances were fulfilled on 986 children who were submitted to surgical procedures between 2008 and 2012 at HR by a single specialist. Results: Surgical procedures were performed on 1137 children, an average of 227/year or 197 children per year. Surgery was carried out in 667 (68%) boys and 319 (32%) girls. Hernias, appendectomies and circumcisions were the most frequent external surgeries. 437 (44%) patients were discharged on the same day and, 549 (56%) were hospitalized. In the Pediatric ICU and in the Neonatal ICU 181 procedures were performed (18%). Conclusion: It was possible to make evident the distribution of surgeries on children, the degree of complexity and a sufficient number of subjects for training in this Specialty. The obtained data allow the development of a study with regards to the inception of a Medical Residence in PedSur at HR for training and retaining the professional in the region.

关键词： Patient Care Pediatric Surgery Epidemiology Resident Education

Comparative Study of Histological Alterations in Intravascular Catheter Region with and without the Use of Local Corticosteroid

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Surgical Science 2017年第4期8卷 175-183页

作者： Carolina Utsunomiya Muniz Maíra Stathourakis Sampaio Amaral Neil Ferreira novo Juliana Abeche Fermozelli Willy Marcus Franç a Medical Science and Health Faculty Sao Paulo Brazil Department of Medicine-Service of Statistical Studies Sao Paulo Brazil Department of Morphology & Pathology Sao Paulo Brazil Department of Medicine and Pediatric Surgeon Sao Paulo Brazil

Introduction: Central venous access is one of the most common procedures in pediatric surgery worldwide for infusion of antibiotics, electrolytes, chemotherapy, total parenteral nutrition, etc. Local regional complications due the permanence of venous catheters are described most frequently as: thrombosis, infection, edema and local cellulites, mobilization and catheter loss. As a result, the catheter must be prematurely removed. The use of local corticosteroid (Betamethasone) can be an alternative to lengthen the catheter maintenance. Aim: This study objective is to analyze perivascular inflammatory alterations in phlebotomies with polytetrafluoroethylene (20 GA) catheter in two periods of permanence 15 and 30 days with or without local Corticosteroid. Material & Method: 32 New Zealand adult rabbits were submitted to catheterization of the External Right Jugular Vein(RJV) and were divided in 4 groups: G1: with 8 rabbits’ catheters collected in the 15th day, without corticosteroid use;G2: with 8 rabbits’ catheters collected in the 15th day, with corticosteroid use;G3: with 8 rabbits’ catheters collected in the 30th day, without corticosteroid use;G4: with 8 rabbits’ catheters collected in the 30th day, with corticosteroid use;G5: Control was the contralateral vein of the rabbit itself. Results: G2 presented lower inflammatory incidence when compared to G1, despite this difference was not statistically significant (p = 0.7333). G4 also displayed lower inflammatory incidence than G3, however it was not statistically significant (p = 0.3571). When G1 and G3 were compared with G2 and G4, there was also lower incidence of the inflammatory process in those subjects using Betamethasone, although this difference was not statistically significant (p = 0.3202). Conclusion: Betamethasone used in the vascular catheters insertion areas through phlebotomy can lessen local inflammatory manifestations of venous catheterizations.

关键词： Experimental Surgery Central Venous Catheter Venous Thrombosis Phlebitis Corticosteroid

Gait Analysis of a Subject with Tarsometatarsal Prosthesis

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Journal of Biosciences and Medicines 2023年第10期11卷 284-297页

作者： Carlos Diaz novo Walter Mar Haller Emiliano Alvarez Ruiz Micaela González Castillo Manuel Bárbaro Cuadra Mateo Olivera García Department of Biomedical Engineering Universidad Tecnológica del Uruguay Fray Bentos Rio Negro Uruguay Department of Mechatronics Engineering Universidad Tecnológica del Uruguay Fray Bentos Rio Negro Uruguay

Introduction: Gait analysis of an adult man after trans-metatarsal unilateral amputation is described. Objective: Instrumental gait analysis of a subject 15 years after trans-metatarsal unilateral amputation in two footwear conditions: while walking barefoot and with prosthesis. Materials and Methods: In a movement analysis laboratory, locomotion studies were carried out at freely chosen walking speed by a 65-year-old subject, obtaining kinematic, kinetic and surface electromyographic data in time and space. Gait analysis was performed using instrumental technologies from a digital eco-system applying walking protocols. Results: When the patient wore the prosthesis, several positive improvements were observed in various aspects of gait. These included enhancements in the base of support, gait speed, and joint range of movements. Additionally, there was a slight improvement in the vertical ground reaction forces pattern, indicating a positive effect of the assistive technology. Furthermore, the use of the prosthesis led to a more organized pattern of muscle activity, which further supports its beneficial impact. However, it is worth noting that some challenges still persisted, particularly regarding stabilizing the body during the double support phase. Despite this difficulty, the overall findings suggest that the use of the prosthesis offers valuable improvements to the patient’s gait dynamics. Conclusions: After conducting a thorough analysis of the parameters related to the gait of a subject who underwent a trans-metatarsal unilateral amputation fifteen years ago, it was found that the use of prosthesis had a positive impact. This study demonstrated important improvements in some kinematic and kinetic parameters, including muscle activation patterns, indicating an increase in comfort and confidence while utilizing the prosthetic device.

关键词： Tarsometatarsal Amputation Prosthesis Gait Motion Analysis Laboratory