The events of ischemia-reperfusion injury trigger a systemic inflammatory response that can lead to cellular damage and even organ failure. Such effects are noted in the post-operative recovery, especially with the use of cardiopulmonary bypass. Nowadays, we know that leukocytes play an important role in this process. Therefore, this study addresses the role of leukocytes in the pathophysiology of ischemia-reperfusion injury and activation of inflammatory cascades through this process and seeks to help in understanding these mechanisms as well as bringing contributions on the therapeutic approaches that may mitigate them. This retrospective review was performed from scientific papers published over the past ten years, in Portuguese and English, indexed in international databases of Medline, SciELO and related classical texts. The descriptors investigated were: ischemiareperfusion, leukocytes, inflammatory response, cardiopulmonary bypass, adverse effects and apoptosis.Keywords: Cardiopulmonary bypass. Leukocytes. Ischemia. Reperfusion injury. ResumoOs eventos de isquemia-reperfusão desencadeiam uma resposta inflamatória sistêmica que pode levar a lesões celulares e até falência de órgãos. Tais repercussões são notadas no pós-operatório de cirurgias, em especial, com o uso de circulação extracorpórea. Sabe-se, atualmente, que os leucócitos exercem importante papel neste processo. Assim, este estudo aborda o papel dos leucócitos na fisiopatologia das lesões de isquemia-reperfusão e a ativação das cascatas inflamatórias por esse processo e procura auxiliar na compreensão destes mecanismos assim como trazer contribuições acerca das abordagens terapêuticas que possam atenuá-los. Esta revisão bibliográfica retrospectiva foi realizada a partir de documentos científicos publicados nos últimos dez anos, em português e inglês, indexados em bases de dados internacionais Medline e SciELO e de textos clássicos relacionados. Os descritores pesquisados foram: isquemia-reperfusão, leucócitos, resposta inflamatória, circulação extracorpórea, efeitos adversos e apoptose.Descritores: Circulação extracorpórea. Leucócitos. Isquemia. Traumatismo por reperfusão. FRANCISCHETTI, I ET AL -Leukocytes and the inflammatory response in ischemia-reperfusion injuryRev Bras Cir Cardiovasc 2010; 25(4): 575-584

Recently, we showed that the arterial in-line application of the leukocyte inhibition module (LIM) within the heart-lung machine limits overshooting leukocyte activity and cardiac tissue damage. Moreover, significantly better cardiac function was found in an experimental animal model when LIM was used. In the meantime, the first promising clinical data exist. LIM has to be regarded as an essential tool in extracorporeal circulation, in the future, to improve postoperative clinical outcome and to reduce costs. This review summarizes the biological background of LIM and the current experience obtained in experimental models and clinical studies.

Extracranial internal carotid artery aneuriysms (EICAA) are rare. There are few reports in the medical literature about its etiology, relating these aneurysms to atherosclerosis, arteritis and alterations due to trauma or after surgical procedure. The natural history of the disease has not been well-defined yet. However, the potential risk of embolism originating from the aneurysm -or even its rupture -indicates a need for intervention. We present the case of a seventy-one year old woman, who was diagnosed an aneurysm of three cm diameter of the right EICA, with throbbing headache complaints. After an unsuccessful attempt of endovascular treatment, we performed a surgical procedure with aneurysmectomy and primary end-to-end anastomosis near the skull base.Keywords: aneurysm; internal carotid artery; surgery. ResumoOs aneurismas de artéria carótida interna (ACI) extracraniana são raros. Há poucos relatos na literatura médica quanto à sua etiologia, relacionando-os à doença aterosclerótica, às arterites e alterações decorrentes do trauma ou após procedimento cirúrgico. A história natural da doença ainda não está bem estabelecida. Entretanto, o potencial risco de embolia originário do aneurisma ou mesmo de sua ruptura indica necessidade de intervenção. Apresentamos o relato de caso de uma mulher de 71 anos diagnosticada com aneurisma de 3 cm de diâmetro da ACI extracraniana direita com queixas de cefaleia pulsátil. Após tentativa sem sucesso de tratamento endovascular, optou-se pelo tratamento cirúrgico com aneurismectomia e anastomose primária término-terminal próximo à base do crânio.Palavras-chave: aneurisma; artéria carótida interna; cirurgia.

This study reports a large animal survival model of thoracic aortic stent graft placement by testing the impact of fibrin glue on EP incorporation. Compared to oversizing alone, fibrin glue placed between the stent graft and the arterial wall increases EP incorporation. Additional studies are needed to determine the potential utility of fibrin glue in the setting of human arterial endografts.

Community medicine represents a far-reaching field for the advance of health care, with impact on people's quality of life and health needs. Health promotion, disease prevention, recovery and rehabilitation have to be incorporated satisfactorily into medical education. The search for a pedagogical tool to fulfill the medical curriculum through actions of community medicine care led us to outline 11 Entrustable Professional Activities (EPAs) for community medicine. The study was carried out at a public Medical School in Brazil that has a Competency-Based Curriculum (CBC). Fifteen teachers with expertise in community medicine analyzed the resulting EPAs. The EPAs were distributed in three domain areas: care needs of the individual, family and community in Primary Health Care. The teachers answered a total of 13 open questions in a two-round Delphi study. The discourses were submitted to thematic content analysis. Three discourse categories were found about the outlined EPAs: curriculum management and social needs, curriculum management and service integration, and curriculum management and actors. The understanding of the EPAs as a curriculum management tool was relevant, as well as their interface with health care and learning development. The consulted teachers agreed with the designed EPAs and that they are adequate for the first two years of the studied medical course in their Brazilian context. Therefore, it was concluded that the community medicine EPAs are appropriate for the new medical profile, especially in countries with social exclusion, and are a very good tool to promote integrality of care and humanism. This study can facilitate the implementation of a CBC in community medicine and How to cite this paper: Francischetti, I.,

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RESUMO -Introdução:A dor deve ser sempre avaliada como uma experiência pessoal que pode ser influenciada, entre outros aspectos, por fatores biológicos, psicológicos e sociais. A avaliação da dor em pediatria é um desafio ainda maior, pois nem sempre a criança consegue descrever as características para que o correto diagnóstico seja realizado. Pacientes com doenças oncológicas comumente apresentam episódios de dor e observa-se que, na prática diária, nem sempre recebem tratamento adequado ao tipo de dor, o que pode, inclusive, afetar o tratamento da patologia de base. Objetivos: Por esse motivo, este trabalho objetivou entender a percepção da família e da equipe de saúde em relação a esse sintoma. Método: Trata-se de estudo qualiquantitavo, multicêntrico, transversal com familiares de pacientes da oncologia pediátrica (10), além de 30 profissionais de saúde (10 técnicos ou auxiliares de enfermagem, 10 enfermeiros, 10 médicos -entre eles oncologistas pediátricos e residentes de pediatria) de dois serviços de oncologia pediátrica no interior do estado de

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