Experience with IONM, the use of an adequate IONM modality, and knowledge of the effect of anesthetic techniques and agents on neurophysiological parameters are fundamental for reliable measurements. The current gold standard in IONM is total intravenous anesthesia without neuromuscular block.

An adequate analysis of processed parameters of electroencephalogram may provide more intraoperative safety as well as result in a better outcome for the patient.

BACKGROUND: The application of CPAP has been used to minimize postoperative pulmonary complications after lung resection surgery. The aim of this study was to quantify both the CPAP effects upon lung function and functional capacity in early postoperative lung resection, as well as to evaluate if CPAP prolongs air leak through the chest drain. METHODS: Thirty patients in the postoperative period of lung resection were allocated into 2 groups: an experimental group, consisting of 15 patients who underwent a 10 cm H 2 O CPAP, and a 15 patient control group, who performed breathing exercises. Arterial blood gas analysis, peak expiratory flow (PEF), respiratory muscle strength, spirometry, and 6-min walk test (6MWT) were assessed in the preoperative period, and repeated postoperatively on the first and on the seventh day (6MWT was repeated only on the seventh day). RESULTS: Significant increases in PEF, muscle strength, and FEV 1 between the first and seventh postoperative day were observed, both in the experimental and in the control group, whereas FVC and P aO 2 increased significantly between the first and seventh postoperative day only in the experimental group. The average loss in 6-min walk distance (6MWD) from preoperative to postoperative day 7 in the experimental group was significantly lower than in control group. When comparing the 2 groups, only 6MWD was statistically different (P < .001). There was no air leakage increase through the drain with the early use of CPAP. CONCLUSION: When compared to breathing exercises, CPAP increases the 6MWD in postoperative lung resection patients, without prolonging air leak through the chest drain.

Abstract. This study aimed to determine the external load demands of elite Brazilian soccer players by position and playing time, using data from global positioning technology (GPS) at a data acquisition frequency of 10Hz from a Polar Team Pro. Twenty-three professional players from a top-flight Brazilian women's soccer team participated in the study. The women were 27.65 ± 4.66 years, 165.35 ± 5.82 cm and 60.91 ± 5.34 kg. Data were collected during two competitions disputed simultaneously, the The São Paulo State Championship and the Brazilian Championship A1 series of 2019. Nine variables related to the external locomotor demand performed by the players in the disputed matches were analyzed. The statistical procedures used were the two-way ANOVA with Bonferroni post hoc for data adjustment, and Cohen’s effect size (d), with a p-value < .05 adopted to demonstrate statistical significance. The significant differences in the variables total distance, walking distance, jogging distance, running distance, Sprinting distance, acceleration zone 1, acceleration zone 2, deceleration zone 1 and deceleration zone 2 were analyzed, and the results showed a decrease in the external locomotor demand of the loads during the matches played by these athletes. These results should be used to improve load control and adapt training practices in women's soccer teams.  Resumen. Este estudio tuvo como objetivo determinar el comportamiento de las demandas de carga externa de los jugadores de fútbol brasileños de élite por posición y tiempo de juego, utilizando datos de la tecnología de posicionamiento global (GPS) a una frecuencia de adquisición de datos de 10Hz de un Polar Team Pro. Veintitrés jugadoras profesionales de un equipo de fútbol femenino brasileño de primer nivel participaron en el estudio. Las mujeres tenían 27.65 ± 4.66 años, 165.35 ± 5.82 cm y 60.91 ± 5.34 kg. Los datos fueron recolectados durante dos competencias disputadas simultáneamente, el Campeonato del Estado de São Paulo y el Brasileño de la serie A1 de 2019. Se analizaron nueve variables relacionadas con la demanda externa de locomotoras realizadas por los jugadores en los partidos disputados. Los procedimientos estadísticos utilizados fueron el ANOVA de dos vías con Bonferroni post hoc para el ajuste de datos, y el tamaño del efecto de Cohen (d), con un valor de p < .05 adoptado para demostrar la significación estadística. Se analizaron las diferencias significativas en las variables distancia caminando, distancia de trote, distancia corriendo, distancia de sprint, zona de aceleración 1, zona de aceleración 2, zona de desaceleración 1 y zona de desaceleración 2, y los resultados mostraron una disminución en la demanda locomotora externa de las cargas durante los partidos jugados por estos Atletas. Estos resultados deberían usarse para mejorar el control de carga y adaptar las prácticas de entrenamiento en los equipos de fútbol femenino.

Background Coagulopathy is quite common in chronic liver disease patients undergoing orthotopic liver transplantation (OLT). Diagnosis of intraoperative bleeding disorders is based on conventional laboratory tests (CLTs), and thus, the patients are frequently exposed to unnecessary transfusions of blood products. The present study aimed to analyze the intraoperative administration of blood products in patients undergoing OLT, using rotational thromboelastometry (ROTEM) or CLTs. Patients and methods A cohort comprising 153 patients undergoing OLT, of whom 82 were evaluated with ROTEM and 71 by CLTs. Both groups were analyzed intraoperatively: the transfusion of blood products. Results The incidence of patients transfused with cryoprecipitate (CRYO) and/or fibrinogen concentrate (54.9 vs. 19.7%; P < 0.001) and prothrombin complex concentrate (PCC) (32.9 vs. 9.9%; P = 0.008) increased significantly in the ROTEM group than in CLT group, respectively. The amount of transfused patient with CRYO (7.6 vs. 1.2; P < 0.001), fibrinogen concentrate (0.8 vs. 0.2; P = 0.004) and PCC (1.4 vs. 0.2; P = 0.002) increased significantly in the ROTEM group than in the CLT group, respectively. In the analysis of fresh–frozen plasma (FFP), the incidence of transfused patients was significantly higher in the CLT group than in the ROTEM group (46.5 vs. 30.5%; P = 0.047, respectively), with a moderate correlation with red blood cells transfusion (r = 0.67, P < 0.001). The incidence of patients receiving antifibrinolytics was significantly higher in the CLT group than in the ROTEM group (85.9 vs. 47.6%; P < 0.001, respectively). Conclusion Transfusion protocol-based thromboelastometry was able to guide administration of hemostatic factors and reduced administration of FFP and antifibrinolytics.

At the end of 2019, the World Health Organization (WHO) reported pneumonia that started in Wuhan, China, as a global emergency problem. Researchers quickly advanced in research to try to understand this COVID-19 and sough solutions for the front-line professionals fighting this fatal disease. One of the tools to aid in the detection, diagnosis, treatment, and prevention of this disease is computed tomography (CT). CT images provide valuable information on how this new disease affects the lungs of patients. However, the analysis of these images is not trivial, especially when researchers are searching for quick solutions. Detecting and evaluating this disease can be tiring, time-consuming, and susceptible to errors. Thus, in this study, we aim to automatically segment infections caused by COVID19 and provide quantitative measures of these infections to specialists, thus serving as a support tool. We use a database of real clinical cases from Pedro Ernesto University Hospital of the State of Rio de Janeiro, Brazil. The method involves five steps: lung segmentation, segmentation and extraction of pulmonary vessels, infection segmentation, infection classification, and infection quantification. For the lung segmentation and infection segmentation tasks, we propose modifications to the traditional U-Net, including batch normalization, leaky ReLU, dropout, and residual block techniques, and name it as Residual U-Net. The proposed method yields an average Dice value of 77.1% and an average specificity of 99.76%. For quantification of infectious findings, the proposed method achieves results like that of specialists, and no measure presented a value of ρ < 0.05 in the paired t-test. The results demonstrate the potential of the proposed method as a tool to help medical professionals combat COVID-19. fight the COVID-19.

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The reduction of awareness incidence during anesthesia is related to the anesthesiologist improved scientific and technical performance, involving issues such as monitoring, comprehension of the anesthesia activity components, hypnotic and analgesic drugs, neuromuscular blocking agents, autonomic and motor reflex control, in addition to the risk factors involved in this event.