ABSTRACT Objective Consequently, in this study, we aimed to evaluate 1,203 cases of referral to a quaternary vascular surgical service, in São Paulo, Brazil, over a 6-year period, to assess the appropriate need for referral; in addition to the prevalence of surgical indications. Methods In this retrospective analysis, we reviewed the institutional records of participants referred from Basic Healthcare Units to a vascular surgical service inside the Brazilian Unified Health System, between May 2015 and December 2020. Demographic and clinical data were collected. The participants were stratified, as per the reason for referral to the vascular surgical service, previous imaging studies, and surgical treatment indications. Referral appropriateness and complementary examinations were evaluated for each disease cohort. Finally, the prevalence of cases requiring surgical treatment was defined as the outcome measure. Results Of the 1,203 referrals evaluated, venous disease was the main reason for referral (53%), followed by peripheral arterial disease (19.4%). A considerable proportion of participants had been referred without complementary imaging or after a long duration of undergoing an examination. Referrals were regarded as inappropriate in 517 (43%) cases. Of these, 32 cases (6.2%) had been referred to the vascular surgical service, as the incorrect specialty. The percentage of referred participants who ultimately underwent surgical treatment was 39.92%. Carotid (18%) and peripheral arterial diseases (18.4%) were correlated with a lower prevalence of surgical treatments. Conclusion The rate of referral appropriateness to specialized vascular care from primary care settings was low. This may represent a subutilization of quaternary surgical services, with low rates of surgical treatment. Consequently study 1203 1 203 1,20 Paulo Brazil 6year year 6 period indications analysis System 201 2020 collected stratified studies cohort Finally measure 53%, 53 53% , (53%) 19.4%. 194 19.4% . 19 4 (19.4%) examination 51 43% 43 (43% these 3 6.2% 62 2 (6.2% specialty 3992 39 92 39.92% 18% 18 (18% 18.4% 184 (18.4% treatments services 120 20 1,2 202 5 (53% 19.4 (19.4% (43 6.2 (6.2 399 9 39.92 (18 18.4 (18.4 12 1, (53 19. (19.4 (4 6. (6. 39.9 (1 18. (18. (5 (19. ( (6 39. (19

Abstract Background and objective: Lower limb varicose veins are a prevalent disease associated with several available treatment options, including conventional surgery and polidocanol foam sclerotherapy. However, few studies have analyzed therapeutic modality outcomes based on Patient-Reported Outcome Measures (PROMs). This large sample-size study was designed to evaluate the outcomes of polidocanol foam sclerotherapy compared to conventional surgery based on an analysis of PROMs. Methods: This was a prospective, observational, and qualitative study of 205 patients who underwent varicose vein treatment with either polidocanol foam sclerotherapy (57 patients, 90 legs) or conventional surgery (148 patients, 236 legs). Patients were preoperatively assessed and re-evaluated 30 days after the procedure using the Venous Disease Severity Score (VCSS) and specific venous disease quality-of-life questionnaires (VEINES-QoL/Sym). Results: Both treatments significantly improved VCSS and VEINES results 30 days after the procedure (p < 0.05). However, surgery promoted greater improvements in VCSS (on average 4.02-points improvement, p < 0.001), VEINES-QoL (average 8-points improvement, p < 0.001), and VEINES-Sym (average 11.66 points improvement, p < 0.001) than did sclerotherapy. Postoperative pain and aesthetic concerns about the legs were the domains of the questionnaires in which the results varied the most between the treatment modalities, with worse results for sclerotherapy. Conclusion: Both polidocanol foam sclerotherapy and conventional surgery positively impact patients’ quality of life after 30 days, but the improvement is more significant for patients who undergo conventional surgery. objective options However PatientReported Patient Reported PROMs . (PROMs) samplesize sample size Methods prospective observational 20 57 (5 9 148 (14 23 legs. reevaluated re evaluated 3 (VCSS qualityoflife VEINESQoL/Sym. VEINESQoLSym QoL/Sym QoL Sym (VEINES-QoL/Sym) Results 0.05. 005 0.05 0 05 0.05) 4.02points 402points 4.02 4 02 0.001, 0001 0.001 , 001 VEINESQoL 8points 8 VEINESSym 1166 11 66 11.6 modalities Conclusion (PROMs 2 5 ( 14 (1 VEINESQoL/Sym QoLSym (VEINES-QoL/Sym 00 0.0 02points 402 4.0 000 0.00 116 1 6 11. 0. 40 4.

ABSTRACT Objective: This study analyzed the impact of sex on self-reported health and lifestyle parameters in peripheral artery disease patients at two periods of the COVID-19 pandemic. Methods: In this longitudinal study, 99 patients with peripheral artery disease (53 men and 46 women) were evaluated during two periods of the COVID-19 pandemic ( i.e ., at onset: May to August 2020, and on follow-up: May to August 2021). Patients were interviewed via telephone, and information regarding lifestyle and health parameters was obtained. Results: At the onset of the COVID-19 pandemic, health and habit parameters were similar between women and men, with 63.0% and 45.3% indicating frequent fatigue, 73.9% and 84.9% reporting increased sitting time, and 23.9% and 39.6% practicing physical activity, respectively. At follow-up, difficulties in physical mobility (women: from 26.1% to 73.9%, p<0.001; men: from 39.6% to 71.7%, p=0.001) and the frequency of hospitalization for reasons other than COVID-19 increased similarly in women and men (women: from 4.3% to 21.7%, p=0.013; men: from 9.4% to 24.5%, p=0.038). The other parameters were similar between the periods. Conclusion: Self-reported physical mobility difficulties and hospitalization frequency increased in women and men with peripheral artery disease. Objective selfreported self reported COVID19 COVID 19 COVID-1 Methods 9 53 (5 4 ie i e . 2020 followup follow up follow-up 2021. 2021 2021) telephone obtained Results 630 63 0 63.0 453 45 3 45.3 fatigue 739 73 73.9 849 84 84.9 time 239 23 23.9 396 39 6 39.6 activity respectively followup, up, (women 261 26 1 26.1 p<0.001 p0001 p 001 717 71 7 71.7% p=0.001 43 4.3 217 21 21.7% p=0.013 p0013 013 94 9.4 245 24 5 24.5% p=0.038. p0038 p=0.038 038 p=0.038) Conclusion Selfreported Self COVID1 COVID- 202 63. 45. 73. 8 84. 2 23. 39. 26. p<0.00 p000 00 71.7 p=0.00 4. 21.7 p=0.01 p001 01 9. 24.5 p003 p=0.03 03 20 p<0.0 p00 71. p=0.0 21. 24. p<0. p0 p=0. p<0 p=0 p< p=

ABSTRACT Background: Patients with peripheral arterial disease have an increased risk of developing cardiovascular complications in the postoperative period of arterial surgeries known as Major Adverse Cardiac Events (MACE), which includes acute myocardial infarction, heart failure, malignant arrhythmias, and stroke. The preoperative evaluation aims to reduce mortality and the risk of MACE. However, there is no standardized approach to performing them. The aim of this study was to compare the preoperative evaluation conducted by general practitioners with those performed by cardiologists. Methods: This is a retrospective analysis of medical records of patients who underwent elective arterial surgeries from January 2016 to December 2020 at a tertiary hospital in São Paulo, Brazil. The authors compared the preoperative evaluation of these patients according to the initial evaluator (general practitioners vs. cardiologists), assessing patients’ clinical factors, mortality, postoperative MACE incidence, rate of requested non-invasive stratification tests, length of hospital stay, among others. Results: 281 patients were evaluated: 169 assessed by cardiologists and 112 by general practitioners. Cardiologists requested more non-invasive stratification tests (40.8%) compared to general practitioners (9%) (p < 0.001), with no impact on mortality (8.8% versus 10.7%; p = 0.609) and postoperative MACE incidence (10.6% versus 6.2%; p = 0.209). The total length of hospital stay was longer in the cardiologist group (17.27 versus 11.79 days; p < 0.001). Conclusion: The increased request for exams didn’t have a significant impact on mortality and postoperative MACE incidence, but prolonged the total length of hospital stay. Health managers should consider these findings and ensure appropriate utilization of human and financial resources. Background MACE, , (MACE) infarction failure arrhythmias stroke However them Methods 201 202 Paulo Brazil vs cardiologists, cardiologists) factors noninvasive non invasive others Results 28 evaluated 16 11 40.8% 408 40 8 (40.8% 9% 9 (9% 0.001, 0001 0.001 0 001 0.001) 8.8% 88 (8.8 10.7% 107 10 7 0.609 0609 609 10.6% 106 6 (10.6 6.2% 62 2 0.209. 0209 0.209 . 209 0.209) 17.27 1727 17 27 (17.2 1179 79 11.7 days 0.001. Conclusion didnt didn t resources (MACE 20 1 40.8 4 (40.8 (9 000 0.00 00 8.8 (8. 10.7 0.60 060 60 10.6 (10. 6.2 020 0.20 17.2 172 (17. 117 11. 40. (40. ( 0.0 8. (8 10. 0.6 06 (10 6. 02 0.2 17. (17 (40 0. (1 (4

ABSTRACT Objective: To analyze the association between the time spent in sedentary behavior and physical activity of different intensities with cardiovascular health in men and women with peripheral artery disease. Methods: Two hundred and sixty patients with peripheral artery disease and claudication symptoms (65.7% men; 66±1 years; ankle brachial index 0.57±0.18) were evaluated. Physical activity and sedentary behavior were assessed using an accelerometer. Physical activity was classified into light and moderate-vigorous intensities. The cardiovascular outcomes included blood pressure (oscillometric method), cardiac autonomic modulation (heart rate variability), and arterial stiffness (pulse wave velocity). Results: Women spent more time engaged in light physical activity than men (341±14 min/day versus 306±9 min/day; p=0.040, respectively). There was no significant difference in the time spent on sedentary behavior and moderate-vigorous physical activity. Women had a higher systolic blood pressure (p=0.025), higher augmentation index (p<0.001), and lower sympathovagal balance (p=0.047) than men. Pulse wave velocity was only negatively associated with light physical activity (β= -4.66; 95%CI= -8.57; -0.76) in men. Light and moderate-vigorous physical activity and sedentary behavior were not associated with other cardiovascular outcomes. Conclusion: Higher levels of light physical activity were associated with lower arterial stiffness in men with peripheral artery disease. Objective Methods 65.7% 657 65 7 (65.7 661 66 1 66± years 0.57±0.18 057018 0 57 18 evaluated accelerometer moderatevigorous moderate vigorous oscillometric method, method , method) heart variability, variability variability) pulse velocity. . velocity) Results 341±14 34114 341 14 (341±1 minday min day 3069 306 9 306± p0040 p 040 p=0.040 respectively. respectively respectively) p=0.025, p0025 p=0.025 025 (p=0.025) p<0.001, p0001 p<0.001 001 (p<0.001) p=0.047 p0047 047 (p=0.047 β= β (β 4.66 466 4 -4.66 95CI CI 95 95%CI 8.57 857 8 -8.57 0.76 076 76 -0.76 Conclusion 65.7 6 (65. 0.57±0.1 05701 5 341±1 3411 34 (341± 30 p004 04 p=0.04 p002 p=0.02 02 (p=0.025 p000 p<0.00 00 (p<0.001 (p=0.04 4.6 46 -4.6 8.5 85 -8.5 0.7 07 -0.7 65. (65 0.57±0. 0570 341± 3 (341 p00 p=0.0 (p=0.02 p<0.0 (p<0.00 (p=0.0 4. -4. 8. -8. 0. -0. (6 0.57±0 057 (34 p0 p=0. p<0. (p<0.0 (p=0. -4 -8 -0 ( 0.57± 05 (3 p=0 p<0 (p<0. (p=0 - 0.57 p= p< (p<0 (p= 0.5 (p< (p

ABSTRACT Objective Identify potential negative impacts arising from implementing an electronic medical record system, classify them according to the level of criticality, and analyze method’s effectiveness after implementation. Methods The research involved identifying the negative impacts, classifying them according to the criteria for criticality, stratifying them as high, medium, or low severity, and finally, analyzing the effectiveness of the identification and classification methods. Results Findings confirmed that 89.20% of identified impacts occurred as predicted, and 88.94% of impacts had a level of criticality compatible with the severity of the problem. Conclusion Predicting and classifying negative impacts are important stages in implementing electronic health records in hospitals. The method for identification and classification of impacts were, in most cases, considered effective. system methods s implementation high medium finally 8920 89 20 89.20 predicted 8894 88 94 88.94 problem hospitals were cases effective 892 8 2 89.2 889 9 88.9 89. 88.

ABSTRACT Spontaneous non-aneurysmal aortic rupture is rare and is usually attributed to penetrating aortic ulcers, infections, tumor infiltrations, or inflammatory and collagen diseases. Chronic rupture is infrequent but extremely rare in non-aneurysmal aortas, which makes diagnosis difficult because the absence of an aneurysm can mislead the physician to rule out rupture. Here, we describe the case of an 85-year-old male, who was undergoing oncological investigation for weight loss, inappetence, and back pain. Computed tomography and magnetic resonance imaging performed 3 months before admission showed a contained pseudoaneurysm of the infrarenal aorta associated with significant aortoiliac calcification and images suggestive of peritoneal implants. The patient was referred to our oncological center and underwent abdominal computed tomography for oncological investigation and staging. The patient was urgently admitted to the intensive care unit after a critical finding of contained rupture of the infrarenal aorta during the scan. Endovascular repair was indicated, and the patient was successfully treated with implantation of an Endurant IIs 25 × 25 × 70 mm endoprosthesis. No procedural complications were observed. Postoperative course was uneventful, and the patient was discharged on the fifth postoperative day. Control computed tomography performed 1 and 6 months after surgery showed no leaks. This case emphasizes the importance of communication between the radiologists and attending physicians. As the rupture was punctual and well defined in the computed tomography and angiography images, endovascular repair with an aortic cuff was safely performed, and the procedure time was reduced. nonaneurysmal non aneurysmal ulcers infections infiltrations diseases aortas Here 85yearold yearold 85 year old male loss inappetence pain implants staging scan indicated 2 7 endoprosthesis observed uneventful day leaks physicians reduced 8

ABSTRACT Objective: This study aimed to evaluate the association between physical activity levels and lower urinary tract symptoms in 20,732 Brazilian men. Methods: This cohort study included 20,732 men of ≥40 years of age, who participated in health screening between January 2008 and December 2018. Standardized health data (anthropometric, laboratory, clinical, and lifestyle data) were collected. A logistic regression model was used to examine associations based on the occurrence of lower urinary tract symptoms. Results: Depressive symptoms (p<0.001), age (p<0.001), erectile dysfunction (p<0.001), and total prostate-specific antigens (p<0.001) were associated with higher odds of lower urinary tract symptoms in men, after adjusting the other factors. However, physical activity levels were associated with lower odds of developing lower urinary tract symptoms (low active, p<0.001; active, p=0.002; and high active, p=0.005). Conclusion: All physical activity levels were associated with lower odds of lower urinary tract symptoms in 20,732 Brazilian men. Objective 20732 20 732 20,73 Methods 40 ≥4 200 2018 anthropometric, anthropometric (anthropometric laboratory clinical collected Results p<0.001, p0001 p p<0.001 , 0 001 prostatespecific prostate specific (p<0.001 factors However low active p=0.002 p0002 002 p=0.005. p0005 p=0.005 . 005 p=0.005) Conclusion 2073 2 73 20,7 4 ≥ 201 p000 p<0.00 00 (p<0.00 p=0.00 207 7 20, p00 p<0.0 (p<0.0 p=0.0 p0 p<0. (p<0. p=0. p<0 (p<0 p=0 p< (p< p= (p

ABSTRACT The focus of this case report is to technically describe a noninvasive diagnostic evaluation of bow Hunter's syndrome using a dynamic computed tomography angiography protocol and discuss its advantages. In addition, we aimed to exemplify the quality of the study by presenting images of a 3D-printed model generated to help plan the surgical treatment for the patient. The dynamic computed tomography angiography protocol consisted of a first image acquisition with the patient in the anatomic position of the head and neck. This was followed by a second acquisition with the head and neck rotated to the side that triggered the symptoms, with technical parameters similar to the first acquisition. The acquired images were used to print a 3D model to better depict the findings for the surgical team. The dynamic computed tomography angiography protocol developed in this study helped visualize the vertebrobasilar arterial anatomy, detect vertebral artery stenosis produced by head and neck rotation, depict the structure responsible for artery stenosis (e.g., bony structure or membranes), and study possible complications of the disease (e.g., posterior cerebral circulation infarction). Additionally, the 3D-printed model better illustrated the findings of stenosis, aiding in surgical planning. In conclusion, dynamic computed tomography angiography for the evaluation of bow Hunter's syndrome is a feasible noninvasive technique that can be used as an alternative to traditional diagnostic methods. Hunters Hunter s advantages addition 3Dprinted Dprinted printed D symptoms team anatomy rotation e.g., eg e g (e.g. membranes, membranes , membranes) infarction. infarction . infarction) Additionally planning conclusion methods e.g. (e.g e.g

ABSTRACT Objective: To objectively evaluate sweat intensity in patients with primary hyperhidrosis by measuring electrodermal activity using a continuous exosomatic technique without external stimuli. Methods: This prospective and transversal study analyzed 10 patients with palmoplantar hyperhidrosis (HH Group) and 10 individuals without it (Control Group) between January and August 2023. All participants underwent one clinical evaluation and completed two multiple-test questionnaires without any intervention from the interviewer, based on their own estimates of sweat perception and anxiety or depression symptoms. Then, the electrodermal activity was measured with the MP36R, a portable instrument from Biopac Systems Inc. (USA), using exosomatic and direct current techniques. Data were tested for normality using the Shapiro-Wilk test. Descriptive statistics were expressed as medians and interquartile ranges (p25-75) for numerical variables and as absolute and relative frequencies for categorical variables. Fisher's exact test and Mann-Whitney U test were used to compare the groups. Statistical significance was set at p<0.05. Results: Palmoplantar sweating was significantly higher in the HH Group than in the Control Group (p<0.01). There were no statistically significant differences in anxiety and depression levels between the groups (p=0.87; p=0.32). Continuous exosomatic electrodermal activity resulted in significantly higher skin conductance in patients with hyperhidrosis than in controls. Conclusion: Continuous exosomatic electrodermal activity without external stimuli proved to be suitable for the objective analysis of patients with hyperhidrosis in a non-invasive and sensitive manner. Objective Methods 1 2023 multipletest multiple interviewer symptoms Then MP36R MPR MP R Inc USA, USA , (USA) techniques ShapiroWilk Shapiro Wilk p2575 p p25 75 (p25-75 Fishers Fisher s MannWhitney Mann Whitney p005 0 05 p<0.05 Results p<0.01. p001 p<0.01 . 01 (p<0.01) p=0.87 p087 87 (p=0.87 p=0.32. p032 p=0.32 32 p=0.32) controls Conclusion noninvasive non invasive manner 202 (USA p257 p2 7 (p25-7 p00 p<0.0 (p<0.01 p=0.8 p08 8 (p=0.8 p03 p=0.3 3 20 (p25- p0 p<0. (p<0.0 p=0. (p=0. 2 (p25 p<0 (p<0. p=0 (p=0 (p2 p< (p<0 p= (p= (p (p<

ABSTRACT Objective: To evaluate the incidence of malfunction and colonization rates of fully implantable long-term catheters left unflushed during the COVID-19 pandemic; and to evaluate the average cost of transporting each patient to the hospital for flushing. Methods: During the COVID-19 pandemic, patients reduced the number of hospital visits and stopped flushing their catheters periodically with saline solution. After the pandemic stabilized in 2022, patients who completed chemotherapy treatment had their long-term catheters removed. We evaluated the catheters’ function and colonization rates. To evaluate the incidence of malfunctions and the colonization rate of these catheters, we tested the flow and reflux during removal surgery, before removal, and by culturing their tips. These catheters were divided into two groups: a standard group, in which the last flushing occurred before 90 days, and another group, in which the last flushing occurred after 90 days. We analyzed the correlation between the time at which these catheters were closed, the incidence of malfunction, and the colonization rate of these catheters. To avoid confusion due to the reduced sample size, a second analysis was performed between the group of catheters that did not work and those that worked, evaluating the time they were closed and the catheter tip culture. We also analyzed the financial costs for each patient from home to the hospital. Results: Among the 66 patients included in the study, 28 spent >90 days without catheter flushing, and 38 spent <90 days. The incidence of infection occurred in two patients with >90 days of flushing and in three patients with <90 days of flushing. Catheter malfunction occurred in 4 patients in the group with >90 days without flushing and in 5 patients with <90 days of flushing. In the secondary analysis, the group with a functioning catheter (n=52) had a mean time of 152 days, whereas for the group with a non-functioning catheter (n=9), the mean time was 229 days (p=0.51). No differences were statistically significant. No correlation was found between the colonization rate of catheter in the group with a functioning or non-functioning catheter, as the group with a functioning catheter had three cases of positive catheter tip culture and the group with a non-functioning catheter had one case of positive catheter tip culture. The average cost for each patient to travel from home to the hospital was 39.01 reais (approximately 7.50 USD). Conclusion: Among the patients followed up at our hospital during the COVID-19 pandemic, no statistically significant difference was observed in the function and colonization rate of long-term catheters between those who underwent flushing at intervals of <90 days and those with intervals of >90 days. Objective longterm long term COVID19 COVID 19 COVID-1 Methods solution 2022 removed surgery tips groups 9 size worked Results 6 study 2 >9 3 <9 n=52 n52 n 52 (n=52 15 nonfunctioning non n=9, n9 n=9 , (n=9) 22 p=0.51. p051 p p=0.51 . 0 51 (p=0.51) 3901 39 01 39.0 approximately 750 7 50 7.5 USD. USD USD) Conclusion COVID1 1 COVID- 202 > < n=5 n5 (n=5 n= (n=9 p05 p=0.5 (p=0.51 390 39. 75 7. 20 (n= p0 p=0. (p=0.5 (n p=0 (p=0. p= (p=0 (p= (p

ABSTRACT Objective: This study tests a suitable model for training robot-assisted peripheral vascular interventions and examines the learning curves of endovascular surgeons with different levels of previous experience and main focus of work, analyzing procedure time, fluoroscopy time, use of contrast, and radiation emission. Methods: Sixteen endovascular surgeons with different previous experience and training performed nine manual and 18 robotic angioplasties using the CorPath GRX platform on a 3D-printed life-size immersed infragenicular arterial phantom. Results: All participants considered the model reliable. When analyzing manual angioplasty outcomes, the juniors took significantly longer to perform angioplasties than the seniors (p=0.044). Among the seniors, interventionists were faster only on the first angioplasty (p=0.046). Analysis of the robotic angioplasty results showed that only one junior failed to cannulate one of the target arteries once. The total duration, fluoroscopy time, and radiation emission did not differ between juniors and seniors (p=0.095, p=0.60, and p=0.64, respectively). In addition, the learning curves for the maximum benefit required two attempts for procedure duration, one for fluoroscopy time, and three for radiation emission. There were no significant differences between senior vascular surgeons and interventionists. Among juniors, residents had a significantly lower procedure duration (p=0.042) and radiation emission (p=0.046) only for the first angioplasty. Conclusion: The learning curves for robotic peripheral arterial interventions were short, with a plateau for the procedure and fluoroscopy times and radiation emission after the third attempt. We observed no differences in the learning curves in relation to previous experience or training. Objective robotassisted robot assisted work time contrast Methods 1 3Dprinted Dprinted 3D printed D lifesize life size phantom Results reliable outcomes p=0.044. p0044 p p=0.044 . 0 044 (p=0.044) p=0.046. p0046 p=0.046 046 once p=0.095, p0095 095 (p=0.095 p060 60 p=0.60 p064 64 p=0.64 respectively. respectively respectively) addition p=0.042 p0042 042 (p=0.042 (p=0.046 Conclusion short attempt p004 p=0.04 04 (p=0.044 p=0.095 p009 09 (p=0.09 p06 6 p=0.6 (p=0.04 p00 p=0.0 p=0.09 (p=0.0 p0 p=0. (p=0. p=0 (p=0 p= (p= (p

ABSTRACT A 42-year-old female patient with a surgical history of iliac venous angioplasty with stenting developed dyspnea on exertion 9 months later. Chest computed tomography angiography revealed a fractured vascular stent in the right cardiac chamber. Doppler echocardiography confirmed that the stent was anchored by the tricuspid valve, causing mild obstruction of the right ventricular filling. The patient underwent robot-assisted cardiac surgery with stent removal, annuloplasty under general anesthesia, and cardiopulmonary bypass via an axillary incision. No sternotomy, cardioplegia, or aortic clamping was required. The right atrium was opened, and no surgical or anesthetic complications occurred. The patient was extubated in the operating room, with no requirement for vasoactive drugs after surgery. She was discharged on the fifth postoperative day in a good general condition, eupneic, and without lower-limb venous symptoms. Re-do iliac venous angioplasty was not necessary. 42yearold yearold 42 year old later chamber valve filling robotassisted robot assisted removal anesthesia incision sternotomy cardioplegia required opened occurred room condition eupneic lowerlimb lower limb symptoms Redo Re do necessary 4

ABSTRACT Objective Peak oxygen consumption (VO2peak), anaerobic threshold, walking economy, and cardiovascular responses during walking are used to guide and monitor walking training in patients with peripheral artery disease and intermittent claudication. Women with peripheral artery disease and intermittent claudication present greater impairments than men, and evaluating training markers according to sex for decisions regarding walking prescription in this population is important. This study aimed to compare VO2peak, walking economy, anaerobic threshold, and cardiovascular responses during walking in men and women with peripheral artery disease and intermittent claudication. Methods Forty patients (20 men and 20 women with similar baseline characteristics) underwent a cardiopulmonary treadmill test (3.2km/h and 2% increase in slope every 2 minutes until maximal leg pain). The VO2 and rate-pressure product were assessed. Data from men and women were compared using t-tests. Results There were no significant differences between men and women (VO2peak: 15.0±4.8 versus 13.9±2.9mL∙kg-1∙min-1, p=0.38; walking economy: 9.6±2.7 versus 8.4±1.6mL∙kg-1∙min-1, p=0.09; anaerobic threshold: 10.5±3.2 versus 10.5±2.2mL∙kg-1∙min-1, p=0.98; rate pressure product at 1st stage: 13,465± 2,910 versus 14,445±4,379bpm∙mmHg, p=0.41; and rate pressure product at anaerobic threshold:13,673±3,100 versus 16,390±5,870bpm∙mmHg, p=0.08 and rate pressure product at peak exercise: 21,253±6,141 versus 21,923±7,414bpm∙mmHg, p=0.76, respectively). Conclusion Men and women with peripheral artery disease and similar baseline characteristics presented similar responses to walking, suggesting that decisions regarding walking prescription and monitoring can be made regardless of sex in this specific population. VO2peak VOpeak , VO (VO2peak) threshold economy important (2 3.2km/h 32kmh kmh 3 2km h km pain. pain . pain) ratepressure assessed ttests. ttests t tests. tests t-tests (VO2peak 15048 15 0 4 8 15.0±4. 13.9±2.9mL∙kg1∙min1, 13929mLkg1min1 mLkgmin 13.9±2.9mL∙kg 1∙min 1, 13 9 9mL kg 1 min mL 13.9±2.9mL∙kg-1∙min-1 p=0.38 p038 p 38 9627 6 7 9.6±2. 8.4±1.6mL∙kg1∙min1, 8416mLkg1min1 8.4±1.6mL∙kg 6mL 8.4±1.6mL∙kg-1∙min-1 p=0.09 p009 09 10532 10 5 10.5±3. 10.5±2.2mL∙kg1∙min1, 10522mLkg1min1 10.5±2.2mL∙kg 2mL 10.5±2.2mL∙kg-1∙min-1 p=0.98 p098 98 st stage 13465 465 13,465 2910 910 2,91 144454379bpmmmHg bpmmmHg 14 445 379bpm mmHg bpm 14,445±4,379bpm∙mmHg p=0.41 p041 41 threshold13,673±3,100 threshold136733100 13,673±3,100 673 100 threshold:13,673±3,10 163905870bpmmmHg 16 390 870bpm 16,390±5,870bpm∙mmHg p008 08 p=0.0 exercise 212536141 21 253 141 21,253±6,14 219237414bpmmmHg 923 414bpm 21,923±7,414bpm∙mmHg p076 76 p=0.76 respectively. respectively respectively) ( 1504 15.0±4 kg1 min1 13.9±2.9mL∙kg1∙min1 mLkg 13929mLkg1min 13929mLkg 1min 13.9±2.9mL∙kg-1∙min- p=0.3 p03 962 9.6±2 8.4±1.6mL∙kg1∙min1 8416mLkg1min 8416mLkg 8.4±1.6mL∙kg-1∙min- p00 1053 10.5±3 10.5±2.2mL∙kg1∙min1 10522mLkg1min 10522mLkg 10.5±2.2mL∙kg-1∙min- p=0.9 p09 1346 46 13,46 291 91 2,9 44 p=0.4 p04 threshold13 threshold13,673±3,10 threshold13673310 136733100 13,673±3,10 67 threshold:13,673±3,1 39 p=0. 21253614 25 21,253±6,1 92 p07 p=0.7 150 15.0± 13.9±2.9mL∙kg1∙min 13.9±2.9mL∙kg-1∙min p0 96 9.6± 8.4±1.6mL∙kg1∙min 8.4±1.6mL∙kg-1∙min 105 10.5± 10.5±2.2mL∙kg1∙min 10.5±2.2mL∙kg-1∙min 134 13,4 29 2, threshold1 threshold13,673±3,1 threshold1367331 13673310 13,673±3,1 threshold:13,673±3, p=0 2125361 21,253±6, 15.0 9.6 10.5 13, threshold13,673±3, threshold136733 1367331 13,673±3, threshold:13,673±3 p= 212536 21,253±6 15. 9. 10. threshold13,673±3 threshold13673 136733 13,673±3 threshold:13,673± 21253 21,253± threshold13,673± threshold1367 13673 13,673± threshold:13,673 2125 21,253 threshold13,673 threshold136 1367 13,673 threshold:13,67 212 21,25 threshold13,67 136 13,67 threshold:13,6 21,2 threshold13,6 13,6 threshold:13, 21, threshold13, threshold:13 threshold:1

RESUMO As fraturas articulares distais da perna estão entre as fraturas mais comuns do ser humano ao longo de todas as faixas etárias, e 50% delas necessitam de tratamento cirúrgico. Existem poucos trabalhos discutindo a epidemiologia e os custos dessa fratura na literatura mundial e, principalmente, na nacional. Objetivo: Avaliar a incidência anual e o valor de reembolso das fraturas distais da perna com indicação para tratamento cirúrgico entre os anos de 2008 e 2021. Métodos: Estudo retrospectivo para analisar os dados complexos estruturados de alto volume e alta variabilidade (Big Data), disponibilizados publicamente na plataforma TabNet (Datasus), através de um software com inteligência artificial. Foram analisados os dados de 2008 a 2021 do tratamento cirúrgico de fratura maleolar, fratura distal da tíbia e fratura isolada da fíbula. Resultados: Entre 2008 e 2021, houve incidência média de 28,8 fraturas/105 habitantes-ano, representando 14,62% de todas as fraturas. O valor total pago pelas internações dessas fraturas foi de R$ 34.218.014,62 ao longo desses 14 anos. Conclusão: A incidência das fraturas articulares distais da perna acompanha o padrão daqueles registrados em outros países. O reajuste do repasse ao longo dos anos foi inferior à inflação acumulada. Nível de Evidência II, Análises Econômicas e de Decisão - Desenvolvimento de Modelo Econômico ou de Decisão. etárias 50 principalmente nacional Objetivo 200 Métodos Big Data, Data , Data) Datasus, Datasus (Datasus) artificial 202 maleolar fíbula Resultados 288 28 8 28, fraturas105 105 fraturas/10 habitantesano, habitantesano habitantes ano, ano habitantes-ano 1462 62 14,62 R 3421801462 34 218 014 34.218.014,6 1 Conclusão países acumulada II 5 20 (Datasus 2 fraturas10 10 fraturas/1 146 6 14,6 342180146 3 21 01 34.218.014, fraturas1 fraturas/ 14, 34218014 0 34.218.014 3421801 34.218.01 342180 34.218.0 34218 34.218. 3421 34.218 342 34.21 34.2 34.

ABSTRACT The distal leg joint fractures are among the most common fractures in humans across all age groups, and 50% of them require surgical treatment. Few studies discuss the epidemiology and costs of this fracture in the global and national literature. Objective: To evaluate the annual incidence and reimbursement value of distal leg joint fractures requiring surgical treatment from 2008 to 2021. Methods: A retrospective study was conducted to analyze the complex structured data of high volume and high variability (Big Data), publicly available on the TabNet platform (DATASUS), via software with artificial intelligence. Data from 2008 to 2021 on surgical treatment for malleolar fracture, distal tibia fracture, and isolated fibula fracture were analyzed. Results: From 2008 to 2021, there was an average incidence of 28.8 fractures/105 inhabitants per year, representing 14.62% of all fractures. The total amount paid for hospitalizations due to these fractures was R$ 34,218,014.62 over these 14 years. Conclusion: The incidence of distal leg joint fractures follows the pattern of those recorded in other countries. The adjustment of reimbursement over the years was lower than the accumulated inflation. Level of Evidence II, Economic and Decision Analyses - Developing an Economic or Decision Model. groups 50 literature Objective 200 Methods Big Data, , Data) DATASUS, DATASUS (DATASUS) intelligence 202 analyzed Results 288 28 8 28. fractures105 105 fractures/10 year 1462 62 14.62 R 3421801462 34 218 014 34,218,014.6 1 Conclusion countries inflation II Model 5 20 (DATASUS 2 fractures10 10 fractures/1 146 6 14.6 342180146 3 21 01 34,218,014. fractures1 fractures/ 14. 34218014 0 34,218,014 3421801 34,218,01 342180 34,218,0 34218 34,218, 3421 34,218 342 34,21 34,2 34,