Abstract Introduction: To support the development of practices and guidelines that might help to reduce adverse events related to human factors, we aimed to study the response and perception by members of a cardiovascular surgery team of various error-driven or adverse features that might arise in the operating room (OR). Methods: A previously validated Disruptions in Surgery Index (DiSI) questionnaire was completed by individuals working together in a cardiovascular surgical unit. Results were submitted to reliability analysis by calculating the Cronbach’s alpha coefficient. Non-parametric Kruskal-Wallis test and Dunn’s post-test were performed to estimate differences in perceptions of adverse events or outcomes between the groups (surgeons, nurses, anesthesiologists, and technicians). P<0.05 was considered statistically significant. Results: Cronbach’s alpha reliability coefficients showed consistency within the recommended range for all disruption types assessed in DiSI: an individual’s skill (0.85), OR environment (0.88), communication (0.81), situational awareness (0.92), patient-related disruption (0.89), team cohesion (0.83), and organizational disruption (0.83). Nurses (27.4%) demonstrated significantly higher perception of disruptions than surgeons (25.4%), anesthetists (23.3%), and technicians (23.0%) (P=0.005). Study participants were more observant of their colleagues’ disruptive behaviors than their own (P=0.0001). Conclusion: Our results revealed that there is a tendency among participants to hold a positive self-perception position. DiSI appears to be a reliable and useful tool to assess surgical disruptions in cardiovascular OR teams, identifying negative features that might imperil teamwork and safety in the OR. And human factors training interventions are available to develop team skills and improve safety and efficiency in the cardiovascular OR.

Abstract INTRODUCTION Dengue has affected Rio de Janeiro City since the 1980s. The sequential Zika and chikungunya virus introductions during 2015 aggravated the health scenario, with 97,241 cases of arboviral diseases reported in 2015-2016, some with neurological disorders. METHODS Arbovirus-related neurologic cases were descriptively analyzed, including neurological syndromes and laboratory results. RESULTS In total, 112 cases with non-congenital neurologic manifestations (Guillain-Barré syndrome, 64.3%; meningoencephalitis, 24.1%; acute demyelinating encephalomyelitis, 8%) were arbovirus-related; 43.7% were laboratory-confirmed, of which 57.1% were chikungunya-positive. CONCLUSIONS Emerging arbovirus infections brought opportunities to study atypical, severe manifestations. Surveillance responses optimized case identification and better clinical approaches.

Abstract Introduction: Most risk stratification scores used in surgery do not include external and non-technical factors as predictors of morbidity and mortality. Objective: The present study aimed to translate and adapt transculturally the Brazilian version of the Disruptions in Surgery Index (DiSI) questionnaire, which was developed to capture the self-perception of each member of the surgical team regarding the disruptions that may contribute to error and obstruction of safe surgical flow. Methods: A universalist approach was adopted to evaluate the conceptual equivalence of items and semantics, which included the following stages: (1) translation of the questionnaire into Portuguese; (2) back translation into English; (3) panel of experts to draft the preliminary version; and (4) pre-test for evaluation of verbal comprehension by the target population of 43 professionals working in cardiothoracic surgery. Results: The questionnaire was translated into Portuguese and its final version with 29 items obtained 89.6% approval from the panel of experts. The target population evaluated all items as easy to understand. The mean overall clarity and verbal comprehension observed in the pre-test reached 4.48 ± 0.16 out of the maximum value of 5 on the psychometric Likert scale. Conclusion: Based on the methodology used, the experts' analysis and the results of the pre-test, it is concluded that the essential stages of translation and cross-cultural adaptation of DiSI to the Portuguese language were satisfactorily fulfilled in this study.

Abstract Introduction: Advances in modern medicine have led to people living longer and healthier lives. Frailty is an emerging concept in medicine yet to be explored as a risk factor in cardiac surgery. When it comes to CABG surgery, randomized controlled clinical trials have primarily focused on low-risk (ROOBY, CORONARY), elevated-risk (GOPCABE) or high-risk patients (BBS), but not on frail patients. Therefore, we believe that off-pump CABG could be an important technique in patients with limited functional capacity to respond to surgical stress. In this study, the authors introduce the new national, multicenter, randomized, controlled trial "FRAGILE", to be developed in the main cardiac surgery centers of Brazil, to clarify the potential benefit of off-pump CABG in frail patients. Methods: FRAGILE is a two-arm, parallel-group, multicentre, individually randomized (1:1) controlled trial which will enroll 630 patients with blinded outcome assessment (at 30 days, 6 months, 1 year, 2 years and 3 years), which aims to compare adverse cardiac and cerebrovascular events after off-pump versus on-pump CABG in pre-frail and frail patients. Primary outcomes will be all-cause mortality, acute myocardial infarction, cardiac arrest with successful resuscitation, low cardiac output syndrome/cardiogenic shock, stroke, and coronary reintervention. Secondary outcomes will be major adverse cardiac and cerebrovascular events, operative time, mechanical ventilation time, hyperdynamic shock, new onset of atrial fibrillation, renal replacement therapy, reoperation for bleeding, pneumonia, length of stay in intensive care unit, length of stay in hospital, number of units of blood transfused, graft patency, rate of complete revascularization, neurobehavioral outcomes after cardiac surgery, quality of life after cardiac surgery and costs. Discussion: FRAGILE trial will determine whether off-pump CABG is superior to conventional on-pump CABG in the surgical treatment of pre-frail and frail patients. Trial registration: ClinicalTrials.gov, ID: NCT02338947. Registered on August 29th 2014; last updated on March 21st 2016.

Introdução: Uma das características da cardiomiopatia dilatada idiopática é a deformação da cavidade ventricular, a qual contribui para a disfunção sistólica. Poucos trabalhos julgam importante a avaliação dessa deformação ventricular levando em consideração regiões e segmentos do ventrículo, o que pode revelar detalhes importantes do processo de remodelamento, dando suporte a um melhor entendimento do seu papel no comprometimento funcional e ao surgimento de novas estratégias terapêuticas. Objetivo: Verificar se, em regiões diferentes, o aumento do perímetro transversal da câmara ventricular esquerda na cardiomiopatia dilatada idiopática ocorre de maneira proporcional entre o segmento septal e o não septal (parede livre). Métodos: Foi realizado um estudo anatômico com 28 corações adultos. Um grupo foi constituído por 18 corações com cardiomiopatia dilatada idiopática e outro grupo com 10 corações normais. Em três regiões diferentes (base, equador e ápice), o perímetro interno transversal do ventrículo esquerdo foi dividido em dois segmentos: septal e não septal. Foi criado um índice de proporcionalidade entre esses segmentos. Em seguida verificou-se se esse índice era o mesmo entre os grupos. Resultados: Entre corações normais e portadores de cardiomiopatia dilatada idiopática, o índice de proporcionalidade entre os dois segmentos (septal e não septal) não apresentou diferença significativa nas três regiões analisadas. Conclusão: Na cardiomiopatia dilatada idiopática, a dilatação transversal do septo é proporcional à dilatação da parede livre nas regiões basal, equatorial e apical da câmara ventricular esquerda.

Introduction: A feature of dilated cardiomyopathy is the deformation of ventricular cavity, which contributes to systolic dysfunction. Few studies have evaluated this deformation bearing in mind ventricular regions and segments of the ventricle, which could reveal important details of the remodeling process, supporting a better understanding of its role in functional impairment and the development of new therapeutic strategies. Objective: To evaluate if, in basal, equatorial and apical regions, increased internal transverse perimeter of left ventricle in idiopathic dilated cardiomyopathy occurs proportionally between the septal and non-septal segment. Methods: We performed an anatomical study with 28 adult hearts from human cadavers. One group consisted of 18 hearts with idiopathic dilated cardiomyopathy and another group with 10 normal hearts. After lamination and left ventricle digital image capture, in three different regions (base, equator and apex), the transversal internal perimeter of left ventricle was divided into two segments: septal and not septal. These segments were measured by proper software. It was established an index of proportionality between these segments, called septal and non-septal segment index. Then we determined whether this index was the same in both groups. Results: Among patients with normal hearts and idiopathic dilated cardiomyopathy, the index of proportionality between the two segments (septal and non-septal) showed no significant difference in the three regions analyzed. The comparison results of the indices NSS/SS among normal and enlarged hearts were respectively: in base 1.99 versus 1.86 (P=0.46), in equator 2.22 versus 2.18 (P=0.79) and in apex 2.96 versus 3.56 (P=0.11). Conclusion: In the idiopathic dilated cardiomyopathy, the transversal dilatation of left ventricular internal perimeter occurs proportionally between the segments corresponding to the septum and free wall at the basal, equatorial and apical regions of this chamber.

Este artigo tem por objetivo discutir aspectos relacionados ao conceito de qualidade de vida em Saúde. Este artigo apresenta também informações relacionadas aos instrumentos de qualidade de vida.

This article aims to discuss aspects concerning Healthrelated to quality of life concepts. This paper presents some piece of information regarding the quality of life instruments.

INTRODUÇÃO: A busca do entendimento de fatores etiológicos, mecanismos e tratamento das doenças tem levado ao desenvolvimento de vários modelos animais nas últimas décadas. OBJETIVO: Esse artigo tem por objetivo discutir aspectos relacionados a modelos animais de experimentação, escolha do animal e tendências atuais nesse campo em nosso país. Além disso, esse estudo buscou avaliar o espaço ocupado por artigos experimentais em revistas médicas. MÉTODOS: Foram selecionadas cinco revistas brasileiras, indexadas na LILACS, SciELO, MEDLINE, e recentemente incorporadas pelo Institute for Scientific Information Journal of Citation Reports. Foram selecionados pelo resumo ou abstract todos os artigos publicados nessas revistas, nos anos de 2007 e 2008, que empregaram modelos animais. RESULTADOS: Do total de 832 artigos publicados no período pelas revistas analisadas, foram selecionados 92 (11,1%) que empregavam animais de experimentação. O número de artigos experimentais variou de 5,2% a 17,9% do conteúdo global da revista. Nas instruções aos autores de quatro (80%) das revistas avaliadas, havia referência explícita aos princípios éticos na condução de estudos com animais. Os modelos animais induzidos representaram 100% dos artigos analisados neste estudo. O rato foi o animal mais empregado nos artigos analisados, sendo utilizado em 78,3% deles. CONCLUSÕES: O presente estudo poderá fornecer subsídios para adoção de políticas editoriais futuras relativas à publicação de artigos originários de pesquisa animal na RBCCV.

INTRODUCTION: The search of the understanding of etiological factors, mechanisms and treatment of the diseases has been taking to the development of several animal models in the last decades. OBJECTIVE: To discuss aspects related to animal models of experimentation, animal choice and current trends in this field in our country. In addition, this study evaluated the frequency of experimental articles in medical journals. METHODS: Five Brazilian journals indexed by LILACS, SciELO, MEDLINE, and recently incorporate for Institute for Scientific Information Journal of Citation Reports were analyzed. All the papers published in those journals, between 2007 and 2008, that used animal models, were selected based on the abstracts. RESULTS: Of the total of 832 articles published in the period, 92 (11.1%) experimentation papers were selected. The number of experimental articles ranged from 5.2% to 17.9% of the global content of the journal. In the instructions to the authors, four (80%) journals presented explicit reference to the ethical principles in the conduction of studies with animals. The induced animal models represented 100% of the articles analyzed in this study. The rat was the most employed animal in the analyzed articles (78.3%). CONCLUSIONS: The present study can contribute, supplying subsidies for adoption of future editorials policies regarding the publication of animal research papers in Brazilian Journal of Cardiovascular Surgery.

OBJETIVO: Investigar a função do sistema mucociliar em ratos transplantados sob a influência de imunossupressores. MÉTODOS: Trinta e seis ratos foram submetidos ao transplante pulmonar unilateral e divididos em dois grupos, onde um grupo foi tratado com ciclosporina e outro foi controle. Administrada ciclosporina por via subcutânea na dose de 10 mg/kg diariamente. Os ratos foram sacrificados 2, 15 e 30 dias após o transplante pulmonar. O transporte mucociliar brônquico (TMC) in situ e a freqüência de batimento ciliar (FBC) foram analisados na porção proximal e distal à anastomose brônquica. Realizada correlação dos achados com parâmetros gasométricos e histologia. RESULTADOS: Foi encontrada melhora progressiva e significante no TMC na região proximal e distal a anastomose no grupo que recebeu ciclosporina em 15 e 30 dias (p<0,01). Não houve diferença na FBC nos dois grupos estudados. A análise histológica mostrou que a rejeição foi significantemente maior no grupo controle (p<0,05). A oxigenação foi melhor nos animais que receberam a ciclosporina. CONCLUSÃO: A ciclosporina exerceu influência positiva no transporte mucociliar brônquico, provavelmente por sua ação imunossupressora.

PURPOSE: To investigate the function of the bronchial mucociliary system in transplanted rat lungs with and without the influence of immunosuppression. METHODS: Thirty-six rats underwent single-lung transplantation and were divided into two groups, one of which received cyclosporine treatment, and the control group which did not. Cyclosporine was administered subcutaneously in doses of 10 mg/kg daily. The rats were sacrificed 2, 15 or 30 days after transplantation. In situ bronchial mucociliary transport (MCT) and ciliary beat frequency (CBF) were determined proximal and distal to the bronchial anastomosis. RESULTS: Significant progressive improvement on MCT, proximal and distal to the anastomotic site, was also found in the cyclosporine-treated group at 15 and 30 days (p<0.01). No significant change in MCT was found in the control group. CBF behavior in the two groups. Histological analysis showed that rejection was significantly higher in the control group (p<0.05). CONCLUSION: Cyclosporine has a positive influence on bronchial mucociliary transport but not on CBF due to the effect of the rejection mechanism.

OBJETIVO: Analisar as instruções aos autores contidas em revistas científicas nacionais que publicam artigos da área cirúrgica, buscando traçar um panorama da situação, bem como fazer recomendações para editores e autores. MÉTODOS: Foram analisadas as Instruções aos Autores de 20 revistas e classificadas segundo os Requisitos de Vancouver. Foram consultadas na SciELO, nos sites das revistas ou no último fascículo impresso disponível na coleção da BIREME. Os resultados foram analisados descritivamente, sendo considerada a freqüência de cada variável. RESULTADOS: 75% recomendam a adoção dos Requisitos de Vancouver, embora nem sempre indiquem a versão atualizada; 90% das revistas fizeram menção ao cumprimento de princípios éticos de pesquisa, 80% ao processo de revisão por pares e 70% ao conflito de interesses e à cessão dos direitos autorais. Os idiomas estrangeiros aceitos com maior freqüência foram inglês (80%) e espanhol (30%). Todas as revistas publicam artigos originais, seguidos pelos de revisão (90%), relatos de caso (80%), cartas ao editor (70%) e artigos de atualização (55%). A nomenclatura adotada para as seções das revistas é muito variada. CONCLUSÃO: Ainda que a liberdade editorial e independência de cada editor devam ser respeitadas, há critérios aceitos internacionalmente que devem ser observados. As tendências atuais, visando à priorização das revistas eletrônicas em acesso aberto, implicarão em modificações no processo de editoração das revistas científicas.

PURPOSE: To analyze the instructions for authors of Brazilian scientific journals in the surgery field, in order to describe the present situation, as well to make recommendations for editors and authors. METHODS: Instruction for authors of 20 journals were analyzed and classified following Vancouver requirements. Instructions were taken from SciELO, from the journals’ homepage, or from the last printed issue available in BIREME’s collection. Results were descriptively analyzed, considering the frequency of each variable. RESULTS: 75% of the journals recommended ICMJE Uniform Requirements, although not always the newest version was indicated; 90% of the journals mentioned ethical research principles, 80% the peer-review process and 70% the conflict of interests and the author rights transfer agreement. Foreign languages frequently accepted were English (80%) and Spanish (30%). All journals publish original papers, followed by reviews (90%), case reports (80%), letters to the editor (70%), and clinical updates or continuing education (55%). The nomenclature for the sections varied among journals. CONCLUSION: Even though publishing freedom and independence of each publisher must be respected, there are internationally accepted criteria that must be observed. The current trends, towards the prioritization of open access electronic journals, will lead to important changes in the process of publishing scientific journals.

Em cães, a comprovação da real viabilidade da pneumonectomia direita, bem como, o estudo das complicações resultantes deste procedimento cirúrgico, tornam-se importantes diante da pequena quantidade de estudos na literatura específicos sobre pneumonectomia nesta espécie. O objetivo deste trabalho foi realizar um estudo experimental para avaliar a viabilidade da pneumonectomia direita em cães, através da avaliação paramétrica, hemogasométrica e radiográfica Foram utilizados 10 cães adultos, sadios, machos e fêmeas sem raça definida, pesando entre 13 e 32 kg. Todos os cães foram submetidos à intubação seletiva e toracotomia direita no 5º espaço intercostal, onde foi realizada a pneumonectomia. Foi realizado estudo temporal aos 7, 30 e 60 dias de pós-operatório, onde foi feito avaliação radiográfica, bem como, avaliação paramétrica e hemogasométrica (antes da indução anestésica, 1 hora após extubação, 48 horas, 7, 30 e 60 dias após o procedimento cirúrgico), con,siderados importantes para avaliar as possíveis complicações relacionadas com a técnica anestésica, cirúrgica, assim como, as complicações resultantes deste procedimento cirúrgico. Os resultados encontrados foram analisados estatisticamente. Apesar das alterações dos índices paramétricos e hemogasométricos, todos os cães apresentaram compensação das trocas gasosas após retirada de 57% do volume pulmonar. Na avaliação radiográfica, observamos que a expansão do pulmão remanescente causou deslocamento do coração e pulmão para hemitórax direito. Concluiu-se que a realização da pneumonectomia direita é plenamente viável no cão, permitindo evolução paramétrica, hemogasométrica e radiográfica satisfatória em todos os cães.

In dogs, the evidence of viability of the right pneumonectomy, as well as the study of complications resulting from surgical procedure, are very important regarding the few specific studies made on the pneumonectomy in this animal species. The objective of this project was to carry out an experimental study to evaluate the viability of the right pneumonectomy in dogs through parametric, hemogasometric and radiographic evaluation. Ten adult healthy mongrel dogs, males and females, weighing 13-32 kg, were used. The dogs were submitted to selective intubation and right thoracotomy at the 5th intercostal space, where the pneumonectomy was performed. A radiografic evaluation was made on days 7, 30 and 60 after the surgery, as well as parametric and hemogasometric evaluations were done (before anesthetic induction, 1 hour after extubation, 48 hours and on days 7, 30 and 60 after the surgical procedure), considered important to evaluate possible complications due to the anesthetic and surgical techniques, as well as complications resulting from these procedures. The results were analyzed statistically. Besides the parametric and hemogasometric alterations, all dogs showed compensation for the gaseous exchanges after removing 57% of the pulmonary volume. Regarding the radiographic evaluation, it could be observed that the expansion of the remaining lung caused heart and lung displacement into the right hemithorax. It can be concluded that the right pneumonectomy is completely feasible in dogs, allowing a parametric, hemogasometric and radiographic satisfactory evaluation in all the animals.