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Digital interventions are important tools to promote mental health literacy among university students. “Depression in Portuguese University Students” (Depressão em Estudantes Universitários Portugueses, DEEP) is an audiovisual intervention describing how symptoms can be identified and what possible treatments can be applied. The aim of this study was to evaluate the impact of this intervention. A random sample of 98 students, aged 20–38 years old, participated in a 12-week study. Participants were recruited through social media by the academic services and institutional emails of two Portuguese universities. Participants were contacted and distributed into four study groups (G1, G2, G3 and G4): G1 received the DEEP intervention in audiovisual format; G2 was given the DEEP in text format; G3 received four news articles on depression; G4 was the control group. A questionnaire was shared to collect socio-demographic and depression knowledge data as a pre-intervention method; content was then distributed to each group following a set schedule; the depression knowledge questionnaire was then administered to compare pre-intervention, post-intervention and follow-up literacy levels. Using the Scheffé and Least Significant Difference (LSD) multiple comparisons test, it was found that G1, which received the DEEP audiovisual intervention, differed significantly from the other groups, with higher depression knowledge scores in post-intervention stages. The DEEP audiovisual intervention, compared to the other formats used (narrative text format; news format), proved to be an effective tool for increasing depression knowledge in university students.

INTRODUCTION This study presents the first steps and results towards the development of a system for predicting the quality of surgical performance and workload in laparoscopic training. MATERIAL AND METHODS Surgeons wore a smartwatch which recorded their heart rate and hand motion during each laparoscopic procedure. Data was then correlated with both the Surgery Task Load Index (SURG-TLX) subjective questionnaire and the Global Operational Assessment of Laparoscopic Skills (GOALS) objective evaluation tool. Statistical analysis was conducted in order to study the relationship between parameters and to compare the results according to the surgeons’ level of experience. RESULTS Nine laparoscopic surgeons participated in this study, five gynecologists and four digestive surgeons. Gynecological surgeons showed a positive correlation between their level of experience, heart rate, hand motion, and GOALS score, except for bimanual dexterity. The reduction in the variability of hand accelerations led to improved tissue handling. Digestive surgeons showed a negative correlation between their level of experience and the reported temporal demand and complexity of the procedure. Novice digestive surgeons reported increased workload during surgery, mainly in mental, physical, and temporal workload. In both surgical specialties, it was observed that reduction in surgical workload was associated with improved GOALS score. CONCLUSIONS Preliminary results showed that bimanual dexterity is independent of the experience of gynecological surgeons. During laparoscopic surgical procedures, reduced variability in hand accelerations leads to better tissue manipulation. In addition, in gynecological and upper gastrointestinal procedures, reduced surgical workload is associated with improved surgical performance.

El seudoaneurisma del seno de Valsalva constituye una afeccion aortica sumamente infrecuente; por encima, incluso, de los aneurismas congenitos. Su etiologia engloba desde casos traumaticos e infecciosos hasta otros de naturaleza idiopatica. Presentamos el caso de un varon de 74 anos, con varios ingresos cardiologicos previos por infarto de miocardio y clinica sincopal y de dolor toracico atipico, en el que las pruebas diagnosticas angiograficas y de resonancia magnetica pusieron de manifiesto un seudoaneurisma de genesis espontanea a nivel del seno coronariano izquierdo. Asociaba, ademas, dilatacion de aorta ascendente e insuficiencia aortica grave sobre una valvula bicuspide. La correccion se llevo a cabo mediante sustitucion valvular aortica y de aorta ascendente sinusal y tubular proximal mediante tubo valvulado de dacron (protesis biologica), con buen resultado quirurgico. En el periodo postoperatorio preciso implantacion de marcapasos definitivo por fibrilacion auricular (FA) con bloqueo auriculoventricular (AV) completo. El paciente se halla, en la actualidad y tras 8 meses de seguimiento, asintomatico.

Objetivo El objetivo de no danar la arteria mamaria evitando su diseccion y clampaje supone un reto para la proteccion miocardica debido al lavado de la cardioplejia. Presentamos nuestra experiencia en reintervenciones sin disecar ni clampar los injertos arteriales. Material y metodos Desde septiembre de 2000 hasta febrero de 2010 se realizaron 29 reintervenciones en 28 pacientes, (89,7% varones), edad media 73,17 ± 7,38 anos. Las causas de reoperacion fueron: progresion de valvulopatia 17 pacientes (58,6%), endocarditis 10 (34,4%), disfuncion protesica no estructural 2 (6,9%). La mediana del EuroS-CORE logistico fue 14,84 (4-77,25). La cirugia fue urgente en 7 pacientes. Se realizo sustitucion valvular aortica aislada en 18 y se asocio revascularizacion en 4, sustitucion/plastia mitral en 4, sustitucion de aorta en 2; sustitucion mitral aislada en 1. La proteccion miocardica se realizo con cardioplejia hematica con esmolol, K + y Mg + , administrandola siempre que no dificultaba el trabajo quirurgico (intervalos nunca > 20 min). Temperatura sistemica media 32,26 ± 3,23 °C. Resultados La mediana del tiempo de circulacion extracorporea (CEC) fue 153 (91-494) y de clampaje 103 (71-430) min. Presentaron infarto postoperatorio 1 paciente (3,4%) y sindrome de bajo gasto postoperatorio 2 pacientes (6,5%). La mediana de troponina I postoperatoria fue 7,03 ng/ml (1,84-109,5). La mortalidad hospitalaria fue 3 pacientes (10,3%) (cirugia urgente por endocarditis). Las causas de mortalidad fueron: dano neurologico irreversible (1 paciente), sepsis y bajo gasto (2 pacientes). La mediana de estancia hospitalaria fue 7 (1-33) dias. Conclusion En nuestra experiencia, sin clampar los injertos arteriales y con la estrategia descrita, la proteccion miocardica parece adecuada y la mortalidad hospitalaria aceptable.

Objetivo Evaluar los resultados de la crioablacion de la fibrilacion auricular (FA) en pacientes sometidos a otra cirugia cardiaca. Material y metodos Entre julio de 2006 y septiembre de 2009 fueron tratados 152 pacientes (70 hombres/82 mujeres) con edad media de 69,85 anos, FA cronica en 122 (80,3%) pacientes, paroxistica en 19 (12,5%), y 3 (2%) en flutter, intervenidos de cirugia polivalvular y/o combinada 93, mitral 41, valvular aortica 13, y coronaria 3. Se realizo de forma endocardica en el 78,3% y biauricular en 5 pacientes. Ligadura de orejuela izquierda: 79,1%. Se hizo revision al alta, al mes, a los 3, 6, 12 meses y anualmente. Seguimiento medio de 17 meses (100% de los pacientes). Resultados Mortalidad hospitalaria: 16 (10,5%) pacientes, sin relacion con la tecnica. Mortalidad tardia: 10 (7,4%) pacientes. Necesidad de marcapasos 7 (4,6%) pacientes (Tabla 1). Tabla 1 . Ritmo Alta 1 mes 3 meses 6 meses 1 ano 2 anos N.° pacientes 136 135 134 122 08 53 Sinusal 61,7% 58,5% 62,7% 71,3% 73,1% (76,5 * /60,9 † ) 67,9% FA 28,6% 31,8% 28,3% 21,3% 19,5% 26,4% Marcapasos 9,6% 9,6% 9% 3,3% 7,4% 5,7% Anti arritmico 59,5% 60% 63,4% 59% 54,6% 39,6% ACO 97,1% 92,5% 88% 83,6% 68,2% 62,3% Ablacion: * endocardica; † epicardica. Conclusiones La curacion de la FA es posible y segura mediante crioablacion, si bien son necesarios estudios mas amplios en cuanto a tamano muestral y seguimiento. Nuestros resultados son similares a los publicados en la literatura.

Objetivo Comparacion entre la ablacion con criotermia (CT) y con ultrasonidos (US) desde la superficie epicardica en pacientes intervenidos por otra cardiopatia para valorar su seguridad y eficacia a corto y medio plazo. Material y metodos Entre julio de 2006 y septiembre de 2009 fueron tratados 86 pacientes (52 hombres/34 mujeres) con US, de edad media 74,15 anos, fibrilacion auricular (FA) cronica en 60 (69,8%) y 33 (15 hombres/18mujeres) con crioablacion, de edad media 73,09 anos, FA cronica en 78,8%. Todos fueron intervenidos para tratar su cardiopatia principal. Se hizo un seguimiento al alta, al mes, a los 3, 6, 12 meses y anualmente, en el 100% de los pacientes. Resultados Mortalidad hospitalaria: 9 (10,6%) y 3 (9,1%) pacientes con ambas tecnicas. No hubo complicaciones relacionadas con la tecnica ( Tabla 1 ). Conclusiones En nuestra experiencia, con la crioablacion y US no se ha encontrado ninguna diferencia estadistica significativa entre ambas.

Humoral Immune Response Against Low Density Lipoproteins in Insulin-Dependent Diabetes Mellitus

One of the mechanisms currently proposed to explain the cardioprotective effect of hormone replacement therapy (HRT) is the antioxidative property of estrogens. Considering that HRT involves the administration of an estrogen, usually combined with a progestin and sometimes with an androgen, we investigated the following in vitro: (1) the effect of estradiol, progesterone, and testosterone on the oxidation of low density lipoprotein; (2) the possible pro-oxidative effect of progesterone and testosterone on native low density lipoprotein; and (3) the possible modification of the antioxidant effect of estradiol on low density lipoprotein induced by progestins.Low density lipoprotein was isolated from blood samples obtained from 20 untreated postmenopausal women and divided in multiple aliquots, each containing 0.5 mg LDL protein. In Protocol 1 (n = 10) different doses of estradiol, progesterone, and testosterone ranging from 0 to 26 micrograms/ml were tested inducing oxidation with 15 microM copper sulfate. In Protocol 2 (n = 6) we studied the rate of oxidation of low density lipoprotein incubated with progesterone or testosterone without any oxidative induction. In Protocol 3 (n = 10) we studied the concomitant effect of 15 microM estradiol with four separate progestins (progesterone, medroxyprogesterone acetate, norethindrone, and norgestrel) in different doses (0, 5, 15, and 50 microM). After incubation for 4 h at 37 degrees C, malonaldehyde was measured as a marker of low density lipoprotein oxidation. The results were expressed in mean +/- SD.Protocol 1: Estradiol induced a dose-dependent decrease in malonaldehyde generation, from a baseline of 61.8 +/- 30.2 nmol/mg protein to 11.6 +/- 7.1 nmol/mg protein at the highest dose of estradiol tested (p0.0001). Progesterone or testosterone did not modify malonaldehyde generation. Protocol 2: Progesterone and testosterone did not show pro-oxidative action. Protocol 3: Estradiol 15 microM alone induced a 35% decrease in malonaldehyde generation, from a baseline of 75.4 +/- 25.4 to 49.3 +/- 18.8 nmol/mg protein (p0.0001). Norgestrel and norethindrone did not modify the antioxidant effect of estradiol (p0.05). Progesterone and medroxyprogesterone acetate induced a further reduction of malonaldehyde concentration to 37.2 +/- 20.8 and 38.6 +/- 18.2 nmol/mg protein, only at the highest dose tested (p0.02 and p0.01, respectively).Our results demonstrate that, in contrast with the potent antioxidant effect of estradiol, progesterone and testosterone did not show any pro- or antioxidant effect on low density lipoprotein in vitro. Furthermore, progestins did not counteract the antioxidant effect of estradiol in vitro.