ASSESSMENT OF SIMULATED SURGICAL DEXTERITY AFTER MODIFIABLE EXTERNAL EXPOSURES AMONG NOVICE VERSUS EXPERIENCED VITREORETINAL SURGEONS.

PURPOSE: To evaluate novice and senior vitreoretinal surgeons after various exposures. Multiple comparisons ranked the importance of these exposures for surgical dexterity based on experience. METHODS: This prospective cohort study included 15 novice and 11 senior vitreoretinal surgeons (<2 and >10 years' practice, respectively). Eyesi-simulator tasks were performed after each exposure. Day 1, placebo, 2.5 mg/kg caffeine, and 5.0 mg/kg caffeine; day 2, placebo, 0.2 mg/kg propranolol, and 0.6 mg/kg propranolol; day 3, baseline simulation, breathalyzer readings of 0.06% to 0.10% and 0.11% to 0.15% blood alcohol concentrations; day 4, baseline simulation, push-up sets with 50% and 85% repetitions maximum; and day 5, 3-hour sleep deprivation. Eyesi-generated score (0-700, worst-best), out-of-tolerance tremor (0-100, best-worst), task completion time (minutes), and intraocular pathway (in millimeters) were measured. RESULTS: Novice surgeons performed worse after caffeine (-29.53, 95% confidence interval [CI]: -57.80 to -1.27, P = 0.041) and alcohol (-51.33, 95% CI: -80.49 to -22.16, P = 0.001) consumption. Alcohol caused longer intraocular instrument movement pathways (212.84 mm, 95% CI: 34.03-391.65 mm, P = 0.02) and greater tremor (7.72, 95% CI: 0.74-14.70, P = 0.003) among novices. Sleep deprivation negatively affected novice performance time (2.57 minutes, 95% CI: 1.09-4.05 minutes, P = 0.001) and tremor (8.62, 95% CI: 0.80-16.45, P = 0.03); however, their speed increased after propranolol (-1.43 minutes, 95% CI: -2.71 to -0.15 minutes, P = 0.029). Senior surgeons' scores deteriorated only following alcohol consumption (-47.36, 95% CI: -80.37 to -14.36, P = 0.005). CONCLUSION: Alcohol compromised all participants despite their expertise level. Experience negated the effects of caffeine, propranolol, exercise, and sleep deprivation on surgical skills.

Os trigonum: a discussion of its role in posterior ankle impingement syndrome and a meta-analysis of its prevalence.

PURPOSE: the os trigonum is a supernumerary bone that may lead to posterior ankle impingement syndrome. The present study aims to assess the prevalence of this bone. METHODS: A meta-analysis regarding the presence of the os trigonum was performed. For this, the MEDLINE and SciElo databases were searched using "os trigonum" as the keyword. Only original articles, theses, books, dissertations, and monographs were included. Papers with a sample size of < 50 individuals were excluded. The data extracted from the articles were: the total sample size, the prevalence of the trigonum, the method of analysis, the region of the sample, and data regarding sex and side (left or right). Statistical analysis was performed using MedCalc Statistical Software version 14.8.1 (MedCalc Software bvba, Ostend, Belgium). The heterogeneity between the studies was assessed using the I² estimation and the Cochran Q test. For all analyses, a random effect was used and a value of p < 0.05 was considered significant. RESULTS: 249 papers were found, while 18 were included in the meta-analysis. A total of 17,626 ankles were included. The pooled prevalence of the os trigonum was 10.3% (95% CI 7-14.1%) in the present study. There was no significant difference regarding sex or side, while studies conducted in imaging exams showed a higher prevalence in comparison to cadaveric studies. CONCLUSION: Our results suggest that the os trigonum is relatively common. Knowledge of the prevalence of the os trigonum may help surgeons and clinicians diagnose posterior ankle impingement syndrome.

Hybrid crystalline bioparticles with nanochannels encapsulating acemannan from Aloe vera: Structure and interaction with lipid membranes.

Smart nanocarrier-based bioactive delivery systems are a current focus in nanomedicine for allowing and boosting diverse disease treatments. In this context, the design of hybrid lipid-polymer particles can provide structure-sensitive features for tailored, triggered, and stimuli-responsive devices. In this work, we introduce hybrid cubosomes that have been surface-modified with a complex of chitosan-N-arginine and alginate, making them pH-responsive. We achieved high-efficiency encapsulation of acemannan, a bioactive polysaccharide from Aloe vera, within the nanochannels of the bioparticle crystalline structure and demonstrated its controlled release under pH conditions mimicking the gastric and intestinal environments. Furthermore, an acemannan-induced phase transition from Im3m cubic symmetry to inverse hexagonal HII phase enhances the bioactive delivery by compressing the lattice spacing of the cubosome water nanochannels, facilitating the expulsion of the encapsulated solution. We also explored the bioparticle interaction with membranes of varying curvatures, revealing thermodynamically driven affinity towards high-curvature lipid membranes and inducing morphological transformations in giant unilamellar vesicles. These findings underscore the potential of these structure-responsive, membrane-active smart bioparticles for applications such as pH-triggered drug delivery platforms for the gastrointestinal tract, and as modulators and promoters of cellular internalization.

Retrospective case series of high-density silicone oil (Oxane HD) in severe proliferative vitreorretinal retinal detachment patients.

BACKGROUND: Describe complications and clinical outcomes of heavy silicone oil (HSO) Oxane HD® use as an alternative to overcome the challenges of performing vitrectomy to treat tractional and rhegmatogenous retinal detachments with proliferative vitreoretinopathy (PVR). METHODS: A retrospective, observational study was performed on patients from one center from August 2014 to Aug 2023. It was included patients who underwent surgery using HSO Oxane HD® to treat rhegmatogenous retinal detachment with PVR or mixed tractional and rhegmatogenous diabetic retinal detachment. Severely ill patients who could not attend to follow up were excluded. The primary outcome was successful retinal attachment at first postoperative month. A descriptive analysis was performed. RESULTS: Among the 31 patients, 29 (93.5%) underwent surgeries due to rhegmatogenous retinal detachment and two (6.5%) for diabetic retinal detachment. The primary anatomic success was achieved in 27 (87.1%) patients. At the final visit, 17 (56.6%) had vision better than 20/400 (range, 20/30 to light perception). The vision was stable or improved in 22 (76.8%) patients at the end of follow-up. Nineteen (61.3%) patients required hypotensive eye drops after HSO use and twelve (38.7%) still required hypotensive eye drops at the final follow-up; three (9.7%) patients required additional glaucoma surgeries. CONCLUSIONS: HSO is safe and useful for complex retinal detachments cases specially with inferior tears and PVR. Ocular hypertension is frequent and usually clinically controlled with hypotensive eyedrops. Close postoperatively follow-up is advised due to the ocular complications, particularly elevated intraocular pressure and emulsification.

Vitreoretinal surgical performance after acute alcohol consumption and hangover.

AIM: Routine alcohol testing of practicing physicians remains controversial since there are no uniform guidelines or legal regulations in the medical field. Our aim was to quantitatively study the acute and next-morning effects of breath alcohol concentration (BAC)-adjusted alcohol intake on overall simulated surgical performance and microtremor among senior vitreoretinal surgeons. METHODS: This prospective cohort study included 11 vitreoretinal surgeons (>10 years practice). Surgical performance was first assessed using the Eyesi surgical simulator following same-day alcohol consumption producing a BAC reading of 0.06%-0.10% (low-dose), followed by 0.11%-0.15% (high-dose). Dexterity was then evaluated after a 'night out' producing a high-dose BAC combined with a night's sleep. Changes in the total score (0-700, worst-best) and tremor (0-100, best-worst) were measured. RESULTS: Surgeon performance declined after high-dose alcohol compared with low-dose alcohol (-8.60±10.77 vs -1.21±7.71, p=0.04, respectively). The performance during hangover was similar to low-dose alcohol (-1.76±14.47 vs -1.21±7.71, p=1.00, respectively). The performance during hangover tended to be better than after high-dose alcohol (-1.76±14.47 vs -8.60±10.77, p=0.09, respectively). Tremor increased during hangover compared with low-dose alcohol (7.33±21.65 vs -10.31±10.73, p=0.03, respectively). A trend toward greater tremor during hangover occurred compared with high-dose alcohol (7.33±21.65 vs -4.12±17.17, p=0.08, respectively). CONCLUSION: Alcohol-related decline in simulated surgical dexterity among senior vitreoretinal surgeons was dose-dependent. Dexterity improved the following morning but remained comparable to after low-dose alcohol ingestion. Tremor increased during hangover compared with same-day intoxication. Further studies are needed to investigate extrapolations of these data to a real surgical environment regarding patient safety and surgeon performance.

An evaluation of treatment response and remission definitions in adult obsessive-compulsive disorder: A systematic review and individual-patient data meta-analysis.

INTRODUCTION: Expert consensus operationalized treatment response and remission in obsessive-compulsive disorder (OCD) as a Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) reduction ≥35% and score ≤12 with ≤2 on Clinical Global Impressions Improvement (CGI-I) and Severity (CGI-S) scales, respectively. However, there has been scant empirical evidence supporting these definitions. METHODS: We conducted a systematic review and an individual participant data meta-analysis of randomized-controlled trials (RCTs) in adults with OCD to determine optimal Y-BOCS thresholds for response and remission. We estimated pooled sensitivity/specificity for each percent reduction threshold (response) or posttreatment score (remission) to determine response and remission defined by a CGI-I and CGI-S ≤ 2, respectively. RESULTS: Individual participant data from 25 of 94 eligible RCTs (1235 participants) were included. The optimal threshold for response was ≥30% Y-BOCS reduction and for remission was ≤15 posttreatment Y-BOCS. However, differences in sensitivity and specificity between the optimal and nearby thresholds for response and remission were small with some uncertainty demonstrated by the confidence ellipses. CONCLUSION: While the empirically derived Y-BOCS thresholds in our meta-analysis differ from expert consensus, given the predominance of data from more recent trials of OCD, which involved more refractory participants and novel treatment modalities as opposed to first-line therapies, we recommend the continued use of the consensus definitions.

Eye-related emergency visits during the early phase of the coronavirus disease pandemic in a reference hospital in Sao Paulo, Brazil / Atendimento no pronto-socorro de oftalmologia durante o início da pandemia do Covid-19 em um hospital de referência em São Paulo, Brasil

ABSTRACT Purpose: To evaluate the profile of emergency eye-related visits at a reference eye hospital in Sao Paulo during the first months of the quarantine due to the coronavirus disease (COVID-19) pandemic and to compare it with that in the same period of the previous year. Methods: Data were obtained from the emergency department of Ophthal Hospital Especializado, Sao Paulo, Brazil. All the cases registered between March 23 and May 19, 2020, were included in the study as Group 2020. The cases registered between March 23 and May 19, 2019, were included in the study as Group 2019. Frequency tables were used for the descriptive analyses. The chi-square and Fisher exact tests were applied to compare categorical variables between the groups. Results: We observe a decrease of 46.15% in the number of cases during the COVID-19 pandemic in 2020 compared with the same period in 2019. We observed a significant increase in the incidence rates of the following pathologies in 2020 compared with 2019: eyelid disorders (12.3%), corneal disorders (97.1%), retinal pathologies (173.1%), refraction (62.9%), glaucoma (acute and chronic; 43.9%), scleral alterations (68.8%), trauma (39.3%), herpes (54.7%), and cataracts (549.9%). On the other hand, the incidence rates of the following disorders decreased: conjunctivitis (-33.4%), disorders of lacrimal system (-81.0%), iridocyclitis (-39.9%), and postoperative visits (-80.1%). Conclusion: During the early phase of the COVID-19 pandemic, we observed a drastic decrease in the number of patients who visited the emergency eye service. The main reasons for visiting were also changed, with higher frequencies of high-severity cases such as retina disturbances, cornea disturbances, glaucoma, and trauma and lower frequencies of transmittable conditions such as conjunctivitis.

RESUMO Objetivos: Avaliar o perfil das consultas de emergência oftalmológicas durante os primeiros meses de quarentena por pandemia de covid-19 em um hospital oftalmológico de referência em São Paulo e compará-lo com o mesmo período do ano anterior. Métodos: Os dados foram extraídos do serviço de emergência do Hospital Ophthal Especializado, São Paulo, Brasil. Todos os casos registrados entre 23 de março e 19 de maio de 2020 foram incluídos no estudo como Grupo 2020. Os casos registrados entre 23 de março e 19 de maio de 2019 foram incluídos no estudo como Grupo de 2019. Tabelas de frequência foram utilizadas para análises descritivas. Os testes Qui-quadrado e Exato de Fisher foram aplicados para comparar variáveis categóricas entre os grupos. Resultados: Observamos uma diminuição de 46,15% no número de casos durante a pandemia Covid-19 em 2020 quando comparado ao mesmo período sem pandemia em 2019. Foi observado um aumento significativo nos achados de pálpebra (+12,3%), córnea (+97,1%), retina (+173,1%), refração (+62,9%), glaucoma (+43,9%), esclera (+68,8%), trauma (+39,3%), herpes (+54,7%) e catarata (+549,9%) em 2020 quando comparado para 2019. Por outro lado, houve redução nos casos de conjuntivite (-33,4%), transtornos do aparelho lacrimal (-81,0%), iridociclite (-39,9%) e consultas pós-operatórias (-80,1%). Conclusão: durante a fase inicial da pandemia Covid-19, foi observada uma redução drástica no número de pacientes que procuram o serviço de emergência ocular. Houve também uma mudança nos principais motivos para visitas com frequências mais altas de casos de alta gravidade como distúrbios da retina, distúrbios da córnea, glaucoma e trauma, e frequências mais baixas de condições transmissíveis como conjuntivite.

Scleral communication between Glaucoma drainage device capsule and the suprachoroidal space simulating amelanotic choroidal melanoma / Comunicação escleral entre a cápsula de dispositivo de drenagem para glaucoma e o espaço supracoroidal simulando melanoma de coroide amelanótico

ABSTRACT This is a case report involving a 56-year-old male patient with a history of pars plana vitrectomy due to a rhegmatogenous retinal detachment in the right eye that resulted in the implantation of a drainage device after the patient developed secondary glaucoma. Two years after the device's implantation, the patient was referred to our care as his visual acuity had decreased to 20/200 (1.00 LogMAR). At the fundus evaluation, a choroidal amelanotic elevation was observed at the upper temporal equator, and a potential diagnosis was made of amelanotic choroidal melanoma. The ultrasound exam visualized the patient's implanted superotemporal justabulbar drainage device, which revealed a transscleral communication from the plate fibrocapsular's draining space to the suprachoroidal space (fistula). The ultrasound also revealed a focal pocket of choroidal detachment in the patient's superotemporal region, simulating an amelanotic choroidal melanoma. A new pars plana vitrectomy was performed to remove the internal limiting membrane without repercussions at the fistula site. The patient's recovery progressed well, and he regained a visual acuity of 20/70 (0.55 LogMAR). To the best of our knowledge, this is the first case report of this condition.

RESUMO Relato de caso de paciente 56 anos, sexo masculino, com histórico de vitrectomia via pars plana por descolamento de retina em olho direito e posterior implante de dispositivo de drenagem por glaucoma secundário. Dois anos após o procedimento foi encaminhado ao serviço por baixa de acuidade visual (AV) de 20/200 (1.00 LogMAR). À fundoscopia, observou-se uma elevação amelanótica temporal no equador com hipótese diagnóstica de melanoma de coroide amelanótico. O exame de ultrassom mostrou implante de dispositivo de drenagem justabulbar temporal superior com comunicação transescleral para espaço subcoroidal (fístula), sugerindo bolsão focal de descolamento de coroide em equador temporal superior simulando melanoma de coroide amelanótico. O paciente foi abordado cirurgicamente devido membrana epirretiniana com nova vitrectomia via pars plana para peeling de membrana limitante interna, sem repercussões no local da fístula, evoluindo bem com acuidade visual de 20/70 (0.55 LogMAR). Ao nosso conhecimento, este é o primeiro caso relatado nessa condição.

Mucinous Cystadenoma Arising in a Uterine Isthmocele: A Case Report / Cistadenoma mucinoso surgindo em istmocele uterina: relato de caso

Abstract Isthmocele is a discontinuation of the myometrium at the uterine scar site in a patient with a previous cesarian section (CS). The cause of isthmocele appears to be multifactorial. Poor surgical technique, low incision location, uterine retroflection, obesity, smoking, inadequate healing of scars, and maternal age are possible related factors. Most patients with this condition are asymptomatic. However, women can present with postmenstrual bleeding, pelvic pain, subfertility, dysmenorrhea, infertility, and scar abscess. Brazil has one of the world s highest cesarean section rates. One of the consequences of the rising rate of CS is the isthmocele, an emerging female health problem. Here we report a case of mucinous cystadenoma arising in a uterine isthmocele, a complication, as far as we could investigate, not yet described in the literature.

Resumo Istmocele é a descontinuidade do miométrio no local da cicatriz uterina em paciente com cesariana anterior. A causa da istmocele parece ser multifatorial. Má técnica cirúrgica, baixa localização da incisão, retroflexão uterina, obesidade, tabagismo, cicatrização inadequada de cicatrizes e idade materna são possíveis fatores relacionados. A maioria dos pacientes com esta condição é assintomática. No entanto, as mulheres podem apresentar sangramento pós-menstrual, dor pélvica, subfertilidade, dismenorreia, infertilidade e abscesso cicatricial. O Brasil tem uma das maiores taxas de cesariana do mundo. Uma das consequências da taxa crescente de cesarianas é a istmocele, um problema emergente de saúde feminina. Aqui relatamos um caso de cistoadenoma mucinoso originado em uma istmocele uterina, uma complicação ainda não descrita, até onde pudemos investigar.

Os Intermetatarseum: A Rare Variation of Great Relevance / Os Intermetatarseum: Una Rara Variación de Gran Relevancia

SUMMARY: The os intermetatarseum is an accessory bone located in the foot, usually between the first 2 metatarsals and the cuneiform bone. It can be presented as free, articulated or in a fused fashion. It is a very unusual variation found in less than 13 % of the population. A 27-year-old patient presented to the emergency service due to an ankle lesion. Physical exam showed pain and limited range of motion while supporting partial load. Radiographic imaging showed a bony trace near the base of the first and second metatarsals, diagnosed as the os intermetatarseum. Formation of this supernumerary bone begins as a separate ossification center. Most cases are asymptomatic; however, compression of the deep peroneal nerve branches by the os intermetatarseum can lead to pain. Some authors suggest that the presence of this bone may cause hallux valgus. The intermetatarseum can lead to diagnostic confusion, mainly related to Lisfranc fracture. Its origin is still little understood.

El os intermetatarseum es un hueso accesorio ubicado en el pie, generalmente entre los 2 primeros metatarsianos y el hueso cuneiforme. Puede presentarse de forma libre, articulada o fusionada. Es una variación muy inusual que se encuentra en menos del 13 % de la población. Paciente de 27 años que acude a urgencias por lesión en tobillo. El examen físico mostró dolor y rango de movimiento limitado mientras soportaba una carga parcial. Las imágenes radiológicas mostraron un rastro óseo cerca de la base del primer y segundo metatarsianos, diagnosticado como os intermetatarseum. La formación de este hueso supernumerario comienza como un centro de osificación separado. La mayoría de los casos son asintomáticos; sin embargo, la compresión de las ramas profundas del nervio fibular en el espacio intermetatarsiano puede provocar dolor. Algunos autores sugieren que la presencia de este hueso puede provocar hallux valgus. El hueso intermetatarsiano puede llevar a confusión diagnóstica, principalmente relacionada con la fractura de Lisfranc. Su origen aún es poco comprendido.

Equivalent keratometer reading para cálculo biométrico em córneas assimétricas: série de casos / Equivalent keratometer reading tool for biometric calculation in asymmetric corneas: case series

RESUMO A acurácia do cálculo da lente intraocular não é perfeita, podendo ser comuns erros refrativos pós-operatórios, especialmente em pacientes submetidos à cirurgia refrativa prévia ou na presença de córneas assimétricas. O poder corneano após cirurgia refrativa pode ser medido com maior acurácia utilizando o mapa de poder óptico total na zona central de 4mm, com Orbscan II ou pelo mapa equivalent keratometric reading disponível no pentacam, com medidas centrais de 1,0, 2,0, 3,0 e 4,5mm. O objetivo desta série de casos é demonstrar a abordagem de quatro olhos em condições especiais corneanas, por meio do equivalent keratometric reading do pentacam para mensuração do poder corneano e o utilizando na biometria, em comparação com possíveis resultados obtidos com outras estratégias. Os quatro olhos foram submetidos a procedimentos refrativos prévios, e a lente intraocular escolhida a partir do uso do poder corneano calculado pelo equivalent keratometric reading mostrou excelentes resultados pós-operatórios.

ABSTRACT The accuracy of the intraocular lens calculation is not perfect, and postoperative refractive errors are common, especially in patients who have undergone previous refractive surgery or in presence of asymmetric corneas. Corneal power after refractive surgery can be more accurately measured using the total optical power map in the 4-mm central zone, by means of Orbscan II or equivalent keratometric reading map available on pentacam, with central measurements of 1.0, 2.0, 3.0 and 4.5 mm. The purpose of this case series is to demonstrate four approaches performed in special corneal conditions, using pentacam equivalent keratometric reading to measure corneal power and biometrics, and comparing with possible results obtained with other strategies. The four eyes were submitted to previous refractive procedures, and the intraocular lens chosen from the use of the corneal power calculated by equivalent keratometric reading showed excellent postoperative results.

Supernumerary muscles in the posterior leg compartment: a case report / Músculos supernumerarios en el compartimento posterior de la pierna: reporte de un caso

SUMMARY: The leg muscles are organized in anterior, lateral and posterior compartments. The posterior compartment is usually divided in two layers: superficial and deep. The deep muscles of the posterior compartment of the leg are known to mainly plantar flexion and toes flexion. In comparison to the other leg compartments, variations of the posterior one are rare. These variants often involve the presence or absence of one or more muscles, and they have differences among origin and insertion, which leads to confusion between anatomists. We aim to describe a case of a male cadaver that possessed three supernumerary muscles in the lateral and posterior compartments of both legs: the peroneus quartus muscle and two accessory bellies of the flexor digitorum longus. This presentation seems to be very rare and scarcely reported in the literature. These variants have the potential of causing nervous or vascular compression, thus leading to tarsal tunnel syndrome or a symptomatic peroneus quartus. The clinical and surgical implications of this abnormal presentation is discussed.

RESUMEN: Los músculos de la pierna están organizados en compartimentos anterior, lateral y posterior. El compartimento posterior por lo general es dividido en dos capas: superficial y profunda. Se sabe que los músculos profundos del compartimento posterior de la pierna se caracterizan principalmente por participar de la flexión plantar y la flexión de los dedos de los pies. En comparación con los otros compartimentos de la pierna, las variaciones musculares en el compartimiento posterior son raras. Estas variantes suelen implicar la presencia o ausencia de uno o más músculos y presentan diferencias en el origen y en la inserción, lo que conduce a confusión entre los anatomistas. Nuestro objetivo fue describir el caso de un cadáver masculino que poseía tres músculos supernumerarios en los compartimentos lateral y posterior de ambas piernas: el músculo fibular cuarto y dos vientres accesorios del músculo flexor largo de los dedos. Esta presentación parece ser muy rara y escasamente reportada en la literatura. Estas variantes musculares tienen el potencial de causar compresión nerviosa o vascular, lo que conduce al síndrome del túnel del tarso o un cuarto músculo fibular sintomático. Se discuten las implicaciones clínicas y quirúrgicas de esta presentación anormal.

Changes in ecosystem functions generated by fish populations after the introduction of a non-native predator (Cichla kelberi) (Perciformes: Cichlidae)

The introduction of non-native predators is a matter of great concern, but their impacts on ecosystem functions remain poorly understood. We investigated how changes in fish diversity following the invasion of Cichla kelberi affected ecosystem functions generated by fish populations. Fish assemblages were sampled in macrophyte patches in a Neotropical impoundment over a 5-year period, before and after the introduction of the predator. We assigned seven ecosystem functions (26 trait-states) to each fish species, and examined how these functions behaved after the invasion. We collected 577 fish belonging to 25 species. Species richness, fish biomass and main species declined significantly over periods. The biomass of ecosystem functions changed significantly over time, and most trait-states declined. Few trait-states were lost, but all functions had at least one trait-state reduced by more than 85%. A null model analysis showed that changes in functions were not driven by species identities, while species richness correlated positively with total biomass and with most functions, suggesting that the loss of taxa and biomass drove observed changes in ecosystem functions. Our study provided evidence that community disassembly associated with the invasion of C. kelberi translated to the decline of several ecosystem functions, affecting energy mobilization and transference.(AU)

A introdução de predadores não-nativos tem gerado grande preocupação, mas seus impactos sobre a geração de funções ecossistêmicas permanecem pouco investigados. O presente estudo investigou como mudanças na diversidade de peixes, associadas com a invasão de Cichla kelberi, afetaram funções ecossistêmicas geradas por populações de peixes. As assembleias de peixes foram amostradas em bancos de macrófitas em um grande reservatório Neotropical durante um período de cinco anos, antes e depois da introdução do predador. Um conjunto de funções ecossistêmicas (26 trait-states) foi atribuído a cada espécie de peixe, e examinamos como as funções se comportaram depois da invasão. Foram coletados 577 peixes pertencentes a 25 espécies. Registramos declínio significativo da riqueza de espécies, biomassa total e biomassa das principais espécies ao longo dos períodos. A biomassa das funções ecossistêmicas mudou significativamente ao longo do tempo, e a maioria dos trait-states declinou. Poucos trait-states foram perdidos, mas todas as funções tiveram pelo menos um trait-state reduzido em mais de 85%. Uma análise de modelos nulos mostrou que as mudanças nas funções não foram impulsionadas pela identidade das espécies, enquanto que a riqueza de espécies correlacionou positivamente com a biomassa total e com a maioria das funções, sugerindo que a perda de espécies e biomassa impulsionou as mudanças observadas nas funções ecossistêmicas. Nosso estudo apresenta evidências de que a desestruturação da comunidade, associada com a invasão de C. kelberi, se traduziu no declínio de várias funções ecossistêmicas, afetando a mobilização e transferência de energia.(AU)

Dermolipectomia trocantérica em paciente pós-cirurgia bariátrica: relato de caso / Trochanteric dermolipectomy in a patient after bariatric surgery: case report

Introdução: Atualmente com o aumento das gastroplastias redutoras (cirurgia bariátrica) e grande perda ponderal, há também um aumento na procura destes pacientes pela cirurgia plástica. Uma das características destes pacientes é o excesso de tecido dermogorduroso que causa deformidades, principalmente nos membros inferiores, acometendo a região trocantérica. Objetivo: Relatar um caso de dermolipectomia trocantérica em paciente pós-cirurgia bariátrica, onde a lipoaspiração por si só não resolveria a correção da deformidade. Relato de caso: IPMS, sexo feminino, 55 anos, histórico de gastroplastia redutora (cirurgia bariátrica) com grande perda ponderal. Relata desconforto importante com a lipodistrofia e extensa flacidez em região trocantérica bilateral. Após avaliação pela equipe, foi optado por realizar dermolipectomia trocantérica bilateral, em janeiro de 2019, no Serviço de Cirurgia Plástica Osvaldo Saldanha. Discussão: Nos casos de lipodistrofia trocantérica com deformidades graves, a cicatriz da dermolipectomia em relação à deformidade é favorável quanto a escolha desta técnica, pois a lipoaspiração poderá agravar ainda mais a deformidade, sendo mandatório utilizar a técnica de dermolipectomia trocantérica para corrigila. Quanto à lipodistrofia com deformidade moderada há dúvida entre a relação do benefício e a deformidade resultante, sendo aplicada a técnica de acordo com a necessidade do paciente e, por fim, nos casos de lipodistrofia com deformidade leve, opta-se pela lipoaspiração devido à correção ser realizada sem grandes cicatrizes aparentes. Conclusão: Portanto, a lipoaspiração tem benefício nos casos de adiposidade localizada, limitando as indicações da técnica de dermolipectomia, em especial na região trocantérica, sem invalidá-la para casos selecionados, como o descrito neste relato de caso.

Introduction: Currently, with the increase in reducing gastroplasty (bariatric surgery) and the great weight loss, there is also an increase in the demand of these patients for plastic surgery. One of the characteristics of these patients is the excess of dermal adipose tissue that causes deformities, especially in the lower limbs, affecting the trochanteric region. Objective: To report a case of trochanteric dermolipectomy in a patient after bariatric surgery, where liposuction alone would not solve the correction of the deformity. Case report: IPMS, female, 55 years old, history of reducing gastroplasty (bariatric surgery) with great weight loss. She reports significant discomfort with lipodystrophy and extensive flacidity in the bilateral trochanteric region. After the team's evaluation, it was decided to perform bilateral trochanteric dermolipectomy, in January 2019, at the Plastic Surgery Service Osvaldo Saldanha Discussion: In cases of trochanteric lipodystrophy with severe deformities, the scar of dermolipectomy in relation to the deformity is favorable in terms of the choice of this technique, since liposuction may further aggravate the deformity, and it is mandatory to use the trochanteric dermolipectomy technique to correct it. Conclusion: Therefore, liposuction is beneficial in cases of localized adiposity, limiting the indications for the dermolipectomy technique, especially in the trochanteric region, without invalidating it for selected cases, as described in this case report.

Agenesis of the posterior arch of the atlas: an incidental finding in a polytraumatized patient / Agenesia de arco posterior de atlas: um achado acidental em um paciente politraumatizado / Agenesia del arco posterior del atlas: un hallazgo incidental en un paciente politraumatizado

ABSTRACT The first cervical vertebra is subject to numerous anatomical variations. One of these is posterior arch agenesis, which is classified into five distinct morphological types. Together, all types of posterior arch agenesis comprise only 4% of atlas variations. Furthermore, complete agenesis of the posterior arch associated with the presence of the posterior tubercle is rare. This work reports a case of posterior arch agenesis with the presence of the posterior tubercle in a 33 year-old male victim of a motor vehicle collision. Despite being asymptomatic, this anatomical variation can present with headaches and neck pain. It is mostly found as an incidental finding in imaging studies performed by the emergency team and, as a result, it is often misdiagnosed as a C1 fracture. Knowledge of the variations relating to the first cervical vertebra is therefore essential to avoid delays in diagnosis and treatment of polytraumatized patients. Level of evidence V; Case report.

RESUMO A primeira vértebra cervical é alvo de inúmeras variações anatômicas. Uma destas inclui a agenesia do seu arco posterior, que é classificada em cinco tipos morfológicos distintos. Apesar de uma incidência de 4% na população em geral, a agenesia completa do arco posterior, associada à presença do tubérculo posterior do atlas, é rara. Objetivou-se no presente trabalho relatar a agenesia completa do arco posterior com a presença do tubérculo posterior da primeira vértebra cervical em um paciente de 33 anos de idade, que sofreu um acidente automobilístico. Em geral, essa condição é assintomática, porém, essa variação anatômica pode causar sintomas como dores de cabeça. Na maioria dos casos, é um achado acidental em exames de imagem realizados pela equipe de emergência. Como resultado, a agenesia de arco posterior de atlas pode ser interpretada erroneamente como uma fratura. Portanto, o conhecimento das variações anatômicas da primeira vértebra cervical é essencial para evitar erro no diagnóstico e tratamento de pacientes politraumatizados. Nível de Evidência V; Relato de caso.

RESUMEN La primera vértebra cervical puede presentar numerosas variaciones anatómicas. Una de ellas es la agenesia del arco posterior, que se clasifica en cinco tipos morfológicos distintos. En conjunto, todos los tipos de agenesia del arco posterior comprenden solo el 4% de las variaciones del atlas. Además, la agenesia completa del arco posterior asociada con la presencia del tubérculo posterior es rara. Este trabajo relata un caso de agenesia del arco posterior con presencia del tubérculo posterior en un paciente del sexo masculino de 33 años de edad que sufrió un accidente automovilístico. A pesar de ser asintomática, esta variación anatómica puede causar dolores de cabeza y cuello. Se encontra principalmente como hallazgo incidental en pruebas de imagen realizadas por el equipo de emergencia y como resultado, a menudo se diagnostica erróneamente como una fractura de C1. El conocimiento de las variaciones anatómicas de la primera vértebra cervical es, por lo tanto, esencial para evitar retrasos en el diagnóstico y tratamiento de pacientes politraumatizados. Nivel de Evidencia V; Relato de caso.

Effects of concurrent training associated with N-acetylcysteine on bone density of spontaneously hypertensive rats

Abstract Aim: The present study aimed to analyze the effects of N-acetylcysteine supplementation associated with concurrent training on the bone mineral density of spontaneously hypertensive elderly rats. Methods: For the present study, 28 male spontaneously hypertensive rats, six months old, were distributed in the following groups: control (C, n=7); control + N-acetylcysteine (CNAC, n=7); concurrent training (T, n=7); and concurrent training+N-acetylcysteine (TNAC, n=7). The concurrent training was composed of aerobic training on a treadmill and resistance training in the same training session, three times a week. Animals of the NAC groups received a dose equivalent to 120 mg/kg/day orally for eight weeks. The animals in the trained groups underwent training for eight weeks. The animals were evaluated at the beginning and end of the experiment. After euthanasia, the tibias and femurs were submitted to bone densitometry analysis in an X-ray dual emission device. Results: Lower weight variation was observed in the trained animals and a reduction in pressure values in all groups, but without a statistical difference (p> 0.05). The animals in the T and TNAC groups presented a better performance in the physical tests (p <0.05). In relation to bone, the NAC groups demonstrated a decrease in femoral bone density when compared to groups C and T. Finally, all experimental groups demonstrated an increase in tibial bone density, but with no statistical difference (p>0.05). Conclusion: The animals in group T demonstrated better performance in the physical tests. In addition, the NAC caused a reduction in the bone mineral density of the femur.

Introduction of robotic surgery for endometrial cancer into a Brazilian cancer service: a randomized trial evaluating perioperative clinical outcomes and costs

OBJECTIVE: The purpose of this study was to evaluate the clinical outcome and costs after the implementation of robotic surgery in the treatment of endometrial cancer, compared to the traditional laparoscopic approach. METHODS: In this prospective randomized study from 2015 to 2017, eighty-nine patients with endometrial carcinoma that was clinically restricted to the uterus were randomized in robotic surgery (44 cases) and traditional laparoscopic surgery (45 cases). We compared the number of retrieved lymph nodes, total time of surgery, time of each surgical step, blood loss, length of hospital stay, major and minor complications, conversion rates and costs. RESULTS: The ages of the patients ranged from 47 to 69 years. The median body mass index was 31.1 (21.4-54.2) in the robotic surgery arm and 31.6 (22.9-58.6) in the traditional laparoscopic arm. The median tumor sizes were 4.0 (1.5-10.0) cm and 4.0 (0.0-9.0) cm in the robotic and traditional laparoscopic surgery groups, respectively. The median total numbers of lymph nodes retrieved were 19 (3-61) and 20 (4-34) in the robotic and traditional laparoscopic surgery arms, respectively. The median total duration of the whole procedure was 319.5 (170-520) minutes in the robotic surgery arm and 248 (85-465) minutes in the traditional laparoscopic arm. Eight major complications were registered in each group. The total cost was 41% higher for robotic surgery than for traditional laparoscopic surgery. CONCLUSIONS: Robotic surgery for endometrial cancer presented equivalent perioperative morbidity to that of traditional laparoscopic surgery. The duration and total cost of robotic surgery were higher than those of traditional laparoscopic surgery.

Orthopedic implications of the corona mortis: a case report / Implicaciones ortopédicas de la corona mortis: reporte de un caso

SUMMARY: Corona mortis is classified as a connection between the inferior epigastric and obturator vessels over the superior pubic ramus. Its incidence varies among different studies. The corona mortis is an extremely important anatomical variation as it can be injured in a great number of procedures. Moreover, it can also be injured during pelvic or acetabular fractures. A male cadaver fixed in a 10 % formalin solution had its pelvic region dissected and an arterial corona mortis was observed on its right side. The left hemipelvis presented no variations whatsoever. This vessel was measured with the aid of a digital caliper. We aim to report this variation and address - from an orthopedic point of view - the clinical and surgical significance of the corona mortis.

RESUMEN: La corona mortis es clasificada como una conexión entre los vasos epigástricos inferiores y obturadores sobre la rama superior del pubis. Su incidencia varía según los diferentes estudios. La corona mortis es una variación anatómica extremadamente importante, ya que se es posible dañarla en un número significativo de procedimientos. Además, también puede resultar lesionada durante las fracturas pélvicas o acetabulares. Durante la disección de un cadáver de sexo masculino fijado en solución de formalina al 10 %, se observó la corona mortis arterial en el lado derecho de la región pélvica. El lado izquierdo de la pelvis no presentó ninguna variación. Se midió la corona mortis con ayuda de un calibre digital. Nuestro objetivo fue informar sobre esta variación y abordar - desde el punto de vista ortopédico - la importancia clínica y quirúrgica de la corona mortis.

Single-Site Robotic Radical Hysterectomy and Sentinel Lymphnode Biopsy in Cervical Cancer: A Case Report / Histerectomia radical robótica de portal único e biópsia de linfonodo sentinela: relato de caso

ABSTRACT Robotic surgeries for cervical cancer have several advantages compared with lapa-rotomic or laparoscopic surgeries. Robotic single-site surgery has many advantages compared with the multiport approach, but its safety and feasibility are not established in radical oncologic surgeries. We report a case of a Federation of Gynecology and Obstetrics (FIGO) stage IB1 cervical carcinoma whose radical hysterectomy, sentinel lymph node mapping, and lymph node dissection were entirely performed by robotic single-site approach. The patient recovered very well, and was discharged from the hospital within 24 hours.

RESUMO A cirurgia robótica para carcinoma do colo do útero apresenta vantagens quando comparada com cirurgias laparotômicas ou laparoscópicas. A cirurgia robótica de portal único tem muitas vantagens quando comparada com cirurgias de múltiplos acessos, porém a segurança e a viabilidade deste procedimento ainda não estão estabelecidas para cirurgias oncológicas radicais. Apresentamos um caso de carcinoma de colo do útero, tratado por histerectomia radical, identificação e biópsia de linfonodo sentinela e linfadenectomia pélvica realizada totalmente por cirurgia robótica de acesso único. A paciente recuperou-se bem e recebeu alta no primeiro dia pós-operatório.