Genotoxicity and cytotoxicity of antineoplastic drugs at environmentally relevant concentrations after long-term exposure.

Introduction: 5-fluorouracil (5-FU) and methotrexate (MTX) are the antineoplastic drugs most commonly used worldwide. Considered cytotoxic, these pharmaceuticals exhibit low specificity, causing damage not only to cancer cells but also to healthy cells in organisms. After being consumed and metabolized, these drugs are excreted through urine and feces, followed by wastewater treatment. However, conventional treatments do not have the capacity to completely remove these substances, risking their introduction into freshwater systems. This could pose a risk to human health even at low concentrations. Aims: Thus, the present study aimed to investigate the genotoxicity, cytotoxicity, and mutagenicity of 5-FU and MTX at environmentally relevant concentrations after a long-term exposure, using adult male rats as an experimental model. Methods: Male Wistar rats (70 days old) were distributed into 4 groups (n = 10/group): control, received only vehicle; MTX, received methotrexate at 10ngL-1; 5-FU received 5-fluorouracil at 10ngL-1; and MTX + 5-FU, received a combination of MTX and 5-FU at 10ngL-1 each. The period of exposure was from postnatal day (PND) 70 to PND 160, through drinking water. After that, the animals were euthanized and the samples (liver, testis, femoral bone marrow, and peripheral blood) were obtained. Results: Increased DNA fragmentation was observed in the peripheral blood, liver, and testis, altering the parameters of the tail moment and tail intensity in the Comet assay. Besides, the change in the ratio between PCE and NCE indicates bone marrow suppression. Conclusion: These findings warn the adverse effects for the general population worldwide chronically exposed to these drugs at trace concentration unintentionally.

Challenges in Management of Concomitant Primary Aldosteronism and Pheochromocytoma.

BACKGROUND Primary aldosteronism and pheochromocytoma are endocrine causes of secondary arterial hypertension. The association of primary aldosteronism and pheochromocytoma is rare and the involved mechanisms are poorly understood. Either there is a coexistence of both diseases or the pheochromocytoma stimulates the production of aldosterone. Since management approaches may differ significantly, it is important to properly diagnose the 2 conditions. We describe concomitant pheochromocytoma and primary aldosteronism in a patient with resistant hypertension, which demanded a challenging and individualized approach. CASE REPORT A 64-year-old man was sent for observation in our department for type 2 diabetes and resistant hypertension. Laboratory work-up suggested a primary aldosteronism and a pheochromocytoma. The abdominal CT (before and after intravenous contrast, with portal and delayed phase acquisitions) revealed an indeterminate right adrenal lesion and 3 nodules in the left adrenal gland: 1 indeterminate and 2 compatible with adenomas. A 18F-FDOPA PET-CT showed increased uptake in the right adrenal gland. The patient underwent a right adrenalectomy and a pheochromocytoma was confirmed. An improvement in glycemic control was observed after surgery but the patient remained hypertensive. A captopril test confirmed the persistence of primary aldosteronism, and he was started on eplerenone, achieving blood pressure control. CONCLUSIONS This case highlights the challenges in diagnosing and treating the simultaneous occurrence of pheochromocytoma and primary aldosteronism. Our main goal was surgical removal of the pheochromocytoma due to the risk of an adrenergic crisis.

Como eu faço avaliação ecocardiográfica de pericardite constritiva / My approach to echocardiographic assessment for constrictive pericarditis

A pericardite constritiva (PC) é uma condição na qual a cicatrização e perda de elasticidade do pericárdio resultam em enchimento ventricular prejudicado, disfunção diastólica e insuficiência cardíaca direita. O diagnóstico dessa patologia é desafiador, sendo frequente a necessidade de técnicas de imagem multimodal, dentre as quais a ecocardiografia representa a modalidade de imagem inicial para a avaliação diagnóstica, além de permitir a diferenciação da PC da cardiomiopatia restritiva (CMR) e outras condições que mimetizam constrição. (AU)

Constrictive pericarditis (CP) is a condition in which scarring and loss of elasticity of the pericardium result in impaired ventricular filling, diastolic dysfunction, and right heart failure. The diagnosis of this pathology is challenging, with frequent need for multimodal imaging techniques, among which echocardiography represents the initial imaging modality for the diagnostic evaluation, in addition to allowing the differentiation of CP from restrictive cardiomyopathy (RCM) and other conditions that mimic constriction. (AU)

Postmenopausal sexual function and steroid hormone levels: a hospital-based cross-sectional study.

OBJECTIVE: Steroid hormone levels, particularly androgens, play an important role in sexual function in premenopausal women, but this relationship is not so well determined after menopause. This study aimed to assess the association between steroid hormone levels and sexual function in postmenopausal women. METHODS: A total of 84 postmenopausal women with intact ovaries, who had never used systemic hormone therapy, were enrolled in a cross-sectional study. Sexual function was assessed using the Female Sexual Function Index (FSFI) questionnaire and serum levels of steroid hormones were quantified by gas chromatography and tandem mass spectrometry. Associations between estradiol, testosterone, dehydroepiandrosterone, androstenedione and FSFI domain scores were evaluated. RESULTS: After adjustment for confounding variables, the analysis revealed a statistically significant association between androstenedione and overall sexual function (ß = 1.23, 95% confidence interval [CI] [0.37; 1.98], p = 0.010), arousal (ß = 0.19, 95% CI [0.02; 0.37], p = 0.034), orgasm (ß = 0.33, 95% CI [0.15; 0.45], p = 0.001) and satisfaction (ß = 0.25, 95% CI [0.11; 0.36], p = 0.001). No associations were found between the other hormones and FSFI domains. CONCLUSION: The main finding of this study is the association of androstenedione with sexual function in postmenopausal women, not verified for other steroid hormones. Further studies are necessary to determine the importance of androstenedione for postmenopausal sexual function.

Ocimum gratissimum essential oil and eugenol against Ctenocephalides felis felis and Rhipicephalus sanguineus: In vitro activity and residual efficacy of a eugenol-based spray formulation.

Fleas and ticks are among the main ectoparasites that affect pets. The indiscriminate and incorrect use of chemical antiparasitics may be related to increased insect resistance and environmental contamination, requiring prospection for active ingredients that are less harmful to animals, humans and the environment. The use of essential oils and their isolated compounds has been reported as a potential alternative to synthetic antiparasitics, but there is a lack of studies involving the design and development of stable and safe natural products-based formulations. Therefore, the aim of this study was to establish LC50 and LC90 of Ocimum gratissimum essential oil and eugenol on immature stages and adults of Ctenocephalides felis felis and Rhipicephalus sanguineus; and to design and to determine the in vitro efficacy and residual effect of a natural product-based spray formulation for flea and tick control in pets. Bioassays were carried out according to the filter paper impregnation technique for fleas and through the larval packet test for ticks. O. gratissimum essential oil and eugenol presented pulicidal and acaricidal activity in vitro against immature stages and adults of C. felis felis and immature stages of R. sanguineus. The greater potency of eugenol against fleas and ticks led to the choice of eugenol as the active ingredient in the pharmaceutical form developed. The developed eugenol-based sprays presented adequate physical and chemical characteristics and stability, had pulicidal and acaricidal efficacy after 24 h and residual effect against fleas for up to 48 days.

Retalho nasogeniano de pedículo inferior na reconstrução de asa nasal / Inferior pedicle nasolabial flap in nasal ala reconstruction

Introdução: A asa nasal sempre foi uma grande dificuldade reconstrutiva e, na busca de um retalho com características da pele semelhantes a esta, deparamos com o retalho nasogeniano de pedículo inferior. O objetivo do trabalho foi demonstrar a viabilidade do retalho proposto para reconstrução da asa nasal após a retirada de tumores cutâneos. Métodos: Foram analisados 20 casos de retalho nasogeniano de pedículo inferior realizados com a mesma técnica cirúrgica no período entre 2008 e 2019 e acompanhados por um ano de pós-operatório. Resultados: Dos 20 casos estudados, 13 (65%) não apresentaram complicações, sendo as mais relatadas: cobertura parcial do defeito e desaparecimento parcial do sulco nasogeniano. Conclusão: O retalho nasogeniano de base inferior mostrou ser um retalho viável à reconstrução da asa nasal pela qualidade de pele, fácil execução e índices mínimos de complicações.

Introduction: The nasal alar has always been a major reconstructive diflculty, and in the search for a flap with skin characteristics similar to this one, we came across the inferiorly based nasolabial flap. The objective of this study was to demonstrate the viability of the proposed flap for reconstruction of the nasal alar after removal of skin tumors. Methods: This study analysed twenty cases of inferiorly based nasolabial flap performed with the same surgical technique in the period between 2008-2019 and followed up for one year of postoperative. Results: Of the 20 studied cases, 13 (65%) did not present complications, being the most described: partial defect coverage and partial disappearance of the nasolabial sulcus. Conclusion: The inferiorly based nasolabial flap proved to be a viable flap for nasal alar reconstruction due to the quality of the skin, easy execution, and minimal complication rates.

Growth and survival of the native oyster Crassostrea gasar cultured under different stocking densities in two grow-out systems in tropical climate / [Crescimento e sobrevivência da ostra nativa Crassostrea gasar cultivada em diferentes densidades em dois sistemas em clima tropical]

Survival and growth of the native oyster Crassostrea gasar along the juvenile and adult phases were evaluated in three different stocking densities [low (D), medium (2D) and high (3D)] and in two grow-out systems (fixed and floating system). The fixed system consisted of a rack made with PVC, fixed from the bottom with wood sticks. The floating system consisted of floating bags suspended by a rack made with PVC and maintained submerged from the seawater surface by eight floats. Survival and shell height of oysters cultured after 30, 60 and 90 days were registered in each phase and in each grow-out system. Results showed that the grow-out system did not affect survival and growth of C. gasar in the juvenile and adult phases. The tested densities affected the survival of oysters cultured over time in both phases but did not affect oyster growth. At times analyzed, it was observed positive growth in juvenile oysters grow after 90 days of culture. However, in the adult phase, no growth was observed after 90 days of culture. Oyster yield was higher in the density 3D, in both juvenile and adult phases. These findings contributed to the development of the oyster C. gasar culture.(AU)

A sobrevivência e o crescimento da ostra nativa Crassostrea gasar nas fases juvenil e adulta foram avaliados sob três diferentes densidades de estocagem [baixa (D), média (2D) e alta (3D)] e dois sistemas de engorda (fixo e flutuante). O sistema fixo consistiu em uma mesa de PVC, fixada na parte inferior com varas de madeira. O sistema flutuante consistiu em travesseiros flutuantes suspensos por uma mesa de PVC e mantidas submersas da superfície da água do mar por oito flutuadores. Registraram-se sobrevivência e altura da concha de ostras cultivadas após 30, 60 e 90 dias, em cada fase (juvenil e adulta) e em cada sistema (fixo e flutuante). Os resultados mostraram que o sistema de engorda não afetou a sobrevivência e o crescimento de C. gasar nas fases juvenil e adulta. As densidades testadas afetaram a sobrevivência das ostras ao longo do tempo, em ambas as fases, mas não afetaram o crescimento em altura. Nos tempos analisados, ostras juvenis apresentaram crescimento após 90 dias de cultivo. Porém, na fase adulta, não foi observado crescimento após 90 dias de cultivo. A produção de ostras, foi maior na densidade 3D, nas fases juvenil e adulta. Os presentes achados contribuíram para o desenvolvimento do cultivo da ostra C. gasar.(AU)

BestFLR Trial: Liver Regeneration at CT before Major Hepatectomies for Liver Cancer-A Randomized Controlled Trial Comparing Portal Vein Embolization with N-Butyl-Cyanoacrylate Plus Iodized Oil versus Polyvinyl Alcohol Particles Plus Coils.

Background In patients with liver cancer, portal vein embolization (PVE) is recommended to promote liver growth before major hepatectomies. However, the optimal embolization strategy has not been established. Purpose To compare liver regeneration as seen at CT in participants with liver cancer, before major hepatectomies, with N-butyl-cyanoacrylate (NBCA) plus iodized oil versus standard polyvinyl alcohol (PVA) particles plus coils, for PVE. Materials and Methods In this single-center, prospective, randomized controlled trial (Best Future Liver Remnant, or BestFLR, trial; International Standard Randomized Controlled Trial Number 16062796), PVE with NBCA plus iodized oil was compared with standard PVE with PVA particles plus coils in participants with liver cancer. Participant recruitment started in November 2017 and ended in March 2020. Participants were randomly assigned to undergo PVE with PVA particles plus coils or PVE with NBCA plus iodized oil. The primary end point was liver growth assessed with CT 14 days and 28 days after PVE. Secondary outcomes included posthepatectomy liver failure, surgical complications, and length of intensive care treatment and hospital stay. The Mann-Whitney U test was used to compare continuous outcomes according to PVE material, whereas the Χ2 test or Fisher exact test was used for categoric variables. Results Sixty participants (mean age, 61 years ± 11 [standard deviation]; 32 men) were assigned to the PVA particles plus coils group (n = 30) or to the NBCA plus iodized oil group (n = 30). Interim analysis revealed faster and superior liver hypertrophy for the NBCA plus iodized oil group versus the PVA particles plus coils group 14 days and 28 days after PVE (absolute hypertrophy of 46% vs 30% [P < .001] and 57% vs 37% [P < .001], respectively). Liver growth for the proposed hepatectomy was achieved in 87% of participants (26 of 30) in the NBCA plus iodized oil group versus 53% of participants (16 of 30) in the PVA particles plus coils group (P = .008) 14 days after PVE. Liver failure occurred in 13% of participants (three of 24) in the NBCA plus iodized oil group and in 27% of participants (six of 22) in the PVA particles plus coils group (P = .27). Conclusion Portal vein embolization with N-butyl-cyanoacrylate plus iodized oil produced greater and faster liver growth as seen at CT in participants with liver cancer, compared with portal vein embolization with polyvinyl alcohol particles plus coils, allowing for earlier surgical intervention. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Arellano in this issue.

Diagnostic value of serological biomarkers for detection of non-alcoholic fatty liver disease (NAFLD) and/or advanced liver fibrosis in people living with HIV.

OBJECTIVES: We aimed to evaluate the accuracy of serological biomarkers for non-alcoholic fatty liver disease (NAFLD) and advanced fibrosis (METAVIR-F3F4) in HIV mono-infected individuals. METHODS: In all, 674 participants from the PROSPEC-HIV study (NCT02542020), who had blood sample tests and transient elastography (TE) performed on the same day, were eligible. Exclusion criteria were viral hepatitis co-infection (n = 90), abusive alcohol intake (n = 61), missing data (n = 47) or unreliable TE (n = 39). NAFLD was defined by controlled attenuation parameter ≥ 248 dB/m and advanced fibrosis by liver stiffness measurement ≥ 8.7 kPa with M probe or ≥ 7.2 kPa with XL probe. Biomarkers for NAFLD [Steato-ELSA, Fatty Liver Index (FLI), Hepatic Steatosis Index (HSI), NAFLD-Liver Fat Score (NAFLD-LFS)] and fibrosis [Fibrosis-4 score (FIB-4), Aspartate-to-Platelet Ratio Index (APRI) and NAFLD Fibrosis Score (NFS)] were calculated. RESULTS: A total of 437 patients [57% female, age = 44 (interquartile range: 35-52) years, body mass index (BMI) = 26.1 (23.4-29.3) kg/m2 , CD4 = 660 (427-901) cells/µL] were included. The prevalence [95% confidence interval (CI)] of NAFLD and advanced fibrosis were 38.2% (33.8-42.9) and 10.5% (8.0-13.8), respectively. The areas (95% CI) under the receiver operator curve (AUROCs) for diagnosis of NAFLD were 0.854 (0.818-0.889), 0.840 (0.804-0.877), 0.805 (0.762-0.847) and 0.793 (0.750-0.836) for Steato-ELSA, FLI, HSI and NAFLD-LFS (P < 0.001), respectively. All tests yielded satisfactory sensitivities, specificities and negative predictive values (NPVs). The AUROCs (95% CI) for diagnosis of advanced fibrosis were 0.736 (0.659-0.814), 0.700 (0.614-0.7851) and 0.795 (0.726-0.864) for FIB-4, APRI and NFS (P = 0.077), respectively. These tests yielded high specificities and negative predictive values (NPVs) > 90%. CONCLUSION: Biomarkers for NAFLD had a good accuracy and those for fibrosis had high specificities and NPVs. These tests should be integrated to HIV care to detect NAFLD and to exclude advanced liver fibrosis.

1,8-cineole and castor oil in sodium lauryl ether sulphate disrupt reproduction and ovarian tissue of Rhipicephalus (Boophilus) microplus.

Essential and fixed oils have been researched as alternatives to chemical acaricides. The activity of volatile compounds from essential oils (1,8-cineole, citral and eugenol) at 1.0% (w/v) and fixed oil (castor oil) at 0.3% (w/v) dissolved in 2.0% (v/v) dimethyl sulfoxide (DMSO) + 0.2% (w/v) Tween 80® was assessed against Rhipicephalus microplus using immersion tests. 1,8-cineole (29.0%) and castor oil (30.2%) had the highest reproductive inhibition rate. A second experiment was performed to verify the effect of the 1,8-cineole (10.0% w/v) and, or castor oil (0.3% w/v) on tick reproduction using different solubilizing agents. The highest reproductive inhibition was observed for the combination of 1,8-cineole/castor oil (94.1%) and 1,8-cineole in 2.0% (w/v) sodium lauryl ether sulphate (SLES) (92.8%). A third experiment showed morphological changes in R. microplus oocytes at different stages of development, as well as in pedicel cells. The most intense effects were observed when ticks were immersed in the formulation containing 1,8-cineole (10.0% w/v) and castor oil (0.3% w/v) dissolved in 2% (w/v) SLES. These findings highlight the potential of this formulation as an alternative for managing cattle ticks as their cytotoxic effects can reduce R. microplus reproductive success.

Estratégias para detecção precoce de psicopatologias em pacientes candidatos a cirurgias plásticas pósbariátricas / Strategies for early detection of psychopathologies in candidates for post-bariatric plastic surgery

Introdução: O aumento na demanda pelas cirurgias plásticas pós-bariátricas evidenciou a alta prevalência de psicopatologias nessa população, exigindo a necessidade do diagnóstico dessas doenças no pré-operatório. A utilização de ferramentas para triagem psicológica específica, já na primeira consulta, tem sido estimulada pela maioria dos autores, entretanto, um método padrão-ouro ainda não foi plenamente estabelecido e a busca persiste. Objetivo: Realizar uma revisão da literatura sobre as alternativas disponíveis para a avaliação psicológica preliminar de pacientes candidatos a cirurgias plásticas pós-bariátricas, apresentando a conduta preconizada no ambulatório de Cirurgia Plástica Pós-Bariátrica da Universidade Federal de Mato Grosso do Sul (UFMS). Métodos: Revisão dos ensaios clínicos, que empregaram ferramentas de triagem psicológica pré-operatória em pacientes candidatos à cirurgia plástica pósbariátrica, nos bancos de dados MEDLINE/PubMed, utilizando os descritores "bariatric surgery", "body image", "quality of life", "obesity", "plastic surgery" e "psychiatry", nos últimos 20 anos, discutindo os achados e analisando as metodologias mais utilizadas. Resultados: Foram encontrados apenas 4 ensaios clínicos que utilizaram ferramentas de triagem psicopatológica no pré-operatório de cirurgias plásticas pós-bariátricas, sendo que um método de eleição não pôde ser identificado. Conclusão: A utilização de estratégias apropriadas para a triagem das psicopatologias auxilia na prevenção de prejuízos significativos no pós-operatório, porém a construção da ferramenta ideal ainda carece de validação na população pós-bariátrica. Além do amplo conhecimento técnico clínicocirúrgico, o cirurgião plástico deve manter-se atento aos sinais e sintomas psicopatológicos desses pacientes, encaminhandoos para avaliação psiquiátrica e psicológica quando indicado.

Introduction: The increase in demand for post-bariatric plastic surgery has revealed a high prevalence of psychopathologies in patients undergoing the procedure, requiring the need to diagnose these diseases in the preoperative period. The use of specific psychological screening tools has been promoted; however, a gold-standard method has not yet been fully established. Objective: To carry out a review of the literature for alternatives available for the preliminary psychological evaluation of patients who are candidates for post-bariatric plastic surgery, presenting the method recommended in the Post-Bariatric Plastic Surgery outpatient clinic of the Federal University of Mato Grosso do Sul (UFMS). Methods: We reviewed the clinical trials which employed psychological screening tools preoperatively in patients who were candidates for post-bariatric plastic surgery; the MEDLINE/PubMed database was searched using keywords such as "bariatric surgery", "body image", "quality of life", "obesity", "plastic surgery" and "psychiatry", for clinical trials published in the last 20 years. Herein, we discuss the findings and analyze the most common methodologies used. Results: Only four clinical trials used psychopathology screening tools in postbariatric plastic surgeries preoperatively, and one method could not be identified. Conclusion: The use of appropriate strategies to screen for psychopathologies helps prevent significant losses in the postoperative period, but the tools still lack validation in the post-bariatric population. Besides possessing extensive clinical-surgical technical knowledge, the plastic surgeon must remain attentive to the signs and psychopathological symptoms in these patients, referring them for psychological and psychiatric evaluation when indicated.

Lipofilling no tratamento de casos leves de hemiatrofia facial / Lipofilling for the treatment of mild cases of Facial Hemiatrophy

A hemiatrofia facial ou síndrome de Parry-Romberg é caracterizada por atrofia progressiva dos tecidos da hemiface, acometendo a pele e o subcutâneo. Suas manifestações clínicas são muito variadas. As estratégias terapêuticas de eleição para o tratamento da síndrome ainda não foram completamente estabelecidas. Os autores descrevem um caso de hemiatrofia facial leve, em que o paciente foi submetido a lipofilling (lipoenxertia autóloga), evoluindo com resultado satisfatório. As alternativas de tratamento, suas vantagens e desvantagens, são amplamente discutidas no estudo, sendo que a lipoenxertia autóloga desponta como excelente opção terapêutica, por sua segurança, baixo custo e reprodutibilidade.

Facial hemiatrophy, or Parry-Romberg syndrome, is characterized by the progressive atrophy of the tissues of half of the face, affecting skin and subcutaneous tissue. Its clinical manifestations are very varied. Preferred therapeutic strategies for the treatment of the syndrome were not yet completely established. The authors describe a case of mild facial hemiatrophy, in which the patient underwent lipofilling (autologous fat grafting), progressing with satisfactory result. Treatment alternatives, its advantages and disadvantages are widely discussed in the study, with fat grafting emerging as an excellent therapeutic option due to its safety, low cost and replicability.

Retalho sural reverso de pedículo fasciossubcutâneo: relato de caso / Reverse sural flap of the fasciosubcutaneous pedicle: a case report

Introdução: As perdas de substância no terço inferior da perna costumam exigir elaboradas estratégias cirúrgicas para sua reconstrução. Dentre as opções existentes, o uso do retalho sural reverso de pedículo fasciossubcutâneo ou adipofascial reverso, citado na literatura como interessante alternativa, é pouco relatado, se comparado às outras técnicas mais utilizadas. O objetivo deste estudo é apresentar o resultado do tratamento de uma lesão exposta do tendão de Aquiles, realizado com retalho sural reverso de pedículo fasciossubcutâneo, associado à enxertia de pele total no mesmo tempo cirúrgico, discutindo as alternativas técnicas e as vantagens do procedimento. Relato de caso: A.D., 28 anos, portador de lesão complexa em terço distal da perna, decorrente de evolução desfavorável de procedimento ortopédico de reconstrução do tendão de Aquiles rompido em acidente automobilístico, ocorrido há mais de 30 dias, foi submetido à reconstrução da ferida por meio do retalho sural reverso de pedículo fasciossubcutâneo. A evolução pós-operatória foi favorável, não havendo complicações ou intercorrências. Conclusão: A técnica relatada apresentou uma boa opção com resultado satisfatório para a cobertura de lesão de terço inferior da perna com exposição do tendão de Aquiles.

Introduction: Loss of substance in the lower third of the leg usually requires complex surgical procedures for tissue reconstruction. Among the existing options for tissue reconstruction, reverse sural flap of the fasciosubcutaneous pedicle or reverse adipofascial flap, described in the literature as a viable option, has been little studied compared with other techniques. The objectives of this study were to present the results of surgical treatment of a complex injury due to Achilles tendon rupture using the reverse sural flap of the fasciosubcutaneous pedicle concomitantly with total skin grafting and to discuss the advantages of the procedure as well as other surgical alternatives. Case report: A.D., a 28-year-old male patient, presented with a complex injury in the lower third of the leg because of a poor outcome of surgical repair of Achilles tendon rupture that had occurred during an automobile accident more than 30 days previously. The patient underwent injury reconstruction with the reverse sural flap of the fasciosubcutaneous pedicle. The postoperative result was favorable, without complications. Conclusion: The surgical technique described here is satisfactory for treating lesions in the lower third of the leg due to Achilles tendon rupture.

Analysis of radioprotection and antimutagenic effects of Ilex paraguariensis infusion and its component rutin.

DNA repair pathways, cell cycle checkpoints, and redox protection systems are essential factors for securing genomic stability. The aim of the present study was to analyze the effect of Ilex paraguariensis (Ip) infusion and one of its polyphenolic components rutin on cellular and molecular damage induced by ionizing radiation. Ip is a beverage drank by most inhabitants of Argentina, Paraguay, Southern Brazil, and Uruguay. The yeast Saccharomyces cerevisiae (SC7Klys 2-3) was used as the eukaryotic model. Exponentially growing cells were exposed to gamma rays (γ) in the presence or absence of Ip or rutin. The concentrations used simulated those found in the habitual infusion. Surviving fractions, mutation frequency, and DNA double-strand breaks (DSB) were determined after treatments. A significant increase in surviving fractions after gamma irradiation was observed following combined exposure to γ+R, or γ+Ip. Upon these concomitant treatments, mutation and DSB frequency decreased significantly. In the mutant strain deficient in MEC1, a significant increase in γ sensitivity and a low effect of rutin on γ-induced chromosomal fragmentation was observed. Results were interpreted in the framework of a model of interaction between radiation-induced free radicals, DNA repair pathways, and checkpoint controls, where the DNA damage that induced activation of MEC1 nodal point of the network could be modulated by Ip components including rutin. Furthermore, ionizing radiation-induced redox cascades can be interrupted by rutin potential and other protectors contained in Ip.

A lipoescultura como tratamento complementar na ritidoplastia / Liposculpture as a complementary treatment in rhytidoplasty

Introdução: As múltiplas abordagens e a utilização de diferentes estratégias cirúrgicas contribuem para a obtenção de resultados mais agradáveis nas ritidoplastias. Nesse cenário, a lipoescultura vem ganhando cada vez mais relevância como alternativa para potencializar esses resultados, agregando maior valor estético final para o procedimento. Objetivos: Avaliar os resultados obtidos em pacientes submetidas à associação de ritidoplastia e lipoescultura facial. Métodos: Quatorze pacientes foram submetidas à ritidoplastia clássica de Pitanguy, associada à lipoescultura em áreas específicas da face, sendo acompanhadas por 12 meses. Os resultados pós-operatórios foram avaliados por 17 voluntários utilizando o método de Antell & Orseck. Resultados: Das 14 pacientes avaliadas, nove (64,2%) tiveram o resultado classificado como excelente, três (21,4%) como moderado e dois (14,2%) como fraco. Nenhuma paciente obteve resultados classificados como perfeito ou ruim. Conclusões: A ritidoplastia associada à lipoescultura da face se valida como alternativa importante para o tratamento do envelhecimento facial, proporcionando a obtenção de resultados agradáveis, seguros e duradouros.

Introduction: Multiple approaches and the use of different surgical strategies seem to contribute to the goal of obtaining more satisfactory outcomes in rhytidoplasty. In light of this, liposculpture has been progressively becoming more relevant as an alternative to improve those outcomes, adding greater final aesthetic value to the procedure. Objectives: To evaluate outcomes obtained in patients who underwent the association of rhytidoplasty and facial liposculpture. Methods: Fourteen patients underwent classical Pitanguy rhytidectomy associated with liposuction in specific areas of the face, having been subsequently followed up for 12 months. Seventeen volunteers used the Antell & Orseck method to evaluate the postoperative outcomes. Results: Of the 14 patients evaluated, 9 (64.2%) were classified as having experienced excellent outcomes, while 3 (21.4%) had moderate outcomes, and 2 (14.2%) had poor outcomes. None of the patients experienced outcomes rated as perfect or undesirable. Conclusions: Rhytidoplasty associated with facial liposculpture is an important alternative for the treatment of facial aging, leading to satisfactory, safe and long lasting results.

Equity-focused health impact assessment of Portuguese tobacco control legislation.

The World Health Organization recommend the Equity-Focused Health Impact Assessment (HIA) as a means to assess the impact of social and economic policies on the health of populations, and acknowledges their contribution to health inequality. We describe the application of the Equity-focused Impact Assessment methodology on the Portuguese law on Smoking Prevention and Tobacco Control (Law No. 37/2007). A rapid assessment was carried out to issue recommendations which could be incorporated into the law during a revision in 2014. Quantitative (consumption and health status indicators; equity analysis) and qualitative (Focus Group) approaches were taken to evaluate the impact of the law and formulate recommendations. Young people, men and women of low socioeconomic status, and pregnant women were identified as requiring specific and appropriate interventions to prevent smoking and support smoking cessation.

Analysis of radioprotection and antimutagenic effects of Ilex paraguariensis infusion and its component rutin

DNA repair pathways, cell cycle checkpoints, and redox protection systems are essential factors for securing genomic stability. The aim of the present study was to analyze the effect of Ilex paraguariensis (Ip) infusion and one of its polyphenolic components rutin on cellular and molecular damage induced by ionizing radiation. Ip is a beverage drank by most inhabitants of Argentina, Paraguay, Southern Brazil, and Uruguay. The yeast Saccharomyces cerevisiae (SC7Klys 2-3) was used as the eukaryotic model. Exponentially growing cells were exposed to gamma rays (γ) in the presence or absence of Ip or rutin. The concentrations used simulated those found in the habitual infusion. Surviving fractions, mutation frequency, and DNA double-strand breaks (DSB) were determined after treatments. A significant increase in surviving fractions after gamma irradiation was observed following combined exposure to γ+R, or γ+Ip. Upon these concomitant treatments, mutation and DSB frequency decreased significantly. In the mutant strain deficient in MEC1, a significant increase in γ sensitivity and a low effect of rutin on γ-induced chromosomal fragmentation was observed. Results were interpreted in the framework of a model of interaction between radiation-induced free radicals, DNA repair pathways, and checkpoint controls, where the DNA damage that induced activation of MEC1 nodal point of the network could be modulated by Ip components including rutin. Furthermore, ionizing radiation-induced redox cascades can be interrupted by rutin potential and other protectors contained in Ip.

Autoimmune Syndrome Induced by Adjuvants (ASIA) after Silicone Breast Augmentation Surgery.

Generally, the main complications of silicone implantation are local symptoms. However, some patients develop late-onset systemic symptoms often associated with a rare form of hyperactive immune response, as part of a syndrome known as autoimmune syndrome induced by adjuvants (ASIA). Reported cases of ASIA have shown resolution with explantation, but not with immunomodulatory therapy. In this report, we described a case of a previously healthy 23-year-old woman, who has undergone silicone breast implant augmentation, for aesthetic reasons, and developed localized cutaneous impairment 3 years postsurgery. She received a diagnosis of ASIA with a new presentation: Lupus-like manifestation through localized cutaneous impairment. This patient's symptoms were managed without the need for surgical intervention, which has not been previously reported, because the patient did not want an explantation for aesthetic reasons. The patient was started on hydroxychloroquine, 400 mg per day, and remains asymptomatic after 2 years of treatment. The exact predisposition to ASIA is still unknown. Without implant explantation and with immunomodulatory treatment, this patient's condition substantially improved. Based on our current understanding of this disease, it might not be prudent to indicate breast augmentation with silicone implants in patients with documented autoimmune reaction to an adjuvant, an established autoimmune condition, or genetic predisposition. However, if a patient does develop silicone-induced ASIA, explantation is no longer the only successfully reported option, as these symptoms can be managed with immune suppression.