Empirical Evaluation of a 3D Virtual Simulator of Hysteroscopy Using Leap Motion for Gestural Interfacing.

Surgical training using 3D virtual reality simulators has become an important routine in medical education. Recent research points to Leap Motion as an exciting interface for the control of virtual surgical instruments due to its simplicity and low-cost characteristics. However, previous studies using Leap Motion only evaluated movements of the whole hand, without considering individual finger movements during the manipulation of surgical instruments. This work investigates the use of Leap Motion as an interface for the capture of basic hand and finger movements during a simulated hysteroscopy using a 3D-printed hysteroscope model. We created a virtual simulated uterine environment containing a hysteroscope controlled by movements of the hand and fingers of a user actuating on a 3D-printed model hysteroscope. The model hysteroscope was positioned in a pivot basis allowing the capture of the following basic movements: leftward/rightward, upward/downward, forward/backward, and extrusion/retraction of the virtual resection loop (which rests on the end of the virtual virtual resectoscope). The findings indicate that the arc-shaped paths of the hysteroscope's alpha plane (rightward/leftward) and beta plane (upward/downward) movements are satisfactorily simulated by the virtual reality system. Using Intraclass Correlation, was noted that the similarity between the calculated (ideal standard) and measured arcs was highly significant on both planes (r = 0.9599 on the alpha plane, and r = 0.9208 on the beta plane). Also, the forward/backward trajectory is a straight line; the pinch gesture decreases its accuracy when increase its distance from the Interaction Box of Leap Motion. The results were satisfactorily since compared with previous works, which used Leap Motion for the capture of hands-free gesturing.

Remote ischemic conditioning enhances heart and brain antioxidant defense.

BACKGROUND: Ischemia-reperfusion injury contributes to morbidity after revascularization procedures. Along with early reperfusion, tissue conditioning by alternating intervals of brief ischemia-reperfusion episodes is considered the best approach to limit tissue damage. Remote ischemic conditioning is conducted remotely, in tissues other than those under ischemia. Despite this, remote ischemic conditioning protection mechanisms are poorly understood, which can lead to misapplication. OBJECTIVES: To assess whether remote ischemic conditioning works in the heart and brain through enhancement of cells' antioxidant defenses and whether the response is sustained or temporary. METHODS: Twenty-one male Wistar rats were assigned to three groups (n = 7): SHAM: same procedure as the other groups, but no remote ischemic conditioning was carried out. RIC 10: heart and brain were harvested 10 minutes after the remote ischemic conditioning protocol. RIC 60: heart and brain were harvested 60 minutes after the remote ischemic conditioning protocol. The remote ischemic conditioning protocol consisted of 3 cycles of 5 min left hindlimb ischemia followed by 5 min left hindlimb perfusion, lasting 30 min in total. Heart and brain samples were used to measure the tissue antioxidant capacity. RESULTS: Remote ischemic conditioning increased heart and brain antioxidant capacity after 10 minutes (0.746 ± 0.160/0.801 ± 0.227 mM/L) when compared to SHAM (0.523 ± 0.078/0.404 ± 0.124 mM/L). No enhancement of heart or brain antioxidant capacity was detected 60 minutes after remote ischemic conditioning (0.551 ± 0.073/0.455 ± 0.107 mM/L). CONCLUSIONS: Remote ischemic conditioning temporarily enhances heart and brain antioxidant defenses in male Wistar rats.

CONTEXTO: A lesão de isquemia e reperfusão contribui para a morbidade após procedimentos de revascularização. Juntamente com a reperfusão precoce, o condicionamento tecidual através de breves episódios de isquemia e reperfusão é considerado a melhor abordagem para limitar o dano tecidual. Apesar disso, os mecanismos do condicionamento isquêmico remoto são pouco compreendidos, o que pode levar a uma aplicação incorreta. OBJETIVOS: Avaliar se o condicionamento isquêmico remoto funciona no coração e no cérebro através do aprimoramento da defesa antioxidante das células e se é uma resposta sustentada ou temporária. MÉTODOS: Vinte e um ratos Wistar foram divididos em três grupos (n = 7): SHAM, no qual não foi realizado condicionamento isquêmico; RIC 10, no qual 10 minutos após o protocolo de condicionamento isquêmico, foi realizada a coleta dos órgãos; e RIC 60, no qual 60 minutos após o protocolo de condicionamento isquêmico, foi realizada a coleta dos órgãos. O protocolo de condicionamento isquêmico remoto consistiu em três ciclos de 5 minutos de isquemia, seguidos de 5 minutos de perfusão no membro posterior esquerdo, com duração total de 30 minutos. Amostras foram usadas para medir a capacidade antioxidante do tecido. RESULTADOS: O condicionamento isquêmico remoto aumentou a capacidade antioxidante do coração e do cérebro após 10 minutos (0,746 ± 0,160/0,801 ± 0,227 mM/L) quando comparado ao SHAM (0,523 ± 0,078/0,404 ± 0,124 mM/L) . Sessenta minutos após o condicionamento isquêmico remoto, não foi detectado aumento da capacidade antioxidante do coração ou do cérebro (0,551 ± 0,073/0,455 ± 0,107 mM/L). CONCLUSÕES: O condicionamento isquêmico remoto melhora temporariamente as defesas antioxidantes do coração e do cérebro em ratos Wistar.

Can Smartphones Be Used to Perform Video-Assisted Microanastomosis? An Experimental Study.

BACKGROUND: Smartphone cameras are continuously improving. The present study aimed to evaluate the possibility of using smartphones' magnification system to perform microanastomosis in rats. METHODS: Fifteen rats were randomly divided into 3 groups, according to the magnification system used: Microscope, iPhone 7 smartphone, and Galaxy S7 smartphone. In the microscope group, a DFVasconcelos microsurgery microscope was used. In both smartphone groups, the magnifications systems were connected to a 55-inch television through the mirror function. Animals in both groups underwent femoral artery anastomosis in the right forepaw and femoral nerve neurorrhaphy in the left hindleg. The body weight, arterial and nerve caliber, and anastomosis time and patency were immediately analyzed. RESULTS: No significant differences were observed between the groups regarding body weight, arterial, or nerve caliber. The smartphones did not provide a sufficient quality of image for an adequate identification of the arterial walls. Therefore, neither arterial anastomosis nor neurorrhaphy could be completed, even after 3 hours of surgery. The first steps toward anastomosis or raffia were performed with difficulty. CONCLUSION: The current video resolution and lack of stereoscopic image of available smartphones is not sufficient to perform video-assisted anastomosis of femoral arteries or nerves.

Morphofunctional evaluation of end-to-side neurorrhaphy through video system magnification.

BACKGROUND: The surgical microscope is an essential tool for microsurgery. Nonetheless, several promising alternatives are being developed, including endoscopes and laparoscopes with video systems. However, these alternatives have only been used for arterial anastomoses so far. The aim of this study was to evaluate the use of a low-cost video-assisted magnification system in end-to-side neurorrhaphy in rats. MATERIALS AND METHODS: Forty rats were randomly divided into four matched groups: (1) normality (sciatic nerve was exposed but was kept intact); (2) denervation (fibular nerve was sectioned, and the proximal and distal stumps were sutured-transection without repair); (3) microscope; and (4) video system (fibular nerve was sectioned; the proximal stump was buried inside the adjacent musculature, and the distal stump was sutured to the tibial nerve). Microsurgical procedures were performed with guidance from a microscope or video system. We analyzed weight, nerve caliber, number of stitches, times required to perform the neurorrhaphy, muscle mass, peroneal functional indices, latency and amplitude, and numbers of axons. RESULTS: There were no significant differences in weight, nerve caliber, number of stitches, muscle mass, peroneal functional indices, or latency between microscope and video system groups. Neurorrhaphy took longer using the video system (P < 0.05). The amplitude was higher in the microscope group than in the video group. CONCLUSIONS: It is possible to perform an end-to-side neurorrhaphy in rats through video system magnification. The success rate is satisfactory and comparable with that of procedures performed under surgical microscopes.

High-Definition Video System for Peripheral Neurorrhaphy in Rats.

BACKGROUND: Although all microsurgeries are based on the use of surgical microscopes, several alternative magnification systems have shown promising results. Improvements in image quality facilitated the use of video systems in microsurgeries with safety and accuracy. The aim of this study was to evaluate the use of a low-cost, video-assisted magnification system in peripheral neurorrhaphy in rats. METHODS: Twenty Wistar rats were randomly divided into 2 matched groups according to the magnification system used: the microscope group, with neurorrhaphy performed under a microscope with an image magnification of 40×; and the video system group, with the procedures performed under a video system composed of a high-definition Sony camcorder DCR-SR42 set to 52× magnification, macro lenses, 42-inch television, and a digital HDMI cable. We analyzed weight, nerve caliber, total surgery time, neurorrhaphy time, number of stitches, and number of axons in both ends (proximal and distal). RESULTS: There were no significant differences between groups in weight, nerve caliber, or number of stitches. Neurorrhaphy under the video system took longer (video: 5.60 minutes; microscope: 3.20 minutes; P < .05). Number of axons was similar between groups, both in proximal and distal stumps. CONCLUSION: It is possible to perform a peripheral neurorrhaphy in rats through video system magnification, but with a longer surgical time.

An Innovative Streaming Video System With a Point-of-View Head Camera Transmission of Surgeries to Smartphones and Tablets: An Educational Utility.

PURPOSE: In order to engage medical students and residents from public health centers to utilize the telemedicine features of surgery on their own smartphones and tablets as an educational tool, an innovative streaming system was developed with the purpose of streaming live footage from open surgeries to smartphones and tablets, allowing the visualization of the surgical field from the surgeon's perspective. The current study aims to describe the results of an evaluation on level 1 of Kirkpatrick's Model for Evaluation of the streaming system usage during gynecological surgeries, based on the perception of medical students and gynecology residents. METHODS: Consisted of a live video streaming (from the surgeon's point of view) of gynecological surgeries for smartphones and tablets, one for each volunteer. The volunteers were able to connect to the local wireless network, created by the streaming system, through an access password and watch the video transmission on a web browser on their smartphones. Then, they answered a Likert-type questionnaire containing 14 items about the educational applicability of the streaming system, as well as comparing it to watching an in loco procedure. This study is formally approved by the local ethics commission (Certificate No. 53175915.7.0000.5171/2016). RESULTS: Twenty-one volunteers participated, totalizing 294 items answered, in which 94.2% were in agreement with the items affirmative, 4.1% were neutral, and only 1.7% answers corresponded to negative impressions. Cronbach's α was .82, which represents a good reliability level. Spearman's coefficients were highly significant in 4 comparisons and moderately significant in the other 20 comparisons. CONCLUSIONS: This study presents a local streaming video system of live surgeries to smartphones and tablets and shows its educational utility, low cost, and simple usage, which offers convenience and satisfactory image resolution, thus being potentially applicable in surgical teaching.

A Low-Cost High-Definition Video System for Microsurgical Hindlimb Replantation in Rats.

Background The surgical microscope is still essential for microsurgery, but several alternatives that show promising results are currently under development, such as endoscopes and laparoscopes with video systems; however, as yet, these have only been used for arterial anastomoses. The aim of this study was to evaluate the use of a low-cost video-assisted magnification system in replantation of the hindlimbs of rats. Methods Thirty Wistar rats were randomly divided into two matched groups according to the magnification system used: the microscope group, with hindlimb replantation performed under a microscope with an image magnification of 40× and the video group, with the procedures performed under a video system composed of a high-definition camcorder, macrolenses, a 42-in television, and a digital HDMI cable. The camera was set to 50× magnification. We analyzed weight, arterial and venous caliber, total surgery time, arterial and venous anastomosis time, patency immediately and 7 days postoperatively, the number of stitches, and survival rate. Results There were no significant differences between the groups in weight, arterial or venous caliber, or the number of stitches. Replantation under the video system took longer (p < 0.05). Patency rates were similar between groups, both immediately and 7 days postoperatively. Conclusion It is possible to perform a hindlimb replantation in rats through video system magnification, with a satisfactory success rate comparable with that for procedures performed under surgical microscopes.

Remote ischemic conditioning temporarily improves antioxidant defense.

BACKGROUND: Remote ischemic conditioning (RIC) is the most promising surgical approach to mitigate ischemia and reperfusion (IR) injury. It consists in performing brief cycles of IR in tissues other than those exposed to ischemia. The underlying mechanisms of the induced protection are barely understood, so we evaluated if RIC works enhancing the antioxidant defense of the liver and kidney before IR injury. MATERIALS AND METHODS: Twenty-one Wistar rats were assigned into three groups as follows: sham, same surgical procedure as in the remaining groups was performed, but no RIC was carried out. RIC 10, RIC was performed, and no abdominal organ ischemia was induced. After 10 min of the end of the RIC protocol, the liver and kidney were harvested. RIC 60, similar procedure as performed in RIC 10, but the liver and the kidney were harvested 60 min. RIC consisted of three cycles of 5-min left hind limb ischemia followed by 5-min left hind limb perfusion, lasting 30 min in total. Samples were used to measure tissue total antioxidant capacity. RESULTS: RIC protocol increased both liver (1.064 ± 0.26 mM/L) and kidney (1.310 ± 0.17 mM/L) antioxidant capacity after 10 min when compared with sham (liver, 0.759 ± 0.10 mM/L and kidney, 1.08 ± 0.15 mM/L). Sixty minutes after the RIC protocol, no enhancement on liver (0.687 ± 0.13 mM/L) or kidney (1.09 ± 0.15 mM/L) antioxidant capacity was detected. CONCLUSIONS: RIC works through temporary and short-term enhancement of liver and kidney cells antioxidant defenses to avoid the deleterious consequences of a future IR injury.

Combined remote ischemic perconditioning and local postconditioning on liver ischemia-reperfusion injury.

BACKGROUND: Remote ischemic perconditioning (rPER) is the newest technique described to mitigate ischemia and reperfusion (IR) injury. Local postconditioning (POS) is also an effective technique for this purpose. It is uncertain if adding local POS to rPER provides superior liver protection, so we tested this hypothesis. MATERIALS AND METHODS: Twenty five Wistar rats were assigned into five groups: sham, IR, POS, rPER, and rPER + POS. Animals were subjected to liver ischemia for 60 min. POS consisted of four cycles of 5-min liver perfusion followed by 5-min liver ischemia (40 min total) after the major ischemic period. rPER consisted of four cycles of 5-min hindlimb ischemia followed by 5 min hindlimb perfusion contemporaneously to major liver ischemic period, during its last 40 min. After 2 h, median and left lobes were harvested for malondialdehyde and Trolox equivalent antioxidant capacity (TEAC) measurement, and blood for the measurement of serum transaminases. RESULTS: All tissue conditioning techniques were able to reduce transaminases serum levels, having no differences among them. All tissue conditioning techniques were able to reduce hepatic tissue MDA level; however, only rPER + POS had higher values than SHAM. All tissue conditioning techniques also enhanced TEAC; however, only POS had lower TEAC than SHAM. CONCLUSIONS: rPER appears as the most promising technique to avoid IR injury. This technique reduced oxidative stress of cell membranes and lowered transaminases serum level. There was no additive protection when POS and rPER were held together.

Ischemic perconditioning on mesenteric ischemia/reperfusion injury in rats.

PURPOSE: To evaluate if the perconditioning affects the antioxidant capacity in mesenteric ischemia and reperfusion injury. METHODS: Twenty-one Wistar rats were assigned into three groups, as follows: Sham, IR and rPER. The animals were subjected to mesenteric ischemia for 30 min. rPER consisted of three cycles of 5-min hindlimb ischemia followed by 5 min hindlimb perfusion at the same time to mesenteric ischemic period. After 5 minutes, blood and 5 cm of terminal ileum were harvested for thiobarbituric acid reactive substances (TBARS) and Trolox equivalent antioxidant capacity (TEAC) measurement. RESULTS: rPER technique was able to reduce intestinal tissue TBARS levels (p<0.0001), but no statistic difference was observed in blood levels between groups, although it was verified similar results in rPER and Sham group. rPER technique also enhanced TEAC levels in both blood (p = 0.0314) and intestinal tissue (p = 0.0139), compared to IR group. CONCLUSIONS: rPER appears as the most promising technique to avoid IR injury. This technique reduced TBARS levels in blood and intestinal tissue and promoted the maintenance of antioxidant defense in mesenteric acute injury.

Organ Preservation Solutions in Transplantation: A Literature Review.

OBJECTIVES: Renal transplant with ABO-incompatible donors expands the donor pool. Earlier studies have focused the use of protocol biopsies in ABOincompatible transplant patients. Our study described outcomes of indication (for cause) renal biopsies and clinical outcomes in patients with ABO-incompatible renal transplant. MATERIALS AND METHODS: This retrospective study included 164 patients from January 2012 to June 2019. Biochemical parameters, serial immunoglobulin G anti-ABO titers, and class I and II donor-specific antibody findings were obtained from hospital records, and renal graft biopsies were reviewed according to the Banff 2017 update. RESULTS: We analyzed the results of 65 biopsies from 54 patients. Biopsy-proven acute antibody-mediated rejection (12.8%) was found to be more prevalent than acute cellular rejection (1.8%). Patients with antibodymediated rejection all had microvascular inflammation (g+ptc score of 2 or more, where g+ptc is the sum of the glomerulitis and peritubular capillaritis scores) and were positive for C4d. Acute tubular injury per se was seen in 10.3% of patients; 65% of these patients had C4d positivity in peritubular capillaries, and only 1 patient developed chronic active antibody-mediated rejection on follow-up. Patient and death-censored graft survival rates were 92% and 98% at 1 year after transplant and 88% and 91% at 3 years, respectively. Patients with an episode of antibody-mediated rejection had lower rates of patient (76.5%) and deathcensored graft survival (84.6%) at 1 year. CONCLUSIONS: The microvascular inflammation score (g+ptc score of 2 or higher) is more reliable than diffuse C4d positivity to determine antibody-mediated rejection in ABO-incompatible transplants because diffuse C4d positivity may also be seen in etiologies unrelated to antibody-mediated rejection. Acute tubular injury with C4d positivity without microvascular injury does not confirm antibody-mediated rejection. We suggest that Banff classification be updated in ABOincompatible transplants to include diagnostic criteria for the diagnosis of antibody-mediated rejection.

Remote ischemic conditioning improves rat brain antioxidant defense in a time-dependent mechanism.

PURPOSE: To clarify the best protocol for performing remote ischemic conditioning and to minimize the consequences of ischemia and reperfusion syndrome in brain, the present study aimed to evaluate different time protocols and the relation of the organs and the antioxidant effects of this technique. METHODS: The rat's left femoral artery was clamped with a microvascular clamp in times that ranged from 1 to 5 minutes, according to the corresponding group. After the cycles of remote ischemic conditioning and a reperfusion of 20 minutes, the brain and the left gastrocnemius were collected. The samples were used to measure glutathione peroxidase, glutathione reductase and catalase levels. RESULTS: In the gastrocnemius, the 4-minute protocol increased the catalase concentration compared to the 1-minute protocol, but the latter increased both glutathione peroxidase and glutathione reductase compared to the former. On the other hand, the brain demonstrated higher catalase and glutathione peroxidase in 5-minute group, and the 3-minute group reached higher values of glutathione reductase. CONCLUSIONS: Remote ischemic conditioning increases brain antioxidant capacity in a time-dependent way, while muscle presents higher protection on 1-minute cycles and tends to decrease its defence with longer cycles of intermittent occlusions of the femoral artery.

The role of adiponectin in ischemia-reperfusion syndrome: a literature review.

Adiponectin, among other diverse adipokines, is produced in greater quantity and has an effect on the adipose tissue and other tissues in the body. Adiponectin plays three main roles: regulatory metabolic and sensitizing function of insulin in the liver and muscles; it acts as an anti-inflammatory cytokine and in vascular protection, besides important cardiac protection in the presence of ischemia-reperfusion syndrome. Since many situations resulting from traumatic accidents or pathologies are due to cell damage caused by ischemia-reperfusion syndrome, it is relevant to study new therapeutic alternatives that will contribute to reducing these lesions. The objective of this study is to carry out a literature review on the role of adiponectin in ischemia-reperfusion syndrome.

EFFECT OF COPAIBA OIL IN INTESTINAL MUCOSA OF RATS SUBMITTED TO HYPOVOLEMIC SHOCK.

BACKGROUND: Hypovolemic shock is a common disease in polytrauma patients and may develop ischemia in various organs, increasing morbidity and mortality. The bowel is usually most affected by this condition. AIM: To evaluate the effects of copaiba oil on the intestinal mucosa's injury of rats submitted to hypovolemic shock. METHOD: Fifteen rats were divided into three groups: sham - simulated surgery; ischemia - animals submitted to hypovolemic shock; and copaiba - animals submitted to hypovolemic shock previously treated with copaiba oil. Mean blood pressure, arterial blood gas after shock induction, degree of intestinal lesion and villus length were evaluated. RESULTS: The sham presented the lowest values of lactate and PaCO2 and the highest values of mean arterial pressure, pH and bicarbonate in relation to the other groups. The degree of mesenteric lesion was zero in the sham group; 3.00±1.00 in the ischemia group; and 3.00±0.71 in the copaiba group. The villus length was 173.60±8.42 in the sham, 142.77±8.33 in the ischemia and 143.01±9.57 in the copaiba group. There was a significant difference between the sham and the other groups (p<0.05); however, there not significant difference between groups Ischemia and copaiba. CONCLUSION: Administration of copaiba oil did not reduce the intestinal mucosa lesion of rats after hypovolemic shock.

Histologic evaluation of rats' liver after Croton cajucara Benth (sacaca) administration.

PURPOSE: To evaluate the hepatic effect of Croton cajucara Benth (sacaca) herbal extract in rats. METHODS: 60 Wistar rats (Rattus novergicus albinus) were used, weighing between 250 and 350 g. The animals were distributed randomically in 2 groups: GS - animals which received daily 0,1 ml/ 100 g of sacaca herbal extract through gavage, and GA -animals which received daily 0,1 ml/100g of distilled water through gavage. These were distributed in 3 subgroups with 10 animals, according to theirs euthanasia dates, which were 14th, 28th and 56th day of treatment. RESULTS: Architectural alterations were not observed, however when it was analyzed the presence or absence of necrosis, it was observed in 50% of GS28 subgroup and 90% of subgroup. In 50% of the animals from GS28 subgroup and 90% of GS56 subgroup was observed vast degeneration areas and zonal necrosis, regarding center-lobular veins alterations, there were no alterations in any of the groups CONCLUSION: The Croton cajucara Benth (sacaca) herbal extract in this experiment caused degeneration and hepatic necrosis, suggesting dose-dependent action.

INFLUENCE OF SPLENIC IMPLANTS IN THE SUBCUTANEOUS TISSUE ON ASPLENIC ANIMALS SURVIVAL.

BACKGROUND: The best site for splenic implant was not defined, mainly evaluating the functionality of the implant. AIM: To evaluate the effects of autogenous splenic implantation on the subcutaneous tissue in the survival of splenectomized rats. METHOD: Twenty-one randomly assigned rats were studied in three groups (n=7): group 1 - manipulation of the abdominal cavity and preservation of the spleen; group 2 - total splenectomy; group 3 - splenectomy and implant of the tissue removed in the subcutaneous. The animals were followed for 90 days postoperatively. RESULTS: There was a higher mortality in groups 2 (p=0.0072) and 3 (p=0.0172) in relation to group 1. There was no difference between groups 2 and 3 (p=0.9817). CONCLUSION: The splenic implant in the subcutaneous is ineffective in the survival of rats submitted to splenectomy.

Experimental inoculation model of Walker 256 carcinoma into vagina and cervix uteri of female rats.

PURPOSE: To establish an inoculation model of Walker 256 carcinoma on cervix uteri and vagina of rats. METHODS: Fifteen female rats were used, and assigned to three groups each one with five rats: group A - rats with 4 x 10(6) cells of Walker 256 carcinoma without acid acetic inoculation; group B - rats with 2 x 10(6) cells of Walker 256 carcinoma with acid acetic inoculation and group C: rats with 4 x 10(6) cells of Walker 256 carcinoma with acid acetic inoculation. The day before tumor cells inoculation the rats from groups B and C were anaesthetized with diethylether and 0,3 ml of acetic acid was inoculated into their vaginas. Tumor cell inoculation into the vagina and cervix was done under general anesthesia with diethylether. Then a endocervical brush was used to scrape the vaginal wall and after that 0,3 ml of the liquid containing tumor cells was inoculated on the vagina and cervix. For the tumor analysis, animals were euthanized at day 12 following tumor cell implantation by an excessive inhalation of diethylether. Tumor was resected entirely and weighed and the tumors were then sectioned and counter stained with hematoxylin and eosin for histopathologic evaluation. It was also calculated the percentage of tumor equivalent to the body weight by the formula: P= tumor weight / body weight x 100. Data were analyzed by one-way analysis of variance - ANOVA. P values < 0.05 were taken to indicate statistical significance. RESULTS: Implantation and growth on GB and GC was 100% and on GA 20%. There was no statistical difference between GB and GC averages. CONCLUSION: According to the methods used, the Walker 256 carcinoma inoculation model into vagina and cervix have an implantation and growth rate of 100% when associated with previous acid acetic inoculation and there is no behavioral difference between using 2 x 10(6) or 4 x 10(6) cells on its inoculation.

DIFFERENT PROTOCOLS OF POSTCONDITIONING DOES NOT ATTENUATE MESENTERIC ISCHEMIA-REPERFUSION INJURY AFTER SHORT-TERM REPERFUSION.

Background: Mesenteric ischemia is a challenging diagnosis. Delay in diagnosis can lead to extent bowel necrosis and poor outcomes. Ischemia and reperfusion syndrome plays an important role in this scenario. Aim: To access effects of different post-conditioning cycles on mesenteric ischemia-reperfusion syndrome. Method: Twenty-five rats were assigned into five groups: Sham, used to establish normal parameters; control group, submitted to mesenteric ischemia for 30 min; in groups GP3, GP1 and GP30, ischemia was followed by post-conditioning protocol, which consisted of 1 cycle of 3 min (GP3), 3 cycles of 1 min (GP1) or 6 cycles of 30 s (GP30), respectively. Ileum samples were harvested after one hour of reperfusion. Intestinal mucosal injury was evaluated through histopathological analysis. Results: The average of mesenteric injury degree was 0 in the sham group, 3.6 in the control group, 3.4 in GP3, 3.2 in GP1, and 3.0 in GP30; villous length average was 161.59 in sham group, 136.27 in control group, 135.89 in GP3, 129.46 in GP1, and 135.18 in GP30. Was found significant difference between sham and other groups (p<0.05); however, there was no difference among post-conditioning groups. Conclusion: Post-conditioning adopted protocols were not able to protect intestinal mucosa integrity after mesenteric ischemia and short term reperfusion.

Racional: O desfecho satisfatório na abordagem cirúrgica da obesidade deve contemplar, além da perda de peso, alteração significativa nas comorbidades preexistentes e na qualidade de vida dos pacientes. Objetivo: Avaliar a qualidade de vida no pós-operatório tardio de pacientes submetidos à cirurgia de gastrectomia vertical por videolaparoscopia. Métodos: Foi aplicado o questionário "Bariatric Analysis and Reporting Outcome System" (BAROS) em pacientes submetidos à gastrectomia vertical por videolaparoscopia. Resultados: Foram avaliados 47 pacientes, entre 21 e 60 anos de idade. O IMC médio antes da operação era 43,06±5,87 kg/m². A média percentual de redução do excesso de peso após foi de 85,46±23,6%. A pontuação obtida pelos pacientes no questionário sobre a melhora na qualidade de vida evidenciou resultado excelente (36,17%), ótimo (40,43%), bom (21,28%) e razoável (2,13%). Houve melhora clínica após a operação em todas as comorbidades investigadas. Conclusão: A perda de peso foi fundamental para a melhoria na qualidade de vida e proporcionou resolução ou a melhora clínica em todas as comorbidades investigadas.

Perconditioning combined with postconditioning on kidney ischemia and reperfusion.

PURPOSE:: To evaluate if combination of perconditioning and postconditioning provides improved renal protection compared to perconditioning alone in a model of renal reperfusion injury. METHODS:: Thirty rats were assigned into 6 groups: normality; sham; ischemia and reperfusion; postconditioning; perconditioning; perconditioning + postconditioning. Animals were subjected to right nephrectomy and left renal ischemia for 30 minutes. Postconditioning consisted of 3 cycles of 5 min renal perfusion followed by 5 min of renal ischemia after major ischemic period. Perconditioning consisted of 3 cycles of 5 min hindlimb ischemia followed by 5 min of hindlimb perfusion contemporaneously to renal major ischemic period. After 24 hours, kidney was harvested and blood collected to measure urea and creatinine. RESULTS:: Perconditioning obtained better values for creatinine and urea level than only postconditioning (p<0.01); performing both techniques contemporaneously had no increased results (p>0.05). Regarding tissue structure, perconditioning was the only technique to protect the glomerulus and tubules (p<0.05), while postconditioning protected only the glomerulus (p<0.05). Combination of both techniques shows no effect on glomerulus or tubules (p>0.05). CONCLUSIONS:: Perconditioning had promising results on ischemia and reperfusion induced kidney injury, enhanced kidney function and protected glomerulus and tubules. There was no additive protection when postconditioning and perconditioning were combined.

Development of a laparoscopic training model using a smartphone.

OBJECTIVE: to develop a model of training in video-surgery, of low cost and that uses a smartphone as an image-generating source. METHODS: We developed a 38cm high, 40cm wide, 40cm long hexagonal-shaped training box, with a front opening of 12x8 cm for coupling the smartphone. The internal illumination is made with LED lamps and for the support of the smartphone, we used a selfie stick, fixed in the upper part of the box, that allows control of height, distance, angulation, and the coupling of devices with different formats. We selected 20 undergraduate students without previous training in video-surgery, who performed four exercises in the box, with assessment of the time and amount of errors in the execution of the tasks. Each student completed the training for three consecutive weeks. We collected the data in spreadsheets for later analysis. RESULTS: Nineteen students completed the training program, with significant improvement in the times and in the number of errors. CONCLUSION: the developed model was feasible and promoted the acquisition of skills in this group of students. In addition, it presents low cost, is portable and uses common equipment, such as smartphones.