Multilayer stents affect the final diameter of aortic aneurysms and maintain renal artery patency for a short time in a swine experimental model

OBJECTIVES: We sought to analyze the hemodynamic effects of the multilayer flow-modulated stent (MFMS) in Thoracoabdominal aortic aneurysms (TAAAs). METHODS: The hemodynamic effects of MFMS were analyzed in aortic thoracoabdominal aneurysms in experimental swine models. We randomly assigned 18 pigs to the stent or control groups and underwent the creation of an artificial bovine pericardium transrenal aneurysm. In the stent group, an MFMS (Cardiatis, Isnes, Belgium) was immediately implanted. After 4 weeks, we evaluated aneurysm sac thrombosis and renal branch patency by angiography, duplex scan, and morphological analysis. RESULTS: All the renal arteries remained patent after re-evaluation in both groups. Aneurysmal sac thrombosis was absent in the control group, whereas in the stent group it was present in 66.7% of aneurysmal sacs (p=0.061). The mean final aneurysm sac diameter was significantly lower in the stent group (mean estimated reduction, 6.90 mm; p=0.021). The proximal neck diameter decreased significantly in the stent group (mean difference, 2.51 mm; p=0.022) and grew significantly in the control group (mean difference, 3.02 mm; p=0.007). The distal neck diameter increased significantly in the control group (mean difference, 3.24 mm; p=0.017). There were no significant findings regarding distal neck measurements in the stent group. CONCLUSION: The MFMSs remained patent and did not obstruct the renal arteries within 4 weeks. In the stent group, the device was also associated with a significant decrease in aneurysmal sac diameter and a large proportion (albeit non-significant) of aneurysmal sac thrombosis.

Efeito da isquemia renal unilateral no rim contralateral avaliada pela expressão de Caspase 3 / Effect of unilateral renal ischemia on the contralateral kidney assessed by Caspase 3 expression

Resumo Contexto Estudos demonstraram, por análise histológica e Dopplerfluxométrica, a interferência da isquemia renal unilateral, realizada em algumas cirurgias, sobre o rim contralateral, identificando o fenômeno de kidney-kidney crosstalk. Objetivos Identificar o efeito da isquemia de duas estratégias de oclusão da vasculatura renal esquerda sobre o rim contralateral através do volume de células renais positivas para Caspase 3. Métodos Suínos foram divididos em 2 grupos: A (n = 8), artéria renal esquerda clampeada, e AV (n = 8), artéria e veia renais esquerdas clampeadas. Foi realizado o estudo imuno-histoquímico (anti-Caspase 3), com o material de biópsias coletadas do rim isquêmico e contralateral em 0, 30, 60 e 90 minutos de isquemia, e análise morfométrica, sendo que a média representou o volume de área de Caspase 3 positiva (%). Resultados A análise morfométrica do rim contralateral nos tempos 30, 60 e 90 minutos de isquemia mostrou que a média da área marcada por Caspase 3 foi estatisticamente superior à média do rim isquêmico nos dois grupos: artéria renal clampeada (A) e artéria e veia renais clampeadas (AV). Comparando o rim isquêmico e contralateral nos dois tipos de clampeamento, não houve diferença estatisticamente significante da área marcada por Caspase 3. Conclusões No modelo experimental de isquemia renal unilateral, o rim não isquêmico apresentou dano celular, demonstrado pela expressão da Caspase 3 de forma aguda em decorrência da isquemia contralateral. O tipo de clampeamento do hilo não parece ter influência sobre o volume de área marcada por Caspase 3.

Abstract Background Studies have demonstrated with histological analysis and Doppler flow measurement analysis that unilateral renal ischemia, which is performed in some surgeries, interfered with the contralateral kidney, identifying the phenomenon of kidney-kidney crosstalk. Objectives To identify the effects on the ischemic and contralateral kidney of renal ischemia induced by two types of clamping technique by analyzing the volume of kidney cells positive for Caspase 3. Methods Sixteen pigs were divided into 2 groups, as follows: A (n = 8) - clamping of left renal artery only and AV (n = 8) - clamping of left renal artery and vein. Immunohistochemical analyses (anti Caspase 3) were conducted with biopsy specimens collected from the ischemic and contralateral kidney at 0, 30, 60, and 90 minutes of ischemia and morphometric analysis was performed, taking the mean to represent the volume of the Caspase 3 positive area (%). Results Morphometric analysis of specimens collected at 30, 60, and 90 minutes of ischemia showed that the mean area marked for Caspase 3 was statistically larger in the contralateral kidney than the ischemic kidney in both groups: clamped renal artery (A) and clamped renal artery and vein (AV). Comparing the ischemic and contralateral kidney, there was no statistically significant difference in the area marked for Caspase 3 between the two types of clamping. Conclusions In the experimental model of unilateral renal ischemia, the non-ischemic kidney exhibited cell damage, demonstrated by Caspase 3 expression. The type of hilum clamping does not appear to influence the area marked for Caspase 3.

Profile of medical students in the first group of the Faculdade Israelita de Ciências da Saúde Albert Einstein / Perfil dos ingressantes na primeira turma de graduação em Medicina da Faculdade Israelita de Ciências da Saúde Albert Einstein

ABSTRACT Objective: To describe first medical students' profile of the Faculdade Israelita de Ciências da Saúde Albert Einstein. Methods: Data were collected using an electronic questionnaire during the Biostatistics course in August of 2016. The students were inquired about demographic characteristics, data on their secondary education and college entrance exams, practice of physical exercise, leisure activities done, to have a physician in the family, and specialty that they intended to pursue as a career. Results: Most of the students were women aged 18 to 21 years and who were originally from the state of São Paulo, had received secondary education in a private school, took a course to prepare for college entrance exam, and participated in more than 5 college entrance exams in the same year they entered in the School of Medicine. The majority of participants practiced physical exercise regularly and were engaged in common leisure activities. Most of students (58%) had a physician in the family and more than half (52%) did not know which specialty to pursue as career. There was no association between relationship with a physician and the student's choice of a specialty (p=0.390). Conclusion: Although it was the first group of student of School of Medicine at Faculdade Israelita de Ciências da Saúde Albert Einstein who took a different admission process, our data showed that students' profile is similar to students from other colleges.

RESUMO Objetivo: Descrever o perfil dos estudantes de Medicina ingressantes na primeira turma do curso de graduação em Medicina da Faculdade Israelita de Ciências da Saúde Albert Einstein. Métodos: Os dados foram coletados a partir de uma pesquisa realizada pela internet durante o curso de Bioestatística, em agosto de 2016. A pesquisa abordou características sociodemográficas, dados do ensino médio e dos vestibulares, prática de atividade física, lazer, parentesco médico e especialidade que pretendia seguir. Resultados: A maioria dos estudantes de Medicina era do sexo feminino, procedente do Estado de São Paulo, com idade entre 18 a 21 anos, estudou o Ensino Médio em escola particular, fez cursinho pré-vestibular e prestou mais de cinco vestibulares no ano de ingresso na faculdade. Em geral, realizavam atividade física regularmente e tinham atividades de lazer comuns à essa faixa etária. A maior parte (58%) tinha algum parentesco médico e mais da metade (52%) não sabia qual especialidade seguir. Não houve associação entre parentesco médico e escolha da especialidade (p = 0,390). Conclusão: Apesar de ser a primeira turma e de ter passado por um processo seletivo diferenciado, os dados mostraram que o perfil dos alunos era semelhante ao encontrado em outras faculdades.