BariMEP: uma ferramenta para treinar os pacientes de cirurgia bariátrica / Barimep: a tool for training bariatric surgery patients

ABSTRACT BACKGROUND Bariatric surgery patients have symptoms such as "plugging." Therefore, a possible good way to avoid these eating discomforts, typical of the early period after bariatric surgery, is to educate the patient. The Mindful Eating (ME) consists of paying attention to physical signs of hunger and satiety and developing awareness of emotional triggers related to food. In addition, conscious food choices reflect positively on the speed of chewing at mealtime. AIMS Due to the difficulties that patients reported during consultations to controlling their bad eating habits and the lack of tools to help the bariatric patient change eating habits, we elaborated "BariMEP: A Mindful Eating Placemat for bariatric surgery patients." METHODS The BariMEP was written by the multidisciplinary bariatric team based on a study by Russell et al. and ME principles in order to help bariatric patients pay attention to what and how they eat at each meal. RESULTS The BariMEP has some instructions based on Mindful Eating principles: get your seat at the table; do not distract yourself; before starting to eat, try breathing sometimes; recognize the internal hunger and satiety cues; let the fork rest at each bite and chew a lot; pay attention to the smell and taste; and be as present as possible at this time with nonjudgment. CONCLUSIONS For the first time, a tool has been developed with the aim of preparing the patient for bariatric surgery. Since the BariMEP is easy to teach and cheap, we suggest that the BariMEP be included in the bariatric surgery protocol.

RESUMO RACIONAL Pacientes operados de cirurgia bariátrica apresentam sintomas como "entalo". Portanto, uma possível maneira de evitar esses desconfortos alimentares, típicos do período inicial após a cirurgia bariátrica, é educar o paciente. O Mindful Eating (ME) consiste em avaliar aos sinais físicos de fome e saciedade e desenvolver a consciência dos gatilhos emocionais relacionados à alimentação. Além disso, as escolhas alimentares conscientes refletem positivamente na velocidade da mastigação durante as refeições. OBJETIVOS Devido às dificuldades, que os pacientes relataram durante as consultas, para controlar os maus hábitos alimentares e a falta de ferramentas para ajudar o paciente bariátrico na mudança, elaboramos o "BariMEP: um jogo americano de comer com atenção plena para pacientes de cirurgia bariátrica". MÉTODOS O BariMEP foi escrito pela equipe multidisciplinar bariátrica com base no estudo de Russell et al. e nos princípios do Mindful Eating, para ajudar os pacientes submetidos a cirurgia bariátrica a prestar atenção ao que e como comem em cada refeição. RESULTADOS O BariMEP possui algumas instruções baseadas nos princípios do Mindful Eating: Sente-se à mesa; não se distraia; antes de começar a comer, respire algumas vezes; reconheça os sinais de fome e saciedade; deixe o garfo descansar a cada mordida e mastigue bastante; preste atenção ao aroma e sabor; esteja o mais presente possível neste momento e sem julgamentos. CONCLUSÃO Pela primeira vez, foi desenvolvida uma ferramenta com o objetivo de preparar o paciente para a cirurgia bariátrica. Como o BariMEP é fácil de ensinar e barato, sugerimos que o BariMEP seja incluído no protocolo de cirurgia bariátrica.

Effect of probiotic supplementation on plasma metabolite profile after Roux-Y gastric bypass: a prospective, randomized, double-blind, placebo-controlled clinical trial.

BACKGROUND/OBJECTIVE: There is evidence that metabolic profile changes after Roux-Y gastric bypass (RYGB), especially due to modifications in the gastrointestinal tract. In addition, previous studies have suggested that probiotics can modify the microbiome and produce metabolites important for metabolic health maintenance. In this sense, the aim of this study was to verify the influence of probiotic supplementation on the plasma metabolite profile after RYGB. METHODS: This was a randomized, double-blind, placebo-controlled clinical trial conducted with 31 patients subjected to RYGB surgery, randomized in probiotic group that was supplemented with a probiotic supplement (FloraVantage®) for 3 months after surgery or a placebo group. Plasma metabonomics was performed using nuclear magnetic resonance (NMR) at the preoperative period (T0) and at 45-50 days (T1) and 90-95 days (T2) during the postoperative period/intervention. RESULTS: Reductions in trimethylamine-N-oxide (TMAO) and alanine were observed in both groups, however this reduction was greater in the probiotic group (TMAO 13.82%, p = 0.01 and alanine 14.03%, p = 0.03) at T2. Additionally, ß-hydroxybutyrate (BHB) levels increased 10.77% in the probiotic group (p = 0.03) compared to the placebo group at T2. CONCLUSION: Supplementation with Lactobacillus acidophilus NCFM and Bifidobacterium lactis Bi-07 was able to associate with significant differences in relevant plasma metabolites associated with improved metabolic health.

PROBIOTIC SUPPLEMENTATION ATTENUATES BINGE EATING AND FOOD ADDICTION 1 YEAR AFTER ROUX-EN-Y GASTRIC BYPASS: A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL.

AIM: The use of probiotics as adjuvants in the treatment of eating disorders, known as psychobiotics, has already been investigated as a means of modulating the microbiota-gut-brain axis. This study aimed to assess the effect of probiotic supplementation on binge eating and food addiction in subjects after Roux-en-Y gastric bypass surgery. METHODS: This is a randomized, double-blind, placebo-controlled trial involving 101 patients who received probiotic (Lactobacillus acidophilus NCFM and Bifidobacterium lactis Bi-07) or placebo supplements for 90 days after bariatric surgery, starting on the seventh postoperative day. They were evaluated preoperatively (T0) and postoperatively at 90 days (T1) and 1 year (T2) after surgery. The Yale Food Addiction Scale (YFAS) and Binge Eating Scale (BES) were applied to assess food addiction and binge eating, respectively. RESULTS: Before surgery, one-third of the patients presented with a food addiction and binge eating diagnosis. The number of symptoms of YFAS and the BES score decreased significantly in both groups at T1 compared to T0. However, a significant effect of treatment with probiotics was observed 1 year after surgery (T2). Both the number of symptoms of food addiction and the binge eating score were lower in the probiotic group than in the placebo group (p=0.037 and p=0.030, respectively). CONCLUSION: The use of probiotic supplementation for 90 days in the immediate postoperative period may decrease food addiction symptoms and binge eating score up to 1 year after surgery compared to controls.

Effects of Lactobacillus acidophilus NCFM and Bifidobacterium lactis Bi-07 Supplementation on Nutritional and Metabolic Parameters in the Early Postoperative Period after Roux-en-Y Gastric Bypass: a Randomized, Double-Blind, Placebo-Controlled Trial.

Studies have suggested that Roux-en-Y gastric bypass (RYGB) causes changes in the intestinal microbiota composition and function due to anatomical and physiological modifications. The role of probiotic supplementation after bariatric procedures remains to be determined. PURPOSE: The aim of this study was to investigate the effects of Lactobacillus acidophilus NCFM and Bifidobacterium lactis Bi-07 supplementation on nutritional and metabolic parameters after RYGB. MATERIALS AND METHODS: This is a randomized, double-blind, placebo-controlled clinical trial. Patients were assigned to receive either a probiotic supplement (FloraVantage®) or placebo for three consecutive months, beginning 7 days after surgery. Anthropometric and biochemical indexes were evaluated in the preoperative period and at the end of the study. RESULTS: Following RYGB, serum 25-OH vitamin D increased in both groups compared to baseline; however, this increase was significant only in the probiotic group (p = 0.004). Vitamin B12 levels tended to be higher in the probiotic group compared to the placebo group (p = 0.063), and triglyceride levels showed a significant reduction in the probiotic group only (p < 0.001). In addition, a significant reduction was observed in the anthropometric parameters and glycemic profile (p < 0.05) in both groups. CONCLUSION: Probiotic supplementation after RYGB improves the vitamin and lipid profile.

ACERTO Project - 15 years changing perioperative care in Brazil.

The ACERTO project is a multimodal perioperative care protocol. Implemented in 2005, the project in the last 15 years has disseminated the idea of a modern perioperative care protocol, based on evidence and with interdisciplinary team work. Dozens of published studies, using the protocol, have shown benefits such as reduced hospital stay, postoperative complications and hospital costs. Disseminated in Brazil, the project is supported by the Brazilian College of Surgeons and the Brazilian Society of Parenteral and Enteral Nutrition, among others. This article compiles publications by the authors who belong to the CNPq research group "Acerto em Nutrição e Cirurgia", refers to the experience of other national authors in various surgical specialties, and finally outlines the evolution of the ACERTO project in the timeline.

Acerto Project - 15 years changing perioperative care in Brazil / Projeto Acerto - 15 anos modificando cuidados perioperatórios no Brasil

ABSTRACT The ACERTO project is a multimodal perioperative care protocol. Implemented in 2005, the project in the last 15 years has disseminated the idea of a modern perioperative care protocol, based on evidence and with interdisciplinary team work. Dozens of published studies, using the protocol, have shown benefits such as reduced hospital stay, postoperative complications and hospital costs. Disseminated in Brazil, the project is supported by the Brazilian College of Surgeons and the Brazilian Society of Parenteral and Enteral Nutrition, among others. This article compiles publications by the authors who belong to the CNPq research group "Acerto em Nutrição e Cirurgia", refers to the experience of other national authors in various surgical specialties, and finally outlines the evolution of the ACERTO project in the timeline.

RESUMO O projeto ACERTO é um protocolo multimodal de cuidados perioperatórios. Implementado em 2005, o projeto, nos últimos 15 anos, tem disseminado a ideia de moderno protocolo de cuidados perioperatórios baseados em evidência e com atuação interprofissional. Dezenas de estudos publicados com o uso do protocolo têm mostrado benefícios como redução do tempo de internação, complicações pós-operatórias e custos hospitalares. Disseminado pelo Brasil, o projeto tem apoio do Colégio Brasileiro de Cirurgiões e da Sociedade Brasileira de Nutrição Parenteral e Enteral, entre outros. Este artigo compila publicações dos autores que compõem o grupo de pesquisa do CNPq "Acerto em Nutrição e Cirurgia", cita a experiência de outros autores nacionais em diversas especialidades cirúrgica e finalmente, delineia a evolução do projeto ACERTO ao longo da linha do tempo.

PHYSIOTHERAPEUTIC APPROACHES AND THE EFFECTS ON INSPIRATORY MUSCLE FORCE IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE IN THE PRE-OPERATIVE PREPARATION FOR ABDOMINAL SURGICAL PROCEDURES.

BACKGROUND: Abdominal disorders can alter respiratory function and increase the morbidity and mortality of patients with chronic obstructive pulmonary disease. AIM: To improve the physiotherapeutic and muscular capacity in chronic obstructive pulmonary muscular inspiration in the preoperative preparation in abdominal surgeries. METHOD: Retrospective and documentary study using SINPE © , clinical database software of patients with chronic obstructive pulmonary disease and candidates to abdominal operation. The sample consisted of 100 men aged 55-70 years, all with chronic obstructive pulmonary disease who underwent preoperative physiotherapeutic treatment. They were divided into two groups of 50 individuals (group A and group B). In group A the patients were treated with modern mobility techniques for bronchial clearance and the strengthening of the respiratory muscles was performed with IMT ® Threshold. In group B the treatment performed for bronchial obstruction was with classic maneuvers and for the strengthening of the respiratory muscles for flow incentive was used Respiron ® . RESULTS: Both groups obtained improvement in the values ​​of the PiMáx after the different treatments. Group A obtained greater change in the intervals and a more significant increase of the values of the PiMax in relation to the average pre and post-treatment. However, when analyzing the variance and the standard deviation of the samples, group B presented the best results showing more homogeneity. CONCLUSIONS: The modern and traditional bronchial clearance techniques associated with inspiratory muscle training were equally effective in gaining inspiratory muscle strength with increased Pmax. In this way, the two can be used in the preoperative preparation of patients with chronic obstructive pulmonary disease and referred to abdominal operations.

Physiotherapeutic approaches and the effects on inspiratory muscle force in patients with chronic obstructive pulmonary disease in the pre-operative preparation for abdominal surgical procedures / Abordagens fisioterapêuticas e os efeitos na força muscular inspiratória em pacientes com doença pulmonar obstrutiva crônica no preparo para procedimentos cirúrgicos abdominais

ABSTRACT Background: Abdominal disorders can alter respiratory function and increase the morbidity and mortality of patients with chronic obstructive pulmonary disease. Aim: To improve the physiotherapeutic and muscular capacity in chronic obstructive pulmonary muscular inspiration in the preoperative preparation in abdominal surgeries. Method: Retrospective and documentary study using SINPE © , clinical database software of patients with chronic obstructive pulmonary disease and candidates to abdominal operation. The sample consisted of 100 men aged 55-70 years, all with chronic obstructive pulmonary disease who underwent preoperative physiotherapeutic treatment. They were divided into two groups of 50 individuals (group A and group B). In group A the patients were treated with modern mobility techniques for bronchial clearance and the strengthening of the respiratory muscles was performed with IMT ® Threshold. In group B the treatment performed for bronchial obstruction was with classic maneuvers and for the strengthening of the respiratory muscles for flow incentive was used Respiron ® . Results: Both groups obtained improvement in the values ​​of the PiMáx after the different treatments. Group A obtained greater change in the intervals and a more significant increase of the values of the PiMax in relation to the average pre and post-treatment. However, when analyzing the variance and the standard deviation of the samples, group B presented the best results showing more homogeneity. Conclusions: The modern and traditional bronchial clearance techniques associated with inspiratory muscle training were equally effective in gaining inspiratory muscle strength with increased Pmax. In this way, the two can be used in the preoperative preparation of patients with chronic obstructive pulmonary disease and referred to abdominal operations.

RESUMO Racional: As operações abdominais podem alterar a função respiratória e aumentar a morbimortalidade dos operados com doença pulmonar obstrutiva crônica. Objetivo: Avaliar que técnica fisioterapêutica apresenta melhor efeito na força muscular inspiratória dos pacientes com doença pulmonar obstrutiva crônica no preparo pré-operatório em operações abdominais. Método: Estudo retrospectivo e documental usando o SINPE©, software de banco de dados clínicos de pacientes portadores de doença pulmonar obstrutiva crônica e candidatos a operações abdominais. A amostra foi composta de 100 homens com idade entre 55-70 anos, todos com DPOC com indicação para operação abdominal e que realizaram tratamento fisioterapêutico pré-operatório. Foram divididos em dois grupos de 50 indivíduos (grupo A e grupo B). No grupo A o tratamento realizado para a desobstrução brônquica foi com técnicas modernas e para fortalecimento dos músculos respiratórios foi realizado o Threshold IMT®. No grupo B o tratamento realizado para desobstrução brônquica foi com técnicas tradicionais e para fortalecimento dos músculos respiratórios foi realizado incentivador a fluxo Respiron®. Resultados: Ambos os grupos obtiveram melhora dos valores da PiMáx (Pressão inspiratória Máxima) após o tratamento com abordagens diferentes com melhora também nos intervalos da PiMáx. O grupo A obteve maior mudança nos intervalos e aumento mais significativo dos valores da PiMáx em relação à média pré e pós tratamento. Porém, ao analisar a variância e o desvio-padrão das amostras, o grupo B apresentou melhor distribuição que o grupo A mostrando que seus resultados na amostra foram mais homogêneos. Conclusões: As técnicas modernas e tradicionais de desobstrução brônquica associadas ao treinamento muscular inspiratório mostraram-se igualmente eficazes no ganho de força dos músculos inspiratórios com aumento da PiMáx. Dessa forma as duas podem ser utilizadas no preparo pré-operatório de pacientes com DPOC e encaminhados para operações abdominais.

EFFECT OF OMEGA-3 FATTY ACID IN THE HEALING PROCESS OF COLONIC ANASTOMOSIS IN RATS / EFEITO DO ÁCIDO GRAXO ÔMEGA-3 NA CICATRIZAÇÃO DE ANASTOMOSE COLÔNICA EM RATOS

Background : The use of long-chain polyunsaturated fatty acids has been studied in the context of healing and tissue regeneration mainly due to its anti-inflammatory, immunoregulatory and antioncogenic properties. Previous studies have demonstrated beneficial effects with the use of enteral immunonutrition containing various farmaconutrients such as L-arginine, omega-3, trace elements, but the individual action of each component in the healing of colonic anastomosis remains unclear. Aim : To evaluate the influence of preoperative supplementation with omega-3 fatty acids on the healing of colonic anastomoses of well-nourished rats. Methods : Forty Wistar adult male rats, weighing 234.4±22.3 g were used. The animals were divided into two groups: the control group received for seven days olive oil rich in omega-9 oil through an orogastric tube, while the study group received isocaloric and isovolumetric omega-3 emulsion at a dose of 100 mg/kg/day, also for seven days. Both groups were submitted to two colotomies followed by anastomosis, in the right and left colon, respectively. Parameters evaluated included changes in body weight, anastomotic complications and mortality, as well as maximum tensile strength by using a tensiometer and collagen densitometry at the anastomotic site. Results : There were no differences in body weight or mortality and morbidity between groups. The value of the maximum tensile strength of the control group was 1.9±0.3 N and the study group 1.7±0.2, p=0.357. There was, however, a larger amount of type I collagen deposition in the study group (p=0.0126). The collagen maturation índex was 1.74±0.71 in the control group and 1.67±0.5 in the study group; p=0,719). Conclusions : Preoperative supplementation of omega-3 fatty acid in rats is associated with increased collagen deposition of type I fibers in colonic anastomoses on the 5th postoperative day. No differences were observed in the tensile strength or collagen maturation index.

Racional : O uso de ácidos graxos poliinsaturados de cadeia longa tem sido estudado no contexto de cicatrização e regeneração do tecido, principalmente devido a suas propriedades imunorreguladoras, antioncogênicas e anti-inflamatórias. Estudos anteriores demonstraram efeitos benéficos com o uso de imunonutrição enteral contendo vários farmaconutrientes (L-arginina, ômega-3, oligoelementos), mas a ação individual de cada componente na cicatrização de anastomose colônica permanece incerto. Objetivo : Avaliar a influência da suplementação no pré-operatório com ácidos graxos ômega-3 na cicatrização de anastomoses colônicas de ratos eutróficos. Método : Quarenta ratos Wistar, machos adultos, pesando 234,4±22,3 g foram divididos em dois grupos: grupo controle recebeu a suplementação de azeite de oliva (rico em ômega-9) por gavagem por sete dias e o grupo estudo recebeu ômega-3 em forma de emulsão isocalórica e isovolumétrica, também por gavagem, na dose de 100 mg/kg/dia por sete dias no pré-operatório. Ambos os grupos foram submetidos à duas colotomias seguidas de anastomose colônica, em cólon direito e cólon esquerdo, respectivamente. Foram avaliados a evolução do peso dos animais, morbimortalidade e realizados testes tensiométrico e de densitometria do colágeno dos corpos de prova. Resultados : Não houve diferenças na evolução do peso e na morbimortalidade entre os grupos. O valor da força de tração máxima do grupo controle foi de 1,9±0,3N e no grupo estudo de 1,7±0,2, p=0,357. Houve, no entanto, maior quantidade de colágeno tipo I (p=0,0126) na anastomose no grupo estudo. O índice de maturação do colágeno foi cálculado para os grupos (1,74±0,71 - grupo controle; 1,67±0,5 - grupo estudo, p=0,719). Conclusões : A suplementação pré-operatória com ácido graxo ômega-3 está associada ao aumento da deposição de colágeno do tipo I em anastomoses de cólon em ratos no 5º dia do pós-operatório, mas não exerce influência na resistência tênsil de colorrafia ou no índice de maturação do colágeno.

Influence of preoperative supplementation of omega-3 fatty acid in the healing of colonic anastomoses in malnourished rats receiving paclitaxel.

OBJECTIVE: To evaluate the effect of preoperative supplementation of omega-3 fatty acids on the healing of colonic anastomoses in malnourished rats receiving paclitaxel. METHODS: we studied 160 male Wistar rats, divided in two groups: one subjected to malnutrition by pair feeding (M) for four weeks, and another that received food ad libitum (W). In the fourth week, the groups were further divided into two subgroups that received omega-3 or olive oil by gavage. The animals were submitted to colonic transection and end-to-end anastomosis. After the operation, each of the four groups was divided into two subgroups that received intraperitoneal isovolumetric solutions of saline or paclitaxel. RESULTS: mortality was 26.8% higher in the group of animals that received paclitaxel (p = 0.003). The complete rupture strength was greater in well-nourished-oil Paclitaxel group (WOP) compared with the the malnourished-oil Paclitaxel one (MOP). The collagen maturation index was higher in well-nourished-oil saline group (WOS) in relation to the malnutrition-oil-saline group (MOS), lower in malnourished-oil-saline group (MOS) in relation to malnourished-ômega3-saline one (M3S) and lower in the well-nourished-omega3-saline group (W3S) compared with the malnourished-omega3-saline (M3S). The blood vessel count was higher in the malnourished-oil-saline group (MOS) than in the malnourished-oil-paclitaxel group (MOP) and lower in the malnourished-oil-saline group (MOS) in relation to the malnourished-omega3-paclitaxel group (M3P). CONCLUSION: supplementation with omega-3 fatty acids was associated with a significant increase in the production of mature collagen in malnourished animals, with a reversal of the harmful effects caused by malnutrition associated with the use of paclitaxel on the rupture strength, and with a stimulus to neoangiogenesis in the group receiving paclitaxel.

Influence of preoperative supplementation of omega-3 fatty acid in the healing of colonic anastomoses in malnourished rats receiving paclitaxel / Influência da suplementação pré-operatória com ácido graxo ômega-3 na cicatrização das anastomoses colônicas em ratos desnutridos que receberam paclitaxel

OBJECTIVE: To evaluate the effect of preoperative supplementation of omega-3 fatty acids on the healing of colonic anastomoses in malnourished rats receiving paclitaxel. METHODS: we studied 160 male Wistar rats, divided in two groups: one subjected to malnutrition by pair feeding (M) for four weeks, and another that received food ad libitum (W). In the fourth week, the groups were further divided into two subgroups that received omega-3 or olive oil by gavage. The animals were submitted to colonic transection and end-to-end anastomosis. After the operation, each of the four groups was divided into two subgroups that received intraperitoneal isovolumetric solutions of saline or paclitaxel. RESULTS: mortality was 26.8% higher in the group of animals that received paclitaxel (p = 0.003). The complete rupture strength was greater in well-nourished-oil Paclitaxel group (WOP) compared with the the malnourished-oil Paclitaxel one (MOP). The collagen maturation index was higher in well-nourished-oil saline group (WOS) in relation to the malnutrition-oil-saline group (MOS), lower in malnourished-oil-saline group (MOS) in relation to malnourished-ômega3-saline one (M3S) and lower in the well-nourished-omega3-saline group (W3S) compared with the malnourished-omega3-saline (M3S). The blood vessel count was higher in the malnourished-oil-saline group (MOS) than in the malnourished-oil-paclitaxel group (MOP) and lower in the malnourished-oil-saline group (MOS) in relation to the malnourished-omega3-paclitaxel group (M3P). CONCLUSION: supplementation with omega-3 fatty acids was associated with a significant increase in the production of mature collagen in malnourished animals, with a reversal of the harmful effects caused by malnutrition associated with the use of paclitaxel on the rupture strength, and with a stimulus to neoangiogenesis in the group receiving paclitaxel.

OBJETIVO: Avaliar o efeito da suplementação pré-operatória dos ácidos graxos ômega-3 sobre a cicatrização das anastomoses colônicas em ratos desnutridos que receberam paclitaxel. MÉTODOS: foram estudados 160 ratos Wistar, distribuídos em dois grupos: um submetido à desnutrição pelo pair feeding (D) durante quatro semanas, e outro que recebeu ração ad libitum (N). Na quarta semana, os grupos foram subdivididos em dois subgrupos que receberam, por gavagem, ácido graxo ômega-3 ou azeite de oliva. Os animais foram submetidos à transecção colônica e anastomose término-terminal. Após a operação, foram distribuídos em dois subgrupos que receberam soluções isovolumétricas de salina ou paclitaxel, intraperitonial. RESULTADOS: A mortalidade foi 26,8%, maior no grupo de animais que recebeu paclitaxel (p=0,003). A força de ruptura completa foi maior no grupo nutrido-azeite-paclitaxel (NAP) em relação ao grupo desnutrido-azeite-paclitaxel (DAP). O índice de maturação de colágeno foi maior no grupo nutrido-azeite-salina (NAS) em relação ao grupo desnutrido-azeite-salina (DAS), menor no grupo desnutrido-azeite-salina (DAS) em relação ao grupo desnutrido-ômega3-salina (DOS) e menor no grupo nutrido-ômega3-salina (NOS) em relação ao desnutrido-ômega3-salina (DOS). A contagem do número de vasos sanguíneos foi maior no grupo desnutrido-azeite-salina (DAS) em relação ao grupo desnutrido-azeite-paclitaxel (DAP) e menor no grupo desnutrido-azeite-salina (DAS) em relação ao grupo desnutrido-ômega3-paclitaxel (DOP). CONCLUSÃO: a suplementação com ácidos graxos ômega-3 associou-se ao aumento significativo na produção de colágeno maduro nos animais desnutridos, à reversão do efeito deletério causado pela desnutrição em associação ao uso do paclitaxel, sobre a força de ruptura, e ao estímulo da neoangiogênese no grupo que recebeu paclitaxel.

EFFECT OF OMEGA-3 FATTY ACID IN THE HEALING PROCESS OF COLONIC ANASTOMOSIS IN RATS.

BACKGROUND: The use of long-chain polyunsaturated fatty acids has been studied in the context of healing and tissue regeneration mainly due to its anti-inflammatory, immunoregulatory and antioncogenic properties. Previous studies have demonstrated beneficial effects with the use of enteral immunonutrition containing various farmaconutrients such as L-arginine, omega-3, trace elements, but the individual action of each component in the healing of colonic anastomosis remains unclear. AIM: To evaluate the influence of preoperative supplementation with omega-3 fatty acids on the healing of colonic anastomoses of well-nourished rats. METHODS: Forty Wistar adult male rats, weighing 234.4±22.3 g were used. The animals were divided into two groups: the control group received for seven days olive oil rich in omega-9 oil through an orogastric tube, while the study group received isocaloric and isovolumetric omega-3 emulsion at a dose of 100 mg/kg/day, also for seven days. Both groups were submitted to two colotomies followed by anastomosis, in the right and left colon, respectively. Parameters evaluated included changes in body weight, anastomotic complications and mortality, as well as maximum tensile strength by using a tensiometer and collagen densitometry at the anastomotic site. RESULTS: There were no differences in body weight or mortality and morbidity between groups. The value of the maximum tensile strength of the control group was 1.9±0.3 N and the study group 1.7±0.2, p=0.357. There was, however, a larger amount of type I collagen deposition in the study group (p=0.0126). The collagen maturation índex was 1.74±0.71 in the control group and 1.67±0.5 in the study group; p=0,719). CONCLUSIONS: Preoperative supplementation of omega-3 fatty acid in rats is associated with increased collagen deposition of type I fibers in colonic anastomoses on the 5th postoperative day. No differences were observed in the tensile strength or collagen maturation index.

Influência de dieta imunomoduladora na cicatrização cutânea em ratos / Influence of immunonutritional supplementation on skin wound healing in rats

INTRODUÇÃO: O processo de cicatrização é imediato e dinâmico, com o objetivo de restaurar a continuidade anatômica e funcional, e devem existir condições para esse processo, o que inclui um estado nutricional adequado. Dentre as fórmulas de suplementação existentes, as imunomoduladoras têm sido implicadas na melhora do processo cicatricial e das condições clínicas dos pacientes tratados. Foi avaliada a influência da dieta imunomoduladora (Impact®) sobre diferentes variáveis do processo de cicatrização cutânea. MÉTODO: Ratos adultos e nutridos foram divididos aleatoriamente em quatro grupos, a serem suplementados com a dieta em estudo e com a dieta controle. Dois grupos receberam as respectivas dietas apenas pré-operatoriamente e os outros dois grupos as receberam no perioperatório. Os ratos foram submetidos a três tipos de lesões cutâneas. Foram avaliados os seguintes aspectos: evolução dos pesos, evolução das áreas cruentas, tensiometria das feridas incisionais, taxas de reepitelização e parâmetros histológicos. RESULTADOS: Não houve diferença na evolução dos pesos. Houve melhores índices de fechamento de feridas excisionais nos grupos suplementados com Impact®, a partir do quinto dia de pós-operatório (p=0,02). Os grupos suplementados com a dieta em estudo obtiveram melhores resultados em tensiometria (p = 0,03), taxas de reepitelização (0,04), contagem diferencial de células (p<0,001) e quantidade de colágeno total (p<0,001). CONCLUSÕES: A dieta em estudo (Impact®) promove melhores taxas de fechamento de feridas cruentas, reepitelização mais rápida, cicatrizes com maior resistência tênsil e maiores quantidades de colágeno total nas feridas. Não houve diferença em nenhum dos parâmetros analisados em comparação dos grupos suplementados com Impact® pré e perioperatoriamente.

INTRODUCTION: The wound healing process is immediate and dynamic in order to restore anatomical and functional continuity, and there must be conditions for this process, which include a normal nutritional state. Among the existing supplemental formulas, immuno-enhancing diets have been proposed to improve the wound healing process and patients' clinical conditions. The influence of an immunomodulating diet (Impact®) on different variables of the skin healing process was evaluated. METHOD: Healthy adult rats were randomly divided into four groups of diet supplementation or control. Two groups received their diets only pre-operatively while the other two groups received theirs perioperatively. Rats were subjected to three types of skin lesions. We evaluated the following aspects: changes in weight, development of raw areas, tensiometry of incisional wounds, re-epithelialization rates, and histological parameters. RESULTS: There was no difference in weight changes. There was better closing rates of excisional wounds in groups supplemented with Impact® beginning on the fifth day after surgery (p = 0.02). The groups receiving the dietary supplements obtained the best results in tensiometry (p = 0.03), re-epithelialization rates (p = 0.04), differential cell counts (p < 0.001), and total amount of collagen (p < 0.001). CONCLUSIONS: The study diet (Impact®) promoted better closure rates of raw wounds, faster re-epithelialization, scars with a greater tensile strength, and greater amounts of total collagen in wounds. There was no difference in any of the parameters analyzed compared with the groups supplemented with Impact® pre- and perioperatively.

Protocolo eletrônico para coleta estruturada de dados clínicos para pacientes pediátricos em terapia nutricional utilizando o SINPE© (Sistema Integrado de Protocolos Eletrônicos) / Electronic protocol for structurated data collection of pediatric patients in nutritional therapy using SINPE© (Integrated System of Electronic Protocols)

OBJETIVO: Criar uma base de dados clínicos de terapia nutricional de pacientes pediátricos, informatizar os dados transformando-os em protocolo eletrônico, criar um meio de integração com outros centros médicos a fim de aplicar a base de dados de maneira multicêntrica. MÉTODO: a base de dados foi desenvolvida a partir de busca na literatura médica, em livros-texto e artigos científicos sobre terapia nutricional em pediatria. Inicialmente foi organizado um protocolo mestre, e posteriormente o mesmo foi dividido em dois protocolos específicos, um de admissão e outro de evolução do paciente. A informatização da base de dados foi realizada mediante programa de computador, desenvolvido em linguagem C# (C - Sharp), pelo laboratório eletrônico de pesquisas clínicas do Hospital de Clínicas da Universidade Federal do Paraná. RESULTADOS: o protocolo eletrônico desenvolvido permite armazenar informações clínicas, laboratoriais e complementares de pacientes pediátricos em terapia nutricional. Após a inclusão hierarquizada de todos os itens, foram distribuídos 6694 itens no protocolo mestre, sendo 392 no item Admissão e 6302 em Evolução. CONCLUSÃO: a criação de uma base de coleta de dados de pacientes pediátricos em terapia nutricional foi possível, a informatização da mesma foi factível e existe a possibilidade de integração de diferentes centros para realização de estudos multicêntricos.

OBJECTIVES: To develop a clinical database for pediatric patients in nutrition therapy, to computerize the database turning it into an electronic protocol, to make the multicentric use of the database possible. METHOD: The database was developed based on medical literature search, using textbooks and scientific studies about pediatric nutrition therapy. It was initially organized in one master protocol and after that divided into two specific protocols, one for patient's admission and other one for evolution. The database computerization was performed using a software developed in the C# (C sharp) language, by the electronic laboratory for clinical research at the Hospital of Clinics from Federal University of Paraná. RESULTS: The electronic protocol allows data collection of clinical, laboratorial and radiological parameters. The final version includes 6694 parameters, 392 distributed in Admission and 6302 in Evolution. CONCLUSION: the creation of a database for pediatric patients in nutrition therapy was possible, the computerization of this database was reliable, there is the possibility of integration between different medical centers for development of multicentric studies, the application of the electronic protocol in the mentioned group of patients was reliable.

[Electronic protocol for structurated data collection of pediatric patients in nutritional therapy using SINPE(c) (Integrated System of Electronic Protocols)]. / Protocolo eletrônico para coleta estruturada de dados clínicos para pacientes pediátricos em terapia nutricional utilizando o SINPE(c) (Sistema Integrado de Protocolos Eletrônicos).

OBJECTIVES: To develop a clinical database for pediatric patients in nutrition therapy, to computerize the database turning it into an electronic protocol, to make the multicentric use of the database possible. METHOD: The database was developed based on medical literature search, using textbooks and scientific studies about pediatric nutrition therapy. It was initially organized in one master protocol and after that divided into two specific protocols, one for patient's admission and other one for evolution. The database computerization was performed using a software developed in the C# (C sharp) language, by the electronic laboratory for clinical research at the Hospital of Clinics from Federal University of Paraná. RESULTS: The electronic protocol allows data collection of clinical, laboratorial and radiological parameters. The final version includes 6694 parameters, 392 distributed in Admission and 6302 in Evolution. CONCLUSION: the creation of a database for pediatric patients in nutrition therapy was possible, the computerization of this database was reliable, there is the possibility of integration between different medical centers for development of multicentric studies, the application of the electronic protocol in the mentioned group of patients was reliable.

The role of nutrition in hepatic encephalopathy.

PURPOSE OF REVIEW: Protein-calorie malnutrition may be observed in all clinical stages of liver disease. Nutritional management in these patients is imperative. It is crucial that protein intake is not restricted ad hoc. Administration of vegetable proteins for patients who cannot tolerate standard proteins and, if necessary, branched-chain amino acid-enriched formulae can be an option to these patients. This issue, however, remains controversial. RECENT FINDINGS: This study is an update on the nutritional management of hepatic encephalopathy based on several studies of the last decades, involving dietary protein intake and branched-chain amino acid supplementation. SUMMARY: Malnutrition is a common complication of liver disease and it adversely affects patient outcome. Inadequate dietary protein intake has a very deleterious effect on hepatic encephalopathy, nutritional status, and clinical outcome in these patients and must be avoided. The administration of branched-chain amino acids stimulates hepatic protein synthesis, reduces postinjury catabolism and therefore improves nutritional status. Conflicting results in various different trials, however, exist, and this issue remains unclear.

[Effect of Passiflora edulis (passion fruit) extract on rats' bladder wound healing: morphological study]. / Efeito do extrato de Passiflora edulis (maracujá) na cicatrização de bexiga em ratos: estudo morfológico.

PURPOSE: To evaluate the effects of hydroalcoholic extract of Passiflora edulis leaves in the healing of urinary bladder in rats from histological aspects. METHODS: Forty Wistar male rats were submitted to a longitudinal incision of the bladder followed by a stetching in only one level. After this common procedure, animals were divided at random two groups: Passiflora and Control. In the Passiflora group the only dosage used was administered by intraperitoneal injection of hydroalcoholic extract of Passiflora edulis leaves while in the Control group distilled water was injected. Each subgroup was then divided in two subgroups according to the death of these animals: Control, three and seven days, Passiflora, three and seven days. After the death of these animals, an inventory of the abdominal cavity was performed and the bladder was removed. A comparative analysis was done between the two groups with microscopic evaluation of the healing. There was less acute inflammation (p=0.008), greater collagenous formation (p=0.001) and greater capillary neo-formation (p=0.000) in the third day Passiflora subgroup when compared to the Control subgroup of the third day. RESULTS: There was less acute inflammation (p=0.001), greater fibroblastic proliferation (p=0.011) and greater collagenous formation (p=0.001) in the Passiflora subgroup of seventh day when compared with the Control seventh day subgroup. CONCLUSION: The use of Passiflora edulis leaves extract resulted in less acute inflammation, greater fibroblastic proliferation, collagenous formation and capillary neo-formation on rats' bladder wound healing.

[Extract of Passiflora edulis in the healing process of gastric sutures in rats: a morphological and tensiometric study]. / Efeito do extrato da Passiflora edulis na cicatrização de gastrorrafias em ratos: estudo morfológico e tensiométrico.

INTRODUCTION: Many substances of vegetable origin have been used since the beginning of civilization with the purpose of improving the healing process. Among them, dry leaves extract from Passiflora edulis have been shown to have an anti-inflammatory effect in rats. PURPOSE: To analyze the effect of dry leaves extract from Passiflora edulis in the healing of gastric sutures in rats. METHODS: Forty male adult Wistar rats were divided into two groups of 20 rats, called Passiflora group (GP) and Control group (GC) which were divided into two groups of 10 according to moment of death, on day 3 or day 7 after the operation. All animals were submitted to a midline incision and a gastrotomy was performed on the anterior wall of the stomach followed by gastric suture with polypropylene 6.0 using four stitches on a single layer. Rats from GP were given, before closure of the abdominal wall, a solution of Passiflora edulis extract, 250 mg/kg/weight, while rats from the GC were given an isovolumetric isotonic saline solution. Macroscopic evaluation included the adhesion index proposed by Knightly. Bursting pressure was measure by an electronic device. Microscopic analysis was performed including inflammation parameters. RESULTS: All animals presented adequate healing of the abdominal wall with no clinical signs of infections or dehiscence. The adherence index was similar in both groups both on day 3 (p=0.734) and on day 7 (p=1.000). The gastric sutures presented leak with smaller insufflation pressure on the 3rd P.O. day in both groups as compared to the 3rd P.O. day. There was no significant difference of bursting pressure among the subgroups on the 3rd P.O. day (GC3=41.1 +/- 22.1 mmHg versus GP3=59.2 +/- 20.4 mmHg; p=0.074). On the 7th P.O. day, there was an increased mean bursting pressure in both groups, but there was no statistically significant difference between the two groups (p=0.850). Histologic parameters were similar in both groups, on P.O. days 3 and day 7, except for the fibroblastic proliferation, which was greater on the 7th day in GP (p=0.002). CONCLUSION: The intraperitoneal use of Passiflora edulis extract influences favorably the healing of gastric sutures in rats because of the increase in the fibroblastic proliferation on the 7th P.O. day.