HOS1 promotes plant tolerance to low-energy stress via the SnRK1 protein kinase.

Plants need to integrate internal and environmental signals to mount adequate stress responses. The NUCLEAR PORE COMPLEX (NPC) component HIGH EXPRESSION OF OSMOTICALLY RESPONSIVE GENES 1 (HOS1) is emerging as such an integrator, affecting responses to cold, heat, light, and salinity. Stress conditions often converge in a low-energy signal that activates SUCROSE NON-FERMENTING 1-RELATED KINASE 1 (SnRK1) to promote stress tolerance and survival. Here, we explored the role of HOS1 in the SnRK1-dependent response to low-energy stress in Arabidopsis thaliana, using darkness as a treatment and a combination of genetic, biochemical, and phenotypic assays. We show that the induction of starvation genes and plant tolerance to prolonged darkness are defective in the hos1 mutant. HOS1 interacts physically with the SnRK1α1 catalytic subunit in yeast two-hybrid assays and in planta, and the nuclear accumulation of SnRK1α1 is reduced in the hos1 mutant. Likewise, another NPC mutant, nup160, exhibits lower activation of starvation genes and decreased tolerance to prolonged darkness. Importantly, defects in low-energy responses in the hos1 background are rescued by fusing SnRK1α1 to a potent nuclear localization signal or by sugar supplementation during the dark treatment. Altogether, this work demonstrates the importance of HOS1 for the nuclear accumulation of SnRK1α1, which is key for plant tolerance to low-energy conditions.

Effect of cementation delay on bonding of self-adhesive resin cement to yttria-stabilized tetragonal zirconia polycrystal ceramic treated with nonthermal argon plasma.

STATEMENT OF PROBLEM: Nonthermal argon plasma (NTAP) has been reported to improve the bond strength of resin cements to yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) ceramics. However, the effect of the inevitable delay before cementation and after treating Y-TZP ceramics with NTAP is unclear. PURPOSE: The purpose of this in vitro study was to investigate whether delays of 8, 12, and 24 hours between the Y-TZP ceramic treatment with NTAP and the cementation would affect the surface energy and the bond strength of a self-adhesive resin cement to Y-TZP ceramic. MATERIAL AND METHODS: Sixty plates and 50 blocks of 3Y-TZP ceramic were divided into 2 groups (n=30 and n=25): as-sintered (AS) and airborne-particle abraded with 50-µm Al2O3 (APA). These groups were further divided into 5 subgroups (n=6 and n=5) according to the delay between the NTAP treatment and the measurement of surface energy and microtensile bond strength (µTBS) evaluation: (0, 8, 12, and 24 hours). For both 3Y-TZP surface conditions (AS and APA), a control group without NTAP treatment was used (ASC and APAC). The surface energy (SE) was evaluated with a goniometer and the 3Y-TZP elemental composition with X-ray photoelectron spectroscopy (XPS). For the µTBS test, the 3Y-TZP ceramic blocks were cemented to composite resin blocks with a self-adhesive resin cement. After storage in distilled water at 37 °C for 24 hours, the 3Y-TZP-composite resin blocks were sectioned into beams and submitted to a µTBS test. Data were submitted to 2-way ANOVA and the Tukey HSD test (α=.05). RESULTS: For the AS group, NTAP increased the SE irrespective of the delay before measurement: ASC<0 hour=8 hours=12 hours=24 hours (P<.05). For the APA group, except after 12 hours, NTAP also increased the surface energy (P<.05). XPS analysis showed an increase in the oxygen/carbon ratio after NTAP treatment for both groups. For the AS group, NTAP increased the µTBS after 0, 8, and 12 hours (P<.05), whereas for the APA group this occurred only after 8 hours (P<.05). For the AS and APA groups, the highest µTBS was reached after 8 hours (P<.05). CONCLUSIONS: Treatment of 3Y-TZP ceramic with NTAP improved the SE and increased the µTBS of self-adhesive resin cement to 3Y-TZP ceramic. These effects were time dependent, with better results at 8 hours after NTAP treatment.

Effect of different times of nonthermal argon plasma treatment on the microtensile bond strength of self-adhesive resin cement to yttria-stabilized tetragonal zirconia polycrystal ceramic.

STATEMENT OF PROBLEM: Nonthermal argon plasma may increase the surface energy of yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) dental ceramics. However, studies that evaluated the effect of increased plasma treatment times on the bond strength of resin cements to Y-TZP ceramics are lacking. PURPOSE: The purpose of this in vitro study was to evaluate the effect of different nonthermal argon plasma (NTAP) treatment times on the surface energy and bond strength of a self-adhesive resin cement to Y-TZP ceramic. MATERIAL AND METHODS: Forty-eighty Y-TZP plates were divided into 2 groups (n=24): as-sintered (AS) and airborne-particle abrasion (APA) with 50-µm Al2O3, which were subdivided into 4 groups (n=6) according to the time of NTAP treatment: 0, 20, 60, and 120 seconds. The surface energy was evaluated with a goniometer. Forty Y-TZP blocks submitted to the same surface treatments (8 groups; n=5) were cemented to composite resin blocks, using a self-adhesive resin cement. After storage in distilled water at 37°C for 24 hours, the Y-TZP-composite resin blocks were cut into beams and submitted to a microtensile bond strength (µTBS) test. Data were analyzed using 2-way ANOVA and the Tukey honestly significant differences test (α=.05). RESULTS: Treatment with NTAP increased the surface energy for AS and APA groups (P<.05). For both groups, the µTBS was as follows: 0 seconds < 20 seconds < 60 seconds = 120 seconds (P<.05). Only after 120 seconds of NTAP treatment was the µTBS of APA higher than that of AS (P<.05). CONCLUSIONS: Treatment with NTAP improved the surface energy and increased the µTBS of self-adhesive resin cement to Y-TZP ceramic, with higher times of plasma treatment resulting in higher bond strength.

ABI1 and PP2CA phosphatases are negative regulators of Snf1-related protein kinase1 signaling in Arabidopsis.

Plant survival under environmental stress requires the integration of multiple signaling pathways into a coordinated response, but the molecular mechanisms underlying this integration are poorly understood. Stress-derived energy deprivation activates the Snf1-related protein kinases1 (SnRK1s), triggering a vast transcriptional and metabolic reprogramming that restores homeostasis and promotes tolerance to adverse conditions. Here, we show that two clade A type 2C protein phosphatases (PP2Cs), established repressors of the abscisic acid (ABA) hormonal pathway, interact with the SnRK1 catalytic subunit causing its dephosphorylation and inactivation. Accordingly, SnRK1 repression is abrogated in double and quadruple pp2c knockout mutants, provoking, similarly to SnRK1 overexpression, sugar hypersensitivity during early seedling development. Reporter gene assays and SnRK1 target gene expression analyses further demonstrate that PP2C inhibition by ABA results in SnRK1 activation, promoting SnRK1 signaling during stress and once the energy deficit subsides. Consistent with this, SnRK1 and ABA induce largely overlapping transcriptional responses. Hence, the PP2C hub allows the coordinated activation of ABA and energy signaling, strengthening the stress response through the cooperation of two key and complementary pathways.

Healing of tumor-induced osteomalacia as assessed by high-resolution peripheral quantitative computed tomography is not similar across the skeleton in the first years following complete tumor excision.

Tumor-induced osteomalacia is caused by excessive fibroblast growth factor 23 production mainly from phosphaturic mesenchymal tumors. Surgical excision or tumor ablation are the preferred treatment. Information on bone microarchitecture parameters assessed by high-resolution peripheral quantitative computed tomography is limited. We report a woman with hypophosphatemic osteomalacia with generalized pain, weakness and recurrent fractures, and a large thoracic vertebral mass extending to the posterior mediastinum. Detailed radiologic and histopathologic evaluation revealed a phosphaturic mesenchymal tumor. Two surgeries were necessary for complete removal of the mass. Clinical symptoms improved after attaining normophosphatemia. Four-year post-surgical HR-pQCT parameters, compared to baseline, showed in the left distal radius, stable trabecular and cortical volumetric bone mineral density although below reference range. There was stability of trabecular number and thickness. Both stiffness and failure load decreased. A shift in cortical parameters was noted in year 2. In the left distal tibia, trabecular volumetric bone mineral density decreased whereas cortical volumetric bone mineral density markedly increased, as did cortical area. There was stability in the trabecular number and thickness. Both stiffness and failure load improved. Findings from HR-pQCT measurements in this patient disclosed that the healing of osteomalacia is not similar across the peripheral skeletal sites in the first years following tumor removal. Results contrasted low but stable volumetric bone mineral density in the distal radius with increase in the distal tibia at the expense of cortical bone. Our report helps further delineate the pattern of bone healing after treatment of this rare bone disorder.

Improved dsRNA isolation and purification method validated by viral dsRNA detection using novel primers in Saccharomyces cerevisiae.

Accurate genomic sequencing demands high-quality double-stranded RNA (dsRNA). Existing methods for dsRNA extraction from yeast, fungi, and plants primarily rely on cellulose, suitable only for small volume extractions, or the time-consuming lithium chloride precipitation. To streamline the traditional phenol-chloroform-based dsRNA extraction method, the main challenge is the reduction of mitochondrial DNA (mtDNA) and Single Stranded RNA (ssRNA) to no detectable levels after gel electrophoresis. This challenge is successfully addressed through the modified approach described here, involving phenol extraction at low pH, followed by the addition of ammonium sulfate to the aqueous buffer. The dsRNA isolated using this novel method exhibits comparable quality to that obtained through cellulose purification, and it is readily amenable to RT-PCR. Moreover, a single batch of yeast cell RNA isolation requires only 2-3 h of hands-on time, thus simplifying and expediting the process significantly.•Buffers were redesigned from [32,33,35].•No DNASE, Ribonuclease A or beads were used during the purification.•Simple and inexpensive dsRNA extraction and purification method is described.

Brazilian national bariatric registry - pilot study.

INTRODUCTION: Brazil is a world leader in bariatric surgery. However, the actual number of surgeries performed in the country is still unknown. It is necessary to implement an instrument to monitor the quality of care provided. This study evaluated the implementation of a Bariatric Surgery Data Registry in Brazil. METHODOLOGY: the registry was developed with Dendrite Clinical Systems Ltd., with data collected prospectively on an internet-based software. Seven centers were selected based on surgical volume and data entry commitment. The project covered three years after system implementation. RESULTS: 1,363 procedures performed by 17 surgeons were included. Most patients were female (67.2%), with average age of 39 years old and average baseline BMI of 41.5kg/m2. Diabetes mellitus was present in 34.5%, and hypertension in 40.1%. Roux-en-Y gastric bypass was performed in 79.3%, 95.5% by laparoscopy. There was one in-hospital death of cardiovascular cause. The average hospital stay was 2.03 days. The surgery-related complication rate was 0.97% in the first month, with three reoperations. Short-term follow-up was recorded in 75.6% and one-year follow-up in 21.64%. Total body weight loss was 10% in 30 days, rising to 33.3% after one year, with no difference between surgical techniques. CONCLUSIONS: the population profile was in accordance with the global registry of the International Federation for the Surgery of Obesity and Metabolic Disorders. The main difficulty encountered was low postoperative data entry. The experience acquired in this project will help advance data collection and knowledge of the safety and effectiveness of bariatric surgery in Brazil.

Robotic-assisted bariatric surgery: case series analysis and comparison with the laparoscopic approach. / Cirurgia bariátrica robótico-assistida: análise de série de casos e comparação com via laparoscópica.

OBJECTIVE: to report a series of cases of robotic bariatric surgery in the treatment of obesity in Brazil. METHODS: we evaluated patients undergoing robotic bariatric surgery at the Garrido Institute and compared them with a group submitted to conventional laparoscopic surgery. RESULTS: we analyzed 45 patients, with a mean age of 39.44 years, of which 34 were female, with an initial mean BMI of 41.26kg/m2. Among the procedures performed, 91.11% were Roux-en-Y gastric bypass, while 8.89% were sleeve gastrectomy. The mean total surgery time was 158 (±56.54) minutes, with mean docking time of 7.93 (±3.9) minutes, and console time 113.0 (±41.4) minutes. The average pain presented in the post anesthetic recovery was 2.61 (±3.30) points on a scale of 0 to 10; four patients presented with mild signs of nausea, responding well to drug treatment. Only one patient needed ICU admission for a period of two days after surgery due to previous cardiopathy. In two cases, there was an incisional hernia at the trocar site, which were surgically treated without further complications. In the comparison between robotic versus laparoscopic surgery groups, 45 patients were selected for each group. Operative time was significantly longer in the robotic surgery group, with most other variables being equivalent, including postoperative control of comorbidities. CONCLUSION: robotic bariatric surgery is a safe procedure, with results comparable to laparoscopic surgery.

OBJETIVO: relatar uma série de casos de cirurgia bariátrica robótica no tratamento da obesidade no Brasil. MÉTODOS: foram avaliados pacientes submetidos à cirurgia bariátrica robótica no Instituto Garrido, e realizada comparação com grupo submetido à cirurgia laparoscópica convencional. RESULTADOS: foram analisados 45 pacientes, com média de idade de 39,44 anos, sendo 34 do sexo feminino, com média de IMC inicial de 41,26Kg/m2. Dentre as cirurgias realizadas, 91,11% foram bypass gástrico em Y de Roux, enquanto 8,89% foram do tipo gastrectomia vertical. A média de tempo total de cirurgia foi de 158 (±56,54) minutos, com tempo médio de docking de 7,93 (±3,9) minutos e tempo de console 113,0 (±41,4) minutos. A média de dor apresentada na recuperação pós-anestésica foi de 2,61 (±3,30) pontos, em escala de 0 a 10, com quatro pacientes apresentando sinais leves de náusea, respondendo bem ao tratamento medicamentoso. Somente um paciente necessitou internação em UTI por um período de dois dias após a cirurgia, devido à cardiopatia prévia. Em dois casos ocorreram hérnia incisional em sítio de trocater, tratados cirurgicamente, sem posteriores complicações. Na comparação entre os grupos de cirurgia robótica versus laparoscópica, foram selecionados 45 pacientes para cada grupo. O tempo operatório foi significativamente mais longo na via robótica, sendo a maior parte das outras variáveis equivalentes, inclusive controle pós-operatório de comorbidades. CONCLUSÃO: a cirurgia bariátrica robótica é um procedimento seguro, com resultados comparáveis à cirurgia laparoscópica.

Brazilian national bariatric registry - pilot study / Registro nacional de dados em cirurgia bariátrica - estudo piloto

ABSTRACT Introduction: Brazil is a world leader in bariatric surgery. However, the actual number of surgeries performed in the country is still unknown. It is necessary to implement an instrument to monitor the quality of care provided. This study evaluated the implementation of a Bariatric Surgery Data Registry in Brazil. Methodology: the registry was developed with Dendrite Clinical Systems Ltd., with data collected prospectively on an internet-based software. Seven centers were selected based on surgical volume and data entry commitment. The project covered three years after system implementation. Results: 1,363 procedures performed by 17 surgeons were included. Most patients were female (67.2%), with average age of 39 years old and average baseline BMI of 41.5kg/m2. Diabetes mellitus was present in 34.5%, and hypertension in 40.1%. Roux-en-Y gastric bypass was performed in 79.3%, 95.5% by laparoscopy. There was one in-hospital death of cardiovascular cause. The average hospital stay was 2.03 days. The surgery-related complication rate was 0.97% in the first month, with three reoperations. Short-term follow-up was recorded in 75.6% and one-year follow-up in 21.64%. Total body weight loss was 10% in 30 days, rising to 33.3% after one year, with no difference between surgical techniques. Conclusions: the population profile was in accordance with the global registry of the International Federation for the Surgery of Obesity and Metabolic Disorders. The main difficulty encountered was low postoperative data entry. The experience acquired in this project will help advance data collection and knowledge of the safety and effectiveness of bariatric surgery in Brazil.

RESUMO Introdução: o Brasil é líder mundial em cirurgia bariátrica. No entanto, o número de cirurgias realizadas no país ainda é desconhecido. É necessário um instrumento para monitorar a qualidade da assistência prestada. Este estudo avaliou a implantação de um Registro de Dados de Cirurgia Bariátrica no Brasil. Metodologia: O registro foi desenvolvido com a Dendrite Clinical Systems Ltd., com dados coletados prospectivamente em software na internet. Sete centros foram selecionados, baseado no volume cirúrgico e compromisso de inserção de dados. O projeto abrangeu três anos após implementação. Resultados: foram incluídos 1.363 procedimentos realizados por 17 cirurgiões. A maioria dos pacientes eram mulheres (67,2%), com idade média de 39 anos e IMC basal médio de 41,5kg/m2. Diabetes mellitus estava presente em 34,5% e hipertensão em 40,1%. Bypass gástrico em Y de Roux foi realizado em 79,3%, 95,5% por laparoscopia. Houve um óbito hospitalar de causa cardiovascular. A média de permanência hospitalar foi de 2,03 dias. A taxa de complicações relacionadas à cirurgia foi 0,97% no primeiro mês, com três reoperações. Seguimento de curto prazo foi registrado em 75,6% e de um ano em 21,64%. A perda de peso corporal total foi de 10% em 30 dias, aumentando para 33,3% após um ano, sem diferença entre técnicas cirúrgicas. Conclusões: o perfil populacional está de acordo com o registro global da IFSO. A principal dificuldade encontrada foi a baixa inserção de dados pós-operatórios. A experiência adquirida neste projeto ajudará no conhecimento da segurança e eficácia da cirurgia bariátrica no Brasil.

Thoracic, lumbar, and sacral spine anatomy for endoscopic surgery.

We discuss the anatomy of the thoracic, lumbar, and sacral levels of the spinal cord. Given the nature of endoscopic surgery, it is recommended that the surgeon have thorough knowledge not only of the bony architecture but also of important visceral and other soft tissue structures. It is essential to understand the normal anatomy to recognize the abnormal and anatomic variations. We present the so-called normal anatomic configurations and illustrate how these structures vary at the different levels of the spinal column.

miRNAs mediate SnRK1-dependent energy signaling in Arabidopsis.

The SnRK1 protein kinase, the plant ortholog of mammalian AMPK and yeast Snf1, is activated by the energy depletion caused by adverse environmental conditions. Upon activation, SnRK1 triggers extensive transcriptional changes to restore homeostasis and promote stress tolerance and survival partly through the inhibition of anabolism and the activation of catabolism. Despite the identification of a few bZIP transcription factors as downstream effectors, the mechanisms underlying gene regulation, and in particular gene repression by SnRK1, remain mostly unknown. microRNAs (miRNAs) are 20-24 nt RNAs that regulate gene expression post-transcriptionally by driving the cleavage and/or translation attenuation of complementary mRNA targets. In addition to their role in plant development, mounting evidence implicates miRNAs in the response to environmental stress. Given the involvement of miRNAs in stress responses and the fact that some of the SnRK1-regulated genes are miRNA targets, we postulated that miRNAs drive part of the transcriptional reprogramming triggered by SnRK1. By comparing the transcriptional response to energy deprivation between WT and dcl1-9, a mutant deficient in miRNA biogenesis, we identified 831 starvation genes misregulated in the dcl1-9 mutant, out of which 155 are validated or predicted miRNA targets. Functional clustering analysis revealed that the main cellular processes potentially co-regulated by SnRK1 and miRNAs are translation and organelle function and uncover TCP transcription factors as one of the most highly enriched functional clusters. TCP repression during energy deprivation was impaired in miR319 knockdown (MIM319) plants, demonstrating the involvement of miR319 in the stress-dependent regulation of TCPs. Altogether, our data indicates that miRNAs are components of the SnRK1 signaling cascade contributing to the regulation of specific mRNA targets and possibly tuning down particular cellular processes during the stress response.

Cirurgia bariátrica robótico-assistida: análise de série de casos e comparação com via laparoscópica / Robotic-assisted bariatric surgery: case series analysis and comparison with the laparoscopic approach

RESUMO Objetivo: relatar uma série de casos de cirurgia bariátrica robótica no tratamento da obesidade no Brasil. Métodos: foram avaliados pacientes submetidos à cirurgia bariátrica robótica no Instituto Garrido, e realizada comparação com grupo submetido à cirurgia laparoscópica convencional. Resultados: foram analisados 45 pacientes, com média de idade de 39,44 anos, sendo 34 do sexo feminino, com média de IMC inicial de 41,26Kg/m2. Dentre as cirurgias realizadas, 91,11% foram bypass gástrico em Y de Roux, enquanto 8,89% foram do tipo gastrectomia vertical. A média de tempo total de cirurgia foi de 158 (±56,54) minutos, com tempo médio de docking de 7,93 (±3,9) minutos e tempo de console 113,0 (±41,4) minutos. A média de dor apresentada na recuperação pós-anestésica foi de 2,61 (±3,30) pontos, em escala de 0 a 10, com quatro pacientes apresentando sinais leves de náusea, respondendo bem ao tratamento medicamentoso. Somente um paciente necessitou internação em UTI por um período de dois dias após a cirurgia, devido à cardiopatia prévia. Em dois casos ocorreram hérnia incisional em sítio de trocater, tratados cirurgicamente, sem posteriores complicações. Na comparação entre os grupos de cirurgia robótica versus laparoscópica, foram selecionados 45 pacientes para cada grupo. O tempo operatório foi significativamente mais longo na via robótica, sendo a maior parte das outras variáveis equivalentes, inclusive controle pós-operatório de comorbidades. Conclusão: a cirurgia bariátrica robótica é um procedimento seguro, com resultados comparáveis à cirurgia laparoscópica.

ABSTRACT Objective: to report a series of cases of robotic bariatric surgery in the treatment of obesity in Brazil. Methods: we evaluated patients undergoing robotic bariatric surgery at the Garrido Institute and compared them with a group submitted to conventional laparoscopic surgery. Results: we analyzed 45 patients, with a mean age of 39.44 years, of which 34 were female, with an initial mean BMI of 41.26kg/m2. Among the procedures performed, 91.11% were Roux-en-Y gastric bypass, while 8.89% were sleeve gastrectomy. The mean total surgery time was 158 (±56.54) minutes, with mean docking time of 7.93 (±3.9) minutes, and console time 113.0 (±41.4) minutes. The average pain presented in the post anesthetic recovery was 2.61 (±3.30) points on a scale of 0 to 10; four patients presented with mild signs of nausea, responding well to drug treatment. Only one patient needed ICU admission for a period of two days after surgery due to previous cardiopathy. In two cases, there was an incisional hernia at the trocar site, which were surgically treated without further complications. In the comparison between robotic versus laparoscopic surgery groups, 45 patients were selected for each group. Operative time was significantly longer in the robotic surgery group, with most other variables being equivalent, including postoperative control of comorbidities. Conclusion: robotic bariatric surgery is a safe procedure, with results comparable to laparoscopic surgery.

Thoracic disc herniation: case series and protocol for surgical approaches / Hérnia de disco torácico: série de casos e protocolo de via de acesso cirúrgico / Hernia de disco torácico: serie de casos y protocolo de acceso quirúrgico

ABSTRACT Objective To describe the surgical results of a prospective series of five patients operated according to an approach indication protocol. Methods: Patients were classified according to surgical risk: Group A (high risk) or B (low risk) and subsequently into subgroups according to characteristics of the herniation and ultimately the surgical approach was defined: A.1) calcified central herniations - thoracoscopy; A.2) soft lateral herniations - posterolateral approach; A.3) centrolateral herniations - partial calcification in lateral position - posterolateral approach; higher density central calcification - thoracoscopy; B.1) central or centrolateral calcified herniations - thoracotomy or thoracoscopy; B.2) soft lateral herniations - posterolateral approach. Results: The duration of symptoms ranged from 2 months to 3 years; the age bracket was from 37 to 58 years; sex distribution was 3 female and 2 male patients and the length of hospital stay ranged from 2 to 20 days. The most affected level was T11/12. A patient classified as Group A.3 underwent posterolateral approach. The remaining patients were Group B.1, 3 submitted to thoracotomy and 1 to thoracoscopy. The herniation removal was completed in 5 cases; 3 patients improved and 2 remained stable. The morbidity and the recovery time were higher in patients who underwent anterolateral approaches. Conclusions: Classify patients according to surgical risk and the anatomical characteristics of disc herniation allows for complete decompression, minimizing morbidity and mortality.

RESUMO Objetivo: Descrever os resultados cirúrgicos de uma série prospectiva de cinco casos, operados segundo um protocolo de indicação de vias de acesso. Métodos: Os pacientes foram classificados conforme o risco cirúrgico: Grupo A (alto risco) ou B (baixo risco); posteriormente, foram divididos em subgrupos, conforme características da herniação e, por fim, definiu-se a via de acesso cirúrgico: A.1) hérnias centrais calcificadas - toracoscopia; A.2) hérnias laterais moles - via posterolateral; A.3) hérnias centrolaterais - calcificações parciais de posição lateral - via posterolateral; calcificação de maior densidade e central - toracoscopia; B.1) hérnias centrais ou centrolaterais calcificadas - toracotomia ou toracoscopia; B.2) hérnias laterais moles - via posterolateral. Resultados: A duração dos sintomas variou de dois meses a três anos; a faixa etária foi de 37 a 58 anos; a distribuição por sexo foi de três pacientes do sexo feminino e dois do sexo masculino e o tempo de internação variou de dois a 20 dias. O nível mais acometido foi T11/12. Um paciente classificado como Grupo A.3 foi submetido à via posterolateral. Os demais pacientes foram Grupo B.1, três submetidos à toracotomia e um à toracoscopia. A remoção da herniação foi completa nos cinco casos; três pacientes melhoraram e dois permaneceram estáveis. A morbidade e o tempo de recuperação foram maiores nos pacientes submetidos às vias anterolaterais. Conclusões: Classificar pacientes de acordo com o risco cirúrgico e as particularidades anatômicas da herniação discal permite obter descompressão completa, minimizando a morbidade e a mortalidade.

RESUMEN Objetivo: Describir los resultados quirúrgicos de una serie prospectiva de 5 casos utilizando un protocolo de indicación de las vías de acceso. Métodos: Los pacientes fueron clasificados de acuerdo con el riesgo quirúrgico: Grupo A (alto riesgo) o B (bajo riesgo); luego se dividieron en subgrupos según las características de la hernia y, finalmente, se definió la vía de abordaje quirúrgico: A.1) hernias centrales calcificadas - toracoscopía; A.2) hernias laterales blandas - vía posterolateral; A.3) hernias centrolaterales - calcificaciones parciales en posición lateral - vía posterolateral; calcificación más densa y central - toracoscopía; B.1) hernias centrales o centrolaterales calcificadas - toracotomía o toracoscopía; B.2) hernias laterales blandas - vía posterolateral. Resultados: La duración de los síntomas fue de 2 meses a 3 años, el rango de edad fue de 37-58 años, la distribución por sexo fue 3 mujeres y 2 hombres y la duración de la estancia hospitalaria varió de 2 a 20 días. El nivel más afectado fue el T11/12. Un paciente clasificado como Grupo A.3 se sometió a la vía posterolateral. Los demás pacientes fueron del grupo B.1, con 3 sometidos a toracotomía y uno a toracoscopía. La eliminación de la hernia fue completa en 5 casos; 3 pacientes mejoraron y 2 se mantuvieron estables. La morbilidad y el tiempo de la recuperación fueron mayores en pacientes operados por la vía anterolateral. Conclusiones: Clasificar a los pacientes según el riesgo quirúrgico y las características anatómicas de la hernia de disco, permite la descompresión completa, lo que reduce al mínimo la morbilidad y la mortalidad.

Fusão intersomática lombar transforaminal: experiência de uma instituição / Transforaminal lumbar interbody fusion: a single-center experience / Fusión intersomática lumbar transforaminal: la experiencia de una institución

OBJETIVO: Relatar a experiência inicial de um serviço de referência em cirurgia da coluna em São Paulo, Brasil com a técnica de fusão intersomática lombar transforaminal (TLIF) nas suas mais variadas indicações. MÉTODOS: Avaliamos retrospectivamente os dados gravados em prontuário de 25 pacientes que foram submetidos à cirurgia com a técnica de TLIF no ano de 2011. Um paciente foi excluído porque não consideramos que a TLIF foi a principal técnica empregada. As indicações incluíram nove casos de hérnia de disco lombar, sete espondilolisteses, quatro cirurgias de revisão, sendo duas por pseudoartrose e duas por lombalgias e, finalmente, quatro pacientes com estenose espinhal lombar. RESULTADOS: Todos os pacientes referiram melhora da dor e/ou claudicação neurológica em comparação com o estado pré-operatório. Apenas cinco pacientes continuaram usando alguma medicação analgésica. Cinco pacientes apresentaram alguma complicação, mas somente duas delas estão relacionadas diretamente com o procedimento. CONCLUSÕES: Trata-se de uma técnica segura, possível de ser realizada em todos os níveis da coluna lombar e aplicável a grande parte das doenças que acometem essa região da coluna.

OBJECTIVE: Describe the early results and experience from a reference center in spine surgery in São Paulo, Brazil with transforaminal lumbar interbody fusion (TLIF) technique in its various indications. METHODS: We retrospectively reviewed the medical records of 25 patients who underwent surgery with TLIF technique in 2011. One patient was excluded because we considered that TLIF was not the most important technique used. The indications were 9 lumbar disc herniations, 7 spondylolistheses, 4 revision surgeries of which 2 were for pseudoarthroses and 2 for low back pain, and finally, 4 lumbar spinal stenoses. RESULTS: All the patients reported low back pain and/or neurologic claudication improvement when comparing to preoperative status. Only five patients continued using analgesics. Five patients presented some complication, but only two of them were related to the procedure. CONCLUSIONS: TLIF is a safe technique which can be performed at any lumbar level of the lumbar spine and is applicable to the majority of diseases that affect this region.

OBJETIVO: Relatar la experiencia de un servicio de referencia en cirugía de la columna en São Paulo, Brasil con la técnica de fusión intersomática lumbar transforaminal (TLIF) en sus más variables indicaciones. MÉTODOS: Valoramos retrospectivamente el historial médico de 25 pacientes que fueron sometidos a la cirugía con la técnica de TLIF en el año de 2011. Un paciente fue excluido porque no consideramos que la TLIF fue la principal técnica empleada. Las indicaciones incluyeron nueve casos de hernia de disco lumbar, siete espondilolistesis, cuatro cirugías de revisión siendo dos por pseudoartrosis y dos por lumbalgias y, finalmente, cuatro pacientes con estenosis espinal. RESULTADOS: Todos los pacientes presentaron mejora del dolor y/o claudicación neurogénicas en comparación con el status preoperatorio. Solamente cinco pacientes continuaron usando alguna medicación analgésica. Cinco pacientes presentaran alguna complicación, pero sólo dos de ellas están relacionadas directamente al procedimiento. CONCLUSIONES: Es una técnica segura, posible de ser realizada en todos los niveles de la columna lumbar y es aplicable a la mayoría de las enfermedades que afectan a esta región de la columna.

Derivações gástricas em y- de- roux com anel de silicone para o tratamento da obesidade: estudo das complicações relacionadas com o anel / Roux-en-y gastric bypass with silicone ring for the obesity treatment: study of the complications related to the ring

RACIONAL: O anel de silicone é utilizado como fator de contensão do bypass gástrico em Y-de-Roux para induzir maior perda ponderal. No entanto, ele pode ter alguns inconvenientes nesta restrição forçada. OBJETIVO: Analisar as complicações relacionadas ao anel em pacientes submetidos à operação de bypass gástrico em Y-de-Roux. MÉTODOS: De 1994 a 2005, 7 000 pacientes foram submetidos à bypass gástrico em Y-de-Roux com anel de silicone para o tratamento da obesidade mórbida. Apenas 50 por cento foram acompanhados de dois a 11 anos. A perda média de peso em excesso foi de cerca de 85 por cento. Mas complicações do anel foram registrados em 160 pacientes (2,28 por cento do total e 4,56 por cento dos pacientes seguidos). Assim, esta série é composta de 38 pacientes do sexo masculino (23,8 por cento) e 122 pacientes do feminino (76,2 por cento) com idade média de 44 anos e IMC de 54,4 kg/m². RESULTADOS: Cinco tipos de complicações do anel foram encontradas. A mais frequente foi o de deslocamento (61 por cento) causando sintomas de obstrução. A segunda, foi a erosão do anel de luz (22 por cento), causando dor epigástrica e náuseas. A presença de anel estreito, anel aberto e a inadequação do mesmo são outras complicações que acorreram, porém em menor percentual. CONCLUSÕES: As complicações do anel ocorrem em baixa frequência. Sua remoção, cirúrgica ou endoscópica, é o tratamento mais usual, mas com sua realização o paciente tende a recuperar o peso perdido.

BACKGROUND: The silicone ring is used as containment factor of the Roux-en-Y gastric bypass to induce greater ponderal loss. However, it may have some inconveniences from this stressed restriction. AIM: To analyze the complications related to silicone ring in patients who underwent Roux-en-Y gastric bypass surgery with silicon ring. METHODS: From 1994 to 2005, 7 000 patients were submitted to Roux-in-Y gastric bypass with silicone ring in order to treat morbid obesity. Only 50 percent were followed from two to 11 years. The mean excess weight loss was around 85 percent. But ring complications were registered in 160 patients (2,28 percent of the total and 4,56 percent of the followed patients). Therefore, this series consist of 38 male patients (23.8 percent) and 122 female patients (76.2 percent) with average age of 44 years old and BMI of 54.4 kg/m². RESULTS: Five types of ring complications were found. The most frequent was displacement (61 percent) causing obstructive symptoms. The second most frequent complication was ring erosion to the lumen (22 percent) causing epigastric pain and nausea. CONCLUSIONS: The ring complications occur in low frequency. Ring removal, either surgical or endoscopically done, is the most usual treatment, but tends to cause partial regain of the weight lost.

A discricionariedade técnica nos atos administrativos sanitários / The discretionary administrative acts in the technical health

Por meio de uma intensa exploração doutrinária, vem se discutindo as mutações do direito frente à explosão tecnológica no mundo e, em especial, a tecnificação das atividades de atuação do Estado. Diante dessa situação, exploramos na doutrina internacional e nacional o conceito de um instituto intimamente ligado a tecnificação da atividade Estatal chamado de discricionariedade técnica. Com esta exploração, temos o intuito de demonstrar que, além de esta doutrina ser plenamente aplicável no direito pátrio, a situação de fato correspondente a tecnificação pela aplicação ao direito dos conhecimentos científicos de engenharia, biologia, medicina, saúde pública, entre outros, impulsionado pelas agências reguladoras, demanda o seu reconhecimento como forma de controle e proteção dos direitos contra eventuais abusos e ilegalidades da Administração Pública e, especialmente, da Administração Pública Sanitária. Por isso, iniciamos com os conceitos da discricionariedade técnica em suas duas modalidades e, após isto, buscamos, nas mais recentes doutrinas, os conceitos e limites identificados para a atividade discricionária técnico-administrativa, além de exemplificar ao leitor, circunstâncias em que tal discricionariedade se impõe. Paralelamente à conceituação, demonstramos a correlação e a relevância do reconhecimento deste instituto para o direito sanitário, buscando exemplos existentes neste ramo jurídico para melhor ilustrar a pesquisa. Após conceituar e exemplificar, passamos, finalmente, a justificar a real relevância deste estudo levantando na doutrina os limites formais e materiais deste instituto, como maneira de fornecer ferramentas para a proteção dos direitos coletivos e individuais contra atos ilegais.

Direito tributário sanitário: das taxas de fiscalização sanitária e seus problemas atuais, uma forma de identificação dos erros na busca de soluções / Tributary health surveillance law: of the health surveillance enforcement fee and its current problems, a way to identify mistakes in search for solutions

O Sistema Nacional Tributário Sanitário é totalmente novo. Criado recentemente em 26 de janeiro de 1999 pela Lei n. 9.782, é pouco abordado pelos juristas e cientistas do direito. Porém, muito ao contrário do que se possa imaginar a respeito de artigos e trabalhos que abordam as peculiaridades do Sistema, ele está longe de se constituir num modelo de respeito à Constituição da República e ao Código Tributário Nacional. Portanto, nos impõe ressaltar aos cientistas jurídicos os graves problemas evidenciados neste Sistema para que sejam discutidos na finalidade de buscar o aperfeiçoamento legal, afastando as ilegalidades e inconstitucionalidades, em caráter de urgência, já que prejudica tanto o setor privado quanto o setor público regulado.

Remoção do cisto sinovial da articulação atlantoaxial pela via póstero-lateral transdural / Synovial cyst of the atlantoaxial joint

Mielopatia cervical alta causada por cisto sinovial da articulação atlantoaxial é uma entidade rara e muito pouco descrita na literatura. Os autores descreveram um caso de cisto sinovial localizado posteriormente ao processo odontóide causando compressão bulbo-medular em paciente com 88 anos de idade. O cisto foi removido através de um acesso póstero-lateral direito com hemilaminectomia de C1 e ressecção microcirúrgica transdural. A paciente apresentou uma excelente recuperação. Os aspectos etiológicos e terapêuticos são discutidos.

Epidemiologia do trauma raquimedular cervical na zona norte da cidade de São Paulo / Epidemiology of cervical spine injury in the north area of Sao Paulo City

Objetivos: Estudar a epidemiologia do paciente vítima de trauma raquimedular cervical na zona norte da cidade de São Paulo, na área definida com DIR IV e na região de Franco da Rocha, entre 1996 e 2000. Métodos: Estudo parte retrospectivo, parte prospectivo, baseado em dados de protocolo padronizado para trauma raquimedular, consultas médicas e estudo de prontuários. Casuística: 95 pacientes consecutivos foram estudados entre abril de 1996 e dezembro de 2000. Conclusões: A incidência de casos de trauma raquimedular geral estimada foi de 22,63 milhão/ano e de trauma cervical foi de 8,6 milhão/ano. A média mensal foi 84 por cento maior no ano de 1999 em comparação a 1996. Predominaram as quedas ao solo como causa. A média de idade foi de 35 anos. Quarenta e cinco por cento da amostra apresentava-se com menos de 30 anos. Quarenta e dois por cento dos pacientes apresentaram complicações potencialmente graves. A média de internação foi de 25,86 dias. As lesões 0-C1-C2 causaram dano neurológico menos freqüentemente que as C3-C7 (11,6 por cento/61,04 por cento). As lesões que produziram deficit completo acima de C3 foram fatais. Mais de 60 por cento dos pacientes com traumatismo C3-C7 apresentaram deficits neurológicos e 41,5 por cento apresentaram paralisia, com nenhuma força evidente ao exame, com ou sem preservação sensitiva; 44 por cento destes morreram. Um paciente teve piora neurológica antes da cirurgia e outro teve seu quadro neurológico piorado pela cirurgia. O estado neurológico e o nível da lesão foram os fatores prognósticos mais importantes. Os 95 pacientes utilizaram 77 sistemas de fixação e/ou halo-coletes.