Kinin B1 receptor and TLR4 interaction in inflammatory response.

OBJECTIVE: We aimed to broaden our understanding of a potential interaction between B1R and TLR4, considering earlier studies suggesting that lipopolysaccharide (LPS) may trigger B1R stimulation. METHODS: We assessed the impact of DBK and LPS on the membrane potential of thoracic aortas from C57BL/6, B1R, or TLR4 knockout mice. Additionally, we examined the staining patterns of these receptors in the thoracic aortas of C57BL/6 and in endothelial cells (HBMEC). RESULTS: DBK does not affect the resting membrane potential of aortic rings in C57BL/6 mice, but it hyperpolarizes preparations in B1KO and TLR4KO mice. The hyperpolarization mechanism in B1KO mice involves B2R, and the TLR4KO response is independent of cytoplasmic calcium influx but relies on potassium channels. Conversely, LPS hyperpolarizes thoracic aorta rings in both C57BL/6 and B1KO mice, with the response unaffected by a B1R antagonist. Interestingly, the absence of B1R alters the LPS response to potassium channels. These activities are independent of nitric oxide synthase (NOS). While exposure to DBK and LPS does not alter B1R and TLR4 mRNA expression, treatment with these agonists increases B1R staining in endothelial cells of thoracic aortic rings and modifies the staining pattern of B1R and TLR4 in endothelial cells. Proximity ligation assay suggests a interaction between the receptors. CONCLUSION: Our findings provide additional support for a putative connection between B1R and TLR4 signaling. Given the involvement of these receptors and their agonists in inflammation, it suggests that drugs and therapies targeting their effects could be promising therapeutic avenues worth exploring.

Abdominal Wall Needle Tract Seeding: 15 Years After a Hepatocellular Carcinoma Biopsy.

Percutaneous liver biopsy, although considered a safe procedure, can lead to tumoral needle tract seeding. We describe a case of a 65-year-old woman with a history of hepatocellular carcinoma (HCC) who presented with a painless abdominal lump 15 years post-liver biopsy and left hepatectomy. An MRI revealed an abdominal wall mass suggestive of HCC metastasis from needle tract seeding. Surgical removal confirmed a well-differentiated HCC. Distinctive imaging features of HCC in specific clinical settings reduce the need for biopsy, which should be limited to exceptional cases.

Suboptimal bioinformatic predictions of antimicrobial resistance from whole-genome sequences in multidrug-resistant Corynebacterium isolates.

Herein, we combined different bioinformatics tools and databases (BV-BRC, ResFinder, RAST, and KmerResistance) to perform a prediction of antimicrobial resistance (AMR) in the genomic sequences of 107 Corynebacterium striatum isolates for which trustable antimicrobial susceptibility (AST) phenotypes could be retrieved. Then, the reliabilities of the AMR predictions were evaluated by different metrics: area under the ROC curve (AUC); Major Error Rates (MERs) and Very Major Error Rates (VMERs); Matthews Correlation Coefficient (MCC); F1-Score; and Accuracy. Out of 15 genes that were reliably detected in the C. striatum isolates, only tetW yielded predictive values for tetracycline resistance that were acceptable considering Food and Drug Administration (FDA)'s criteria for quality (MER < 3.0% and VMER with a 95% C.I. ≤1.5-≤7.5%); this was accompanied by a MCC score higher than 0.9 for this gene. Noteworthy, our results indicate that other commonly used metrics (AUC, F1-score, and Accuracy) may render overoptimistic evaluations of AMR-prediction reliabilities on imbalanced datasets. Accordingly, out of 10 genes tested by PCR on additional multidrug-resistant Corynebacterium spp. isolates (n = 18), the tetW gene rendered the best agreement values with AST profiles (94.11%). Overall, our results indicate that genome-based AMR prediction can still be challenging for MDR clinical isolates of emerging Corynebacterium spp.

The Impact of Avian Haemosporidian Infection on Feather Quality and Feather Growth Rate of Migratory Passerines.

Bird feathers have several functions, including flight, insulation, communication, and camouflage. Since feathers degrade over time, birds need to moult regularly to maintain these functions. However, environmental factors like food scarcity, stress, and parasite infections can affect feather quality and moult speed. This study examined the impact of avian haemosporidian infection and uropygial gland volume, as well as feather quality and feather growth rate in two migratory hirundine species captured in southwestern Spain-the house martin (Delichon urbicum) and sand martin (Riparia riparia). Our findings showed that the prevalence of infection varied among species, with house martins having the highest rates, possibly due to their larger colony size. Moreover, haemosporidian infection had a different impact on each species; infected house martins exhibited lower feather quality than healthy individuals, although this outcome was not observed in sand martins. Furthermore, no effect of infection on feather growth rate was observed in both hirundinids. Additionally, feather growth rate only correlated positively with feather quality in house martins. Finally, no link was observed between uropygial gland volume and feather quality or feather growth rate in any of the species in this study. These findings highlight the effect of haemosporidian infections on the plumage of migratory birds, marking, for the first time, how avian haemosporidian infection is shown to adversely impact feather quality. Even so, further research is needed to explore these relationships more deeply.

Avian Haemosporidian Infection in Wildlife Rehabilitation Centres of Portugal: Causes, Consequences, and Genetic Diversity.

In the last decade, over 40% of bird species in Europe have experienced poor and bad conservation status, with more than 30% of bird species in mainland Portugal threatened with extinction. Along with anthropogenic factors, parasites and pathogens such as avian haemosporidians have been suggested to be responsible for these avian population declines. Wildlife rehabilitation centres play an essential role in species conservation and preservation. Moreover, animals admitted for rehabilitation can provide valuable information regarding transmission and pathogenicity of many diseases that affect wild birds that are rarely sampled in nature. However, reports of haemosporidians in captive birds are still limited. Here, we explored the prevalence and genetic diversity of avian haemosporidians in 89 birds from 29 species admitted to rehabilitation centres in Portugal, showing an overall infection prevalence of 30.3%. The prevalence of infection was higher in Strigiformes and in birds admitted to rehabilitation centres due to debilitating diseases. Remarkably, 30% of the infected bird species have not been found to harbour malaria parasites in preceding studies. We detected 15 different haemosporidian lineages infecting a third of bird species sampled. Notably, 2 out of these 15 detected haemosporidian lineages have not been obtained previously in other studies. Furthermore, we also identified nine new host-parasite interactions representing new host records for these haemosporidian parasites. Finally, our results revealed that birds infected with haemosporidians require longer rehabilitation treatments, which increase the economic costs for rehabilitation and may impair their survival prospects. These findings emphasise the importance of integrating haemosporidian infection considerations into rehabilitation protocols, highlighting the challenges posed by these infections in avian conservation and rehabilitation, including economic and logistical demands.

Intraoperative Angle Measurement of Anatomical Structures: A Systematic Review.

Ensuring precise angle measurement during surgical correction of orientation-related deformities is crucial for optimal postoperative outcomes, yet there is a lack of an ideal commercial solution. Current measurement sensors and instrumentation have limitations that make their use context-specific, demanding a methodical evaluation of the field. A systematic review was carried out in March 2023. Studies reporting technologies and validation methods for intraoperative angular measurement of anatomical structures were analyzed. A total of 32 studies were included, 17 focused on image-based technologies (6 fluoroscopy, 4 camera-based tracking, and 7 CT-based), while 15 explored non-image-based technologies (6 manual instruments and 9 inertial sensor-based instruments). Image-based technologies offer better accuracy and 3D capabilities but pose challenges like additional equipment, increased radiation exposure, time, and cost. Non-image-based technologies are cost-effective but may be influenced by the surgeon's perception and require careful calibration. Nevertheless, the choice of the proper technology should take into consideration the influence of the expected error in the surgery, surgery type, and radiation dose limit. This comprehensive review serves as a valuable guide for surgeons seeking precise angle measurements intraoperatively. It not only explores the performance and application of existing technologies but also aids in the future development of innovative solutions.

Glycerophospholipids in Red Blood Cells Are Associated with Aerobic Performance in Young Swimmers.

This study aimed to characterize the composition of lipids in the red blood cells (RBCs) of adolescent swimmers and correlate this lipidome with the aerobic performance of the athletes. Five experimental assessments were performed by 37 adolescent swimmers. During the first session, the athletes went to the laboratory facility for venous blood sampling. The critical velocity protocol was conducted over the 4 subsequent days to measure aerobic performance (CV), comprising maximal efforts over distances of 100, 200, 400, and 800 m in a swimming pool. RBCs were obtained and extracted for analysis using the liquid chromatography-high resolution mass spectrometry untargeted approach. A total of 2146 ions were detected in the RBCs, of which 119 were identified. The enrichment pathway analysis indicated intermediary lipids in the glycerophospholipid, glycerolipid, sphingolipid, linoleic acid, and alpha-linolenic metabolisms, as well as pentose and glucuronate interconversions. A significant impact of the intermediary lipids was observed for the glycerophospholipid metabolism, including phosphatidylethanolamine (PE), phosphatidylcholine (PC), 1-acyl-sn-glycero-3-phosphocholine, sn-glycerol 3-phosphate, and phosphatidic acid. Inverse and significant associations were observed for PE 18:2/18:3 (r = -0.39; p = 0.015), PC 18:3/20:0 (r = -0.33; p = 0.041), and phosphatidic acid 18:0/0:0 (r = -0.47; p = 0.003) with aerobic performance. Swimmers who exhibited higher levels of aerobic performance also had the lowest abundance of PE, PC, and phosphatidic acid.

MTOR gene variants are associated with severe COVID-19 outcomes: A multicenter study.

BACKGROUND: The worst outcomes linked to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been attributed to the cytokine storm, which contributes significantly to the immunopathogenesis of the disease. The mammalian target of rapamycin (mTOR) pathway is essential for orchestrating innate immune cell defense including cytokine production and is dysregulated in severe Coronavirus Disease 2019 (COVID-19) individuals. The individual genetic background might play a role in the exacerbated immune response. OBJECTIVE: In this study, we aimed to investigate the association between MTOR genetic variants and COVID-19 outcomes. METHODS: This study enrolled groups of individuals with severe (n = 285) and mild (n = 207) COVID-19 from Brazilian states. The MTOR variants, rs1057079 and rs2536, were genotyped. A logistic regression analysis and Kaplan-Meier survival curves were performed. We applied a genotyping risk score to estimate the cumulative contribution of the risk alleles. Tumor necrosis factor (TNF) and interleukin-6 (IL-6) plasma levels were also measured. RESULTS: The T allele of the MTOR rs1057079 variant was associated with a higher likelihood of developing the most severe form of COVID-19. In addition, higher levels of IL-6 and COVID-19 death was linked to the T allele of the rs2536 variant. These variants exhibited a cumulative risk when inherited collectively. CONCLUSIONS: These results show a potential pathogenetic role of MTOR gene variants and may be useful for predicting severe outcomes following COVID-19 infection, resulting in a more effective allocation of health resources.

Uso da radiografia panorâmica como fonte de informação para a identificação humana ­ relato de caso pericial / Use of panoramic radiograph as a source for human identification ­ forensic case report

Introdução: A odontologia legal permite a identificação humana por meio da comparação de dados observados em uma documentação odontológica ante mortem (AM) com as informações coletadas post mortem (PM), sendo os exames radiográficos grandes aliados neste processo. Objetivo: Demostrar a contribuição da radiografia panorâmica como fonte de informação para a identificação humana. Relato do caso: foi encaminhado um corpo carbonizado, com parte da região bucomaxilofacial preservada e que ao exame necroscópico era possível identificar a presença de restaurações e ausências dentais. A apresentação de radiografia panorâmica anterior à morte e a realização de exame radiográfico panorâmico no corpo carbonizado possibilitou a comparação de pontos coincidentes e divergências explicáveis, permitindo a identificação positiva do caso. Conclusão: Ao final da perícia foi determinada a identidade da vítima e foi comprovada a importância da radiografia panorâmica para a identificação humana com base em caracteres identificadores anatômicos e terapêuticos presentes no complexo bucomaxilofacial

Introduction: Forensic dentistry allows human identification through the comparison of data observed in ante-mortem (AM) dental documentation with information collected post-mortem (PM), with radiographic examinations being great allies in this process. Objective: To demonstrate the contribution of panoramic radiography as a source of information for human identification. Case report: a charred body was sent, with part of the oral and maxillofacial region preserved and upon necroscopic examination it was possible to identify the presence of restorations and missing teeth. The presentation of a panoramic radiograph prior to death and the performance of a panoramic radiographic examination of the charred body made it possible to compare coincident points and explainable divergences, allowing positive identification of the case. Conclusion: At the end of the forensic examination of the case, the identity of the victim was determined and the importance of panoramic radiography for human identification based on anatomical and therapeutic identifying characters present in the oral and maxillofacial complex was proven

Optimization of a hybrid bacterial/Arabidopsis thaliana fatty acid synthase system II in Saccharomyces cerevisiae.

Fatty acids are produced by eukaryotes like baker's yeast Saccharomyces cerevisiae mainly using a large multifunctional type I fatty acid synthase (FASI) where seven catalytic steps and a carrier domain are shared between one or two protein subunits. While this system may offer efficiency in catalysis, only a narrow range of fatty acids are produced. Prokaryotes, chloroplasts and mitochondria rely instead on a FAS type II (FASII) where each catalytic step is carried out by a monofunctional enzyme encoded by a separate gene. FASII is more flexible and capable of producing a wider range of fatty acid structures, such as the direct production of unsaturated fatty acids. An efficient FASII in the preferred industrial organism S. cerevisiae could provide a platform for developing sustainable production of specialized fatty acids. We functionally replaced either yeast FASI genes (FAS1 or FAS2) with a FASII consisting of nine genes from Escherichia coli (acpP, acpS and fab -A, -B, -D, -F, -G, -H, -Z) as well as three from Arabidopsis thaliana (MOD1, FATA1 and FATB). The genes were expressed from an autonomously replicating multicopy vector assembled using the Yeast Pathway Kit for in-vivo assembly in yeast. Two rounds of adaptation led to a strain with a maximum growth rate (µmax) of 0.19 h-1 without exogenous fatty acids, twice the growth rate previously reported for a comparable strain. Additional copies of the MOD1 or fabH genes resulted in cultures with higher final cell densities and three times higher lipid content compared to the control.

Comparison of endothelial cell loss in diabetic patients after conventional phacoemulsification and femtosecond laser-assisted cataract surgery.

PURPOSE: This study aims to comparatively evaluate the morphological changes of the cornea after phacoemulsification (PHACO) and femtosecond laser-assisted cataract surgery (FLACS) without intercurrences in patients with type 2 diabetes mellitus. METHODS: A total of 95 diabetic patients with moderate cataracts (N2 + and N3+), 47 undergoing PHACO and 48 undergoing FLACS, were selected randomly for the study. Surgeries were performed by a single surgeon between July 2021 and December 2021. Cumulative dissipated energy (CDE) and total balanced saline solution (BSS) data were obtained at the end of each surgery. Changes in corneal endothelial cell density (ECD) and central corneal thickness (CCT) at three months postoperatively were investigated. RESULTS: After three months, evidence is lacking between groups in the CCT measures; the difference was neither statistically nor clinically relevant. However, for ECD, a significant and clinically significant difference was found; if all patients were treated with laser, the mean ECD would be 423.55 greater (RSE: 86.09; p-value < 0.001; 95% CI: 254.81-592.29) than the ECD potential means of 1656.423 among the conventional group (RSE: 74.90; p-value < 0.001; 95% CI: 1509.62-1803.23). CONCLUSIONS: Diabetic patients under treatment with moderate cataracts may predispose themselves to a more significant loss of endothelial cells after conventional phacoemulsification than femtosecond laser-assisted cataract surgery. TRIAL REGISTRATION: It was registered at The Brazilian Registry of Clinical Trials (ReBEC) with the code RBR-6d8whb5 (UTN code: U1111-1277-6020) on 17/05/2022.

Alterações dimensionais em marcas de mordidas humanas simuladas em alimentos: estudo in vitro / Dimensional changes in simulated human bite marks on food: in vitro study

Objetivo: avaliar alterações dimensionais em marcas de mordidas simuladas em um tipo de queijo e de goiabada com o decorrer do tempo. Materiais e Métodos: mordidas foram simuladas em 20 amostras-padrão formato retangular nas medidas 30 x 60 mm e espessura de 20 mm de queijo tipo muçarela (n=10) e goiabada (n=10) com a utilização de um manequim odontológico montado em oclusão normal e acoplado à máquina universal de ensaios mecânicos. Amostras foram mantidas em superfície de vidro em ambiente com temperatura e umidade controladas seguida da aferição das distâncias intercaninas das marcas a cada hora com auxílio de paquímetro digital, durante 120 horas de experimentação. A temperatura e umidade mantiveram-se constantes durante todo período. As medidas obtidas foram estatisticamente analisadas por meio dos testes de Friedman, de Wilcoxon, coeficiente de correlação de Spearman e a partir da análise de regressão linear simples. O nível de significância adotado foi de 5%. Resultados: os alimentos testados mantiveram o padrão das medidas lineares nas primeiras quatro horas (p>0,05). Após esse período, ocorreu uma deformação progressiva, levando ao aumento significativo das medidas (p<0,05). Conclusão: a marca de mordida em queijo tipo muçarela e goiabada apresentou-se dimensionalmente estável nas primeiras quatro horas, pós mordida. Após esse período, as marcas já não apresentaram características favoráveis para serem utilizadas como registro para fins de comparação.

Objective: to evaluate dimensional changes in simulated bite marks in a type of cheese and guava paste over time. Materials and Methods: Bites were simulated on 20 standard rectangular samples. in the measures 30 x 60 mm and thickness of 20 mm of mozzarella cheese (n=10) and guava paste (n=10) using a dental manikin mounted on normal occlusion and coupled to the universal mechanical testing machine. The samples were kept on a glass surface in an environment with controlled temperature and humidity , followed by the measurement of intercanine distances of the marks, every hour, with the aid of a caliper digital, during 120 hours of experimentation. The temperature and humidity remained constant throughout the period. The measurements obtained were statistically analyzed using the Friedman, Wilcoxon, Spearman's correlation coefficient and from the linear regression analysis simple (IBM SPSS. 21.0, 2012, Armonk, NY: IBM Corp.). The level of significance adopted was 5%. Results: the foods tested maintained the pattern of linear measurements in the first four hours (p>0.05). After this period, a progressive deformation occurred, leading to the significant increase in measurements (p<0.05). Conclusion: the bite mark in mozzarella cheese and guava paste it was dimensionally stable in the first four hours, post-bite. After this period, brands no longer have favorable characteristics to be used as a record for comparison purposes.

A new definitive host for Moniliformis cestodiformis (Acanthocephala: Moniliformidae): first report of a naturally infected European hedgehog (Erinaceus europaeus).

European hedgehogs, Erinaceus europaeus (Linnaeus, 1758), are small mammals found in western Europe and also in parts of northern Europe. They can be seen in rural, suburban and urban areas, but are usually found in grassland with edge habitats. These animals are omnivorous and serve as definitive or paratenic hosts for several parasites, including acanthocephalans (phylum Acanthocephala). During necropsy of a European hedgehog, a single adult parasite was collected from the intestinal lumen and preserved in 70% ethanol. After morphological evaluation of the specimen, it was identified as Moniliformis cestodiformis (von Linstow, 1904) (Acanthocephala: Moniliformidae). This is the first report of M. cestodiformis in a European hedgehog, as well as in Europe. More epidemiological studies need to be carried out to map the location and prevalence of this parasite in Portugal and the European continent.

When benign leiomyomas metastasize to the lungs - a case report.

Benign metastasizing leiomyoma is a rare disease that primarily affects premenopausal women who have a history of uterine leiomyoma, which is characterized by pulmonary metastases. The pathogenesis of this condition is unknown. Patients are usually asymptomatic or have vague symptoms. Pathological examination in conjunction with immunohistochemistry is required for diagno-sis. Treatment is determined by the patient's age, hormonal status, symptoms, and the extent of the lesions (number, size, and location of nodules), with surgical resection being the most effective. We present the case of a 72-year-old woman who had a total hysterec-tomy 30 years earlier due to myomas and developed a persistent dry cough. Her computed tomography of the chest revealed several small nodules in the pulmonary parenchyma. Because of the nod-ules' small size and difficult accessibility, a surgical biopsy was per-formed for histopathological examination and immunohistochemi-cal staining, which revealed metastasizing leiomyoma. Letrozole treatment was started and was well tolerated.

Necrotizing Scleritis and Rheumatoid Arthritis: A Clinical Case Report Supported by A Brief Review with Risk of Bias Analysis.

INTRODUCTION: Necrotizing scleritis (NS) presents 30%-40% as having a systemic autoimmune condition. OBJECTIVE: To present a clinical case report and a systematic review of necrotizing scleritis with ocular manifestation as the first sign of rheumatologic disease. METHODS: The present study was elaborated according to the rules of CARE. CASE REPORT: A female patient, 63 years old, a white, administrative assistant, presented irritation, low visual acuity (LVA) in the left eye (LE), and headache. Biomicroscopy (BIO) in the right eye (RE) was normal, and the LE showed hyperemia and scleral thinning. After 1 month, the patient returns without signs of infectious diseases in the exams, and after a rheumatological evaluation with a diagnosis of rheumatoid arthritis, methotrexate and prednisone are prescribed. After 2 months, she relapsed and started treatment with anti-TNF, with remission after the 4th dose. After 1 year, she evolved with LVA in LE. RESULTS: A total of 244 articles were found, 104 articles were evaluated and 10 were included in the brief review. The symmetrical Funnel Plot does not suggest a risk of bias. CONCLUSION: Both in the present case report and the literary findings, it was evidenced that the ophthalmologic findings may precede the systemic changes of the disease for the early diagnosis of rheumatoid arthritis.

Inflammatory myofibroblastic tumor presenting as a subepithelial lesion of the colon.

We present the case of a 42-year-old male admitted to the emergency department for a 15-day history of diarrhea, with bloody stools in the past 7 days. The patient denied abdominal pain or distension as well as any constitutional symptoms. On physical examination he presented good general health condition, with abdomen slightly tender in the lower quadrants; digital rectal examination was remarkable for the presence of dark blood. Laboratory evaluation revealed new onset normocytic anemia (Hb 10.8 g/dL, MCV 89 fL) and RCP of 3.3 mg/dL. Colonoscopy was performed, which showed a large cecal subepithelial lesion, with surface ulcerations. Histology reported mixed inflammatory infiltrate but no malignancy. Further investigation was carried out with an abdominal and pelvic computerized tomography that, other than the cecal mass, showed multiple infracentimetric mesenteric lymph nodes. A right laparoscopic hemicolectomy was performed. Pathological analysis led to the unusual diagnosis of inflammatory myofibroblastic tumor (IMT) of the colon. There was no sign of recurrence after 6 months of follow-up.

Experiences of Women With Breast Cancer Using Telehealth: A Qualitative Systematic Review.

Breast cancer is the most prevalent malignant neoplasm among women. Its treatment comprises different strategies. Telehealth can ensure continuity of care in distant locations. This study aimed to synthesize qualitative evidence of women's experiences with telehealth during the treatment and follow-up of breast cancer. We performed a qualitative systematic review and meta-synthesis. The databases included in the search were: Pubmed, EMBASE, CINAHAL, and Web of Science. The search combined the terms: breast cancer, telemedicine, telehealth, and qualitative study. The studies included were: qualitative design and mixed methods studies with qualitative components. The COREQ Checklist assisted in assessing the quality of included studies and an adaptation of thematic analysis for the qualitative meta-synthesis. We included twelve articles in the review. In the meta-synthesis, 3 themes emerged. (1) Structure: simple design and space to obtain information but in need of adjustments. (2) Usability: about the benefits and limitations of telehealth. (3) Interaction with health professionals. Telehealth is an accepted strategy for the clinical care of women with breast cancer. Patients identified the need for improvements in structure, usability, and interaction. PROTOCOL REGISTRATION: PROSPERO registration number CRD42021228326, registered 06/02/2021.

Unexpectedly high corneal flap thickness and ectasia after mechanical LASIK / Espessura inesperadamente alta do flap corneano e ectasia após LASIK mecânico

ABSTRACT LASIK is a refractive surgical procedure in which a corneal flap is created to expose the corneal stromal bed. Preoperative estimation of corneal flap thickness is necessary to calculate the percentage tissue altered in LASIK, an important quantitative risk factor for ectasia. The objective of this study was to assess flap thickness and calculate percentage tissue altered to check if unexpectedly thicker flaps and higher percentage tissue altered could pose as risk factors of ectasia. Four subjects (eight eyes) were submitted to mechanical LASIK in 2009 and 2010. Pre and postoperative clinical and tomographic data were reviewed. Mean preoperative estimated percentage tissue altered was 39.18±1.31%, which was borderline for increased ectasia risk when considering the limit of 40%. However, when considering the postoperatively measured flap thickness, the actual mean percentage tissue altered turned out to be 45.17 ± 4.13%, which was significantly higher than predicted preoperatively (p=0.002). Unexpectedly higher postoperative percentage tissue altered may be responsible for corneal ectasia after mechanical LASIK.

RESUMO A LASIK é um procedimento cirúrgico refrativo, no qual um retalho corneano é criado para expor o leito estromal corneano. A estimativa pré-operatória da espessura do retalho corneano é necessária para calcular o percentual de tecido alterado no LASIK, um importante fator de risco quantitativo para ectasia. O objetivo deste estudo foi avaliar a espessura do retalho e calcular o percentual de tecido alterado para verificar se retalhos inesperadamente mais espessos e percentuais de tecido alterado mais altos poderiam representar fatores de risco de ectasia. Quatro indivíduos (oito olhos) foram submetidos à LASIK mecânica em 2009 e 2010. Dados clínicos e tomográficos pré e pós-operatórios foram revisados. A média de percentual de tecido alterado pré-operatória estimada foi de 39,18±1,31%, limítrofe para risco aumentado de ectasia quando considerado o limite de 40%. No entanto, ao considerar a espessura do retalho medida no pós-operatório, o percentual de tecido alterado médio real foi de 45,17±4,13%, ou seja, significativamente maior do que o previsto no pré-operatório (p=0,002). O percentual de tecido alterado pós-operatóriao inesperadamente mais alto pode ser responsável pela ectasia da córnea após LASIK mecânico.

Analysis of the thickness of conjunctival autograft in pterygium surgery with the Moscovici dissection technique compared with manual dissection / Análise da espessura do autoenxerto conjuntival na cirurgia de pterígio com a técnica de dissecção de Moscovici comparada com a dissecção manual

ABSTRACT Objective Compare the thickness of conjunctival autografts in pterygium surgery using the Moscovici dissection technique with manual dissection and assess the difficulty of the techniques. Methods In this randomized clinical trial, 30 eyes of 30 patients undergoing pterygium surgery were divided into the Moscovici Dissection Technique Group and the Manual Dissection Group. The patients were treated at the Hospital Oftalmológico Visão Laser (Santos, São Paulo, Brazil). Optical coherence tomography was performed to measure graft thickness three months postoperatively. Three images were obtained from each eye, and three measurements were taken at a distance of 1.5mm perpendicular to the limbus in each capture. The surgeon graded the difficulty of obtaining the graft with the technique performed from one (lowest difficulty) to four (highest difficulty). Results We found statistically significant difference between the difficulty of the two techniques and the mean conjunctival autograft thickness in the two groups (p=0.01 e p=0.05, respectively). The average difficulty rating for the Moscovici Dissection Technique Group (Air Group) was 1.47, while that for the Manual Dissection Group (MD group) was 2.20. The mean thickness of the three measurements was 252µ in the Air Group and 298µ in the MD Group, with medians of 250µ and 278µ, respectively. Conclusion Our study showed that the Moscovici technique results in thinner grafts and can be performed with greater surgical ease.

RESUMO Objetivo Comparar a espessura de autoenxertos conjuntivais em cirurgia de pterígio utilizando a técnica de dissecção de Moscovici com a de dissecção manual e avaliar a dificuldade das técnicas. Métodos Neste ensaio clínico randomizado, 30 olhos de 30 pacientes submetidos à cirurgia de pterígio foram divididos em um Grupo de Técnica de Dissecção de Moscovici e um Grupo de Dissecção Manual. Os pacientes foram tratados e avaliados no Hospital Oftalmológico Visão Laser (Santos, São Paulo, Brasil). A tomografia de coerência óptica foi realizada para medir a espessura do enxerto 3 meses após a cirurgia. Três imagens foram obtidas de cada olho, e três medidas foram realizadas a uma distância de 1,5mm perpendicular ao limbo em cada captura. O cirurgião classificou a dificuldade de obtenção do enxerto com a técnica realizada de um (menor dificuldade) para quatro (maior dificuldade). Resultados Encontramos diferenças estatisticamente significantes entre a dificuldade das duas técnicas e a espessura média do autoenxerto conjuntival nos dois grupos (p=0,01 e p=0,05, respectivamente). A classificação média de dificuldade para o Grupo de Técnica de Dissecção de Moscovici foi de 1,47, enquanto a do Grupo de Dissecção Manual foi de 2,20. A espessura média das três medidas foi de 252μ no Grupo de Técnica de Dissecção de Moscovici e de 298μ no Grupo de Dissecção Manual, com medianas de 250μ e 278μ, respectivamente. Conclusão Nosso estudo mostrou que a técnica de Moscovici resulta em enxertos mais finos e pode ser realizada com maior facilidade cirúrgica.