NANOCELLULOSE MEMBRANE WITH VASCULAR ENDOTHELIUM GROWTH FACTOR (VEGF): FUTURE IN HEALING DEEP BURNS? / MEMBRANA DE NANOCELULOSE COM FATOR DE CRESCIMENTO DO ENDOTÉLIO VASCULAR (VEGF): FUTURO NA CICATRIZAÇÃO DE QUEIMADURAS PROFUNDAS?

Introduction: Burns are injuries caused by various agents that promote the destruction of the skin and can lead to the exposure of deeper tissues. To make better use of this variety of treatment options, it is important to know its causes, extent and treatment methods. Objective: Update the use of nanocellulose membranes with glycerol, vascular endothelial growth factor and other complements in burn healing. Method: Review carried out with material and analysis selected from research on virtual platforms (SciELO, Google Scholar, Virtual Health Library, Pubmed and Scopus) using the descriptors: "bacterial membrane proteins; vascular endothelial growth factor; VEGFR; biological dressings; dressings" with AND or OR search, considering the title and/or abstract. Afterwards, the articles were read in full. Result: 45 articles were included. Conclusion: Although more research is needed, published studies show that the enrichment of nanocellulose membranes with some additives such as Vascular Endothelial Growth Factor VEGF) and incorporation of sensors that can monitor wound conditions will result in highly effective dressings. Considering the technological advances to produce low-cost membranes, associated with artificial intelligence and the efforts of researchers, the benefit to public health will soon be evident.

Introdução: Queimaduras são lesões causadas por diversos agentes que promovem a destruição da pele podendo chegar à exposição de tecidos mais profundos. Para melhor uso desta variedade de opções de seu tratamento é importante conhecer-se suas causas, extensão e métodos de tratamento. Objetivo: Atualizar o uso de membranas de nanocelulose, fator de crescimento do endotélio vascular e outros complementos na cicatrização de queimaduras. Método: Revisão feita com material e análise  selecionados a partir de pesquisa em plataformas virtuais (SciELO, Google Scholar, Biblioteca Virtual em Saúde, Pubmed e Scopus) por meio dos descritores: "proteínas da membrana bacteriana; fator de crescimento do endotélio vascular; VEGFR; curativos biológicos; curativos" e seus equivalentes em inglês "bacterial outer membrane proteins; vascular endothelial growth fator; dressing; VEGFR; biological dressings" com busca AND ou OR, considerando o título e/ou resumo. Após, foi feita leitura na íntegra dos artigos. Resultado: Foram incluídos 45 artigos. Conclusão: Embora sejam necessárias mais pesquisas, estudos já publicados evidenciam que o enriquecimento das membranas de nanocelulose com alguns aditivos como o Fator de Crescimento do Endotélio Vascular VEGF) e incorporação de sensores que possam monitorar as condições das feridas resultará em curativos altamente eficazes. Considerando o avanço tecnológico para produzir membranas de baixo custo, associado à inteligência artificial e os esforços dos pesquisadores, em breve o benefício à saúde pública será evidente.

Gene Expression of GABAA Receptor Subunits and Association with Patient Survival in Glioma.

Rapid neuronal inhibition in the brain is mediated by γ-aminobutyric acid (GABA) activation of GABAA receptors. The GABRA5 gene, which encodes the α5 subunit of the GABAA receptor, has been implicated in an aggressive subgroup of medulloblastoma (MB), a type of pediatric brain tumor. However, the possible role of GABAA receptor subunits in glioma remains poorly understood. Here, we examined the expression of genes encoding GABAA receptor subunits in different types of glioma, and its possible association with patient prognosis assessed by overall survival (OS). Data were obtained from the French and The Cancer Genome Atlas Brain Lower Grade Glioma (TCGA-LGG) datasets and analyzed for expression of GABAA receptor subunit genes. OS was calculated using the Kaplan-Meier estimate. We found that genes GABRA2, GABRA3, GABRB3, GABRG1, and GABRG2 showed a significant association with OS, with higher gene expression indicating better prognosis. In patients with GBM, high expression of GABRA2 was associated with shorter OS, whereas, in contrast, higher levels of GABRB3 were associated with better prognosis indicated by longer OS. In patients with lower grade gliomas, GABRA3, GABRB3, GABRG1, and GABRG2, were associated with longer OS. High GABRB3 expression was related to longer survival when low grade glioma types were analyzed separately. Our results suggest an overall association between higher expression of most genes encoding GABAA receptor subunits and better prognosis in different types of glioma. Our findings support the possibility that down-regulation of GABAA receptors in glioma contributes to promoting tumor progression by reducing negative inhibition. These findings might contribute to further evaluation of GABAA receptors as a therapeutic target in glioma.

Gene Expression of CSF3R/CD114 Is Associated with Poorer Patient Survival in Glioma.

Gliomas comprise most cases of central nervous system (CNS) tumors. Gliomas afflict both adults and children, and glioblastoma (GBM) in adults represents the clinically most important type of malignant brain cancer, with a very poor prognosis. The cell surface glycoprotein CD114, which is encoded by the CSF3R gene, acts as the receptor for the granulocyte colony stimulating factor (GCSF), and is thus also called GCSFR or CSFR. CD114 is a marker of cancer stem cells (CSCs), and its expression has been reported in several cancer types. In addition, CD114 may represent one among various cases where brain tumors hijack molecular mechanisms involved in neuronal survival and synaptic plasticity. Here, we describe CSF3R mRNA expression in human gliomas and their association with patient prognosis as assessed by overall survival (OS). We found that the levels of CSF3R/CD114 transcripts are higher in a few different types of gliomas, namely astrocytoma, pilocytic astrocytoma, and GBM, in comparison to non-tumoral neural tissue. We also observed that higher expression of CSF3R/CD114 in gliomas is associated with poorer outcome as measured by a shorter OS. Our findings provide early evidence suggesting that CSF3R/CD114 shows a potential role as a prognosis marker of OS in patients with GBM.

ARE SUPERFICIAL SERRATED LESIONS IN EARLY STAGES HYPERPLASTIC OR SESSILE SERRATED LESIONS? / LESÕES SERRILHADAS SUPERFICIAIS NAS FASES INICIAIS SÃO HIPERPLÁSICAS OU LESÕES SÉSSEIS SERRILHADAS?

BACKGROUND: At least 20% of colorectal adenocarcinomas arise through serrated lesions and studying them in early stages is important in prevention. AIM: To analyze and compare the endoscopic and histopathological characteristics of superficial serrated lesions in early stages, greater than 5 mm in length, completely resected during colonoscopies, and classified. METHOD: Retrospective and observational study evaluating 12,653 colonoscopy exams where 217 cases were selected that underwent endoscopic resections of superficial serrated lesions measuring more than 5 mm in diameter, addressed in terms of anatomical location, endoscopic findings, the average size of the lesions, average age, gender, and anatomopathological result. RESULTS: There were 2 groups G1 and G2. G1 had 126 hyperplastic lesions (HL) and G2 had 91 sessile serrated lesions. The anatomical location was 57.9% proximal and 42.1% distal in G1 and 94.5% and 5.5% respectively in G2. In G1, type 0-IIa was found in 26.2% and lateral spreading in 73.8%; in G2, 15.4% and 84.6%, respectively. The average size of the lesions in G1 was 15.4 mm and in G2, 16.7 mm. The average age G1 was 62.6 and G2, 63.5. Women were predominant in the total number of patients. No invasive adenocarcinomas were observed in the 2 groups. CONCLUSIONS: Superficially elevated serrated lesions, measuring more than 5 mm and resected by colonoscopies, were hyperplastic (58%). HL was observed throughout the colon and rectum and SSL was predominantly in the proximal colon. HL did not present dysplasia and SSL did. No invasive adenocarcinomas were observed in the submucosa.

RACIONAL: Pelo menos 20% dos adenocarcinomas colorretais surgem através de lesões serrilhadas e estudá-los em estágios iniciais é importante na prevenção. OBJETIVO: Analisar e comparar as características endoscópicas e histopatológicas de lesões superficiais serrilhadas em estágios iniciais, maiores que 5 mm de comprimento, completamente ressecadas durante colonoscopias e classificadas. MÉTODO: Estudo retrospectivo e observacional avaliando 12.653 exames de colonoscopia, onde foram selecionados 217 casos submetidos às ressecções endoscópicas de lesões superficiais serrilhadas medindo mais de 5 mm de diâmetro, abordados quanto à localização anatômica, achados endoscópicos, tamanho médio das lesões, idade média, sexo e resultado anatomopatológico. RESULTADOS: Houve 2 grupos, G1 e G2. O G1 apresentou 126 lesões hiperplásicas (HL) e o G2 91 lesões serrilhadas sésseis. A localização anatômica foi 57,9% proximal e 42,1% distal no G1 e 94,5% e 5,5% respectivamente no G2. No G1, o tipo 0-IIa foi encontrado em 26,2% e o espalhamento lateral em 73,8%; no G2, 15,4% e 84,6%, respectivamente. O tamanho médio das lesões G1 foi de 15,4 mm e G2 de 16,7 mm. A média de idade do G1 foi de 62,6 anos e do G2, 63,5 anos. As mulheres predominaram no total de pacientes. Não foram observados adenocarcinomas invasivos nos 2 grupos. CONCLUSÕES: Lesões serrilhadas superficialmente elevadas, medindo mais de 5 mm e ressecadas por colonoscopia, eram hiperplásicas (58%). O HL foi observado em todo o cólon e reto e o SSL foi predominantemente no cólon proximal. HL não apresentou displasia e SSL sim. Não foram observados adenocarcinomas invasivos na submucosa.

The Nervous System Development Regulator Neuropilin-1 as a Potential Prognostic Marker and Therapeutic Target in Brain Cancer.

Neuropilins are transmembrane glycoproteins that regulate developmental processes in the nervous system and other tissues. Overexpression of neuropilin-1 (NRP1) occurs in many solid tumor types and, in several instances, may predict patient outcome in terms of overall survival. Experimental inhibition of NRP1 activity can display antitumor effects in different cancer models. Here, we review NRP1 expression and function in adult and pediatric brain cancers, particularly glioblastomas (GBMs) and medulloblastomas, and present analyses of NRP1 transcript levels and their association with patient survival in GBMs. The case of NRP1 highlights the potential of regulators of neurodevelopment as biomarkers and therapeutic targets in brain cancer.

Low Expression of the NRP1 Gene Is Associated with Shorter Overall Survival in Patients with Sonic Hedgehog and Group 3 Medulloblastoma.

Medulloblastoma (MB) is the most common type of malignant pediatric brain tumor. Neuropilin-1 (NRP1), encoded by the NRP1 gene, is a transmembrane glycoprotein overexpressed in several types of cancer. Previous studies indicate that NRP1 inhibition displays antitumor effects in MB models and higher NRP1 levels are associated with poorer prognosis in MB patients. Here, we used a large MB tumor dataset to examine NRP1 gene expression in different molecular subgroups and subtypes of MB. We found overall widespread NRP1 expression across MB samples. Tumors in the sonic hedgehog (SHH) subgroup showed significantly higher NRP1 transcript levels in comparison with Group 3 and Group 4 tumors, with SHH samples belonging to the α, ß, Δ, and γ subtypes. When all MB subgroups were combined, lower NRP1 expression was associated with significantly shorter patient overall survival (OS). Further analysis showed that low NRP1 was related to poorer OS, specifically in MB subgroups SHH and Group 3 MB. Our findings indicate that patients with SHH and Group 3 tumors that show lower expression of NRP1 in MB have a worse prognosis, which highlights the need for subgroup-specific investigation of the NRP1 role in MB.

MACROSCOPIC AND HISTOLOGICAL ANALYSIS ON ENDOSCOPICALLY RESECTED RECTAL LESIONS.

BACKGROUND: Colorectal cancer is among the most common malignancies worldwide. Colonoscopy is the examination of choice for the prevention of CRC because of its great diagnostic and, especially, therapeutic capacity in relation to adenomatous lesions. AIMS: This study aimed to analyze the prevalence, macroscopic, and histological characteristics of polypoid rectal lesions resected through endoscopic techniques and assess whether endoscopic therapy is safe and efficient for treating lesions located in the rectum. METHODS: This is a retrospective observational study with an analysis of the medical records of all patients undergoing resection of rectal polyps. RESULTS: A total of 123 patients with rectal lesions were evaluated, with 59 men and 64 women of mean age 56 years. All patients underwent endoscopic resection: 70% with polypectomy and 30% with wide mucosectomy. Complete colonoscopy with removal of the entire rectal lesion occurred in 91%, while in 5% the preparation was inadequate and poor clinical conditions were an impeditive factor, and in 4% surgical treatment was indicated because there was an infiltrative lesion with central ulceration. Histological evaluation showed adenomas in 3.25%, hyperplasia in 7.32%, and hamartoma in 0.81%; low-grade dysplasia was identified in 34.96%, high-grade dysplasia in 51.22%, and adenocarcinoma in 1.63%, while one case (0.81%) was classified as erosion. CONCLUSIONS: Polyps in the rectum are common and were found in 37% of these colonoscopies. Adenomas with dysplasia were the most common form of Colorectal cancer . Therapeutic colonoscopy proved to be a safe and efficient method for the complete treatment of rectal lesions.

BARIATRIC SURGERY AND THE NEW CORONAVIRUS PANDEMIC: COMPARATIVE ANALYSIS OF THE IMPACT ON SUS AND AGREEMENT PROCEDURES / CIRURGIA BARIÁTRICA E A PANDEMIA DO NOVO CORONAVÍRUS: ANÁLISE COMPARATIVA DO IMPACTO EM PROCEDIMENTOS DO SUS E DE CONVÊNIO

Introduction: The treatment of obesity involves several multidisciplinary approaches, including surgical intervention. The COVID-19 pandemic has impacted access to it, creating difficulties in its resumption and accentuating the disparities between the public and private system. Objective: To analyze the impact of the pandemic on bariatric surgery performed by SUS and medical insurance in Brazil. Methods: Data were collected using the TABNET databases of the Hospital Information System (SIH), of the Unified Health System (SUS), and the TISS data panel of the National Supplementary Health Agency (ANS), in the period of 2015 to 2021 and a descriptive quantitative analysis was performed, calculating the average of the information. In addition, statistical estimates were performed using linear regression in SPSS software, with a 95% confidence interval. Results: A significant and direct correlation was identified between the increase in the number of procedures performed by the SUS and the average increase in procedures over the years, while in the health insurance system there was no significant correlation. During the pandemic, there was a significant drop in surgical volume in both systems, with the public system being more affected. The resumption of surgical volume has not yet reached pre-pandemic levels in the public system, while the private system showed a significant increase. Conclusion: COVID-19 pandemic had a significant impact on the ability of the public and private sector to perform bariatric surgeries in Brazil. The results show regional and socioeconomic differences in the performance of these procedures.

Introdução : O tratamento da obesidade envolve diversas abordagens multidisciplinares, incluindo a intervenção cirúrgica. A pandemia de COVID-19 impactou o acesso a ela gerando dificuldades em sua retomada e acentuando as disparidades entre o sistema público e privado. Objetivo : Analisar o impacto da pandemia na cirurgia bariátrica realizada pelo SUS e por convênios médicos no Brasil. Métodos: Os dados foram coletados utilizando as bases de dados TABNET do Sistema de Informações Hospitalares (SIH), do Sistema Único de Saúde (SUS), e o Painel de dados do TISS da Agência Nacional de Saúde Suplementar (ANS), no período de 2015 a 2021 e foi realizada uma análise quantitativa descritiva, calculando-se a média das informações. Além disso, foram realizadas estimativas estatísticas utilizando regressão linear no software SPSS, com intervalo de confiança de 95%. Resultados : Foi identificado de forma significativa e direta entre o aumento do número de procedimentos realizados pelo SUS e o aumento do meio de procedimentos ao longo dos anos, enquanto nenhum sistema de atendimentos não foi significativo.Durante uma pandemia, houve queda expressiva no volume emitido em ambos os sistemas, com o sistema público sendo mais afetado. A retomada do volume aspirado ainda não alcançou os níveis superiores à pandemia no sistema público, enquanto o sistema privado apresentou aumento significativo. Conclusão : A pandemia do COVID-19 teve impacto significativo na capacidade do setor público e privado em realizar operações bariátricas no Brasil. Os resultados evidenciam diferenças regionais e socioeconômicas na realização desses procedimentos.

WHICH LESIONS ARE AT HIGHER RISK OF DEVELOPING COLORECTAL CARCINOMAS: SUPERFICIALLY ELEVATED SERRATED LESIONS OR DEPRESSED LESIONS?

BACKGROUND: There are lesions that are still being missed in colonoscopy. Many of those could be superficially elevated serrated lesions or depressed ones. AIMS: The aim of this study was to compare the histopathological characteristics of these lesions and their risks for submucosal carcinoma. METHODS: This is a retrospective, cross-sectional, and observational study comparing 217 superficially elevated serrated lesions larger than 5 mm resected by colonoscopies (G1) with 558 depressed lesions (G2). RESULTS: In G1, 217 lesions were found in 12,653 (1.7%) colonoscopies; in G2, 558 lesions were found in 36,174 (1.5%) colonoscopies. In G1, 63.4% were women and in G2, there was no gender predominance. The average size of G1 was 16.2 mm and G2 was 9.2 mm (p<0.001). G1 predominated on the proximal colon and G2 on the distal and rectum (p<0.001). In G1, there were 214 (98.6%) low-grade intramucosal neoplasia and 3 (1.4%) high-grade intramucosal neoplasia. Excluding 126 hyperplastic polyps and considering 91 sessile serrated adenomas in G1, we observed 88 (96.7%) low-grade intramucosal neoplasia and 3 (3.3%) high-grade intramucosal neoplasia; in G2, we observed 417 (74.7%) low-grade intramucosal neoplasia, 113 (20.3%) high-grade intramucosal neoplasia, and 28 (5.0%) submucosal adenocarcinomas (p<0.001). CONCLUSION: Depressed lesions significantly had more high-grade intramucosal neoplasia and more invasive carcinomas in the submucosal layer than superficially elevated serrated lesions and more than superficially elevated sessile serrated adenomas.

Macroscopic and histological analysis on endoscopically resected rectal lesions / Análise macroscópica e histológica de lesões retais endoscopicamente ressecadas

ABSTRACT BACKGROUND: Colorectal cancer is among the most common malignancies worldwide. Colonoscopy is the examination of choice for the prevention of CRC because of its great diagnostic and, especially, therapeutic capacity in relation to adenomatous lesions. AIMS: This study aimed to analyze the prevalence, macroscopic, and histological characteristics of polypoid rectal lesions resected through endoscopic techniques and assess whether endoscopic therapy is safe and efficient for treating lesions located in the rectum. METHODS: This is a retrospective observational study with an analysis of the medical records of all patients undergoing resection of rectal polyps. RESULTS: A total of 123 patients with rectal lesions were evaluated, with 59 men and 64 women of mean age 56 years. All patients underwent endoscopic resection: 70% with polypectomy and 30% with wide mucosectomy. Complete colonoscopy with removal of the entire rectal lesion occurred in 91%, while in 5% the preparation was inadequate and poor clinical conditions were an impeditive factor, and in 4% surgical treatment was indicated because there was an infiltrative lesion with central ulceration. Histological evaluation showed adenomas in 3.25%, hyperplasia in 7.32%, and hamartoma in 0.81%; low-grade dysplasia was identified in 34.96%, high-grade dysplasia in 51.22%, and adenocarcinoma in 1.63%, while one case (0.81%) was classified as erosion. CONCLUSIONS: Polyps in the rectum are common and were found in 37% of these colonoscopies. Adenomas with dysplasia were the most common form of Colorectal cancer . Therapeutic colonoscopy proved to be a safe and efficient method for the complete treatment of rectal lesions.

RESUMO RACIONAL: O câncer colorretal (CCR) está entre as neoplasias mais comuns em todo o mundo. A colonoscopia é o exame de escolha para prevenção por sua grande capacidade diagnóstica e, principalmente, terapêutica em relação às lesões adenomatosas. OBJETIVOS: Analisar a prevalência, as características macroscópicas e histológicas das lesões polipoides retais ressecadas por técnicas endoscópicas e avaliar se a terapia endoscópica é segura e eficaz para o tratamento de lesões localizadas no reto. MÉTODOS: Estudo observacional retrospectivo com análise dos prontuários de todos os pacientes submetidos à ressecção de pólipos retais. RESULTADOS: Foram avaliados 123 pacientes com lesões retais: 59 homens e 64 mulheres com idade média de 56 anos. Todos os pacientes foram submetidos à ressecção endoscópica: 70% com polipectomia e 30% com mucosectomia ampla. A colonoscopia completa com retirada de toda a lesão retal ocorreu em 91%, enquanto em 5% o preparo foi inadequado e as más condições clínicas foram fator impeditivo, e em 4% o tratamento cirúrgico foi indicado por haver lesão infiltrativa com ulceração central. A avaliação histológica mostrou adenomas em 3,25%, hiperplasia em 7,32% e hamartoma em 0,81%; displasia de baixo grau foi identificada em 34,96%, displasia de alto grau em 51,22% e adenocarcinoma em 1,63%, enquanto um caso (0,81%) foi classificado como erosão. CONCLUSÕES: Pólipos no reto são comuns e foram encontrados em 37% das colonoscopias. Adenomas com displasia foram a forma mais comum de câncer colorretal. A colonoscopia terapêutica mostrou-se método seguro e eficiente para o tratamento completo das lesões retais.

Cirurgia bariátrica e a pandemia do novo coronavírus: análise comparativa do impacto em procedimentos do sus e de convênio / Bariatric surgery and the new coronavirus pandemic: comparative analysis of the impact on sus and agreement procedures

Introdução: O tratamento da obesidade envolve diversas abordagens multidisciplinares, incluindo a intervenção cirúrgica. A pandemia de COVID-19 impactou o acesso a ela gerando dificuldades em sua retomada e acentuando as disparidades entre o sistema público e privado. Objetivo: Analisar o impacto da pandemia na cirurgia bariátrica realizada pelo SUS e por convênios médicos no Brasil. Métodos: Os dados foram coletados utilizando as bases de dados TABNET do Sistema de Informações Hospitalares (SIH), do Sistema Único de Saúde (SUS), e o Painel de dados do TISS da Agência Nacional de Saúde Suplementar (ANS), no período de 2015 a 2021 e foi realizada uma análise quantitativa descritiva, calculando-se a média das informações. Além disso, foram realizadas estimativas estatísticas utilizando regressão linear no software SPSS, com intervalo de confiança de 95%. Resultados: Foi identificada correlação significativa e direta entre o aumento do número de procedimentos realizados pelo SUS e o aumento médio de procedimentos ao longo dos anos, enquanto no sistema de convênios não houve correlação significativa. Durante a pandemia, houve queda expressiva no volume cirúrgico em ambos os sistemas, com o sistema público sendo mais afetado. A retomada do volume cirúrgico ainda não alcançou os níveis anteriores à pandemia no sistema público, enquanto o sistema privado apresentou aumento significativo. Conclusão: A pandemia do COVID-19 teve impacto significativo na capacidade do setor público e privado em realizar operações bariátricas no Brasil. Os resultados evidenciam diferenças regionais e socioeconômicas na realização desses procedimentos.

Introduction: The treatment of obesity involves several multidisciplinary approaches, including surgical intervention. The COVID-19 pandemic has impacted access to it, creating difficulties in its resumption and accentuating the disparities between the public and private system. Objective: To analyze the impact of the pandemic on bariatric surgery performed by SUS and medical insurance in Brazil. Methods: Data were collected using the TABNET databases of the Hospital Information System (SIH), of the Unified Health System (SUS), and the TISS data panel of the National Supplementary Health Agency (ANS), in the period of 2015 to 2021 and a descriptive quantitative analysis was performed, calculating the average of the information. In addition, statistical estimates were performed using linear regression in SPSS software, with a 95% confidence interval. Results: A significant and direct correlation was identified between the increase in the number of procedures performed by the SUS and the average increase in procedures over the years, while in the health insurance system there was no significant correlation. During the pandemic, there was a significant drop in surgical volume in both systems, with the public system being more affected. The resumption of surgical volume has not yet reached pre-pandemic levels in the public system, while the private system showed a significant increase. Conclusion: COVID-19 pandemic had a significant impact on the ability of the public and private sector to perform bariatric surgeries in Brazil. The results show regional and socioeconomic differences in the performance of these procedures.

Câncer de reto: qual a melhor técnica para excisão total do mesorreto laparoscópica ou robótica? / Rectum cancer: which is the best technique for total excision of the mesorectum laparoscopic or robotic?

Introdução: As operações laparoscópicas, assistidas por robô e a abertas são técnicas cirúrgicas comumente utilizadas na vida diária. A viabilidade e os resultados em curto e longo prazos dos procedimentos laparoscópicos e robóticos têm sido amplamente relatados. Objetivos: Comparar os dados clínicos e oncológicos da cirurgia assistida por robô e laparoscópica no câncer retal. Métodos: Foram pesquisados o Pubmed/Medline, Embase, e Cochrane Library para artigos relevantes publicados até 2021. Estudos baseados na comparabilidade entre operação assistida por robô e laparoscópica para câncer retal foram designados. Os parâmetros analisados incluíram tempo operatório, conversão para procedimento aberto, perda estimada de sangue, tempo de recuperação da função intestinal, tempo de internação, vazamento da anastomose e complicações pós-operatórias. Resultados: Operação assistida por robô foi associada com maior tempo operatório (342 vs.192 min na cirurgia laparoscópica, p<0,001), menor conversão para procedimento aberto, menor tempo de internação hospitalar e recuperação mais rápida da função intestinal, menores complicações pós-operatórias de forma significativa (p=0,041). A perda estimada de sangue, a taxa de vazamento da anastomose e os resultados oncológicos, incluindo o número de linfonodos extraídos, não mostraram diferenças significativas entre os grupos. Conclusão: A cirurgia assistida por robô para câncer retal mostrou maior tempo operatório, menor conversão, taxas de recuperação da função intestinal mais rápidas e menor permanência no hospital. Seus resultados oncológicos forram semelhantes à cirurgia laparoscópica.

Introduction: Laparoscopic surgery, robot-assisted surgery and open surgery are the most commonly used surgical techniques in daily living. The feasibility and short- and long-term results of laparoscopic and robotic procedures have been widely reported. Objectives: To compare the clinical and oncological results of robot-assisted and laparoscopic surgery for rectal cancer. Methods: PubMed/Medline, Embase, The Cochrane Library were searched for relevant articles published until 2021. Studies based on comparability between robot-assisted and laparoscopic surgery for rectal cancer were designed. The parameters analyzed included operative time, conversion to open surgery, estimated blood loss, bowel function recovery time, length of hospital stay, anastomosis leak, and postoperative complications. Results: The robot-assisted surgery group was associated with longer operative time (342 vs. 192 min in laparoscopic surgery,p <0.001), lower conversion to open surgery, shorter length of hospital stay, faster bowel function recovery and lower postoperative complications significantly (p=0.041). Estimated blood loss, anastomosis leak rate, and oncological outcomes including the number of lymph nodes extracted showed no significant differences between groups. Conclusion: Robot-assisted surgery for rectal cancer showed longer operative time, lower conversion, faster bowel function recovery rates, shorter hospital stay, and similar oncological outcomes compared to laparoscopic surgery.

Platelet-derived growth factor (PDGF) cross-signaling via non-corresponding receptors indicates bypassed signaling in colorectal cancer.

Platelet-derived growth factor (PDGF) signaling, besides other growth factor-mediated signaling pathways like vascular endothelial growth factor (VEGF) and epidermal growth factor (EGF), seems to play a crucial role in tumor development and progression. We have recently provided evidence for upregulation of PDGF expression in UICC stage I-IV primary colorectal cancer (CRC) and demonstrated PDGF-mediated induction of PI3K/Akt/mTOR signaling in CRC cell lines. The present study sought to follow up on our previous findings and explore the alternative receptor cross-binding potential of PDGF in CRC. Our analysis of primary human colon tumor samples demonstrated upregulation of the PDGFRß, VEGFR1, and VEGFR2 genes in UICC stage I-III tumors. Immunohistological analysis revealed co-expression of PDGF and its putative cross-binding partners, VEGFR2 and EGFR. We then analyzed several CRC cell lines for PDGFRα, PDGFRß, VEGFR1, and VEGFR2 protein expression and found these receptors to be variably expressed amongst the investigated cell lines. Interestingly, whereas Caco-2 and SW480 cells showed expression of all analyzed receptors, HT29 cells expressed only VEGFR1 and VEGFR2. However, stimulation of HT29 cells with PDGF resulted in upregulation of VEGFR1 and VEGFR2 expression despite the absence of PDGFR expression and mimicked the effect of VEGF stimulation. Moreover, PDGF recovered HT29 cell proliferation under simultaneous treatment with a VEGFR or EGFR inhibitor. Our results provide some of the first evidence for PDGF cross-signaling through alternative receptors in colorectal cancer and support anti-PDGF therapy as a combination strategy alongside VEGF and EGF targeting even in tumors lacking PDGFR expression.

EVALUATION OF THE OMENTUM AS A STEM CELL DONOR ISCHEMIC MYOCARDIAL THROUGH CD34 IMMUNOHISTOCHEMICAL ANALYSIS / AVALIAÇÃO DO OMENTO COMO DOADOR DE CÉLULAS TRONCO NO MIOCÁRDIO ISQUÊMICO ATRAVÉS DA ANÁLISE IMUNOHISTOQUÍMICA DO CD34

Background: Cardiovascular diseases are the leading cause of death in the world. The use of hematopoietic precursor cells and recent advances made in heart graft bioengineering offer a new therapeutic modality for post-myocardial infarction (MI)  and cardiac tissue regeneration. CD34 is a marker expressed on all hematopoietic and endothelial precursor cells, and functions as a cell adhesion factor. The antibody corresponding to this marker is used in immunohistochemistry to assess the formation of new vessels and the presence of stem cells. Aim: To evaluate the efficacy of omentopexy as stem cell donor, on previously infarcted myocardium, using immunohistochemically analysis of CD34. Method: Myocardial infarction was generated in four pigs, by ligature of the 1st and 2nd marginal branches of the circumflex artery. In three animals, abrasion of the infarcted epicardium was performed followed by multiple myocardial perforations and the mobilization of the omentum from the abdominal cavity to the mediastinum, sutured on the infarcted area. In the fourth animal, omentopexy was not performed and only the abrasion and perforation of the infarcted area were performed. All hearts were removed for CD34 immunohistochemically evaluation. Results:  In the samples from the group submitted to omentopexy, there was a 60% increase in angiogenesis, and in the samples from the control animal there was minimal staining.  Four samples from different sites of each animal, totaling 16 histopathological samples were evaluated. All samples were immunolabelled for CD34. Conclusions: Omentopexy proved to be effective in seeding previously infarcted myocardium with stem angiogenic cells, seen through immunohistochemistry, using CD34 marker.

Racional: As doenças cardiovasculares são a principal causa de morte no mundo. O uso de células precursoras hematopoiéticas e os recentes progressos feitos na bioengenharia de enxertos cardíacos oferecem uma nova modalidade terapêutica para a regeneração do tecido cardíaco pós-infarto do miocárdio (IM). O CD34 é um marcador expresso em todas as células precursoras hematopoiéticas e endoteliais, e funciona como fator de adesão celular. O anticorpo que correspondente a este marcador é utilizado na imunohistoquímica para avaliar a formação de novos vasos e a presença de células-tronco. Objetivo: O estudo teve por objetivo avaliar a eficácia da omentopexia na neovascularização e na doação de células tronco de corações suínos previamente infartados, a partir da análise imunohistoquímica do CD34. Método: O infarto do miocárdio foi gerado em 4 suínos, por ligadura do 1°e 2° ramos marginais da artéria circunflexa. Em 3 animais realizou-se abrasão cuidadosa do epicárdio infartado seguido de múltiplas perfurações miocárdicas e a mobilização do omento da cavidade abdominal para o mediastino, envolvendo a área infartada e as perfurações. No quarto animal não foi realizado a omentopexia sendo realizado apenas a abrasão e perfuração da área infartada. Todos os animais foram eutanasiados ao 30º dia pós operatório e os corações retirados para avaliação macroscópica, microscópica e Imunohistoquímica do CD34. Resultados: Nas amostras do grupo submetido a omentopexia, ocorreu um aumento de 60% da angiogênese, sendo que nas amostras do animal controle houve marcação mínima. Foram avaliadas quatro amostras de diferentes sítios de cada coração dos animais, totalizando 16 amostras histopatológicas. Todas as amostras foram imunomarcadas para CD-34. Conclusões: O omento mostrou-se eficiente na indução de neovascularização pela presença de células tronco, vista através da marcação do CD34, demonstrando grande potencial como futura terapêutica para restaurar áreas de miocárdio isquêmico.

BioSCIENCE: A NEW PROPOSAL FOR OPEN SCIENCE / BioSCIENCE: UNA NUEVA PROPUESTA DE CIENCIA ABIERTA / BioSCIENCE: NOVA PROPOSTA PARA A CIÊNCIA ABERTA

Academic publishing has undergone many changes with the digital age, making room for new ideas, no longer watertight and associated with the traditional aspects, used for decades, but interactive, modern and with freely accessible possibilities. The objective of this project was to present a new publishing model including, in addition to the traditional aspects, several sections that allow the inclusion of multimedia, infographics, videos, videocasts, postcasts, sounds, images, data publication (data papers), continuing education and university interactivity. A digital review was carried out on the most traditional journals in the medical field, placing the status quo of national and international publishing and raising all the structural needs for the creation of a new model regarding the institutional repository to house all the data and submissions in long term. In conclusion, it was possible to transform a traditional journal with 80 years of continuous publication into a modern project integrated with Open Science and Open Access.

La publicación académica ha sufrido muchos cambios con la era digital, dando lugar a nuevas ideas. Ya no debe ser estanco y se asociaba a los aspectos tradicionales, vigentes desde hacía décadas, posibilidades interactivas, modernas y de libre acceso. El objetivo de este proyecto fue presentar un nuevo modelo editorial que incluye, además de los aspectos tradicionales, varias secciones que permiten la inclusión de multimedia, infografías, videos, videocasts, postcasts, sonidos, imágenes, publicación de datos (data papers), educación continua y interactividad universitaria. Se realizó una revisión digital de las revistas más tradicionales del ámbito médico, situando el statu quo de la edición nacional e internacional y planteando todas las necesidades estructurales para la creación de un nuevo modelo en cuanto al repositorio institucional para albergar todos los datos y artículos el largo plazo. En conclusión, se logró transformar una revista tradicional con 80 años de publicación continua en un proyecto moderno integrado con Ciencia Abierta y Acceso Abierto.

A editoração acadêmica tem muitas ideias com novas ideias, promovendo mudanças para novas áreas. Deixou de ser estanque e associado aos aspectos tradicionais, vigentes por extensões e possibilidades interativas, modernas, de acesso livre. O objetivo deste foi apresentar novo modelo de editoração projeto, além de aspectos tradicionais, seções diversas que permitem inclusão da multimídia, infografia, vídeos, videocasts, postcasts, sons, educação, publicação de dados (data papers), continuada e interatividade universitária . Foi realizada revisão digital sobre o tradicional como as revisões da área médica em situação o tradicionais da editoração nacional e para a criação de novas necessidades de status novo modelo no que se refere a todos os dados institucionais internacionais para albergar em todos os prazos e submissões. Em conclusão, foi possível transformar um periódico com 80 anos de publicação contínua em projeto moderno e integrado com a Ciência Aberta e Open Access.

Avoiding vascular complications in insular glioma surgery - A microsurgical anatomy study and critical reflections regarding intraoperative findings.

Introduction: Vascular lesions in insular glioma surgery can severely impact patients' quality of life. This study aims to present the results of our dissections and authors' reflections on the insular vascular anatomy. Matherials and Methods: The insular vascularization was examined using ×3 to ×40 magnification in 20 cadaveric cerebral hemispheres in which the arteries and veins had been perfused with colored silicone. Results: In insular gliomas, this individualization of the anatomical structures is rarely possible, as the gyri are swollen by the tumor and lose their individuality. In the transsylvian approaches, the anatomical parameters for delimiting the insula in tumors are best provided by the superior and inferior circular sulci. The branches of the MCA are easily identified in the transcortical approach, but only at the end of the surgery after the tumor is resected.). One of the factors under-discussed in the literature is the involvement of the lenticulostriate arteries by the medial part of the tumor. In our experience of 52 patients (article submitted to publishing), LSTa were founded to be involved by the tumor in 13 cases. In 39 patients, there was no involvement of the LSTa, which allowed a more aggressive resection. Early preoperative identification of the anterior perforated substance on the MRI and its proximity to the tumor may help determine the route of the LSTa over the medial tumor boundaries. Discussion: Our reflections introduced our imaging and anatomical concept regarding LSTa in insular glioma surgery. Accurate identification of origin, route, and distribution of the LSTa is pivotal to surgical success, especially in the lateral group. The anatomical knowledge of their path directly impacts the extent of tumor resection and functional preservation. Conclusion: Knowledge of microsurgical anatomy, brain mapping, and surgical experience counts a lot in this type of surgery, creating a reasonable procedure flowchart to be taken intraoperatively.

USE OF DECELLULARIZED HUMAN AMNIOTIC MEMBRANE IN INTESTINAL ANASTOMOSES: A STUDY IN RATS TREATED WITH 5-FLUOROURACIL / USO DE MEMBRANA AMNIÓTICA HUMANA DESCELULARIZADA EM ANASTOMOSES INTESTINAIS: ESTUDO EM RATOS TRATADOS COM 5-FLUOROURACIL

Introduction: currently, the most relevant applications of perinatal derivatives are in wound healing, for example, the use of amniotic membrane (AM) as a biomaterials source for use in different healing processes. The anastomotic healing compromised by antimetabolic drugs, such as 5-fluorouracil (5-FU), is a potential target of AM. Objective: To evaluate the healing effects of the AM use in rats treated with 5-FU at a dose of 20 mg/kg on the 7th postoperative day, regarding the parameters percentage of type I collagen (mature), cell viability, microvascular density and granulation tissue formation. Method: Thirty-two Wistar rats were submitted to colotomy and colorraphy, separated in 4 groups with 8t rats each and received, by 7 days, different treatments intraperitoneally, once daily from the operation day until sacrifice: 1- saline solution (C), 2- 20 mg/kg 5-FU, 3- 20 mg/kg 5-FU and 4- MA, and MA. Results: Tthe treatment with 5-FU (20 mg/kg ­ 7 days) induced adverse effects in the anastomotic healing process evidenced by the decrease of type I collagen (mature), cell viability, percentage microvascular density, granulation tissue formation (leukocyte-fibrin crust and angio-fibroblastic proliferation). The use of AM, under these conditions, induced an improvement in type I collagen (mature) percentage. Conclusion: The treatment with 5-FU induced adverse effects on the healing anastomotic process, and the use of AM, under these conditions, induced improvement in type I (mature) collagen percentage.

Introdução: Atualmente emerge em nosso meio aplicações mais relevantes dos derivados perinatais, por exemplo, a membrana amniótica (MA), como fonte de biomateriais para emprego em diferentes processos cicatriciais. O comprometimento anastomótico por drogas antimetabólicas como o 5-fluorouracil (5-FU) é um potencial alvo da MA. Objetivo: Avaliar os efeitos cicatriciais do uso da MA em ratos tratados com 5-FU na dose de 20 mg/kg ao 7º. dia de evolução pós-operatória quanto aos parâmetros porcentagem de colágeno tipo I (maduro), viabilidade celular, densidade microvascular e formação do tecido de granulação. Método: Utilizaram-se 32 ratos da linhagem Wistar submetidos à colotomia e colorrafia separados em 4 grupos com 8 e receberam diferentes tratamentos diariamente por via intraperitoneal até o dia do sacrifício: Solução fisiológica (C), 20  mg/kg 5-FU, 20 mg/kg 5-FU e MA, MA. Resultados: O tratamento com 20 mg/kg de 5-FU, ao 7º. dia pós-operatório induziu efeitos adversos no processo cicatricial anastomótico evidenciados pela diminuição da porcentagem de colágeno tipo I (maduro), da viabilidade celular, da densidade microvascular, da formação de crosta fibrinoleucocitária e da proliferação angiofibroblástica; o uso da MA nestas condições induziu melhora da porcentagem de colágeno tipo I (maduro). Conclusão: O tratamento com 20 mg/kg de 5-FU, ao 7º. dia pós-operatório induziu efeitos adversos no processo cicatricial anastomótico e o uso da MA nestas condições induziu melhora da porcentagem de colágeno tipo I (maduro).

THE USE OF SURGICAL ADHESIVE AND SUTURE FIXING MESHES TO THE ABDOMINAL WALL: AN EXPERIMENTAL STUDY IN RATS.

AIM: Proper fixation of the surgical mesh determines the success of a herniorrhaphy. Understanding the inflammatory response and the mechanical properties of the mesh helps to define whether a fixation method is superior. This study aimed to evaluate the healing of defects in the abdominal wall of rats, comparing the repair of macroporous polypropylene meshes fixed with surgical glue and polypropylene thread. METHODS: In 20 Wistar rats, a defect was produced in the abdominal wall, with the integrity of the parietal peritoneum. For correction, the meshes were fixed with surgical glue (2-octyl cyanoacrylate) (subgroup C1), or polypropylene suture (subgroup C2). The two subgroups of 10 animals were euthanized on the 90th postoperative day, and the fragments of the abdominal wall were submitted to macroscopic, histological, and tensiometric analysis. RESULTS: Macroscopic analysis did not show any abnormalities. Tensiometry on the 90th postoperative day in subgroup C1 showed mean rupture tension of 28.47N and in subgroup C2 32.06N (p=0.773). The inflammatory process score revealed that both groups are in the subacute phase (p=0.380). CONCLUSION: The fixation of a polypropylene macroporous mesh to repair an abdominal wall defect can be performed with surgical glue (2-octyl cyanoacrylate) or polypropylene suture, both methods being equally effective.

Which lesions are at higher risk of developing colorectal carcinomas: superficially elevated serrated lesions or depressed lesions? / QUAIS LESÕES APRESENTAM MAIOR RISCO DE EVOLUÇÃO PARA CARCINOMAS COLORRETAIS: AS SERRILHADAS SUPERFICIALMENTE ELEVADAS OU AS DEPRIMIDAS?

Background: There are lesions that are still being missed in colonoscopy. Many of those could be superficially elevated serrated lesions or depressed ones. Aim: Compare the histopathological characteristics of these lesions and their risks for submucosal carcinoma. Methods: Retrospective, cross-sectional and observational study comparing 217 superficially elevated serrated lesions larger than 5 mm resected by colonoscopies (G1) with 558 depressed lesions (G2). Results: In G1, 217 lesions were found in 12653 colonoscopies (1,7%); in G2, 558 lesions in 36174 colonoscopies (1.5%). In G1 there were 63.4% of women and in G2 no gender predominance. Average size was G1 with 16.2 mm and G2 with 9.2 mm (p<0.001). G1 predominated on the proximal colon and G2 on the distal and rectum (p<0.001). In G1 there were 214 low-grade intramucosal neoplasia (98,6%) and three high grade intramucosal neoplasia (1,4%). Excluding 126 hyperplastic polyps and considering 91 sessile serrated adenomas in G1, was observed 88 (96.7%) with low-grade intramucosal neoplasia and three (3.3%) high-grade intramucosal neoplasia; in G2, 417 low-grade intramucosal neoplasia (74,7%), 113 high-grade intramucosal neoplasia (20,3%) and 28 (5,0%) submucosal adenocarcinomas (p<0.001). Conclusion: Depressed lesions significantly had more high-grade intramucosal neoplasia and more invasive carcinomas for the submucosal layer than superficially elevated serrated lesions and more than superficially elevated sessile serrated adenomas.

Racional: Há ainda lesões que podem ser perdidas nas colonoscopias. Muitas delas poderiam ser serrilhadas superficialmente elevadas ou deprimidas. Objetivo: Comparar as características histopatológicas destas lesões e seus riscos para carcinoma invasivo para a submucosa. Método: Estudo retrospectivo, transversal, observacional comparando 217 lesões serrilhadas superficialmente elevadas com mais de 5 mm e ressecadas por colonoscopias (G1) com 558 lesões deprimidas (G2). Resultados: As 217 lesões do G1 foram encontradas em 12653 colonoscopias (1,7%) enquanto as 558 do G2 ocorreram dentre 36174 colonoscopias (1,5%). No G1, 63,4% eram mulheres e no G2 não houve predominância de gênero. O tamanho médio foi no G1, 16,2 mm e no G2, 9,2 mm (p<0,001). G1 predominaram no cólon proximal e G2, no distal e reto (p<0,001). No G1, ocorreram 214 (98,6%) neoplasias mucosas de baixo grau e três de alto grau (1,4%). Excluídos 126 pólipos hiperplásicos e considerados os 91 adenomas sésseis serrilhados, no G1 observou- se 88 (96,7%) neoplasias mucosas de baixo grau e três (3,3%) de alto grau, e no G2, 417 (74,7%) neoplasias mucosas de baixo grau 113 (20,3%) de alto grau e 28 (5,0%) adenocarcinomas invadindo a submucosa (p<0,001). Conclusões: As lesões deprimidas apresentaram significativamente mais neoplasias mucosas de alto grau e carcinomas invasivos para a submucosa do que as serrilhadas superficialmente elevadas e mais do que os adenomas sésseis serrilhados superficialmente elevados.