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.

Surgical management of retinal detachment and macular holes secondary to ocular toxoplasmosis: a systematic review and meta-analysis.

BACKGROUND: Toxoplasma gondii causes ocular toxoplasmosis (OT), involving inflammation, scarring, and retinal complications. The OT complications were retinal detachment (RD), and retinal breakage (RB). Surgical interventions like scleral buckling (SB) and vitrectomy are common. Limited understanding exists of the safety and efficacy of surgical management of RD/RB secondary to OT. Another complication is toxoplasmosis-related macular holes (tMH), with sparse evidence on surgical outcomes. This meta-analysis aims to clarify clinical characteristics, and surgical results, and enhance understanding of RD, RB, and MH secondary to OT. METHODS: PubMed, Cochrane, Embase and Web of Science database were queried for retrospective studies, case series and case reports that provided information on RD, RB and MH associated with OT and reported the outcomes of: (1) Retinal reattachment of RD/RB and tMH closure; (2) Best-corrected visual acuity (BCVA) improvement; and (3) Complications. Heterogeneity was examined with I2 statistics. A random-effects model was used for outcomes with high heterogeneity. Statistical analysis was performed using the software R (version 4.2.3, R Foundation for Statistical Computing, Vienna, Austria). RESULTS: Fourteen final studies, comprising a total of 96 patients were analyzed, 81 with RD or RB and 15 with tMH. Overall, surgical management was associated with several advantages: a high rate of retinal reattachment of RD/RB of 97% (95% Confidence Interval [CI] 92-100%; I2 = 0%), retinal reattachment of just RD of 96% (95% CI 89-100%; I2 = 30%) and tMH closure 97% (95% CI 87-100; I2 = 12%). There were significant differences in BCVA after surgeries in studies of RD/RB (MD 0.60; 95% CI 0.35-0.65; I2 = 20%) and MH (MD 0.67; 95% CI 0.50-0.84; I2 = 0%). The overall complication rate associated with surgical procedures in RD/RB secondary to OT was confirmed to be 25%. CONCLUSIONS: The systematic review and meta-analysis showed that the treatment approaches currently in use are effective, with a remarkable rate of retinal reattachment of RD/RB, tMH closure, and substantial improvements in visual acuity. More randomized, long-term studies on disease and surgical factors can provide valuable insights into their impact on anatomical and visual outcomes.

Hippocampal Microglia Activation Induced by Acute Pancreatic Injury in Rats.

BACKGROUND: Acute pancreatitis is an inflammation of the pancreatic glandular parenchyma that causes injury with or without the destruction of pancreatic acini. Clinical and experimental evidence suggest that certain systemic proinflammatory mediators may be responsible for initiating the fundamental mechanisms involved in microglial reactivity. Here, we investigated the possible repercussions of acute pancreatitis (AP) on the production of inflammatory mediators in the brain parenchyma focusing on microglial activation in the hippocampus. METHODS: The acute pancreatic injury in rats was induced by a pancreas ligation surgical procedure (PLSP) on the splenic lobe, which corresponds to approximately 10% of total mass of the pancreas. Blood samples were collected via intracardiac puncture for the measurement of serum amylase. After euthanasia, frozen or paraffin-embedded brains and pancreas were analyzed using qRT-PCR or immunohistochemistry, respectively. RESULTS: Immunohistochemistry assays showed a large number of Iba1 and PU.1-positive cells in the CA1, CA3, and dentate gyrus (DG) regions of the hippocampus of the PLSP group. TNF-α mRNA expression was significantly higher in the brain from PLSP group. NLRP3 inflammasome expression was found to be significantly increased in the pancreas and brain of rats of the PLSP group. High levels of BNDF mRNA were found in the rat brain of PLSP group. In contrast, NGF mRNA levels were significantly higher in the control group versus PLSP group. CONCLUSION: Our findings suggest that AP has the potential to induce morphological changes in microglia consistent with an activated phenotype.

PERFORMANCE OF AGA, FUKUOKA AND EUROPEAN GUIDELINES IN INCIDENTALOMAS OF THE PANCREAS SUBMITTED TO ENDOSCOPIC ULTRASOUND WITH FINE NEEDLE PUNCH / DESEMPENHO DAS DIRETRIZES AGA, FUKUOKA E EUROPEIA NOS INCIDENTALOMAS MUCINOSOS DO PÂNCREAS SUBMETIDOS À ULTRASSONOGRAFIA ENDOSCÓPICA COM PUNÇÃO POR AGULHA FINA

Introduction: Pancreatic cystic lesions are common and are not exclusively benign. There are 3 guidelines that help recommend surgery if there is a risk factor, sign of malignancy or follow the patient with imaging tests. Objective: To review and compare the performance of these guidelines in asymptomatic patients with mucinous neoplasms. Method: The literature review was carried out by collecting information published on virtual platforms in Portuguese and English. The material for reading and analysis was selected from the SciELO, Google Scholar, Pubmed and Scopus platforms. Initially, a search was carried out using the keywords "mucinous cystic neoplasm. pancreatic intraductal neoplasms. endoscopic ultrasound. fine needle aspiration" with AND or OR search, considering the title and/or abstract. Afterwards, considering only those that were most related to the topic, the full texts were read. Results: 37 articles were included. Conclusion: The European Guideline-DE-2018 proved to be more accurate for use in patients with asymptomatic mucinous neoplasia after the diagnosis obtained by EUS-PAF.

Introdução: As lesões císticas pancreáticas são comuns e não são exclusivamente benignas. Existem 3 diretrizes que ajudam a indicar cirurgia no caso de haver algum fator de risco, sinal de malignidade ou acompanhar o paciente com exames de imagem. Objetivo: Revisar e comparar o desempenho dessas diretrizes em neoplasias mucinosas identificados de forma incidental. Método: A revisão da literatura foi feita colhendo informações publicadas em plataformas virtuais em português e inglês. O material para leitura e análise foi selecionado das plataformas SciELO, Google Scholar, Pubmed e Scopus. Inicialmente foi realizada busca por descritores "neoplasia cística mucinosa. neoplasias intraductais pancreáticas. ultrassonografia endoscópica. aspiração por agulha fina" com busca AND ou OR, considerando o título e/ou resumo. Após, considerando-se somente os que tinham maior relação ao tema, foi realizada a leitura da íntegra dos textos. Resultados: Foram incluídos 37 artigos. Conclusão: A Diretriz Europeia- DE-2018 mostrou-se mais precisa para ser utilizada em pacientes com neoplasia mucinosa assintomática após o diagnóstico obtido pela USE-PAF.

CAN BLUE LASER IMAGING COLLABORATE IN THE DIFFERENTIAL DIAGNOSIS BETWEEN NEOPLASTIC AND NON-NEOPLASTIC COLORECTAL LESIONS? / PODE O BLUE LASER IMAGING COLABORAR NO DIAGNÓSTICO DIFERENCIAL ENTRE LESÕES NEOPLÁSICAS E NÃO NEOPLÁSICAS COLORRETAIS?

Introduction: Improved endoscopic imaging allows the differential diagnosis of colorectal lesions in real time through the study of the microvasculature. Objective: To review the use of Blue Laser Imaging (BLI) in analyzing the capillary patern for the differential diagnosis between neoplastic and non-neoplastic lesions. Method: This is an integrative review of the literature that collected information published on virtual platforms in Portuguese and English. The search for reading and analysis was carried out on the SciELO ­ Scientific Electronic Library Online, Google Scholar, Pubmed and Scopus platforms. The descriptors taken from DeCS/MESH were: "Blue laser imaging. Endoscopy. Chromoendoscopy, Colorectal polyps. Magnification" and its English counterparts "Blue laser imaging. Image-enhanced endoscopy. Chromoendoscopy. Colorectal polyps. Magnification" with AND or OR search, considering the title and/or abstract. Only those that had the greatest correlation to the topic were included, and the review was based on them, with reading, in full, of the texts. Results: In the end, 22 articles resulted that made up this review. Conclusion: BLI associated with magnification showed good results in real-time predictive histological diagnosis for colon and rectal lesions.

Introdução: Imagem endoscópica aprimorada permite o diagnóstico diferencial das lesões colorretais em tempo real através do estudo da microvasculatura. Objetivo: Revisar o uso do Blue Laser Imaging (BLI) na análise do padrão dos capilares para o diagnóstico diferencial entre lesões neoplásicas e não neoplásicas. Método: Esta é revisão integrativa da literatura  que colheu informações publicadas em plataformas virtuais em português e inglês. A busca para leitura e análise foi realizada nas plataformas SciELO ­ Scientific Electronic Library Online, Google Scholar, Pubmed e Scopus.  Os descritores retirados do DeCS/MESH foram: "Blue laser imaging. Endoscopia. Cromoendoscopia, Pólipos colorretais. Magnificação" e seus correspondentes em inglês "Blue laser imaging. Image-enhanced endoscopy. Chromoendoscopy. Colorectal polyps. Magnification" com busca AND ou OR, considerando o título e/ou resumo. Foram incluídos somente os que tivessem maior correlação ao tema, e neles foi baseada a revisão com leitura, na íntegra, dos textos. Resultados: Ao final resultaram  22 artigos que compuseram esta revisão. Conclusão: BLI associada à magnificação mostrou bons resultados no diagnóstico histológico preditivo em tempo real para as lesões de cólon e reto.

Gastrotomy followed by gastrorrhaphy as a reliable and more physiologic technique for inducing peritoneal adhesion in rats.

OBJECTIVE: this research objective was to develop a new peritoneal adhesion animal model that would lead to adhesions formation in all operated animals, simple and reproducible, associated with maintenance the animal's health. METHODS: eighteen adult male Wistar rats (Rattus norvegicus) were randomly distributed into three groups: Control Group (anatomical and clinical parameters), Sham Group (delicate manipulation of the stomach and exposure of the peritoneal cavity to ambient air) and Surgery Group (gastrotomy followed by gastrorrhaphy). The animals were analyzed and classificated macroscopically according to two adhesion classification models and differences between groups were considered significant when p<0.05. RESULTS: the six animals in the control group had no peritoneal adhesions, three of the six animals in the sham group had focal peritoneal adhesions, and all animals in the surgery group (gastrotomy followed by gastrorraphy) had firm peritoneal adhesions. All adhesions found were macroscopically quantified and microscopically confirmed, without carrying out a microscopic classification of the adhesions. CONCLUSION: the new model developed of gastrotomy followed by gastrorrhaphy, proved to be safe and efficient to induce and study peritoneal adhesions.

Que alterações de aprendizado tiveram os residentes de obstetrícia e ginecologia durante a COVID­19? / What changes in learning have obstetrics and gynecoligic residents experienced during COVID­19?

Introdução: A pandemia da COVID-19 teve repercussão significativa na educação médica, incluindo na formação de residentes afetando o ensino presencial e levando as instituições a adotar métodos de ensino à distância. Objetivo: Avaliar a percepção dos residentes em ginecologia e obstetrícia em relação ao impacto da pandemia em seu aprendizado, identificando sua segurança ao realizarem seus atendimentos e buscando investigar se os residentes considerariam estender sua residência. Métodos: Foi utilizado um questionário com perguntas fechadas e respostas em escala Likert, abordando diferentes aspectos da residência médica durante a pandemia para atender aos objetivos. Resultados: Dos 71 residentes a maioria era de mulheres (74,65%). A análise dos dados revelou que a prática cirúrgica foi afetada para a maioria deles (85,92%), com o adiamento de operações eletivas em ginecologia (97,18%). Em relação ao aprendizado prático, 42,25% consideraram que foi parcialmente satisfatório, enquanto 14,08% o consideraram insatisfatório. No campo teórico, a percepção dos residentes foi melhor, com 43,66% considerando o aprendizado satisfatório e 47,89% parcialmente. A pandemia afetou parcialmente a residência médica para a maioria dos residentes (85,92%), e foram adotadas alternativas para substituir a falta de aulas teóricas e atividades práticas. Conclusão: A pandemia teve efeito negativo na educação médica e na formação dos residentes. A interrupção das atividades presenciais afetou tanto o aprendizado prático quanto o teórico.

Introduction: The COVID-19 pandemic had a significant impact on medical education, including the training of residents, affecting in-person teaching and leading institutions to adopt distance learning methods. Objective: To evaluate the perception of residents in gynecology and obstetrics regarding the impact of the pandemic on their learning, identifying their safety when providing care and seeking to investigate whether residents would consider extending their residency. Methods: A questionnaire with closed questions and responses on a Likert scale was used, addressing different aspects of medical residency during the pandemic to meet the objectives. Results: Of the 71 residents, the majority were women (74.65%). Data analysis revealed that surgical practice was affected for the majority of them (85.92%), with the postponement of elective operations in gynecology (97.18%). Regarding practical learning, 42.25% considered it to be partially satisfactory, while 14.08% considered it unsatisfactory. In the theoretical field, residents' perception was better, with 43.66% considering the learning satisfactory and 47.89% partially so. The pandemic partially affected medical residency for the majority of residents (85.92%), and alternatives were adopted to replace the lack of theoretical classes and practical activities. Conclusion: The pandemic had a negative effect on medical education and resident training. The interruption of face-to-face activities affected both practical and theoretical learning.

Câncer de pele não melanoma: revisão integrativa / Non-melanoma skin cancer: an integrative review

Introdução: O câncer de pele não melanoma compeende grupo de neoplasias com alta incidência na população mundial. É dividido em carcinoma basocelular e de células escamosas. Por ser de grande prevalência, entender o processo de oncogênese e a relação com íons, proteínas e receptores celulares no câncer de pele não melanoma pode contribuir para que novas terapêuticas sejam avaliadas. Objetivo: Entender o processo da oncogênese dos tumores de pele não melanomas e sua relação com a imunolocalização do IP3R. Métodos: Revisão integrativa da literatura com síntese de evidências. A base de dados foi o PubMed; a estratégia de busca: "carcinoma espinocelular, AND/ OR carcinoma basocelular, AND/OR IP3R, AND/OR imunoistoquímica". Foram considerados para revisão os trabalhos publicados entre 2018 e 2023. Foram incluídos 40 trabalhos, integralmente lidos e resumidos. Resultados: Câncer de pele não melanoma são os tumores malignos mais comuns em todo o mundo, sendo 75-80% o carcinoma basocelular, e até 25% o de células escamosas. As interações moleculares de forma geral, envolvem grande participação de moléculas supressoras tumorais, assim como de procto-oncogenes. Além disso, canais iônicos voltagem dependente controlam o fluxo citosólico de íons, dentre eles o cálcio. O IP3R (receptor do fosfatidil inositol-3) permite a saída de cálcio do retículo endoplasmático para que seja utilizado pela célula para atividades fisiológias como proliferação, angiogênese, motilidade e capacidade de invasão. Conclusão: O IP3R, pelas características de expressão imunoistoquímica, parece estar relacionado também, à fisiopatologia do câncer de pele não melanoma.

Introduction: Non-melanoma skin cancer comprises a group of neoplasms with a high incidence in the world population. It is divided into basal cell carcinoma and squamous cell carcinoma. As it is highly prevalent, understanding the process of oncogenesis and the relationship with ions, proteins and cellular receptors in nonmelanoma skin cancer can contribute to the evaluation of new therapies. Objective: To understand the oncogenesis process of non-melanoma skin tumors and its relationship with the immunolocalization of IP3R. Methods: Integrative literature review with evidence synthesis. The database was PubMed; the search strategy: "squamous cell carcinoma, AND/OR basal cell carcinoma, AND/OR IP3R, AND/OR immunohistochemistry". Works published between 2018 and 2023 were considered for review; 40 works were included, fully read and summarized. Results: Non-melanoma skin cancer is the most common malignant tumor worldwide, with 75-80% being basal cell carcinoma, and up to 25% being cell carcinoma. Molecular interactions in general involve a large participation of tumor suppressor molecules, as well as procto-oncogenes. Furthermore, voltage-dependent ion channels control the cytosolic flow of ions, including calcium. The IP3R (phosphatidyl inositol-3 receptor) allows the exit of calcium from the endoplasmic reticulum so that it can be used by the cell for physiological activities such as proliferation, angiogenesis, motility and invasion capacity. Conclusion: The IP3R, due to its immunohistochemical expression characteristics, appears may also be related to the pathophysiology of nonmelanoma skin cancer.

Pode o Blue Laser Imaging colaborar no diagnóstico diferencial entre lesões neoplásicas e não neoplásicas colorretais? / Can Blue Laser Imaging collaborate in the differential diagnosis between neoplastic and non-neoplastic colorectal lesions?

Introdução: Imagem endoscópica aprimorada permite o diagnóstico diferencial das lesões colorretais em tempo real através do estudo da microvasculatura. Objetivo: Revisar o uso do Blue Laser Imaging (BLI) na análise do padrão dos capilares para o diagnóstico diferencial entre lesões neoplásicas e não neoplásicas. Métodos: Esta é revisão integrativa da literatura que colheu informações publicadas em plataformas virtuais em português e inglês. A busca para leitura e análise foi realizada nas plataformas SciELO ­ Scientific Electronic Library Online, Google Scholar, Pubmed e Scopus. Os descritores retirados do DeCS/MESH foram: "Blue laser imaging. Endoscopia. Cromoendoscopia, Pólipos colorretais. Magnificação" e seus correspondentes em inglês "Blue laser imaging. Image-enhanced endoscopy. Chromoendoscopy. Colorectal polyps. Magnification" com busca AND ou OR, considerando o título e/ou resumo. Foram incluídos somente os que tivessem maior correlação ao tema, e neles foi baseada a revisão com leitura, na íntegra, dos textos. Resultados: Ao final resultaram 22 artigos que compuseram esta revisão. Conclusão: BLI associada à magnificação mostrou bons resultados no diagnóstico histológico preditivo em tempo real para as lesões de cólon e reto.

Introduction: Improved endoscopic imaging allows the differential diagnosis of colorectal lesions in real time through the study of the microvasculature. Objective: To review the use of Blue Laser Imaging (BLI) in analyzing the capillary patern for the differential diagnosis between neoplastic and nonneoplastic lesions. Methods: This is an integrative review of the literature that collected information published on virtual platforms in Portuguese and English. The search for reading and analysis was carried out on the SciELO ­ Scientific Electronic Library Online, Google Scholar, Pubmed and Scopus platforms. The descriptors taken from DeCS/MESH were: "Blue laser imaging. Endoscopy. Chromoendoscopy, Colorectal polyps. Magnification" and its English counterparts "Blue laser imaging. Image-enhanced endoscopy. Chromoendoscopy. Colorectal polyps. Magnification" with AND or OR search, considering the title and/or abstract. Only those that had the greatest correlation to the topic were included, and the review was based on them, with reading, in full, of the texts. Results: In the end, 22 articles resulted that made up this review. Conclusion: BLI associated with magnification showed good results in real-time predictive histological diagnosis for colon and rectal lesions.

Gastrotomy followed by gastrorrhaphy as a reliable and more physiologic technique for inducing peritoneal adhesion in rats / Gastrotomia seguida de gastrorrafia, uma técnica mais confiável e fisiológica para a indução de aderências peritoneais em ratos

ABSTRACT Objective: this research objective was to develop a new peritoneal adhesion animal model that would lead to adhesions formation in all operated animals, simple and reproducible, associated with maintenance the animal's health. Methods: eighteen adult male Wistar rats (Rattus norvegicus) were randomly distributed into three groups: Control Group (anatomical and clinical parameters), Sham Group (delicate manipulation of the stomach and exposure of the peritoneal cavity to ambient air) and Surgery Group (gastrotomy followed by gastrorrhaphy). The animals were analyzed and classificated macroscopically according to two adhesion classification models and differences between groups were considered significant when p<0.05. Results: the six animals in the control group had no peritoneal adhesions, three of the six animals in the sham group had focal peritoneal adhesions, and all animals in the surgery group (gastrotomy followed by gastrorraphy) had firm peritoneal adhesions. All adhesions found were macroscopically quantified and microscopically confirmed, without carrying out a microscopic classification of the adhesions. Conclusion: the new model developed of gastrotomy followed by gastrorrhaphy, proved to be safe and efficient to induce and study peritoneal adhesions.

RESUMO Objetivo: o objetivo deste estudo foi criar um novo modelo animal de indução de aderências peritoneais capaz de levar à formação de aderências em todos os animais operados, simples e reprodutível, associado a manutenção da saúde dos animais. Métodos: Dezoito ratos machos, adultos, da linhagem Wistar (Rattus norvegicus) foram distribuídos aleatoriamente em três grupos: Grupo Controle (parâmetro anatômico e clínico), Grupo Sham (manipulação delicada do estômago e exposição de cavidade peritoneal ao ar ambiente) e Grupo Cirurgia (gastrotomia seguida de gastrorrafia). Os animais foram submetidos à análise e classificação macroscópicas, seguindo dois modelos de classificação de aderências. As diferenças entre os grupos foram consideradas estatisticamente significantes se p<0,05. Resultados: os seis animais do grupo controle não apresentavam aderências peritoneais, três dos seis animais do grupo sham apresentavam aderências peritoneais focais e todos os seis animais do grupo cirurgia (gastrotomia seguida de gastrorrafia) apresentavam aderências peritoneais firmes. Todas as aderências encontradas foram quantificadas macroscopicamente e confirmadas microscopicamente, sem a realização de classificação microscópica das aderências. Conclusão: o novo modelo desenvolvido, de gastrotomia seguida de gastrorrafia, mostrou-se seguro e eficiente para induzir e estudar aderências peritoneais.

PANCREATODUODENECTOMY IN PATIENT WITH VON HIPPEL-LINDAU DISEASE: A LITERATURE REVIEW.

BACKGROUND: The von Hippel-Lindau disease is a highly penetrant autosomal dominant syndrome characterized by tumor predisposition in different organs. AIM: This study aimed to describe a case of a pancreatoduodenectomy for a 30-year-old male patient with von Hippel-Lindau disease. METHODS: We present a case study and the literature review aiming at the state-of-the-art management of a patient with pheochromocytoma, capillary hemangioblastoma in the peripheral retina, and two neuroendocrine tumors in the pancreas. RESULTS: A larger pancreatic lesion was located in the uncinate process, measuring 31 mm. The smaller lesion was located in the proximal pancreas and was detected only on the positron emission tomography-computed tomography scan with DOTATOC-68Ga. Genetic investigation revealed a mutation in the locus NM_000551.3 c.482G>A (p.Arg161Gln) of the Von Hippel-Lindau Human Suppressor gene. The uncinate process tumor was larger than 30 mm and the patient had a mutation on exon 3; therefore, we indicated a pancreatoduodenectomy involving the proximal pancreas to resect both tumors en bloc. During the postoperative period, the patient presented a peripancreatic fluid collection, which was treated as a grade B pancreatic fistula with clinical resolution of the complication. On postoperative day 21, he was discharged home. CONCLUSION: The management of patients with von Hippel-Lindau disease and pancreatic neuroendocrine tumors is complex and must be centered on tertiary institutions with a large volume of pancreatic surgery. Although the current literature assists in decision-making in most situations, each step of the treatment requires analysis and discussion between different medical specialties, including surgeons, clinicians, radiologists, and anesthesiologists.

Evaluation of right ventricular function during liver transplantation with transesophageal echocardiography.

BACKGROUND: The pathophysiology of advanced liver cirrhosis may induce alterations in the circulatory system that may be challenging for the anesthesiologist to manage intraoperatively, and perioperative cardiovascular events are associated with worse outcomes in cirrhotic patients undergoing liver transplantation. It remains controversial whether right ventricular function is impaired during this procedure. Studies using transesophageal echocardiography for quantitative analysis of the right ventricle remain scarce in this setting, yielding conflicting results. The aim of this study was to perform a quantitative assessment of right ventricular function with two parameters derived from transesophageal echocardiography during liver transplantation. METHODS: Nineteen adult patients of both genders undergoing liver transplantation were evaluated in this observational study. The exclusion criteria were age under 18 or above 65 years old, fulminant hepatic failure, hepatopulmonary syndrome, portopulmonary hypertension, cardiopulmonary disease, and contraindications to the transesophageal echocardiogram. Right ventricular function was assessed at five stages during liver transplantation: baseline, hepatectomy, anhepatic, postreperfusion, and closure by measuring tricuspid annular plane systolic excursion and right ventricular fractional area change obtained with transesophageal echocardiography. RESULTS: Right ventricular function was found to be normal throughout the procedure. The tricuspid annular plane systolic excursion showed a trend toward a decrease in the anhepatic phase compared to baseline (2.0 ± 0.9 cm vs. 2.4 ± 0.7 cm; P = 0.24) but with full recovery after reperfusion. Right ventricular fractional area change remained nearly constant during all stages studied (minimum: 50% ± 10 at baseline and anhepatic phase; maximum: 56% ± 12 at postreperfusion; P = 0.24). CONCLUSIONS: Right ventricular function was preserved during liver transplantation at the time points evaluated by two quantitative parameters derived from transesophageal echocardiogram.

Ultrasound biomicroscopy for the assessment of early-stage nonalcoholic fatty liver disease induced in rats by a high-fat diet.

PURPOSE: The aim of this study was to assess the ability of ultrasound biomicroscopy (UBM) to diagnose the initial stages of nonalcoholic fatty liver disease (NAFLD) in a rat model. METHODS: Eighteen male Wistar rats were allocated to control or experimental groups. A high-fat diet (HFD) with 20% fructose and 2% cholesterol, resembling a common Western diet, was fed to animals in the experimental groups for up to 16 weeks; those in the control group received a regular diet. A 21 MHz UBM system was used to acquire B-mode images at specific times: baseline (T0), 10 weeks (T10), and 16 weeks (T16). The sonographic hepatorenal index (SHRI), based on the average ultrasound image gray-level intensities from the liver parenchyma and right renal cortex, was determined at T0, T10, and T16. The liver specimen histology was classified using the modified Nonalcoholic Steatohepatitis Clinical Research Network NAFLD activity scoring system. RESULTS: The livers in the animals in the experimental groups progressed from sinusoidal congestion and moderate macro- and micro-vesicular steatosis to moderate steatosis and frequent hepatocyte ballooning. The SHRI obtained in the experimental group animals at T10 and T16 was significantly different from the SHRI of pooled control group. No significant difference existed between the SHRI in animals receiving HFD between T10 and T16. CONCLUSION: SHRI measurement using UBM may be a promising noninvasive tool to characterize early-stage NAFLD in rat models.

Laparoscopic Pancreatectomy in Rats: The Development of an Experimental Model.

INTRODUCTION: several pancreatectomy techniques in rats have been described and utilized for research concerning the pancreas endocrine and exocrine functions. However, we did not find a description of any kind of laparoscopic pancreatectomy in rats in the consulted databases. The objective of this study is to describe a laparoscopic splenic lobe pancreatectomy in rats. METHODS: ten Wistars rats weighting more then 300 g were operated for standardizing the laparoscopic pancreatosplenectomy technique, aided by previous descriptions of laparoscopic splenectomy and open pancreatectomy in rats. Adjustments have been progressively adopted for technical refinement. RESULTS: In five animals a low-cost rat laparoscopic set was used. In other five animals we used a standard laparoscopic set. Three rats died early due to different causes: transection of the gastroesophageal junction, hemorrhagic shock and inadvertent colonic injury. The postoperative period of the other seven rats was uneventful until the seventh postoperative day. DISCUSSION: laparoscopic distal pancreatectomy and splenectomy in rats is feasible and safe, even with a low-cost set, in which the results were alike the standard laparoscopic set.

Pancreatoduodenectomy in patient with von hippel-lindau disease: a literature review / Pancreaticoduodenectomia em paciente com doença de von hippel-lindau - revisão da literatura

ABSTRACT BACKGROUND: The von Hippel-Lindau disease is a highly penetrant autosomal dominant syndrome characterized by tumor predisposition in different organs. AIM: This study aimed to describe a case of a pancreatoduodenectomy for a 30-year-old male patient with von Hippel-Lindau disease. METHODS: We present a case study and the literature review aiming at the state-of-the-art management of a patient with pheochromocytoma, capillary hemangioblastoma in the peripheral retina, and two neuroendocrine tumors in the pancreas. RESULTS: A larger pancreatic lesion was located in the uncinate process, measuring 31 mm. The smaller lesion was located in the proximal pancreas and was detected only on the positron emission tomography-computed tomography scan with DOTATOC-68Ga. Genetic investigation revealed a mutation in the locus NM_000551.3 c.482G>A (p.Arg161Gln) of the Von Hippel-Lindau Human Suppressor gene. The uncinate process tumor was larger than 30 mm and the patient had a mutation on exon 3; therefore, we indicated a pancreatoduodenectomy involving the proximal pancreas to resect both tumors en bloc. During the postoperative period, the patient presented a peripancreatic fluid collection, which was treated as a grade B pancreatic fistula with clinical resolution of the complication. On postoperative day 21, he was discharged home. CONCLUSION: The management of patients with von Hippel-Lindau disease and pancreatic neuroendocrine tumors is complex and must be centered on tertiary institutions with a large volume of pancreatic surgery. Although the current literature assists in decision-making in most situations, each step of the treatment requires analysis and discussion between different medical specialties, including surgeons, clinicians, radiologists, and anesthesiologists.

RESUMO RACIONAL: A doença de von Hippel Lindau é uma síndrome autossômica dominante que se caracteriza por maior incidência de tumores em diferentes órgãos. OBJETIVO: Descrever um caso de pancreatoduodenectomia em paciente do sexo masculino de 30 anos com von Hippel Lindau. MÉTODO: Apresentamos o caso e a revisão da literatura realizada para otimizar o manejo do paciente, que apresentava feocromocitoma, hemangioblastoma capilar na retina periférica e dois tumores neuroendócrinos no pâncreas. RESULTADOS: O maior tumor pancreático localizava-se no processo uncinado medindo 31 mm. A lesão menor estava localizada no corpo proximal do pâncreas e foi detectada apenas na tomografia computadorizada por emissão de pósitrons com DOTATOC-68Ga. A investigação genética revelou uma mutação no locus NM_000551.3 c.482G>A (p.Arg161Gln) do gene supressor humano de Von Hippel-Lindau. O tumor no processo era maior que 30mm e o paciente apresentava mutação no exon 3. Indicamos pancreatoduodenectomia envolvendo o corpo proximal do pâncreas para ressecar em bloco ambos os tumores. No pós-operatório o paciente apresentou coleção líquida peripancreática que foi tratada como fístula pancreática grau B, com resolução clínica da complicação. Ele recebeu alta hospitalar no vigésimo primeiro dia pós-operatório. CONCLUSÕES: o manejo de pacientes com doença de von Hippel Lindau e tumores neuroendócrinos pancreáticos é complexo e deve ser centrado em instituições terciárias com grande volume de cirurgia pancreática. Embora a literatura atual auxilie na tomada de decisão na maioria das situações, cada etapa do tratamento requer análise e discussão entre diferentes especialidades médicas, incluindo cirurgiões, clínicos, radiologistas e anestesiologistas.

Healing effect of andiroba-based emulsion in cutaneous wound healing via modulation of inflammation and transforming growth factor beta 31.

PURPOSE: To evaluate the effects and mechanisms of andiroba-based emulsion (ABE) topical treatment on full-thickness cutaneous wounds in rats. METHODS: The wounds were harvested on days 3, 7, 15, and 20 post-surgery. Wound contraction rate, quantitative immunohistochemistry [macrophages, myofibroblasts, capillaries, collagens (col) I and III, transforming growth factor ß3ß (TGFß3)], and tensile strength were assessed. RESULTS: Treated wounds were smaller, contracted earlier and had increased angiogenesis, fewer CD68+ and M2 macrophages on days 7 and 15, but higher on day 20. Myofibroblasts appeared on days 3 to 7 in untreated wounds and on days 7 to 15 in treated wounds. TGFß3 levels were higher in the treated wounds, less dense collagen fibers, lower col I/III ratios and a higher tensile strength. CONCLUSION: These results demonstrate the important anti-inflammatory role of treatment and the associated modulation of macrophages, myofibroblasts, and TGFß3 levels. Collagen fibers in the treated wounds were more organized and less dense, similar to unwounded skin, which likely contributed to the higher tensile strength.

Rat models of high risk colorectal anastomoses 1.

PURPOSE: To evaluate the most frequent surgical techniques of high-risk colorectal anastomoses in rats. METHODS: Wistar rats were enrolled in three different models comprising inflammatory (TNBS enema), vascular (portal vein occlusion) or obstructive (a non-ischemic constricting ring) mechanisms associated with colonic anastomosis that had accomplished after these former lesions. Histological analyses (Hematoxylin and eosin and Picrosirius red) were performed. RESULTS: All anastomoses techniques were associated with risk factors and had complications, mainly anastomotic leakage. In Study 1, the use of a pharmacological agent, trinitrobenzene sulfonic acid (TNBS) mimicked an inflammatory bowel disease such as Crohn's disease with 50% of anastomosis leakage, the higher percentage among all models tested. In Study 2, after portal ischemia followed by reperfusion it was observed a dense neutrophil infiltrate in the midst of necrotic tissue and fibrin at the anastomotic site and 5 days after the anastomosis, no collagen was produced. In Study 3, 5 days after the mechanical obstruction some denuded areas of epithelium with marked oedema of mucosa and submucosa were seen, at the anastomotic site and anastomosis group showed some reduction of collagen density when compared with Control/Sham group. CONCLUSION: All the experimental surgical techniques tested in rats were associated with high-risk colorectal anastomoses and were useful to study colonic anastomotic healing and intestinal leakage.

Healing effect of andiroba-based emulsion in cutaneous wound healing via modulation of inflammation and transforming growth factor beta 3

Abstract Purpose: To evaluate the effects and mechanisms of andiroba-based emulsion (ABE) topical treatment on full-thickness cutaneous wounds in rats. Methods: The wounds were harvested on days 3, 7, 15, and 20 post-surgery. Wound contraction rate, quantitative immunohistochemistry [macrophages, myofibroblasts, capillaries, collagens (col) I and III, transforming growth factor β3β (TGFβ3)], and tensile strength were assessed. Results: Treated wounds were smaller, contracted earlier and had increased angiogenesis, fewer CD68+ and M2 macrophages on days 7 and 15, but higher on day 20. Myofibroblasts appeared on days 3 to 7 in untreated wounds and on days 7 to 15 in treated wounds. TGFβ3 levels were higher in the treated wounds, less dense collagen fibers, lower col I/III ratios and a higher tensile strength. Conclusion: These results demonstrate the important anti-inflammatory role of treatment and the associated modulation of macrophages, myofibroblasts, and TGFβ3 levels. Collagen fibers in the treated wounds were more organized and less dense, similar to unwounded skin, which likely contributed to the higher tensile strength.

A technical note on low cost rat laparoscopy an initial experience.

PURPOSE: To evaluate a novel and adapted low-cost set model for laparoscopic surgery in rats. METHODS: Nine Wistar rats underwent two different laparoscopic procedures, splenectomy (n=3) and distal pancreatectomy with splenectomy (n = 6), after assembling a low-cost set replacing the conventional one (monitor, micro camera, image processor, light source, laparoscope and insufflator). The new set included an Android Tablet 10.5 ", a 5mm USB Endoscope and semiautomatic sphygmomanometer monitor. RESULTS: The same surgeon performed the laparoscopic procedures. Total surgical time ranged from 36 to 60 minutes with a mean of 45.8 minutes. Three rats died during the distal pancreatic and splenectomy procedure (33.3%), due to respiratory failure (n = 1), uncontrolled abdominal hemorrhage (n=1) and iatrogenic gastric perforation (n = 1). We followed the other six rats (66.6%) for seven days with no further evidence of complications. CONCLUSIONS: The laparoscopic partial pancreatectomy and splenectomy can be performed with the novel low-cost set assembled in the present experimental study. Both specific training and skills development are required to validate more advanced laparoscopic procedures and achieve a desirable outcome.

Rat models of high risk colorectal anastomoses

Abstract Purpose: To evaluate the most frequent surgical techniques of high-risk colorectal anastomoses in rats. Methods: Wistar rats were enrolled in three different models comprising inflammatory (TNBS enema), vascular (portal vein occlusion) or obstructive (a non-ischemic constricting ring) mechanisms associated with colonic anastomosis that had accomplished after these former lesions. Histological analyses (Hematoxylin and eosin and Picrosirius red) were performed. Results: All anastomoses techniques were associated with risk factors and had complications, mainly anastomotic leakage. In Study 1, the use of a pharmacological agent, trinitrobenzene sulfonic acid (TNBS) mimicked an inflammatory bowel disease such as Crohn's disease with 50% of anastomosis leakage, the higher percentage among all models tested. In Study 2, after portal ischemia followed by reperfusion it was observed a dense neutrophil infiltrate in the midst of necrotic tissue and fibrin at the anastomotic site and 5 days after the anastomosis, no collagen was produced. In Study 3, 5 days after the mechanical obstruction some denuded areas of epithelium with marked oedema of mucosa and submucosa were seen, at the anastomotic site and anastomosis group showed some reduction of collagen density when compared with Control/Sham group. Conclusion: All the experimental surgical techniques tested in rats were associated with high-risk colorectal anastomoses and were useful to study colonic anastomotic healing and intestinal leakage.