EVALUATION OF VOLUME AND STRENGTH OF THE QUADRICEPS MUSCLE BEFORE AND AFTER ANTERIOR CRUCIATED LIGAMENT RECONSTRUCTION SURGERY / AVALIAÇÃO DO VOLUME E FORÇA DO MÚSCULO QUADRÍCEPS ANTES E APÓS OPERAÇÃO DE RECONSTRUÇÃO DO LIGAMENTO CRUZADO ANTERIOR

Introduction: The anterior cruciate ligament is one of the main ligaments of the knee, often more susceptible to injuries due to its central position and its vital role in stabilizing this joint. The strength of the quadriceps plays a crucial role, with impact absorption function, helping to reduce load. Objective: To evaluate the volume and strength of the quadriceps muscle before and after reconstruction of the anterior cruciate ligament of the knee, their correlation and which variables predict pre- and postoperative muscle strength. Method: Prospective cohort of 37 patients evaluated preoperatively and 4 months after the operation, using magnetic resonance imaging and isokinetic dynamometry. The measurements of the limb undergoing the operation were compared to the contralateral limb as a control. Result: The volume of the quadriceps muscle was 65.2+13.4cm3 before and 63.4+15.9 cm3 after, significantly lower in the control at both moments, with a reduction of 3.0cm3 (4.1%) in the pre and 7.8 cm3 post (12.0%). Muscle strength was 105.5+29.9N/m before and 100.9+28.6N/m after, significantly lower in the operated limb (126.4+28.2N/m and 129.6+27.6N /m, p<0.001). This reduction was similar in the 2 evaluation moments, on average of 17.5N/m (16.3%) in the pre and 22.8N/m (22.5%) in the post. The loss of strength was greater than the loss of muscle volume, with muscle volume and time of anterior cruciate ligament injury being the main determinants of muscle strength in the pre-op. The strength in the post was mainly determined by that in the pre. Conclusion: The loss of muscle strength was 4 times greater than the loss of volume pre-operatively and 2 times greater post-operatively, indicating the beginning of recovery 4 months post-operatively.

Introdução: O ligamento cruzado anterior é um dos principais ligamentos do joelho, frequentemente mais suscetível às lesões devido à sua posição central e seu papel vital na estabilização desta articulação. A força do quadríceps desempenha papel crucial, com função de absorção de impacto, auxiliando na redução de carga. Objetivo: Avaliar o volume e a força do músculo quadríceps antes e após a reconstrução do ligamento cruzado anterior do joelho, sua correlação e quais as variáveis preditivas da força muscular pré e pós-operatória. Método: Coorte prospectiva de 37 pacientes avaliados no pré-operatório e com 4 meses após a operação, por meio de ressonância magnética e dinamometria isocinética. As medidas do membro submetido à operação foram comparadas ao membro contralateral como controle. Resultado: O volume do músculo quadríceps foi de 65,2+13,4cm3 antes e de 63,4+15,9 cm3 após, significativamente menor no controle nos 2 momentos, com redução de 3,0cm3 (4,1%) no pré e 7,8 cm3 no pós (12,0%). A força muscular foi de 105,5+29,9N/m antes e de 100,9+28,6N/m após, significativamente menor no membro operado (126,4+28,2N/m e 129,6+27,6N/m, p<0,001). Esta redução foi semelhante nos 2 momentos de avaliação, em média de 17,5N/m (16,3%) no pré e de 22,8N/m (22,5%) no pós. A perda de força foi maior que a perda de volume muscular, sendo que o volume muscular e o tempo da lesão do ligamento cruzado anterior foram os principais determinantes da força muscular no pré. A força no pós foi determinada principalmente pela do pré. Conclusão: A perda de força muscular foi 4 vezes maior que a perda de volume no pré e 2 vezes maior no pós, indicando início da recuperação com 4 meses no pós-operatório.

HOW MUCH VOLUMETRIC AND STRENGTH LOSS OF THE QUADRICEPS FEMORAL MUSCLE IS EXPECTED IN THE POST-OPERATIVE RECONSTRUCTION OF THE ANTERIOR CRUCIATED LIGAMENT? / QUANTO DE PERDA VOLUMÉTRICA E DE FORÇA DO MÚSCULO QUADRÍCEPS FEMORAL É ESPERADA NO PÓS-OPERATÓRIO DA RECONSTRUÇÃO DO LIGAMENTO CRUZADO ANTERIOR?

Introduction: When injured and/or reconstructed the anterior cruciate ligament, not only occurs decrease in strength, but also less contraction of the quadriceps, in addition to muscle atrophy. Magnetic resonance imaging and isokinetic dynamometry have offered better evaluation of the pre- and post-surgical periods and can better monitor and predict postoperative rehabilitation. Objectives: To review the role of volume and strength of the quadriceps femoris muscle before and after reconstruction of the anterior cruciate ligament and how these measurements correlate with the predictive variables of pre- and postoperative muscle strength. Method: Integrative review collecting information on virtual platforms. The texts were selected from SciELO, Google Scholar, Pubmed and Scopus. The descriptors related to the topic were the following: anterior cruciate ligament reconstruction; magnetic resonance imaging; quadriceps muscle in Portuguese and English with AND or OR search, considering the title and/or abstract. Results: The entire selected texts were read and 61 articles were included. Conclusion: A loss of volume and strength of the quadriceps muscle was observed after reconstruction. The loss of strength was 4 times greater than the preoperative volume and 2 times greater postoperatively, with improvement 4 months after the operation.

Introdução: Observa-se, quando da lesão e/ou reconstrução do ligamento cruzado anterior, não somente que há diminuição da força, mas também da qualidade e da contração do quadríceps, além de atrofia muscular. A ressonância magnética e dinamometria isocinética têm oferecido melhor avaliação dos períodos pré e pós-cirúrgicos, podendo melhor monitorizar e prever a reabilitação pós-operatória. Objetivos: Revisar o papel do volume e da força do músculo quadríceps femoral antes e após reconstrução do ligamento cruzado anterior e como estas medidas se correlacionam com as variáveis preditivas da força muscular pré e pós-operatória. Método: Revisão integrativa colhendo informações em plataformas virtuais. Os textos foram selecionados do SciELO, Google Scholar, Pubmed e Scopus. Os descritores relacionados ao tema foram os seguintes: reconstrução do ligamento cruzado anterior; ressonância magnética; músculo quadríceps em português e inglês com busca AND ou OR, considerando o título e/ou resumo. Resultados: Foi realizada a leitura da íntegra dos textos selecionados e incluídos 61 artigos. Conclusão: Observou-se perda de volume e força do músculo quadríceps após a reconstrução. A perda da força muscular foi 4 vezes maior que a do volume pré- operatório e 2 vezes maior no pós-operatório com melhora após 4 meses da operação.

INFLUENCE OF LOCAL ANESTHETICS ON INFLAMMATION, NEOVASCULARIZATION AND COLLAGEN DEPOSITION IN WOUND HEALING / INFLUÊNCIA DOS ANESTÉSICOS LOCAIS NA INFLAMAÇÃO, NEOVASCULARIZAÇÃO E DEPOSIÇÃO DE COLÁGENO NA CICATRIZAÇÃO DE FERIDAS

Introduction: Evaluating the scarring differences between areas previously anesthetized with different local anesthetics is interesting to verify whether the choice of anesthetic helps in surgical healing in relation to inflammation, neovascularization and collagen deposition. Objectives: To analyze the influence of ropivacaine and levobupivacaine on the inflammatory phase of surgical incision healing. Method: Thirty male Wistar rats were divided into 3 groups to evaluate the effects of these local anesthetics in comparison with each other and with a control group. The animals were subjected to general anesthesia and subsequently scheduled for administration of the solutions and their samples were excised after 5 days. The scar area, neovascularization and collagen deposition were studied. Results: Regarding inflammation and neovascularization, there were no significant differences between the groups, with all of them presenting pronounced levels. As for collagen deposition, this group exhibited significantly higher levels of type I, II, and III collagens compared to groups C and R. Regarding collagen deposition, this group demonstrated significantly higher levels of type I, II and III collagen when compared to groups C and R. Conclusions: No differences were observed between the groups in relation to the variation in scar measurements, inflammation and neovascularization. However, there was a significant difference in the production of collagens with an intensity of 6 to 12 times greater in collagen types I, II and III with the use of levobupivacaine.

Introdução: Avaliar as diferenças cicatriciais entre áreas previamente anestesiadas com diferentes anestésicos locais é interessante para verificar se a escolha do anestésico auxilia na cicatrização cirúrgica em relação à inflamação, neovascularização e deposição de colágeno. Objetivos: Analisar a influência da ropivacaína e levobupivacaína na fase inflamatória da cicatrização de incisões cirúrgicas. Método: Trinta ratos Wistar machos foram divididos em 3 grupos para avaliar os efeitos desses anestésicos locais em comparação entre si e com grupo controle. Os animais foram submetidos à anestesia geral e, posteriormente, marcados para a administração das soluções e terem excisadas suas amostras após 5 dias. Estudou-se a área cicatricial, neovascularização e deposição de colágenos. Resultados: Em relação à inflamação e neovascularização, não houve diferenças significativas entre os grupos., todos apresentando níveis acentuados. Quanto à deposição de colágenos, este grupo demonstrou níveis significativamente mais altos de colágenos tipo I, II e III quando comparados aos grupos C e R. Conclusões: Não se observou diferenças entre os grupos em relação à variação das medidas cicatriciais, inflamação e à neovascularização. Entretanto, verificou-se sim diferença significativa na produção de colágenos com intensidade de 6 a 12 vezes maior de colágenos tipos I, II e III com o uso da levobupivacaína.

CD114 MEMBRANE RECEPTORS CAN HELP IN THE ASSESSMENT OF MOLECULAR MORTALITY IN MEDULOBLASTOMAS? / RECEPTORES DE MEMBRANA CD114 PODEM AUXILIAR NA AVALIAÇÃO DA MORTALIDADE MOLECULAR EM MEDULOBLASTOMAS?

Introduction: Medulloblastomas are the most common solid tumors of childhood and many studies seek to develop new chemotherapy drugs by identifying genes whose expression is new molecular targets for drugs, such as membrane receptors associated with cell replication. Objective: To review existing knowledge about the association of CD114 expression with mortality in medulloblastoma. Method: Narrative review collecting information with material for reading and analysis selected from research on virtual platforms (SciELO, Pubmed and Scopus). Initially, a search was carried out for descriptors related to the topic, which were identified through MESH using the following terms: "neurosurgery, surgical oncology, molecular targeted therapy, medulloblastoma" with AND or OR search, considering the title and/or abstract. After, the search was carried out, the title and abstract were analyzed and those that could be included were read in full. Results: 23 articles were included. Conclusion: There is no direct relationship between the expression of the CD114 membrane receptor and mortality in patients with medulloblastoma, and additional studies should be carried out on the intracellular signaling pathways associated with this receptor and its gene, CSF3R

Introdução: Meduloblastomas são os tumores sólidos mais comuns da infância e muitos estudos buscam desenvolvimento de novos quimioterápicos com a identificação de genes cuja expressão sejam novos alvos moleculares para drogas, como receptores de membrana associados à replicação celular. Objetivo: Revisar o cohecimento existente sobre a associação da expressão de CD114 com a mortalidade no meduloblastoma. Método: Revisão narrativa colhendo informações com o material para leitura e análise selecionado a partir de pesquisa em plataformas virtuais (SciELO, Pubmed e Scopus). Inicialmente foi realizada busca por descritores relacionados ao tema, os quais foram identificados por meio do DeCS utilizando os seguintes termos: "neurocirurgia, oncologia cirúrgica, terapia de alvo molecular, meduloblastoma" " e seus equivalentes em inglês  "neurosurgery, surgical oncology, molecular targeted therapy, medulloblastoma" com busca AND ou OR, considerando o título e/ou resumo. Feita a busca, foi realizada análise do título, resumo e lidos na íntegra aqueles que poderiam ser incluídos.  Resultados: Foram incluídos 23 artigos. Conclusão: Não há relação direta entre a expressão do receptor de membrana CD114 e a mortalidade em pacientes portadores de meduloblastoma e estudos adicionais devem ser feitos sobre as vias de sinalização intracelulares associadas a esse receptor e ao seu gene, o CSF3R.

Platelet-rich fibrin improves the osteoneogenesis in non-critical defects in calvaria: a histological and histometric study.

PURPOSE: The aim of this study was to evaluate the effect of platelet-rich fibrin (PRF) and autograft on non-critical bone repair. METHODS: Four bone defects (8.3 × 2 mm) were produced on the calvarium of 15 rabbits. The surgical defects were treated with either autograft, autograft associated to PRF, PRF alone, and sham. Animals were euthanized on the second, fourth or sixth posteoperative week. Histological analyses for presence of bone development on deffect was evaluated comparing the groups treated with autograft and without the autograft separately within the same period. Mann-Whitney's tests were used to compare the percentage of bone repair in each post-operative period for autograft × autograft + PRF groups and also for control × PRF groups (α = 5%). RESULTS: No differences were observed between the groups that received autograft and autograft associated to PRF on the second and fourth postoperative week, but areas treated with PRF demonstrated significant osteogenesis when compared to sham group on the fourth and sixth weeks. The groups that received PRF (with autograft or alone) demonstrated an enlarged bone deposition when compared to their control group. CONCLUSIONS: The use of PRF may influence bone repair and improve the bone deposition in late period of repair demonstrating osteoconductive and osteogenic properties.

The impact of bariatric and metabolic surgery on the morbidity and mortality of patients infected during the COVID-19 pandemic: a retrospective cohort study

ABSTRACT BACKGROUND: Since the impact of the coronavirus disease 2019 (COVID-19) pandemic in March 2020, several studies have shown a strong relationship between obesity and severe cases of COVID-19. It is imperative to assess whether bariatric surgery exerts a protective effect in such cases. OBJECTIVE: This study aimed to assess the impact of bariatric surgery on the morbidity and mortality in obese patients during the COVID-19 pandemic. A comprehensive search was performed using the PubMed and Cochrane Library databases. DESIGN AND SETTING: Retrospective cohort studies conducted in the Faculdade de Medicina da Universidade Cidade de São Paulo, São Paulo (SP), Brazil. METHODS: The search comprised the following descriptors: "bariatric, surgery, COVID-19". Current retrospective cohort studies that examined the influence of bariatric surgery on the morbidity and mortality of obese patients during the COVID-19 pandemic were considered eligible. RESULTS: After removing duplicates, 184 studies were obtained from the databases. Of these, 181 were excluded from the analysis as they did not meet the eligibility criteria. Patients undergoing postoperative follow-up of bariatric surgery had a similar probability of SARS-CoV-2 infection compared to the general population, and persistent comorbidities were associated with an increased risk and severity of infection. CONCLUSION: Bariatric surgery has a protective effect against severe COVID-19 in the obese population, bringing the prevalence of severe disease cases to levels equivalent to those of the nonobese general population, with a positive impact on morbidity and mortality.

Identification of CD114 Membrane Receptors as a Molecular Target in Medulloblastomas.

Medulloblastomas are the most common solid tumors in children, accounting for 8-30% of pediatric brain cancers. It is a high-grade tumor with aggressive behavior and a typically b poor prognosis. Its treatment includes surgery, chemotherapy, and radiotherapy, and presents high morbidity. Significant clinical, genetic, and prognostic differences exist between its four molecular subgroups: WNT, SHH, Group 3, and Group 4. Many studies seek to develop new chemotherapeutic agents for medulloblastomas through the identification of genes whose expressions are new molecular targets for drugs, such as membrane receptors associated with cell replication. This study aimed to assess the association of CD114 expression with mortality in patients with medulloblastoma. Databases from the Medulloblastoma Advanced Genomics International Consortium (MAGIC) were analyzed, focusing on the expression of the CD114 membrane receptor in different molecular types and its possible association with mortality. Our findings showed different CD114 expressions between Group 3 and other molecular groups, as well as between the molecular subtypes SHH γ and Group 3 α and Group 3 ß. There was no statistically significant difference between the other groups and subtypes. Regarding mortality, this study did not find statistical significance in the association between low and high CD114 expressions and mortality. Medulloblastoma is a heterogeneous disease with many subtype variations of its genetic and intracellular signaling pathways. Similarly to this study, which could not demonstrate different CD114 membrane receptor expression patterns between groups, others who sought to associate CD114 expression with mortality in other types of cancer failed to establish a direct association. Since many indications point to the relation of this gene with cancer stem cells (CSCs), it may be part of a more extensive cellular signaling pathway with an eventual association with tumor recurrence. This study found no direct relationship between CD114 expression and mortality in patients with medulloblastoma. Further studies are needed on the intracellular signaling pathways associated with this receptor and its gene (the CSF3R).

Colecistectomia robótica por incisão única na doença da vesícula biliar: revisão sistemática e metanálise / Robotic single-incision cholecystectomy in gallbladder disease: systematic review and meta-analysis

Introdução: A colecistectomia por incisão única assistida por robótica é técnica cirúrgica emergente para o tratamento da doença da vesícula biliar. Objetivo: Analisar os resultados clínicos e o custo efetividade dela, com foco no tempo de permanência hospitalar, tempo de operação, custo total e taxa de conversão entre robótica e outros procedimentos. Métodos: Revisão sistemática e metanálise foram realizadas de acordo com o Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Os bancos de dados PubMed, Embase e Cochrane foram pesquisados desde o início até março de 2023. Análise estatística foi feita usando o R versão 6.2.1. Metanálise de efeitos aleatórios com razão de risco, diferença média e intervalo de confiança de 95% foi estimada usando a variância inversa e o método de Mantel-Haenszel para resultados binários e o estimador DerSimonian-Laird para resultados contínuos. Resultados: Um total de 452 pacientes foram envolvidos, incluindo 4 estudos randomizados. Os desfechos escolhidos para metanálise foram: permanência hospitalar (MD −0.03 dias, CI 95% −0.12 a 0.18, p=0.708), tempo de operação (MD 12.93 min, CI 95% −21.40 a 47.25, p=0.460) e taxa de conversão (RR 0.90, CI 95% 0.44 a 1.83, p=0.771). Conclusão: Não houve diferença estatisticamente significativa em relação à duração da permanência hospitalar, tempo de operação e taxa de conversão entre a colecistectomia robótica por incisão única e outras técnicas cirúrgicas para a doença da vesícula biliar.

Introduction: Robotic-assisted single-incision cholecystectomy is an emerging surgical technique for the treatment of gallbladder disease. Objective: To analyze the clinical results and its cost effectiveness, focusing on length of hospital stay, operating time, total cost and conversion rate between robotics and other procedures. Methods: Systematic review and meta-analysis were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase, and Cochrane databases were searched from inception through March 2023. Statistical analysis was performed using R version 6.2.1. Random effects meta-analysis with hazard ratio, mean difference and 95% confidence interval was estimated using inverse variance and the Mantel-Haenszel method for binary outcomes and the DerSimonian-Laird estimator for continuous results. Results: A total of 452 patients were enrolled, including 4 randomized trials. The outcomes chosen for meta-analysis were: hospital stay (MD −0.03 days, CI 95% −0.12 to 0.18, p=0.708), operating time (MD 12.93 min, CI 95% −21.40 to 47.25, p=0.460) and of conversion (RR 0.90, CI 95% 0.44 to 1.83, p=0.771). Conclusion: There was no statistically significant difference regarding length of hospital stay, operating time and conversion rate between single-incision robotic cholecystectomy and other surgical techniques for gallbladder disease.

Tratamento da síndrome da artéria mesentérica superior / Treatment of superior mesenteric artery syndrome

Introdução: A síndrome da artéria mesentérica superior (SMAS) resulta da compressão extrínseca dela e obstrução sintomática da terceira porção do duodeno anteriormente, e pela aorta posteriormente. Esse estreitamento leva à compressão extrínseca e à obstrução do duodeno, impedindo a passagem do conteúdo intestinal. Objetivo: Por meio de revisão integrativa, sintetizar evidências sobre o tratamento dessa síndrome. Métodos: Revisão integrativa da literatura com síntese de evidências. A base de dados escolhida para seleção dos trabalhos foi o PUBMED, utilizando a seguinte estratégia de busca: "superior mesenteric artery syndrome"[title] AND (treatment[title] OR surgical[title]). Foram considerados para revisão os trabalhos publicados entre os anos de 2018 e 2023. Resultados: Inicialmente foram identificados 13 trabalhos que atenderam à estratégia de busca previamente estabelecida. Após a leitura dos títulos e resumos, 4 textos foram excluídos por não discutirem o tema proposto, restando 9 trabalhos para revisão. Conclusão: As modalidades cirúrgicas disponíveis para o tratamento da SMA foram consideradas seguras, com baixos índices de recidiva, além de eficazes no controle de sintomas e no manejo da síndrome.

Introduction: Superior mesenteric artery syndrome (SMAS) results from extrinsic compression and symptomatic obstruction of the third portion of the duodenum by it anteriorly, and by the aorta posteriorly. This narrowing leads to extrinsic compression and obstruction of the duodenum, preventing the passage of intestinal contents. Objective: Through an integrative review, to synthesize evidence on the treatment of SMAS. Methods: Integrative literature review with evidence synthesis. The database chosen for the selection of papers was PUBMED, using the following search strategy: "superior mesenteric artery syndrome"[title] AND (treatment[title] OR surgical[title]). Papers published between the years 2018 and 2023 were considered for review. Results: Initially, 13 papers were identified that met the previously established search strategy. After reading the titles and abstracts, 4 were excluded for not discussing the proposed theme, leaving 9 papers for review. Conclusion: The surgical modalities available for SMA treatment were considered safe, with low recurrence rates, and effective in symptom control and management of the syndrome.

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.

Platelet-rich fibrin improves the osteoneogenesis in non-critical defects in calvaria: a histological and histometric study

ABSTRACT Purpose: The aim of this study was to evaluate the effect of platelet-rich fibrin (PRF) and autograft on non-critical bone repair. Methods: Four bone defects (8.3 × 2 mm) were produced on the calvarium of 15 rabbits. The surgical defects were treated with either autograft, autograft associated to PRF, PRF alone, and sham. Animals were euthanized on the second, fourth or sixth posteoperative week. Histological analyses for presence of bone development on deffect was evaluated comparing the groups treated with autograft and without the autograft separately within the same period. Mann-Whitney's tests were used to compare the percentage of bone repair in each post-operative period for autograft × autograft + PRF groups and also for control × PRF groups (α = 5%). Results: No differences were observed between the groups that received autograft and autograft associated to PRF on the second and fourth postoperative week, but areas treated with PRF demonstrated significant osteogenesis when compared to sham group on the fourth and sixth weeks. The groups that received PRF (with autograft or alone) demonstrated an enlarged bone deposition when compared to their control group. Conclusions: The use of PRF may influence bone repair and improve the bone deposition in late period of repair demonstrating osteoconductive and osteogenic properties.

O impacto da suplementação proteica na manutenção de massa magra em pacientes submetidos a cirurgia bariátrica / The impact of protein supplementation on the maintenance of lean mass in patients undergoing bariatric surgery

Introdução: A obesidade é doença crônica que tem se tornado preocupação em saúde pública global. A cirurgia bariátrica é opção de tratamento eficaz para a obesidade mórbida, proporcionando a perda de peso e a melhora da qualidade de vida. No entanto, a perda de massa magra pós-operatória é preocupação importante. Objetivo: Estudo retrospectivo sobre o impacto da suplementação proteica com whey protein na perda de massa magra em pacientes submetidos ao bypass gástrico. Método: Pacientes de 18-60 anos sem complicações foram acompanhados por pelo menos 6 meses e divididos em 2 grupos: um que recebeu suplementação proteica com whey protein (Grupo A, n=19) e outro de controle que não recebeu suplementação (Grupo B, n=13). Os dados demográficos, antropométricos, clínicos e laboratoriais foram coletados e avaliação dos pacientes sobre qualidade de vida antes e depois da operação. Resultados: A média de idade foi de 38 anos. A perda média de massa magra foi de 34,67 kg. Não houve diferença estatisticamente significativa na perda de massa magra ou total entre os grupos (p=0,121 e p=0,072, respectivamente). A qualidade de vida média antes foi de 3,06 pontos e após a operação de 8,13 pontos. Houve diferença estatisticamente significativa na qualidade de vida entre os grupos (p=0,018). O grupo que recebeu suplementação apresentou média de adesão às orientações dietéticas de 8,06 pontos, enquanto aquele sem com média de 6,14 pontos (p=0,045). Conclusão: Os resultados indicaram que a suplementação proteica não teve efeito significativo na perda de massa magra. No entanto, ela melhorou a adesão dos pacientes às orientações dietéticas pós-cirúrgicas e não afetou a qualidade de vida.

Introduction: Obesity is a chronic disease that has become a global public health concern. Bariatric surgery is an effective treatment option for morbid obesity, providing weight loss and improved quality of life. However, postoperative lean mass loss is an important concern. Objective: Retrospective study on the impact of protein supplementation with whey protein on the loss of lean body mass in patients undergoing gastric bypass. Method: Patients aged 18-60 years without complications were followed up for at two years and divided into 2 groups: one received protein supplementation with whey protein (Group A, n=19) and another, control group, that did not receive supplementation (Group B , n=13). Demographic, anthropometric, clinical and laboratory data were collected and patients' assessment of quality of life before and after the operation. Results: The mean age was 38 years. The average loss of lean mass was 34.67 kg. There was no statistically significant difference in lean or total mass loss between groups (p=0.121 and p=0.072, respectively). The average quality of life before was 3.06 points and after the operation, 8.13 points. There was a statistically significant difference in quality of life between groups (p=0.018). The group that received supplementation had an average adherence to dietary guidelines of 8.06 points, while the one without an average of 6.14 points (p=0.045). Conclusion: The results indicated that protein supplementation had no significant effect on lean mass loss. However, improved patients' adherence to post-surgical dietary guidelines and did not affect quality of life.

Qual a melhor técnica de fixação da tela na cirurgia laparoscópica da hérnia inguinal? / What is the best mesh fixation technique in laparoscopic inguinal hernia surgery?

Introdução: As operações laparoscópicas têm aumentado anualmente, bem como os casos de prevalência das hérnias da parede abdominal. Com isso, as técnicas de se realizar as operações, bem como certos procedimentos vem sendo estudados. Uma das questões debatidas é a respeito do tipo de fixação da tela. Objetivo: Avaliar as técnicas de fixação da tela na cirurgia laparoscópica ventral da hérnia inguinal. Método: Trata-se de um estudo de revisão sistemática. Três bases de dados foram consultadas: Cochrane Database of Systematic Reviews (CDSR), EMBASE e PUBMED. Durante as buscas foram utilizados descritores com vocabulário controlado e text words. Resultados: Em relação ao desenho do estudo 1 revisão incluiu apenas ECA, 2 ECA e ECNA e 1 combinou a inclusão de ECA e estudos observacionais. Em relação ao tipo de fixação 2 estudos compararam os efeitos da fixação por tacha vs. cola de fibrina e outros 2 a comparação da fixação do grampo vs. cola de fibrina. De todos os desfechos de metanálise avaliados, apenas a redução da dor inguinal crônica pela fixação por cola de fibrina foi estatisticamente superior ao método de fixação mecânico em 3 dos 4 estudos. Conclusão: Os achados mostram que a diferença entre as técnicas de fixação da tela na cirurgia laparoscópica ventral da hérnia inguinal é que a fixação por cola diminui a incidência de dor crônica pós-operatória.

Introduction: Laparoscopic operations have increased annually, as well as the prevalence of abdominal wall hernias. With this, the techniques of performing the operations, as well as certain procedures, have been studied. One of the debated questions is about the type of fixation of the mesh. Objective: To evaluate mesh fixation techniques in ventral laparoscopic surgery for inguinal hernia. Method: This is a systematic review. Three databases were consulted: Cochrane Database of Systematic Reviews (CDSR), EMBASE and PUBMED. During the searches, descriptors with controlled vocabulary and text words were used. Results: Regarding the study design, 1 review included only ACE, 2 ACE and ECNA and 1 combined the inclusion of ACE and observational studies. Regarding the type of fixation, 2 studies compared the effects of stud fixation vs. fibrin glue and 2 others comparison of staple vs. fibrin glue. Of all the meta-analysis outcomes evaluated, only the reduction of chronic groin pain by fibrin glue fixation was statistically superior to the mechanical fixation method in 3 of 4 studies. Conclusion: The findings show that the difference between mesh fixation techniques in laparoscopic ventral inguinal hernia surgery is that glue fixation decreases the incidence of postoperative chronic pain.

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.

The impact of bariatric and metabolic surgery on the morbidity and mortality of patients infected during the COVID-19 pandemic: a retrospective cohort study.

BACKGROUND: Since the impact of the coronavirus disease 2019 (COVID-19) pandemic in March 2020, several studies have shown a strong relationship between obesity and severe cases of COVID-19. It is imperative to assess whether bariatric surgery exerts a protective effect in such cases. OBJECTIVE: This study aimed to assess the impact of bariatric surgery on the morbidity and mortality in obese patients during the COVID-19 pandemic. A comprehensive search was performed using the PubMed and Cochrane Library databases. DESIGN AND SETTING: Retrospective cohort studies conducted in the Faculdade de Medicina da Universidade Cidade de São Paulo, São Paulo (SP), Brazil. METHODS: The search comprised the following descriptors: "bariatric, surgery, COVID-19". Current retrospective cohort studies that examined the influence of bariatric surgery on the morbidity and mortality of obese patients during the COVID-19 pandemic were considered eligible. RESULTS: After removing duplicates, 184 studies were obtained from the databases. Of these, 181 were excluded from the analysis as they did not meet the eligibility criteria. Patients undergoing postoperative follow-up of bariatric surgery had a similar probability of SARS-CoV-2 infection compared to the general population, and persistent comorbidities were associated with an increased risk and severity of infection. CONCLUSION: Bariatric surgery has a protective effect against severe COVID-19 in the obese population, bringing the prevalence of severe disease cases to levels equivalent to those of the nonobese general population, with a positive impact on morbidity and mortality.

INVASIVE DUCTAL BREAST CARCINOMA: CORRELATION OF AXL AND Β-CATENIN IMMUNOHISTOCHEMICAL EXPRESSION WITH TUMOR AGGRESSIVITY / CARCINOMA MAMÁRIO DUCTAL INVASOR: CORRELAÇÃO DA EXPRESSÃO IMUNOISTOQUÍMICA DE AXL E Β-CATENINA COM A AGRESSIVIDADE TUMORAL

Introduction: Invasive ductal carcinoma corresponds to the most common histological type of the breast, coexisting with different forms of clinical evolution, histological grading, expression of certain tissue markers and genomic profiles that seek a better understanding of the disease. Objectives: To analyze the correlation of ß-catenin and AXL markers with tumor aggressiveness, with reference to overall survival, tumor progression and histopathological prognostic factors. Methods: A study of 101 samples of invasive ductal mammary carcinoma was performed. Those with a diagnosis of ductal type, initially submitted to biopsy or definitive surgical treatment, were included. For control purposes, 20 samples of intraductal carcinoma, 35 of breast fibroadenoma and 10 of breast tissue without any alteration were included. Those undergoing neoadjuvant chemotherapy, those without a tumor sample prior to chemotherapy, those lost to follow-up, and those with incomplete data, were excluded. Results: When the ß-catenin expression was analyzed, it was negative. As for AXL, different degrees of expression were observed without statistical significance between them. Conclusion: When analyzing invasive ductal breast adenocarcinoma in TMA, there was no correlation in the expression of ß-Catenin and AXL when compared to overall survival, tumor progression and histological grade.

Introdução: O carcinoma ductal invasor corresponde ao tipo histológico mais comum da mama coexistindo com formas diferentes de evolução clínica, graduação histológica, expressão de determinados marcadores teciduais e perfis genômicos que procuram melhor entendimento da doença. Objetivos: Analisar a correlação dos marcadores ß-catenina e AXL com a agressividade tumoral, tendo como referência a sobrevida global, progressão tumoral e fatores prognósticos histopatológicos. Métodos: Foi realizado estudo de 101 amostras de carcinoma mamário ductal invasor. Foram incluídas aquelas com diagnóstico do tipo ductal, submetidas inicialmente à biópsia ou tratamento cirúrgico definitivo. Incluiu-se para fins de controle 20 amostras de carcinoma intraductal, 35 de fibroadenoma mamário e 10 de tecido mamário sem qualquer alteração. Foram excluídos os submetidos à quimioterapia neoadjuvante, que não tivessem amostra tumoral prévia ao tratamento quimioterápico, que perderam o seguimento, e com dados incompletos. Resultados: Quando analisada a expressão da ß-catenina, foi negativa. Quanto ao AXL foram observados diferentes graus de expressão sem significância estatística entre eles. Conclusão: Quando analisados adenocarcinoma mamário do tipo ductal invasor em TMA não houve correlação na expressão de ß-catenina e AXL quando comparados a sobrevida global, progressão tumoral e grau histológico.