VIDEOSURGERY TEACHING HISTORY / HISTÓRICO DO ENSINO DA VIDEOCIRURGIA

Introduction: Surgical procedures were systematized and scientifically based at the end of the 19th century by William Stewart Halsted. Through scientific studies, anatomical principles, knowledge of physiology and pathology, strict aseptic techniques, gentle tissue manipulation, among others, were systematized. This lasted for centuries. But the modern technological era invented videosurgery and complicated the previously used teaching method. Objective: Review previously published teaching methods using simulators. Method: This is a narrative review carried out in the PubMed and Scielo databases. The search used the following keywords: videosurgery, teaching, simulators, training. The inclusion criteria comprised review articles and experimental studies, written in Portuguese and English and available in full text. The selected articles were analyzed based on the technologies covered, future perspectives and challenges mentioned. Result: 28 articles were included. Conclusion: As the results of this review on simulators show, once trained residents begin learning videolaparoscopic operations much more easily and safely.

Introdução: Os procedimentos cirúrgicos foram sistematizados e embasados cientificamente no final do século XIX por William Stewart Halsted. Por meio de estudos científicos, princípios anatômicos, conhecimento de fisiologia e patologia que permitiram sistematizar técnica asséptica estrita, manipulação tecidual gentil, dentro de outros. Isto perdurou por séculos. Mas a moderna era tecnológica inventou a videocirurgia e complicou o método de ensino anteriormente usado. Objetivo: Revisar os métodos de ensino feito por simuladores já publicados. Método: Trata-se de revisão narrativa realizada nas bases de dados PubMed e Scielo. A busca utilizou as seguintes palavras-chave: videocirurgia, ensino, simuladores, treinamento. Os critérios de inclusão compreenderam artigos de revisão e estudos experimentais, escritos em português e inglês e disponíveis em texto completo. Os trabalhos selecionados foram analisados com base nas tecnologias abordadas, perspectivas futuras e desafios mencionados. Resultado: Foram incluídos 28 artigos. Conclusão: Conforme mostram os resultados desta revisão sobre simuladores, os residentes depois de treinados, iniciariam o aprendizado de operações videolaparoscópicas com muito mais facilidade e segurança.

IMPACT OF VIDEOSURGERY TRAINING IN GENERAL SURGERY RESIDENTS WITH LOW FIDELITY SIMULATOR ADAPTED FROM THE FUNDAMENTS OF LAPAROSCOPIC SURGERY (FLS) / IMPACTO DO TREINAMENTO EM VIDEOCIRURGIA DE MÉDICOS RESIDENTES DE CIRURGIA GERAL EM SIMULADOR DE BAIXA FIDELIDADE ADAPTADO DO PROGRAMA DE FUNDAMENTS OF LAPAROSCOPIC SURGERY (FLS)

Introduction: Teaching in surgery must follow the evolution of medical techniques, procedures and technology. Since the 90s videosurgery has been developing and nowadays is the gold standard for many procedures in general surgery. As there are different characteristics from conventional surgery, residents need to practice in order to adapt to simulators. The world medical literature has established many training programs among them the Fundaments of laparoscopic Surgery (FLS). Evaluation of surgical technical abilities is a major tool for the residency programs. Objectives: To assess the effect of training acquiring skills of residents at first and second postgraduated level year (PGY1 and PGY2) before and after practice using low fidelity simulator based on tasks from FLS. Methods: A prospective study was conducted to determinate skills acquisition of residents at first and second postgraduated level year l (PGY1 and PGY2) before and after standardized practice using low fidelity simulator. Conclusions: There was a significant improve of the technical abilities reaching levels of improvement. Resident's performance was evident in the sample groups. First year residents (PGY1) achieved knowledge retention after training similar to the performance of second in the initial assessment, suggesting that the sequenced training carried out is equivalent to one year of practice in the general surgery residency program

Introdução: O ensino em cirurgia deve acompanhar a evolução das técnicas, procedimentos e tecnologia. Desde a década de 90 a videocirurgia vem se desenvolvendo e hoje é a primeira escolha para muitos procedimentos em cirugia geral. Com características diferentes da cirurgia convencional, os residentes treinaram em simuladores para adaptação. A literatura médica mundial já apresenta programas consagrados para treinamento entre eles os Fundamentos da Cirurgia Laparoscópica (FLS). A avaliação das habilidades técnicas cirúrgicas é uma ferramenta importante em programas de residência médica. Objetivo: Avaliar o impacto do treinamento através de aquisição de habilidades dos médicos residentes em cirurgia geral antes e após treinamento teórico-prático em videocirurgia utilizando um simulador de baixa fidelidade baseado em exercícios do FLS. Método: Estudar de modo prospectivo a aquisição de habilidades de médicos residentes em cirurgia geral de primeiro e segundo ano (R1 e R2), antes e após realização de treinamento teórico-prático pré-definido. Conclusão: Houve melhora significativa com o treinamento atingindo níveis de conhecimento e aprimoramento semelhantes aos trabalhos da literatura mundial. A melhoria no desempenho dos residentes foi evidente em ambos os grupos da amostra. Aqueles do primeiro ano atingiram a concentração de conhecimento após o treinamento semelhante ao desempenho dos residentes de segundo ano na avaliação inicial, destacando que o treinamento sequenciado realizado equivale a um ano de prática no programa de residência geral de cirurgia

CAN LOCAL ANESTHETICS HELP WITH THE HEALING PROCESS OF SURGICAL WOUNDS? / PODEM OS ANESTÉSICOS LOCAIS AJUDAR NO PROCESSO CICATRICIAL DAS FERIDAS CIRÚRGICAS?

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: Review the existing literature with a focus on analyzing the role of local anesthetics in aiding the healing of surgical wounds. Method: Narrative review of literature selected from the SciELO ­ Scientific Electronic Library Online, Google Scholar, Pubmed and Scopus platforms. Initially, the review searched for keywords in the focus of the research, based on MESH/DeCS with the following terms: "local anesthetics, healing, neovascularization, collagen" with AND or OR search, considering the title and/or abstract. Next, only those that were most related to the topic were included, and the texts were read for inclusion. Results: 73 articles were included, read and interpreted focusing on the role of anesthetics in healing, pain, side effects and the best that currently emerge in analgesia and scar potential. Conclusions: No differences were observed between the anesthetics studied in terms of healing, inflammation and neovascularization. However, there was a significant difference in the production of collagens with an intensity of 6 to 12 times greater than 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: Revisar a literatura existente com foco de análise sobre o papel dos anestésicos locais no auxílio da cicatrização de feridas cirúrgicas. Método: Revisão narrativa da literatura selecionada das plataformas SciELO ­ Scientific Electronic Library Online, Google Scholar, Pubmed e Scopus.  Inicialmente a revisão realizou a busca por palavras-chave no foco da pesquisa, com base no MESH/DeCS com os seguintes termos: "anestésicos locais, cicatrização, neovascularização, colágeno" com busca AND ou OR, considerando o título e/ou resumo. A seguir, foram incluídos somente os que tinham maior relação ao tema, e realizada a leitura dos textos para inclusão. Resultados: Foram incluídos, lidos e interpretados 73 artigos enfocando o papel dos anestésicos na cicatrização, dor, efeitos colaterais e os melhores que despontam na atualidade na analgesia e potencial cicatricial. Conclusões: Não se observou diferenças entre anestésicos pesquisados quanto à cicatrização, inflamação e neovascularização. Contudo, verificou-se 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.

EVALUATION OF THE IMMUNOLOCALIZATION OF THE PHOSPHATIDYL INOSITOL-3 RECEPTOR (IP3R) IN BASAL CELL AND SQUAMOUS CELL SKIN CARCINOMAS / AVALIAÇÃO DA IMUNOLOCALIZAÇÃO DO RECEPTOR DO FOSFATIDIL INOSITOL-3 (IP3R) EM CARCINOMAS BASOCELULAR E DE CÉLULAS ESCAMOSAS DE PELE

Introduction: Non-melanoma skin neoplasms (basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) form the most common group of all types of neoplasms. Although cancer is not yet being classified as a channelopathy, it has been suggested that pumps and ionic channels contribute to its progression by affecting autophagy, which could become an important therapeutic target in this context. Objective: To evaluate the immunohistochemical expression of IP3R in both skin tumors. Method: Immunohistochemistry was performed on 60 slides of non-melanoma cancer using primary anti-IP3R antibodies, verifying their presence and quantifying Results: For the first time, IP3R immunolocalization was identified in non-melanoma skin neoplasms, being evident above 90% of neoplastic cells was observed in all slides studied, regardless of the histological pattern, invasion and other tumor characteristics. Unlike what was seen in the internal control of normal skin, in which there was immunolocalization of IP3R in basal cell, in tumors, immunohistochemical expression occurred throughout the entire body of the neoplasm. Conclusion: There was immunolocalization of IP3R in tumor cells in both BCC and SCC. It was not possible to establish a correlation between tumor characteristics and IP3R expression, as immunostaining was similar in all analyzed samples. Despite this, IP3R to be associated with the pathophysiology of non-melanoma skin cancer, but its expression does not seem to be associated with tumor aggressiveness.

Introdução: As neoplasias de pele não melanoma (carcinoma basocelular (CBC) e carcinoma espinocelular (CEC) formam o grupo mais comum de todos os tipos de neoplasias. Embora o câncer ainda não esteja sendo pautado como canalopatia, tem sido sugerido que bombas e canais iônicos contribuem para a sua progressão por afetar a autofagia. Proteínas iônicas, em especial as de canais de cálcio, como o receptor da fosfatidil inositol 3 (IP3R) participam de maneira ativa na autofagia por estarem envolvidas na etapa inicial de formação do autofagossomo, podendo se tornar em alvo terapêutico importante neste contexto. Objetivo: Avaliar a expressão imuno histoquímica do IP3R em ambos os tumores de pele. Método: Foi realizada imuno histoquímica em 60 lâminas de câncer não melanoma utilizando anticorpos primários anti-IP3R verificando a sua expressão. Resultados: Pela primeira vez foi identificada a imunolocalização do IP3R em câncer de pele não melanoma, sendo evidente em mais de 90% das células neoplásicas em todas as lâminas estudadas, independentemente do padrão histológico, invasão e demais características tumorais. Diferentemente do visualizado no controle interno de pele normal, no qual houve imunolocalização de IP3R em células basais, nos tumores, a expressão imuno histoquímica ocorreu em todo o corpo da neoplasia. Conclusão: Houve imunolocalização de IP3R em células tumorais tanto em CBC quanto em CEC. Não foi possível estabelecer correlação entre as características tumorais e a expressão de IP3R, pois a imunomarcação apresentou-se de forma similar em todas as amostras analisadas. Apesar disso, IP3R está associado à fisiopatologia do câncer de pele não melanoma, mas a sua expressão não parece estar associada à agressividade tumoral.

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.

EFFECTIVENESS OF AGA, FUKUOKA AND EUROPEAN GUIDELINES IN THE MANAGEMENT OF INCIDENTALOMAS OF THE PANCREAS ANALYZED PRIOR TO PERFORMING ENDOSCOPIC ULTRASOUND WITH FINE NEEDLE PUNCTURE / EFICÁCIA DAS DIRETRIZES AGA, FUKUOKA E EUROPÉIA NO MANUSEIO DOS INCIDENTALOMAS MUCINOSOS DO PÂNCREAS ANALISADAS PREVIAMENTE À REALIZAÇÃO DA ULTRASSONOGRAFIA ENDOSCÓPICA COM PUNÇÃO POR AGULHA FINA

Introduction: International consensus guidelines are commonly used to identify patients at high risk of developing cancer or with cancer. Its applicability, however, is based on investigation through imaging tests, however without histological confirmation. Objective: To compare the performance and results of international guidelines in incidental mucinous neoplasia after diagnosis obtained by endoscopic ultrasound-guided fine needle puncture (EUS-PAF). Methods: Single-center study with prospective collection of data from asymptomatic patients with the disease who underwent EUS-PAF. Appropriate cohort selection included images that were ambiguous regarding this diagnosis or the presence and/or development of other worrisome features as defined by international guidelines. After microhistological analysis of the material obtained, each of the guideline criteria was applied to identify cancer among patients with the disease. Results: 251 patients had the diagnosis confirmed by EUS-PAF or surgical procedure. The majority were asymptomatic. The final diagnosis revealed 27.8% (n=39) with malignant disease or high-risk signs. After applying the AGA-2015, IAP-2017 and DE-2018 criteria, it was observed that those detected incidentally were referred for surgery unnecessarily. These guidelines did not identify malignant and high-risk disease in 59%, 33.3% and 46.1%, respectively. Conclusion: The European DE-2018 proved to be more accurate for use in patients with asymptomatic incidental mucinous neoplasia after the diagnosis obtained by EUS-PAF.

Introdução: Consensos internacionais, são diretrizes comumente usadas para identificar pacientes com alto risco de desenvolver câncer ou com câncer. Sua aplicabilidade, entretanto, baseia-se na investigação por exames de imagem, contudo sem confirmação histológica. Objetivo: Comparar o desempenho e os resultados das diretrizes internacionais em neoplasia mucinosa incidental após diagnóstico obtido pela punção com agulha fina guiada por ultrassom endoscópico (USE-PAF). Métodos: Estudo unicêntrico com coleta prospectiva de dados de pacientes assintomáticos com a doença submetidos a USE-PAF. A seleção apropriada da coorte incluiu imagens ambíguas quanto a esse diagnóstico ou a presença e/ou desenvolvimento de outras características preocupantes, conforme definido pelas diretrizes internacionais. Após análise microhistológica do material obtido, cada um dos critérios das diretrizes foi aplicado para identificar câncer entre os pacientes com a doença. Resultados: 251 pacientes tiveram o diagnóstico confirmado pela USE-PAF ou procedimento cirúrgico. A maioria era assintomática. O diagnóstico final revelou 27,8% (n=39) com doença maligna ou sinais de alto risco.. Após aplicação dos critérios AGA-2015, IAP-2017 e DE-2018, observou-se que os detectados incidentalmente foram encaminhados para cirurgia desnecessariamente. Essas diretrizes não identificaram doença maligna e de alto risco em 59%, 33,3% e 46,1%, respectivamente às diretrizes. Conclusão: A DE-2018 europeia mostrou-se mais precisa para ser utilizada em pacientes com neoplasia mucinosa incidental assintomática após o diagnóstico obtido pela USE-PAF.

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.

Prolong intermittent injection of human parathyroid hormone in rats modulates the expression of several proteins in the neuropil of the cerebellar cortex.

INTRODUCTION: The intermittent use of recombinant human parathyroid hormone (iPTH) alters calcium metabolism and induces osteogenesis in experimental models. However, the real effects of iPTH in excitable cells and neurons that require membrane receptors to undergo membrane depolarization/repolarization (Na+K+ATPase) to generate ATP, voltage-gated calcium channel (calcium-IP3R-calponin) as well as GABAergic (GABAA) signaling remains unclear. OBJECTIVES: In this study, the expression of IP3R, Na+K+-ATPase, GABAA and calmodulin proteins were evaluated in histological sections of the cerebellum of rats following prolonged injection of iPTH. METHODS: Twenty Wistar rats were used in this study and randomly assigned as either or control group. The test group were subcutaneously injected with 20 µg/kg of iPTH, 3×/week for 8 weeks, while the control group received 1 ml/kg of 0.9% saline solution. The rats were euthanized on the 60th day after the first administration, and their cerebellar vermis was removed and submitted to histological and immunohistochemical evaluation for detection of IP3R, Na+K+-ATPase, GABAA and calmodulin proteins. The expression of proteins was evaluated in the areas corresponding to the Purkinje cells as well as in neuropil of molecular layer of cerebellum. All results were transformed into a percentage for each area analyzed to verify significance between groups. RESULTS: Rats that received iPTH demonstrated significant reduction of IP3R, calmodulin and GABAA in Purkinje cells and neuropil of molecular layer while the expression of Na+K+-ATPase was similar. CONCLUSION: It was concluded that iPTH decreased the expression of IP3R and calmodulin while it did not alter the expression of Na+K+-ATPase. These changes insinuate the ionic activity of calcium and sodium/potassium. Yet, the iPTH alters GABAergic signaling in Purkinje cells, suggesting neurotransmission activity changes in the cerebellum.

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.

Há diferenças endoscópicas e histopatológicas entre lesões serrilhadas superficiais nas suas fases iniciais? / Are there endoscopic and histopathological differences between superficial serrated lesions in their initial phases?

Introdução: Lesões serrilhadas são consideradas precursoras dos adenocarcinomas colorretais. Estudá-las em suas fases iniciais é importante ao pensar na prevenção do câncer, quando, então, são lesões hiperplásicas, ou sésseis serrilhadas Objetivo: Realizar revisão integrativa da literatura para comparar as características endoscópicas e histopatológicas nas fases iniciais da doença, com a intenção de auxiliar no entendimento do câncer colorretal. Métodos: Revisão integrativa da literatura baseada em material de análise existente nas plataformas digitais SciELO ­ Scientific Electronic Library Online, Google Scholar, Pubmed e Scopus. O início foi a busca com os seguintes descritores: "lesões sésseis serrilhadas, carcinoma colorretal, lesões superficiais", e seus equivalentes em inglês "serrated sessile lesions, colorectal carcinoma, superficial lesions" com busca AND ou OR, considerando o título e/ou resumo, e incluindo-se posteriormente somente aqueles com maior correlação para leitura dos textos completos. Resultados: Incluíram-se 39 artigos. Conclusão: A maioria das lesões serrilhadas superficialmente elevadas com mais de 5 mm e ressecadas por colonoscopias, são hiperplásicas. Elas ocorrem por todo o cólon e reto, enquanto as sésseis serrilhadas localizamse preferencialmente no cólon proximal. As hiperplásicas geralmente não apresentam displasias e as sésseis serrilhadas podem tê-las de forma intensa.

Introduction: Serrated lesions are considered precursors of colorectal adenocarcinomas. Studying them in their initial phases is important when thinking about cancer prevention, when they are hyperplastic lesions, or sessile serrated lesions. Objective: To carry out an integrative review of the literature to compare the endoscopic and histopathological characteristics in the initial phases of the disease, with the intention to help understand colorectal cancer. Methods: Integrative literature review based on existing analysis material on the digital platforms SciELO ­ Scientific Electronic Library Online, Google Scholar, Pubmed and Scopus. The beginning was the search with the following descriptors: "serrated sessile lesions, colorectal carcinoma, superficial lesions", with AND or OR search, considering the title and/or abstract , and subsequently including only those with the highest correlation for reading the full texts. Results: 39 articles were included. Conclusion: The majority of superficially elevated serrated lesions measuring more than 5 mm and resected by colonoscopies are hyperplastic. They occur throughout the colon and rectum, while the serrated sessiles are preferentially located in the proximal colon. Hyperplastic ones generally do not present dysplasias and sessile serrated ones can have them intensely.

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.

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.

Qual é a influência da microbiota na obesidade e em seu quadro inflamatório? / What is the influence of microbiota on obesity and its inflammatory involvement?

A obesidade tem causa multifatorial que atinge atualmente mais da metade da população brasileira. Mais recentemente, a microbiota intestinal foi considerada um fator que contribui para essa condição. Os objetivos deste estudo foram revisar a influência da microbiota intestinal na obesidade e no processo inflamatório, e analisar os efeitos da utilização dos pré e probióticos. Foi realizada revisão sistemática sobre o assunto. Dos mais de 27.000 artigos, apenas 16 respeitaram os critérios de inclusão. Em conclusão, o desequilíbrio da microbiota aparece como fator favorável ao desenvolvimento da obesidade e do quadro inflamatório decorrente dela. Tanto o uso de prebióticos quanto probióticos são recursos válidos no tratamento da obesidade, porém os primeiros parecem proporcionar melhor qualidade de vida.

Obesity has a multifactorial etiological condition that involves more than half of the Brazilian population. More recently, the intestinal microbiota was considered a factor that contributes to this condition. The aims of this study were to review the intestinal microbiota influence in the obesity and in the inflammatory response, and to analyze the effects of using prebiotic and probiotic medications. A systematic review was firstly done. More than 27,000 articles were found, but only 16 contained the proper criteria. In conclusion, the microbiota imbalance seems to increase the obesity development and its inflammatory aspects. Both the use of pre and probiotics are good options in the obesity treatment, though the first ones seem to enhance bettere quality of life.

WHAT IS THE INFLUENCE OF MICROBIOTA ON OBESITY AND ITS INFLAMMATORY INVOLVEMENT? / QUAL É A INFLUÊNCIA DA MICROBIOTA NA OBESIDADE E EM SEU QUADRO INFLAMATÓRIO?

Obesity has a multifactorial etiological condition that involves more than half of the Brazilian population. More recently, the intestinal microbiota was considered a factor that contributes to this condition. The aims of this study were to review the intestinal microbiota influence in the obesity and in the inflammatory response, and to analyze the effects of using prebiotic and probiotic medications. A systematic review was firstly done. More than 27,000 articles were found, but only 16 contained the proper criteria. In conclusion, the microbiota imbalance seems to increase the obesity development and its inflammatory aspects. Both the use of pre and probiotics are good options in the obesity treatment, though the first ones seem to enhance bettere quality of life.

A obesidade tem causa multifatorial que atinge atualmente mais da metade da população brasileira. Mais recentemente, a microbiota intestinal foi considerada um fator que contribui para essa condição. Os objetivos deste estudo foram revisar a influência da microbiota intestinal na obesidade e no processo inflamatório, e analisar os efeitos da utilização dos pré e probióticos. Foi realizada revisão sistemática sobre o assunto. Dos mais de 27.000 artigos, apenas 16 respeitaram os critérios de inclusão. Em conclusão, o desequilíbrio da microbiota aparece como fator favorável ao desenvolvimento da obesidade e do quadro inflamatório decorrente dela. Tanto o uso de prebióticos quanto probióticos são recursos válidos no tratamento da obesidade, porém os primeiros parecem proporcionar melhor qualidade de vida.

EPIDEMIOLOGICAL ASSESSMENT AND EXPRESSION OF MARKERS P16/KI67 AS RISK FACTORS IN PERSISTENCE OR RECURRENCE OF HIGH GRADE SQUAMOUS INTRAEPITHELIAL LESION / AVALIAÇÃO EPIDEMIOLÓGICA E EXPRESSÃO DOS MARCADORES P16/KI67 COMO FATORES DE RISCO NA PERSISTÊNCIA OU RECIDIVA DA LESÃO INTRAEPITELIAL DE ALTO GRAU

Background: Even when pre-neoplastic lesions are treated, there is a risk that the disease will persist or recur. Objectives: Assess whether the status of the surgical margins, the age, the colposcopic lesion size,type of surgery and the expression of the P16 and KI67 markers are risk factors for the persistence or recurrence of high-grade squamous intraepithelial lesion after CIN 2 and CIN 3 treatment. Methods: A cross-sectional, observational study with retrospective data collection of patients undergoing cold knife( CKC) or Loop electrosurgical excision procedure (LEEP) for CIN 2 or CIN 3. The following factors were analyzed in relation to recurrence: compromised margins, age, lesion size, type of surgery and staining of immunomarkers P16 and KI67. Results: Among the 271 women, aged between 17 and 67 years, 71 had CKC and 200 LEEP, 95 had CIN 2 and 173 CIN 3, regarding the status of the margins, 183 patients had free surgical margins, 76 compromised and 12 damaged by artifacts or fragmentation. Of the 76 with compromised margins, 55 were endocervical, 11 ectocervical and 10 both margins. Of the 264 who completed followup, 38 persisted or relapsed the disease. A hundred-five reactions with the P16 marker were performed. As for the analysis of the P16 color intensity, 8 cases were mild, 32 moderate and 65 were strong. Regarding the analysis of immunostained epithelial thickness, 7 had 1/3 of the epithelium stained, 36 stained 2/3 and 62 stained the entire epithelium. A total of 113 reactions with the 67 KI marker were performed. As for the analysis of staining intensity, 3 cases were mild, 24 moderate and 86 strong. Regarding the analysis of immunostained epithelial thickness, 6 occurred in 1/3 of the epithelium, 48 in 2/3 and 59 in the entire epithelium. Conclusion: Only the status of the endocervical margins was associated with the persistence or recurrence of the lesion. Age, colposcopic lesion size, type of surgery and expression of P16/KI67 markers were not associated with recurrence or persistence of the lesion.

Introdução: Mesmo quando as dificuldades pré-neoplásicas são tratadas, existem os riscos de persistência ou recorrência da doença. Objetivos: Avaliar se o status das margens, idade, tamanho da lesão colposcópica, tipo de operação e expressão dos marcadores p16/ki67 são fatores de risco na persistência ou recidiva da lesão intraescamosa de alto3. Estudos: Estudos de transformação de dados transversais, observacionais de pacientes de dados de processamento de alta frequência (EZT) ou exercícios de análise de dados de alta frequência (EZT) ou NIC com 2 ou 3. Método NIC com 2 ou 3. relação a recidiva: comprometimento das margens, idade da lesão colpo, tipo de operação e tamanho com imunomarcadores P16 e KI67. 2 Resultados: Dentre as 271 mulheres, de 17 a 67 anos, 71 outros CF e 200EZT;95 apresentaram NIC 2 e 173 NIC 3; em relação ao status das margens,183 tiveram como margens, 76 prejudicadas por ameaças ou fragmentação. Das 76 com margens esquerdas, 55 foram endovicais, 11 e 10 as margens. Das 64 que a continuação ou 38 persistiram da persistência da doença completa. Foram realizadas 105 reações com o marcador P16. Quantos casos à análise da intensidade da identificação do P16, 8 foram leves, 32 moderados e 65 fortes. Referente a análise da espessura epitelial imunocorada, 7 tiveram 1/3 do epitélio, 36 coraram 2/3 e 62 todo o epitélio. Foram realizadas 113 reações com o marcador KI67. Quanto à análise da identificação da identificação, 3 casos foram moderados e 86 fortes.Em relação a análise da espessura epitelial imunocorada, 48 e pitélio em 1/3, 59 em todo o epitélio. Apenas conclusão: Apenas conclusão endovicais se associam com persistência ou a recidiva da recidiva. A idade, o tamanho da lesão colposcópica, o tipo de procedimento cirúrgico e a expressão dos marcadores P16/KI67 não tiveram associação com a recidiva ou persistência da lesão

INTENSIVE CARE UNIT PRESCRIPTIONS MUST FIT RISK FACTORS TO PREVENT STRESS ULCER BLEEDING.

BACKGROUND: The physiological stress of critically ill patients can trigger several complications, including digestive bleeding due to stress ulcers (DBSU). The use of acid secretion suppressants to reduce their incidence has become widely used, but with the current understanding of the risks of these drugs, their use, as prophylaxis in critically ill patients, is limited to the patients with established risk factors. AIM: To determine the appropriateness of the use of prophylaxis for stress ulcer bleeding in acutely ill patients admitted to intensive care units and to analyze the association of risk factors with adherence to the prophylaxis guideline. METHODS: Retrospective, analytical study carried out in three general adult intensive care units. Electronic medical records were analyzed for epidemiological data, risk factors for DBSU, use of stress ulcer prophylaxis, occurrence of any digestive bleeding and confirmed DBSU. The daily analysis of risk factors and prophylaxis use were in accordance with criteria based on the Guidelines of the Portuguese Society of Intensive Care for stress ulcer prophylaxis. RESULTS: One hundred and five patients were included. Of the patient days with the opportunity to prescribe prophylaxis, compliance was observed in 95.1%. Of the prescription days, 82.35% were considered to be of appropriate use. Overt digestive bleeding occurred in 3.81% of those included. The occurrence of confirmed DBSU was identified at 0.95%. Multivariate analysis by logistic regression did not identify risk factors independently associated with adherence to the guideline, but identified risk factors with a negative association, which were spinal cord injury (OR 0.02 p <0.01) and shock (OR 0.36 p=0.024). CONCLUSION: The present study showed a high rate of adherence to stress ulcer prophylaxis, but with inappropriate use still significant. In the indication of prophylaxis, attention should be paid to patients with spinal cord injury and in shock.

DOES AGE INFLUENCE IN ENDOSCOPIC THERAPEUTIC SUCCESS ON THE BILIARY TRACT?

BACKGROUND: Retrograde endoscopic cholangiopancreatography (ERCP) effectively treats biliary and pancreatic disorders. Its indications are limited and precise, since its misuse delays adequate treatment, increases costs and to patient´s adverse events. AIM: To compare clinical, radiological and exploratory characteristics in relation to therapeutic success in patients undergoing ERCP in relation to age. METHOD: 421 patients who underwent the method were retrospectively studied; those who were not able to access the duodenal papilla were excluded. The patients were divided into two age groups: <60 years (group 1) and >60 years (group 2), and the variables of gender, examination indications, radiological findings, therapeutic success, diagnosis and the occurrence of immediate adverse events were analyzed. RESULTS: 177 patients were allocated to group 1 and 235 to group 2. The main indication found in both groups was choledocholithiasis. In group 2, the number of cases of acute cholangitis (p=0.001), biliary stenosis (p=0.002) and papilla cancer (p=0.046) was higher. In this group, urgent indication for ERCP was higher (p=0.042), as well as the diagnosis of biliary tract dilatation (p<0.001). The placement of prostheses was the most common procedure performed in both groups, but the greatest number of patients in absolute quantity occurred in group 2. In group 1, the success in catheterization and the chance of achieving clearing of the biliary tract was significantly higher in compared to group 2 (p=0.016, OR=2.1). CONCLUSION: The success of catheterization and complete clearance of the bile duct was significantly higher in the group of young patients.

VEGETABLE CELLULOSE NANOFIBER DRESSING AIDS IN THE HEALING PROCESS OF THIRD-DEGREE BURNS? STUDY ON RATS.

BACKGROUND: The treatment of 3rd degree burns represents a major medical challenge. Pinus vegetable cellulose is a biomaterial with characteristic similar to bacterial cellulose. AIM: To evaluate the safety of cellulose membrane (Pinus sp) in the treatment of 3rd burns in rats and to compare its effectiveness with the bacterial membrane already on the market. METHOD: Thirty-three Wistar rats were beaten with a 3rd degree burn on back skin by applying water at 98º C for 30 s. Then, they were divided into three groups (n=11): group 1 - simple dressing with gauze; group 2 - dressing with bacterial cellulose membrane; and group 3 - dressing with vegetable cellulose membrane. The animals were maintained for 15 days to check the general clinical status, macroscopic aspect, contraction of the wounds and microscopic analysis for the degree of healing and collagenization. RESULTS: They were clinically well during the experiment. During the removal of the dressing, there was bleeding in the wound of the control group, unlike the groups treated with cellulose membranes, which protected the bed from injury. The macroscopic evaluation showed a greater contraction of the wounds treated with the membranes in relation to the control. A microscopic analysis revealed that most of the wounds were in advanced healing degree with predominance of mature collagen in all groups. CONCLUSION: Pinus sp cellulose membrane showed efficacy similar to that of the bacterial membrane in the treatment of 3rd degree burns.

Platelet-concentrated and platelet poor-plasma promote different pattern on immunohistochemical expression of TGF-ß1, however they impairs the osteoneogensis in calvarial defects treated with autograft due suppression of osteocalcin.

PURPOSE: Herein we evaluated the effects of platelet concentrate (PC) and platelet-poor plasma (PPP) on bone repair using noncritical defects in the calvaria of rabbits and compared them to the presence of TGF-ß1 and osteocalcin on reparative sites. METHODS: Five noncritical defects of 8.7 mm in diameter were created on the calvaria of 15 animals. Each defect was treated differently, using autograft (ABG), ABG associated with PC (ABG + PC), ABG with PPP (ABG + PPP), isolated PPP, and blood clot (control). The animals were submitted to euthanasia on the second, fourth and sixth week post-surgery. RESULTS: The defects that received ABG+PC or PPP demonstrated lower bone formation when compared to specimens that received ABG in the same period. These results coincided to significant higher immunopositivity for TGF-ß1 for specimens that received PC, and lower presence of cytokine in the group PPP. However, either higher or lower presence of TGF-ß1 were also correlated to lower presence of osteocalcin. Likewise, these results were similar to findings in specimens treated only with PPP when compared to control. CONCLUSIONS: PC and PPP were not effective when applied in association with ABG. Similarly, isolated use of PPP was not beneficial in optimizing the bone repair.