Flexible Neural Probe Fabrication Enhanced with a Low-Temperature Cured Polyimide and Platinum Electrodeposition.

Polyimide is an emerging and very interesting material for substrate and passivation of neural probes. However, the standard curing temperature of polyimide (350 °C) is critical for the microelectrodes and contact pads of the neural probe, due to the thermal oxidation of the metals during the passivation process of the neural probe. Here, the fabrication process of a flexible neural probe, enhanced with a photosensitive and low-temperature cured polyimide, is presented. Annealing tests were performed with metallic films deposited on polyimide, which led to the reduction of the curing temperature to 250 °C, with no significant irregularities in the metallic sample annealed at that temperature and an effective polyimide curing. The use of a lower curing temperature reduces the thermal oxidation of the metals during the polyimide curing process to passivate the neural probe. Additionally, in this fabrication process, the microelectrodes of the neural probe were coated with electrodeposited platinum (Pt), only after the passivation process, and its electrochemical performance was accessed. At 1 kHz, the impedance of the microelectrodes before Pt electrodeposition was approximately 1.2 MΩ, and after Pt electrodeposition, it was approximately 350 kΩ. Pt electrodeposition changed the equivalent circuit of the microelectrodes and reduced their impedance, which will be crucial for future in-vivo tests to acquire the electrical activity of the neurons with the fabricated neural probe.

Specific adsorbents for the treatment of OMW phenolic compounds by activation of bio-residues from the olive oil industry.

A series of adsorbents was developed by physical (CO2) and chemical (KOH) activation of two bio-residues: olive stones (OS) and wood from olive tree pruning (OTP). The physicochemical properties of such materials were determined and correlated with their adsorptive performance in the removal of phenolic compounds of olive mill wastewater (OMW). Adsorption isotherms and kinetics of single phenolic acids, as well as the kinetics for competitive multi-compound adsorption, were fitted by applying different models, though Langmuir and pseudo-second order models fitted better the experimental results, respectively. The intraparticle diffusion model pointed out that mesoporosity reduces the influence of phenolic compounds' restrictions in the external film diffusion of the adsorbent particle-solution interphase, but adsorption capacity linearly increases with the micropore volume accessible to N2 at -196 °C (and also with BET surface area), while diffusion into ultramicropores (<0.7 nm, determined by CO2-adsorption) is slow and presents minor influence on the total adsorption capacity. After saturation, thermal regeneration of spent adsorbents allows the removal of adsorbed products, enabling the reuse of samples whilst maintaining a significant performance.

Coupling of acrylic dyeing wastewater treatment by heterogeneous Fenton oxidation in a continuous stirred tank reactor with biological degradation in a sequential batch reactor.

This work deals with the treatment of a recalcitrant effluent, from the dyeing stage of acrylic fibres, by combination of the heterogeneous Fenton's process in a continuous stirred tank reactor (CSTR) with biological degradation in a sequential batch reactor (SBR). Three different catalysts (a commercial Fe/ZSM-5 zeolite and two distinct Fe-containing activated carbons - ACs - prepared by wet impregnation of iron acetate and iron nitrate) were employed on the Fenton's process, and afterwards a parametric study was carried out to determine the effect of the main operating conditions, namely the hydrogen peroxide feed concentration, temperature and contact time. Under the best operating conditions found, using the activated carbon impregnated with iron nitrate, 62.7% of discolouration and 39.9% of total organic carbon (TOC) reduction were achieved, at steady-state. Furthermore, a considerable increase in the effluent's biodegradability was attained (BOD5:COD ratio increased from <0.001 to 0.27 and SOUR - specific oxygen uptake rate - from <0.2 to 11.1 mg O2/(gVSS·h)), alongside a major decrease in its toxicity (from 92.1 to 94.0% of Vibrio fischeri inhibition down to 6.9-9.9%). This allowed the application of the subsequent biological degradation stage. The combination of the two processes provided a treated effluent that clearly complies with the legislated discharge limits. It was also found that the iron leaching from the three catalysts tested was very small in all runs, a crucial factor for the stability and long-term use of such materials.

Enhancing Liquefaction Efficiency: Exploring the Impact of Pre-Hydrolysis on Hazelnut Shell (Corylus avellana L.).

Hazelnut shells (HS), scientifically known as Corylus avellana L. shells, are waste produced by companies that process nuts. The main objective of this study was to find an efficient way to maximize the chemical potential of HS by solubilizing the hemicelluloses, which could then be used to recover sugars and, at the same time, increase the lignin content of this material to produce adhesives or high-strength foams. In order to optimize the pre-hydrolysis process, two different temperatures (160 and 170 °C) and times varying from 15 to 180 min were tested. All the remaining solid materials were then liquefied using polyalcohols with acid catalysis. The chemical composition of hazelnut shells was determined before and after the pre-hydrolysis. All of the process was monitored using Fourier Transform Infrared Spectroscopy with Attenuated Total Reflectance (FTIR-ATR) by determining the spectra of solids and liquids after the pre-hydrolysis and liquefaction steps. The highest solubilization of hazelnut shells was found for 170 °C and 180 min, resulting in a 25.8% solubilization. Chemical analysis after the hydrolysis process showed a gradual increase in the solubilization of hemicelluloses as both the temperature and time of the reactor were increased. Simultaneously, the percentages of α-cellulose and lignin in the material also increased with rises in temperature and duration. FTIR-ATR allowed for the detection of significant spectral changes in the hazelnut shells from their initial state to the solid residue and further into the liquefied phase. This confirmed that pre-hydrolysis was effective in enhancing the chemical composition of the material, making it more suitable for the production of adhesives, polyurethane foams, or in the production of bioplastics and composite materials, combined with other biopolymers or synthetic polymers to enhance the mechanical properties and biodegradability of the resulting materials.

Analgesic Effect of Sulforaphane: A New Application for Poloxamer-Hyaluronic Acid Hydrogels.

Sulforaphane (SFN) has shown potential as an antioxidant and anti-inflammatory agent. To improve its druggability, we developed new analgesic formulations with sulforaphane-loaded hyaluronic acid (HA)-poloxamer (PL) hydrogel. This study evaluated the pre-clinical safety and effectiveness of these formulations. Effectiveness was tested on Wistar rats divided into groups (n = 15) receiving (IM, 10 mg/kg) SFN formulations or control groups (without SFN). This study used a hind paw incision postoperative pain model to evaluate mechanical hypersensitivity with von Frey filaments. TNF-α, IL-1ß, substance P, and CGRP levels verified anti-inflammatory activity in the hind paw tissue. Histopathology of tissues surrounding the injection site was assessed after 2 and 7 days post-treatment. To corroborate drug safety, cell viability of 3T3 and RAW 264.7 cultures was assessed. Additionally, RAW 264.7 cultures primed with carrageenan evaluated nitric oxide (NO) levels. All animals exhibited post-incisional hypersensitivity, and F2 (PL 407/338 (18/2%) + HA 1% + SFN 0.1%) showed a longer analgesic effect (p < 0.05). F2 reduced TNF-α, IL-1ß, and CGRP levels (p < 0.05). Histopathological evaluation showed mild to moderate inflammatory reactions after the formulations' injections. F2 produced no significant difference in cell viability (p > 0.05) but reduced NO production (p < 0.05). Thus, our results highlight the biocompatibility and effectiveness of F2.

Nanotechnology Applied to Cellulosic Materials.

In recent years, nanocellulosic materials have attracted special attention because of their performance in different advanced applications, biodegradability, availability, and biocompatibility. Nanocellulosic materials can assume three distinct morphologies, including cellulose nanocrystals (CNC), cellulose nanofibers (CNF), and bacterial cellulose (BC). This review consists of two main parts related to obtaining and applying nanocelluloses in advanced materials. In the first part, the mechanical, chemical, and enzymatic treatments necessary for the production of nanocelluloses are discussed. Among chemical pretreatments, the most common approaches are described, such as acid- and alkali-catalyzed organosolvation, 2,2,6,6-tetramethylpiperidine-1-oxyl (TEMPO)-mediated oxidation, ammonium persulfate (APS) and sodium persulfate (SPS) oxidative treatments, ozone, extraction with ionic liquids, and acid hydrolysis. As for mechanical/physical treatments, methods reviewed include refining, high-pressure homogenization, microfluidization, grinding, cryogenic crushing, steam blasting, ultrasound, extrusion, aqueous counter collision, and electrospinning. The application of nanocellulose focused, in particular, on triboelectric nanogenerators (TENGs) with CNC, CNF, and BC. With the development of TENGs, an unparalleled revolution is expected; there will be self-powered sensors, wearable and implantable electronic components, and a series of other innovative applications. In the future new era of TENGs, nanocellulose will certainly be a promising material in their constitution.

HPV testing for cervical cancer screening: Should reflex cytology be performed after a positive test for HPV 16 and 18?

At Portuguese-organized cervical cancer (CC) screening programs, all women testing positive for human papillomavirus (HPV) 16 and/or 18 are referred for immediate colposcopy. This study aimed to evaluate the utility of reflex cytology in women who test positive for HPV 16 and/or 18 to improve the efficiency of CC screening. A cross-sectional and retrospective study was performed based on data from the routine CC screening protocol in force at Cova da Beira University Hospital Center, Portugal between August 2012 and June 2021. The screening method was the Cobas 4800 HPV test using the liquid medium Surepath. In all the selected cases, the patient's HPV test results and the cytology and histology findings of the biopsies obtained using colposcopy were analyzed. This study included 339 women who first tested positive for HPV 16 and/or 18 and were referred for immediate colposcopy, in whom 40 (11.8%) cases of high-grade squamous intraepithelial lesion (HSIL+) were diagnosed. Of these, 12 (30%) had reflex cytology negative for intraepithelial lesion or malignancy (NILM) and 14 (35%) had HSIL+ cytology. After 3 years, 14 (9.3%) of the 150 women who were still undergoing follow-up were diagnosed with histologic HSIL+ lesions, of which 5 (35.7%) had baseline NILM cytology. Despite the small sample, the results of this study allow us to conclude that reflex cytology is not useful for discrimination to immediate referral for colposcopy in women who test positive for HPV 16 and/or 18, as most women with a histologic diagnosis of an HSIL+ lesion had

Microwaves and Ultrasound as Emerging Techniques for Lignocellulosic Materials.

Currently, in the context of biorefinery and bioeconomy, lignocellulosic biomass is increasingly used to produce biofuels, biochemicals and other value-added products. Microwaves and ultrasound are emerging techniques that enable efficient and environmentally sustainable routes in the transformation of lignocellulosic biomass. This review presents some of the most important works published in the last few years on the application of microwaves and/or ultrasound in lignocellulosic materials pretreatment and can be used as a starting point for research into this theme. This review is divided into four parts. In Part I, the theoretical fundamentals of microwave and ultrasound treatments are reviewed. Dielectric constants for biomass, factors that influence pretreatment, are some of the subjects addressed. In Part II, the effects that these techniques have on lignocellulosic biomass (on the size and surface area of the particle; on the content of lignin, hemicellulose and cellulose; on the crystallinity index of cellulose; on the effect of solubilization of organic matter; on hydrolysis and reduction of sugars) are discussed. In Part III, emphasis is given to the contribution of microwaves and ultrasound in obtaining value-added products. In this context, several examples of liquefaction and extraction procedures are presented. Part IV describes examples of performing sonocatalysis on lignocellulosic biomass to obtain value-added products, such as furfural, whose production is significantly reduced by ultrasound treatment.

Particleboard Production from Paulownia tomentosa (Thunb.) Steud. Grown in Portugal.

Paulownia wood has raised high attention due to its rapid growth and fire resistance. The number of plantations in Portugal has been growing, and new exploitation methods are needed. This study intends to determine the properties of particleboards made with very young Paulownia trees from Portuguese plantations. Single layer particleboards were produced with 3-year-old Paulownia trees using different processing parameters and different board composition in order to determine the best properties for use in dry environments. The standard particleboard was produced at 180 °C and a 36.3 kg/cm2 pressure for 6 min using 40 g of raw material with 10% urea-formaldehyde resin. Higher particle size lead to lower-density particleboards, while higher resin contents lead to higher density of the boards. Density has a major effect on board properties with higher densities improving mechanical properties such as bending strength, modulus of elasticity (MOE) and internal bond, lower water absorption but higher thickness swelling and thermal conductivity. Particleboards meeting the requirements for dry environment according to NP EN 312 standard, could be produced with young Paulownia wood with acceptable mechanical and thermal conductivity properties with density around 0.65 g/cm3 and a thermal conductivity of 0.115 W/mK.

Application of Nanoparticles in Cancer Treatment: A Concise Review.

Timely diagnosis and appropriate antitumoral treatments remain of utmost importance, since cancer remains a leading cause of death worldwide. Within this context, nanotechnology offers specific benefits in terms of cancer therapy by reducing its adverse effects and guiding drugs to selectively target cancer cells. In this comprehensive review, we have summarized the most relevant novel outcomes in the range of 2010-2023, covering the design and application of nanosystems for cancer therapy. We have established the general requirements for nanoparticles to be used in drug delivery and strategies for their uptake in tumor microenvironment and vasculature, including the reticuloendothelial system uptake and surface functionalization with protein corona. After a brief review of the classes of nanovectors, we have covered different classes of nanoparticles used in cancer therapies. First, the advances in the encapsulation of drugs (such as paclitaxel and fisetin) into nanoliposomes and nanoemulsions are described, as well as their relevance in current clinical trials. Then, polymeric nanoparticles are presented, namely the ones comprising poly lactic-co-glycolic acid, polyethylene glycol (and PEG dilemma) and dendrimers. The relevance of quantum dots in bioimaging is also covered, namely the systems with zinc sulfide and indium phosphide. Afterwards, we have reviewed gold nanoparticles (spheres and anisotropic) and their application in plasmon-induced photothermal therapy. The clinical relevance of iron oxide nanoparticles, such as magnetite and maghemite, has been analyzed in different fields, namely for magnetic resonance imaging, immunotherapy, hyperthermia, and drug delivery. Lastly, we have covered the recent advances in the systems using carbon nanomaterials, namely graphene oxide, carbon nanotubes, fullerenes, and carbon dots. Finally, we have compared the strategies of passive and active targeting of nanoparticles and their relevance in cancer theranostics. This review aims to be a (nano)mark on the ongoing journey towards realizing the remarkable potential of different nanoparticles in the realm of cancer therapeutics.

Wood-Poly(furfuryl Alcohol) Prepreg: A Novel, Ecofriendly Laminate Composite.

Prepregs are commonly fabricated with non-renewable petroleum-based materials. To reduce the impact of the manufacturing of these materials and to produce more sustainable prepregs, this research aims to manufacture poly(furfuryl alcohol)/wood veneer prepregs and their posterior molding in laminate composites. For this purpose, the vacuum infusion process was used to impregnate the wood veneers, and compression molding was applied to manufacture three- and four-layer laminate composites. Scanning electronic microscopy was used to evaluate the impregnation. the laminate manufacturing and differential scanning calorimetry were used to predict the shelf-life of the prepregs, Fourier-transform infrared was used to evaluate the induced hydrolysis resistance, and thermogravimetric analysis was used to determine the thermal degradation of the laminates. Moreover, water uptake and flexural, compressive, and tensile properties were evaluated. The kinetic models were effective and showed a shelf life for the laminates of approximately 30 days in storage at -7 °C, which is an interesting result for laminates with lignocellulosic materials. FTIR proved the laminates' excellent resistance to hydrolysis. The water absorption, thermal stability, and mechanical properties did not differ as the amount of wood veneer increased, but these results were up to ~40% higher compared with unidirectional wood laminates found in the literature, which is probably linked to the excellent interface observed with SEM.

Edible Insects: Perceptions of Marketing, Economic, and Social Aspects among Citizens of Different Countries.

Because edible insects (EI) have been, in recent years, recommended as a nutritious animal protein food with enormous environmental advantages over other sources of animal protein for human consumption, studies aimed at investigating the consumer perspective have become more prominent. Hence, this study intended to examine the perceptions of participants from different countries about the commercialization and economic and social impacts of edible insects. The study was made using a questionnaire survey, and data were collected in Brazil, Croatia, Greece, Latvia, Lebanon, Lithuania, Mexico, Poland, Portugal, Romania, Serbia, Slovenia, Spain, and Turkey. The final number of received answers was 7222 participants. For the treatment of the results, different statistical techniques were used: factor analysis, internal reliability by Cronbach's alpha, cluster analysis, ANOVA to test differences between groups, and Chi-square tests. The results obtained confirmed the validity of the scale, constituted by 12 out of the 14 items initially considered, distributed by 4 factors: the first related to the economic impact of EIs, the second related to the motivation for consumption of EIs, the third related to the places of purchase of EIs, and the fourth corresponding to a question presented to the participants as a false statement. A cluster analysis allowed identifying three clusters, with significant differences between them according to all the sociodemographic variables tested. Also, it was found that the participants expressed an exceptionally high level of agreement with aspects such as the difficulty in finding EIs on sale, knowledge acting as a strong motivator for EI consumption, and the role of personalities and influencers in increasing the will to consume EIs. Finally, practically all sociodemographic variables were found to be significantly associated with perceptions (country, sex, education, living environment, and income), but not age. In conclusion, the perceptions about EI commercialization were investigated and revealed differences among samples originating from different countries. Moreover, the sociodemographic characteristics of the participants were found to be strongly associated with their perceptions.

Repeated Positive Cervical HPV Testing and Absent or Minor Cytology Abnormality at Pap Smear. What is the Next Step?

BACKGROUND: Human papillomavirus (HPV) screening has significantly reduced cervical cancer (CC) mortality. Women who consecutively test positive for high-risk HPV without and minor changes on reflex cytology (atypical squamous cells of undetermined significance [ASC-US] or low-grade squamous intraepithelial lesion [LSIL]) or dysplasia on cervical colposcopy-oriented biopsy are always referred to colposcopy. The aim of the present study was to assess whether this guidance is appropriate for COBAS HPV testing with reflex cytology. METHODS: A cross-sectional, retrospective study was carried out in 5,227 women who underwent routine CC screening over a period of five years (2012-2017). All HPV tests were performed using Cobas®4800 HPV. The study included women attending gynecology appointments whose first HPV test was positive and who had any type of follow-up. Patients' HPV test results as well as cytology and biopsy findings obtained during the abovementioned period were analyzed. A descriptive and comparative statistical study was conducted using this data. RESULTS: A total of 765 out of 6003 HPV tests performed in 5,227 women were positive, and 141 women who had a positive HPV test (with negative for intraepithelial lesion or malignancy [NILM] or inflammation, or ASC-US and LSIL cytology, but no lesions on colposcopy, or absence of dysplasia on histology) repeated the HPV test at least once. Of these 141 women, 6 were diagnosed with high-grade squamous intraepithelial lesion (HSIL) during the follow-up period. All cases of HSIL were diagnosed after the second HPV test. CONCLUSION: This study shows that, at cervical cancer screening, all women testing positive for HPV regardless of Pap smear result should be referred to colposcopy.

Fitting Biochars and Activated Carbons from Residues of the Olive Oil Industry as Supports of Fe- Catalysts for the Heterogeneous Fenton-Like Treatment of Simulated Olive Mill Wastewater.

A series of biochars and activated carbons (ACs) was prepared combining carbonization and physical or chemical activation of cheap and abundant residues of the olive oil industry. These materials were used as Fe-support to develop low-cost catalysts for the heterogeneous Fenton-like oxidation of simulated olive mill wastewater (OMW), the highly pollutant effluent generated by this agroindustry. Commercial ACs were also used as reference. All catalysts prepared were extensively characterized and results related with their performances in the catalytic wet peroxide oxidation (CWPO). Results showed a linear relationship of the textural properties of the catalysts with the adsorptive and catalytic performance, as well as the preferential adsorption and degradation of some phenolic compounds (caffeic and gallic acids) by specific interactions with the catalysts' surface. Despite the best performance of catalysts developed using commercial supports, those prepared from agro-industrial residues present some advantages, including a smaller catalyst deactivation by iron leaching. CWPO results show that catalysts from physically activated olive stones are the most promising materials, reaching total organic carbon and toxicity reductions of 35% and 60%, respectively, as well an efficient use of H2O2, comparable with those obtained using commercial supports. This approach showed that the optimized treatment of this type of residues will allow their integration in the circular economic process of the olive oil production.

Synthetic olive mill wastewater treatment by Fenton's process in batch and continuous reactors operation.

Degradation of total phenol (TPh) and organic matter, (expressed as total organic carbon TOC), of a simulated olive mill wastewater was evaluated by the Fenton oxidation process under batch and continuous mode conditions. A mixture of six phenolic acids usually found in these agro-industrial wastewaters was used for this purpose. The study focused on the optimization of key operational parameters of the Fenton process in a batch reactor, namely Fe2+ dosage, hydrogen peroxide concentration, pH, and reaction temperature. On the assessment of the process efficiency, > 99% of TPh and > 56% of TOC removal were attained when [Fe2+] = 100 ppm, [H2O2] = 2.0 g/L, T = 30 °C, and initial pH = 5.0, after 300 min of reaction. Under those operational conditions, experiments on a continuous stirred-tank reactor (CSTR) were performed for different space-time values (τ). TOC and TPh removals of 47.5 and 96.9%, respectively, were reached at steady-state (for τ = 120 min). High removal of COD (> 75%) and BOD5 (> 70%) was achieved for both batch and CSTR optimum conditions; analysis of the BOD5/COD ratio also revealed an increase in the effluent's biodegradability. Despite the high removal of lumped parameters, the treated effluent did not met the Portuguese legal limits for direct discharge of wastewaters into water bodies, which indicates that coupled chemical-biological process may be the best solution for real olive mill wastewater treatment.

Vitamin D and its Relation to Bone Mineral Density in Postmenopause Women.

OBJECTIVE: Compare the level of vitamin D with the bone mineral density (BMD) in postmenopausal women, with or without fractures. METHODS: 250 women with mean age of 71.1 were evaluated. The serum levels of vitamin D considered sufficient were ≥ 30 ng/mL, insufficient between 20 and 30 ng/mL and deficient < 20 ng/mL. The bone mineral density was measured and considered osteopenia when T value total of lumbar spine or hip was between -1 and -2.5 and osteoporosis < 2.5. The patients with fractures accounted for 25.2%. RESULTS: There was no significant difference in the vitamin D (ng/mL) levels among the age groups (p = 0.25), the levels of fractures (p = 0.79) and the levels of BMD (p = 0.76). CONCLUSION: 82% of the patients presented deficient and insufficient blood levels of vitamin D. Ours results showed any significant correlation between vitamin D levels and bone mineral density after adjusting for age.

Positioning of the acetabular component in cemented prostheses - radiographic calculation.

OBJECTIVE: to assess the reliability of the inclination angle and anteversion of acetabular cup component in patients with idiopatic osteoarthritis of the hip, aseptic necrosis and hip neck fracture using trigonometric formula and plain radiographs. METHODS: 66 patients underwent cemented total arthroplasty of 72 hips. The inclination of acetabular component was measured using plain radiograph. The acetabular component anteversion was measured using trigonometric formula. RESULTS: it was observed that, in the osteoarthritic hips, hip neck fracture and aseptic necrosis, the degree of agreement was highly significant (p < 0.0001), in the measurements of anteversion and inclination angles, among the three assessments, from intra as well as inter-observers. All the agreement pairs were of excellent degree (ICC > 0.80). CONCLUSION: using plain radiographs and trigonometric formula, the method resulted to be highly accurate and reliable. Besides being easy to be calculated. No significant variation was found in the anteversion and inclination angles when compared with osteoarthritis of the hip, aseptic necrosis and hip neck fracture.

Avaliação da influência da radioterapia nas reconstruções de mama com TRAM / Evaluation of the effects of radiotherapy on breast reconstruction with a transverse rectus abdominis myocutaneous flap

Introdução: A radiação influencia negativamente os resultados das reconstruções de mama que utilizam implantes. No entanto, os efeitos da radiação sobre as reconstruções de mama apenas com tecidos autólogos ainda não está clara. O objetivo do trabalho é avaliar as complicações pós-operatórias de pacientes submetidas à reconstrução de mama com retalho do músculo reto abdominal (TRAM) imediato e tardio e correlacionar estatisticamente essas complicações com a presença ou não da radioterapia (RT). Métodos: Levantamento retrospectivo de prontuários de pacientes submetidas à reconstrução mamária, das quais 126 pacientes realizaram reconstrução mamária com TRAM no período de 2004 a 2011. Foram analisadas a presença ou não de RT e as complicações pós-operatórias nas reconstruções imediatas e tardias. As pacientes foram divididas em 3 grupos: 1) sem RT (somente TRAM), 2) (TRAM→RT), 3) (RT→TRAM). Para cada grupo foi avaliada a presença e ausência de complicações menores e maiores e aplicados testes estatísticos. Resultados: Os grupos estudados foram considerados homogêneos quanto a idade e índice de massa corporal. Houve maior incidência de complicações maiores nos grupos com RT após o TRAM (29,6%) em relação aos demais grupos: sem RT (23,4%) e RT antes do TRAM (5,6%). Entretanto, a diferença entre os grupos não se mostra estatisticamente significativa. Para as Complicações Menores, também não há evidências de diferenças estatisticamente significativas entre os grupos. Conclusão: Nesse estudo a radioterapia adjuvante não se mostrou como fator potencializador de complicações nas pacientes submetidas à reconstrução imediata com TRAM pós-mastectomia.

Introduction: Radiation negatively influences the results of breast reconstruction using implants. However, the effects of radiation on breast reconstruction with autologous tissue is still unclear. The objective of this study was to evaluate the postoperative complications in patients who underwent immediate and late breast reconstruction with a transverse rectus abdominis myocutaneous (TRAM) flap and statistically correlate these complications with the use of radiotherapy (RT). Methods: A retrospective survey of the medical records of patients who underwent breast reconstruction was conducted. Of the patients, 126 underwent breast reconstruction with a TRAM flap between 2004 and 2011. The presence or absence of RT and postoperative complications in the immediate and late reconstructions was assessed. The patients were divided into 3 groups as follows: 1) without RT (TRAM alone group), 2) TRAM→RT group, and 3) RT→TRAM group. The patients in each group were evaluated for the presence and absence of minor and major complications, and results were statistically analyzed. Results: The groups were considered homogenous for age and body mass index. The incidence of major complications was higher in the groups with RT after TRAM (29.6%) than in the other groups, namely the groups without RT (23.4%) and with RT before TRAM flap reconstruction (5.6%). However, the differences among the groups were not statistically significant. No evidence of statistically significant differences in minor complications were found among the groups. Conclusion: In this study, adjuvant RT was not a potentiating factor of complications in the patients who underwent immediate reconstruction with a TRAM flap after mastectomy.

Reconstrução mamária em mulheres jovens e suas peculiaridades / Breast reconstruction in young women and their peculiarities

Introdução: O objetivo do trabalho foi avaliar as principais características e métodos utilizados na reconstrução mamária de mulheres jovens, considerando suas peculiaridades. Métodos: Foi realizada uma revisão retrospectiva dos prontuários das pacientes submetidas à mastectomia seguida de reconstrução mamária no período de janeiro de 2008 a dezembro de 2015, sendo selecionados aqueles cuja reconstrução foi realizada em mulheres de até 40 anos de idade. Resultados: 43 pacientes foram selecionadas. A média de idade foi de 33,86 anos. Grande parte possuía alguma comorbidade, sendo as mais comuns o sobrepeso e o transtorno ansioso/depressivo. Quatorze pacientes tinham história familiar da doença. A maioria obteve o diagnóstico de carcinoma ductal invasor. Tratamentos oncológicos complementares foram realizados em grande parte dos casos. Todas as pacientes foram submetidas à mastectomia total na mama portadora da neoplasia, sendo que em 16 houve a opção pela mastectomia redutora de risco contralateral. Do total de 43 reconstruções, 36 foram imediatas e 7 tardias; sendo 17 reconstruídos com implantes mamários, 13 com expansores teciduais, 4 com TRAM e 9 com GD. Houve 15 complicações, sendo as mais graves um caso de infecção com perda da reconstrução e um caso de necrose de aréola. Conclusões: Mulheres jovens submetidas à reconstrução mamária representam um subgrupo populacional com características próprias. Os padrões tumorais, pessoais e sociais diferem e, com base nesta imensa lista de variáveis, as possibilidades de tratamento são diversas. Em nossa casuística, o emprego de implantes mamários e expansores teciduais foi realizado com maior frequência neste subgrupo de pacientes.

Introduction: To evaluate the main features and methods used in breast reconstruction in young women considering their unique characteristics. Methods: A retrospective records review of patients who underwent mastectomy followed by breast reconstruction between January 2008 and December 2015 was conducted, selecting those reconstructions that were performed in women younger than 40 years. Results: Forty-three patients were selected. The average age was 33.86 years. Many had some comorbidities, the most common being overweight and anxiety/ depressive disorder. Fourteen patients had a family history of the disease. Most were diagnosed with invasive ductal carcinoma. Additional cancer treatments were administered in most cases. All patients underwent a full mastectomy in the breast with cancer, and in 16, there was the option of contralateral risk-reducing mastectomy. Of the 43 reconstructions, 36 were immediate and 7 were delayed, and 17 involved use of implants, 13 involved use of tissue expanders, 4 involved the TRAM, and 9 involved the GD. We observed 15 complications; the most severe were infection with reconstruction loss in one patient and areola necrosis in another. Conclusions: Young women undergoing breast reconstruction represent a population subgroup with its own characteristics. The tumors and personal and social patterns differ, and based on this long list of variables, treatment options are diverse. In our series, breast implants and tissue expanders were often most used.

Excisões circunferenciais no tronco e associações em pacientes ex-obesos / Circumferential excisions in the trunk and associations in ex-obese patients

INTRODUÇÃO: A obesidade é um problema importante na atualidade. Mudanças de hábitos dietéticos, exercícios físicos e a cirurgia bariátrica promovem melhor qualidade de vida. A redução ponderal excessiva ocasiona deformidades em diversos segmentos corporais que são corrigidas em múltiplos tempos operatórios. Apresentamos uma sistematização das maneiras de tratamento destes pacientes, que nos permitem atos operatórios envolvendo as várias regiões do corpo em uma mesma etapa. MÉTODOS: Estudo observacional longitudinal retrospectivo. A técnica cirúrgica consistiu em incisão do tipo asa de gaivota em dorso, com ressecção do excedente dermogorduroso associada à abdominoplastia, promovendo melhorias no púbis, dorso, nádegas e face lateral das coxas apenas por esta única incisão. A associação de excisões satélites como o em lifting em de coxas ocorreu em determinadas situações, bem como o tratamento do segmento superior do tronco em um segundo momento. RESULTADOS: A faixa etária dos pacientes variou de 24 a 52 anos, com média de 34 anos. O tempo médio do ato operatório nas excisões circunferenciais foi de 4 horas e 8 minutos. Não foram observadas complicações cirúrgicas como hematoma, necrose do retalho e/ou infecção. Três casos de pequenas deiscências e seroma, além de um caso de tromboembolismo pulmonar, foram observados. No seguimento ambulatorial, 85,7% dos pacientes mostraram-se muito satisfeitos quanto ao tamanho e posição das cicatrizes. A análise técnica apresentou um grau de satisfação de 92,8%. CONCLUSÃO: Os resultados satisfatórios elucidam a segurança e praticabilidade da técnica, sendo as cicatrizes aceitáveis devido à melhora do contorno corporal.

INTRODUCTION: Currently, obesity is a major problem. Changes in dietary habits, regular exercise and bariatric surgery promote better quality of life. Massive weight loss may cause deformities in different body segments, which are normally corrected in multiple surgeries. We present a systematic way of treating these patients, which enable surgical procedures in different regions of the body in a single step. METHODS: This was a retrospective observational longitudinal study. The surgical technique consisted of gull-wing type incision on the back with resection of fatty tissue associated with abdominoplasty that promoted improvements in the pubis, back, buttocks and lateral thighs via a single incision. The combination of satellite excision as the thigh lifting was associated in certain situations as well as treatment of the upper segment of the trunk in a second time. RESULTS: The age of patients ranged from 24 to 52 years, average of 34 years old. The mean surgical time in the circumferential excisions was 4 hours and 8 minutes. Surgical complications observed were hematoma, flap necrosis and/or infection. There were three cases of small dehiscence and seroma and one case of pulmonary thromboembolism. In the outpatient follow-up, 85.7% of patients showed to be very satisfied with the final result and no complaints about the size and position of scars. Technical analysis showed a satisfaction level of 92.8% of cases. CONCLUSION: Satisfactory results elucidated the safety and feasibility of the technique, and scars were acceptable due to significant improvement in body contouring.