Resumo em Inglês:

ABSTRACT Purpose: In reconstructive surgery, complications of flaps include thrombosis and necrosis, partly originated from ischemia-reperfusion (I/R) injury. Therefore, investigations on the factors that influence tissue perfusion are essential. We wished to investigate microcirculation, micro-rheological factors, histomorphological, and biomechanical alterations of adipocutaneous flaps with/without I/R. Methods: In anesthetized rats, groin flaps were prepared bilaterally. On the left side, the vascular pedicle was clamped for 2 hours before re-suturing the flaps. Skin temperature and microcirculation were monitored before/after surgery and on the first, third, seventh, and 14th postoperative days, besides blood samplings for testing hematological parameters, erythrocyte deformability and aggregation. At the end of experiment, skin samples were taken for histological and tensile strength examinations. Results: The hematological and micro-rheological parameters reflected the acute phase reactions, showing erythrocyte deformability impairment and enhanced aggregation. The microcirculatory values of the ischemic flaps were lower than the contralateral ones even two weeks after surgery. The ischemic-side flaps shrank to a greater extent. Histology revealed that mastocyte number decreased, and the quantity and organization of collagen fibers were altered in ischemic flaps. Conclusion: The microcirculatory and micro-rheological alterations during the regeneration of the flaps were well observed. Flap ischemia modulated the tissue perfusion parameters, tensile strength, collagen content, and fiber organization.

Resumo em Inglês:

ABSTRACT Purpose: Acute lung injury is the most severe complication of hemorrhagic shock and closely correlates with the mortality rate of hemorrhagic shock. TIPE2 is a critical regulator of inflammation and is implicated in the pathogenesis of various inflammatory diseases. However, its role in hemorrhagic shock-induced acute lung injury is unclear, and the underlying mechanisms remain to be elucidated. Therefore, the purpose of this study was to investigate the role of TIPE2 in hemorrhagic shock-induced acute lung injury and its underlying mechanisms. Methods: C57BL/6J and TIPE2 knockout mice were used to establish hemorrhagic shock model, with a sham surgery as the control. The pulmonary ventilation function was evaluated using in-vivo testing system. Blood gas analysis was conducted to evaluate changes in blood oxygen level, reflecting the body’s acid-base balance. Hematoxylin and eosin staining facilitated the observation of lesion progression in pulmonary tissue. The expression levels of TIPE2, myeloperoxidase, and citrullinated histone in lung tissues were determined by Western blotting, whereas the levels of tumor necrosis factor-α and IFN-γ in bronchoalveolar lavage fluid were quantified by enzyme-linked immunosorbent assay to evaluate the levels of key inflammatory mediators. VE-cadherin and E-cadherin expression in lung tissues were assessed by Western blotting to indicate changes of lung microvascular and alveolar permeability. Results: Following hemorrhagic shock, mice developed severe acute lung injury, characterized by impaired lung function, respiratory acidosis, structural damage, and pulmonary edema. This was accompanied by a heightened inflammatory response, evidenced by elevated neutrophil activity and pro-inflammatory cytokines, alongside impaired endothelial and epithelial barrier integrity. Notably, TIPE2 knockout conferred protection against hemorrhagic shock-induced lung injury in mice. Conclusion: TIPE2 knockout attenuates hemorrhagic shock-induced acute lung injury through mechanisms involving downregulation of inflammatory-associated protein expression, suppression of proinflammatory cytokine release, and restoration of pulmonary barrier permeability.

Resumo em Inglês:

ABSTRACT Purpose: The significant change during testicular ischemia-reperfusion is the generation of high levels of reactive oxygen species, which trigger impairment of spermatogenic cells. Naringenin, a plant-derived flavonoid, can alleviate oxidative stress. The current study was conducted to examine the possible protective ability of naringenin on testicular ischemia-reperfusion injury. Methods: Three groups of male rats were created: group 1 (sham operation), group 2 (left testicular ischemia-reperfusion), and group 3 (treatment with naringenin after left testicular ischemia-reperfusion). Testicular ischemia of rats was induced by 2 hours of left testicular torsion, and subsequently testicular detorsion was performed for reperfusion. Rat testes of three groups were taken to analyze nicotinamide adenine dinucleotide phosphate (NADPH) oxidase activity, which contributes to the production of reactive oxygen species, malondialdehyde content (an index of reactive oxygen species), and testicular reproductive function. Results: The NADPH oxidase activity and malondialdehyde content were higher in ipsilateral testes, but testicular reproductive function was lower in testicular ischemia-reperfusion group than in sham group. Conversely, NADPH oxidase activity and malondialdehyde content decreased in ipsilateral testes after naringenin treatment, leading to enhanced testicular reproductive function. Conclusion: Naringenin reduced NADPH oxidase activity and inhibited generation of reactive oxygen species to achieve protection of testicular reproductive function.

Resumo em Inglês:

ABSTRACT Purpose: To evaluate the effects of direct and remote ischemic preconditioning and postconditioning on kidney ischemia–reperfusion injury in young rats. Methods: This study was divided into two experimental phases: preconditioning and postconditioning. In each phase, 78 rats were randomly assigned to four groups: control (CG), ischemia-reperfusion (IRG), direct ischemic pre/postconditioning (DIPG), and remote ischemic pre/postconditioning (RIPG). Animals were euthanized at 0- or 24-hours post-procedure, and samples were collected for histological and biochemical analyses. Results: The sum of the histological findings revealed no significant differences among the pre/postconditioning groups. However, serum calcium levels were significantly higher in preconditioning, DIPG compared to the control group (p = 0.002), and in postconditioning, DIPG and RIPG compared to the control group (p = 0.028 and p = 0.005, respectively). In postconditioning, the chlorine levels were higher in IRG compared to the DIPG group (p = 0.029). Conclusion: In our findings, ischemic preconditioning and ischemic postconditioning no provided significant protection of renal tissue.

Resumo em Inglês:

ABSTRACT Purpose: To evaluate the renal morphology after isolated and combined administration of dutasteride and tamsulosin in rats. Methods: Forty male rats were divided in groups: control group; D, receiving 0.5 mg/kg/day of dutasteride; T, receiving 0.4 mg/kg/day of tamsulosin; and D+T, receiving both dutasteride and tamsulosin. The drugs were given by gavage for 40 days. The animals were killed, and kidneys were collected for stereological analyses of kidney volume, cortical volume, volumetric density of glomeruli, mean glomerular volume, and number of glomeruli per kidney. Data was compared by analysis of variance followed by Bonferroni’s post-hoc test. Results: Kidney weight, kidney volume, cortical volume, and glomerular volumetric density were reduced in all treated groups, in comparison to control group. The mean glomerular volume was reduced in groups D and D+T, in comparison to control rats, but in group T this parameter was not altered. Finally, the number of glomeruli per kidney was reduced by 37.9% in the group D, by 25.7% in group T, and by 33.07% in group D+T, in comparison to control group. Conclusion: The use of dutasteride and tamsulosin (isolated or in combination) promoted kidney damage with nephron losses in the rodent model. Animals that received dutasteride showed more severe renal modifications than those that received tamsulosin and combined therapy.

Resumo em Inglês:

ABSTRACT Purpose: Hypothesis centered on the idea that ranolazine could induce responses similar to ischemic preconditioning, involving nitric oxide, adenosine, bradykinin, and adenosine triphosphate (ATP)-dependent potassium channels. Methods: Ischemia-reperfusion injury was established using Langendroff technique. Thirty-minute ischemia and 120-minute reperfusion to coronary artery to isolated heart were model of myocardial infarction. There were studied the following groups: control (ischemia-reperfusion), ischemic preconditioning, ranolazine (10 µmol/L), ranolazine + L-NAME (30 µmol/L) and ranolazine + aminoguanidine (30 µmol/L), ranolazine + theophylline (50 µmol/L), ranolazine + aminophylline (50 µmol/L), ranolazine + icatibantl (100 µmol/L), ranolazine + bromelain (250 µmol/L), ranolazine + 5-hydroxydecanoate (30 µmol/L), and ranolazine + glimepiride (50 µmol/L) in perfusate. Results: Ranolazine and ischemic preconditioning groups demonstrated cardioprotective effects by reducing infarct size, as well as levels of lactate dehydrogenase (LDH), creatine phosphokinase myoglobin (CK-MB), and troponin I and cardiac parameters like left ventricular developed pressure (LVDP) and left ventricular maximum rate of contraction (dP/dTmax). Maximum rate of relaxation (dP/dTmin) was improved. Conversely, treatments with L-NAME, aminoguanidine, theophylline, aminophylline, icatibant, bromelain, 5-hydroxydecanoate, and glimepiride increased infarct size, LDH, CK-MB, and troponin I levels, and cardiac parameters like LVDP, dP/dTmax, and dP/dTmin were depressed. This data provides evidence that ranolazine employs nitric oxide, adenosine, bradykinin, and ATP-dependent potassium channels as secondary messengers in cardioprotection. Conclusion: ranolazine can be a pharmacological alternative to surgical ischemic preconditioning utilized prior to interventional procedures like coronary artery bypass graft surgery and heart transplantation, offering improved patient compliance.

Resumo em Inglês:

ABSTRACT Purpose: To evaluate the efficacy and safety of Ankaferd in comparison with Arista and Surgiflo in a rat zero-ischemia partial nephrectomy model. Methods: A total of 28 Wistar albino rats were randomly assigned to four groups: control, Ankaferd, Arista, and Surgiflo. During partial nephrectomy, both the amount of bleeding and bleeding time were recorded. Intra-abdominal adhesions were evaluated on postoperative day 10. Nephrectomy specimens were harvested for histopathological assessment of tubular and glomerular necrosis, as well as for CD142 immunostaining. Results: Ankaferd demonstrated superior performance in terms of bleeding amount and bleeding time compared with both Arista and Surgiflo, although the differences did not reach statistical significance. Intra-abdominal adhesion scores were higher in the Ankaferd group than in the Arista and Surgiflo groups, with a statistically significant difference compared with the control group (p = 0.01). Histopathological analysis revealed a significantly higher glomerular necrosis score in the Ankaferd group compared with the control group (p = 0.043), while no significant differences were observed for tubular necrosis or CD142 immunohistochemical evaluation among the study groups. Conclusion: Ankaferd achieved more effective and rapid hemostasis than Arista and Surgiflo, but its higher adhesion scores limit its reliability for intra-abdominal use.

Resumo em Inglês:

ABSTRACT Purpose: This study aimed to evaluate the effect of oral administration of a hydroethanolic extract of Commiphora leptophloeos leaves (CLF) on the progression of 5-fluorouracil (5-FU)-induced intestinal mucositis. Methods: Female Swiss mice were orally administered CLF at doses of 10, 100, or 300 mg/kg, or saline (negative control, NC), starting 30 minutes before intraperitoneal injection of 5-FU. A positive control (PC) group received 5-FU without CLF treatment. Treatment continued until euthanasia, three days after 5-FU injection. Body weight was monitored throughout the experiment. On day 4, small intestine tissue samples were collected for histopathological analysis. Duodenal tissue was also assessed for Muc-2 immunostaining. Results: In the CLF 10, 100 and 300 mg/kg groups, the duodenum histopathological score was 1 (1–1.5) p < 0.001, 1 (1–1.5) p < 0.01; 1 (1–1.25) p < 0.01, while the PC group score was 2 (2–2.75). Immunostaining analysis for Muc-2 revealed a score of 3 (3–3) in the CLF 10 group, compared to score 1.2 (0.8–1.6) in the PC group (p < 0.001), indicating that CLF 10 increased Muc-2 expression. Conclusion: The oral administration of a hydroethanolic extract of CLF protected the duodenal segment of Swiss mice from 5-FU-induced intestinal mucositis, likely by increasing mucin production.

Resumo em Inglês:

ABSTRACT Purpose: To evaluate the effects of maternal arginine-enriched diet during lactation, following gestational undernutrition, on offspring growth and wound healing. Methods: Pregnant Wistar rats were divided into two groups during gestation: control (C; ad libitum diet) and undernourished (Und; 60% of control diet). After delivery, the undernourished mothers were reassigned to two subgroups: ad libitum + Impact® (Arg) and ad libitum + Nutren® (Hh). Evaluated parameters included offspring anthropometric measurements, serum albumin, tensile strength, and collagen morphometry at the surgical wound. Statistical analyses included analysis of variance (ANOVA) and Tukey’s, Student’s t-test, and Fisher’s test. Results: Maternal immunonutrition during lactation promoted recovery of offspring weight (C = 29.21 ± 2.86 g; Arg = 36.08 ± 5.38 g; p = 0.0009) and body length (C = 9.87 ± 0.32 cm; Arg = 10.91 ± 0.73 cm; p = 0.0008), shifting values from significantly lower at birth to higher than controls by weaning. Offspring healing parameters showed no significant differences compared with controls. Conclusion: An arginine-enriched diet provided to lactating rats malnourished during gestation significantly improved offspring anthropometric growth and supported wound healing following surgery at weaning.

Resumo em Inglês:

ABSTRACT Purpose: To establish an acetic acid-induced acute ulcerative colitis model in rats and to evaluate the clinical, biochemical, and histopathological effects of thymoquinone (TQ) and caffeic acid phenethyl ester (CAPE) in this model. Methods: Forty male Wistar albino rats (190–303 g) were randomly assigned to five groups (n = 8). All groups except the control received rectal acetic acid (4%) to induce colitis. Group 1 (control) received intraperitoneally (IP) 0.9% saline for five days. Group 2 (colitis) received IP 10% ethanol (vehicle for CAPE). Group 3 (TQ) received IP thymoquinone (10 mg/kg/day). Group 4 (CAPE) received IP caffeic acid phenethyl ester (10 µmol/kg/day). Group 5 (TQ+CAPE) received both agents at the same doses. On day 5, animals were euthanized, and colon and serum samples were collected for biochemical and histopathological analysis. Results: Significant differences were observed in the disease activity index, tumor necrosis factor-α, catalase, glutathione peroxidase, interleukin-10, and malondialdehyte indicating a balance between oxidant and antioxidant parameters. CAPE was found to have a greater anti-inflammatory effect than TQ histopathologically. The combined administration of CAPE and TQ mitigated oxidative stress as demonstrated by decreased oxidative stress biomarkers and improved antioxidant protection. Conclusion: Both CAPE and TQ demonstrated anti-inflammatory and antioxidant effects in an acetic acid-induced colitis model, with CAPE showing greater histological improvement. Their combined administration yielded additional benefits in oxidative stress reduction. These findings suggest that CAPE and TQ, particularly in combination, may hold promise as adjunctive agents in colitis management and warrant further investigation.

Resumo em Inglês:

ABSTRACT Purpose: To evaluate the self-ligation of the spermatic cord and vas deferens in healthy adult dogs undergoing open orchiectomy, through clinical assessment, evaluation of acute inflammation, and surgeon satisfaction. Methods: Twenty adult male crossbreed dogs were included in the study and were randomly assigned to two groups of ten animals each. The SCT group underwent spermatic cord ligation using absorbable suture material, whereas, in the SCVT group, hemostasis was achieved through self-ligation involving the spermatic duct and vas deferens. The evaluated variables included clinical parameters, acute inflammatory biomarkers, inflammation at the surgical knot site via infrared thermography, surgical time, intraoperative bleeding, and surgeon satisfaction by using standardized scoring systems. Results: Surgical time was significantly shorter in the SCVT group compared to the SCT group (p = 0.021). The total leukocyte count was significantly higher (p = 0.01) in the SCVT group 24 hours after surgery. Conclusion: Both techniques proved to be safe and effective for open orchiectomy in healthy, medium-sized, crossbreed adult dogs. The SCVT was faster to perform, but it elicited a greater acute inflammatory response, as indicated by the increased total leukocyte count.

Resumo em Inglês:

ABSTRACT Purpose: Although methylene blue (MB) has long been used to treat vasoplegic syndrome, its pharmacodynamics and cardiovascular effects remain unclear. Therefore, we decided to evaluate the potential molecular targets of MB through molecular docking and its cardioprotective and antioxidant actions. Methods: Adult male spontaneously hypertensive rats (SHR) were allocated into four groups: sham-operated; treated with vehicle and subjected to cardiac ischemia and reperfusion (CIR) (SS+CIR); treated with 2 mg/kg of MB before cardiac ischemia and reperfusion (MB+ISQ); and treated with 2 mg/kg of MB before cardiac reperfusion (ISQ+MB). The animals were monitored with electrocardiogram to assess the incidence of ventricular arrhythmias (VA), atrioventricular blocks (AVB), and lethality (LET). Blood samples and hearts were collected for histopathological analysis, serum creatine kinase MB dosage, and measurement of lipid hydroperoxide (LH) in myocardium serum creatine kinase MB. Results: The incidences of AVB and LET, serum CK-MB concentration, and myocardial injury increased in the MB+ISQ group, but not in the ISQ+MB group when compared with the SS+CIR group. LH concentration decreased in both MB-treated groups when compared with the SS+CIR group. Conclusion: These results indicate that MB produces a cardiotoxic effect only when administered before CIR, but not when administered before cardiac reperfusion.

Resumo em Inglês:

ABSTRACT Purpose: To investigate the biochemical and histopathological efficacy of agmatine as a protective agent in experimental rat contrast-induced nephropathy (CIN) model. Methods: Twenty-eight male Sprague Dawley rats were randomized into four groups: sham (no intervention), contrast agent (single dose 10 mL/kg iohexol iv), contrast agent + agmatine (single dose 10 mL/kg iohexol iv + 20 mg/kg po agmatine three days) and contrast agent + placebo (single dose 10 mL/kg iohexol iv + 1 mL of 0.9% saline ip). Biochemical and histopathological evaluations were accomplished on the fourth day, including measurements of cystatin-C, malondialdehyde (MDA), glutathione peroxidase (GPx), interleukin (IL)-1 β, superoxide dismutase (SOD), and tumor necrosis factor (TNF)-α. Results: The contrast agent group exhibited elevated cystatin-C, IL-1β, TNF-α, and MDA levels, with decreased SOD and GPx levels. The agmatine treatment group showed decrease in cystatin-C, IL-1β, TNF-α, and MDA, along with increased GPx and SOD levels. Histopathological evaluation revealed nephrotoxic effects in the contrast agent and placebo groups, whereas agmatine-treated rats displayed a significant reduction in tubular damage. Conclusion: Agmatine administration along side contrast exposure demonstrated protective effects against CIN, evidenced by biochemical and histopathological improvements.

Resumo em Inglês:

ABSTRACT Purpose: To investigate the effect and mechanism of Portulaca oleracea L. (POL) extract on acetic acid and alloantigen-induced chronic ulcerative colitis in rats. Methods: Ulcerative colitis was induced in rats by sensitization with rabbit colon antigen and acetic acid. Rats received oral sulfasalazine, intestine-quieting tablet, or POL (high, medium, or low dose) for 14 days. Disease activity index (DAI), colonic mucosal damage index (CMDI), and histological score (HS) were assessed. Serum levels of interleukin (IL)-4, IL-8, IL-17, C-reactive protein (CRP), immunoglobulin G (IgG), and interferon-γ (IFN-γ); colonic levels of myeloperoxidase (MPO), epidermal growth factor (EGF), and tumor necrosis factor (TNF)-α; serum hemolysin (by immunoturbidimetry); splenic T lymphocyte subsets (by flow cytometry); and serum IgG, IgM, IgA, C3, and C4 were measured. Results: Compared with the model group, POL significantly reduced DAI, CMDI, and HS scores in a dose-dependent manner—most markedly in the high-dose group (p < 0.01). POL also significantly decreased serum IL-8, IL-17, CRP, IFN-γ, and IgG, and colonic TNF-α and MPO (p < 0.05 or p < 0.01), while increasing serum IL-4 and colonic EGF (p < 0.01). All POL dosage groups significantly increased hemolysin, IgM, and CD4+CD25+/CD4+ levels in rats (p < 0.05 or p < 0.01), while decreasing serum IgG, IgA, complement C3/C4, CD4+/CD8+, and IL-17+ CD4+ (p < 0.05 or p < 0.01). Conclusion: The POL extract exerts therapeutic effects in chronic ulcerative colitis rats, likely by downregulating pro-inflammatory mediators—including IL-8, IL-17, CRP, IFN-γ, TNF-α, and MPO—, as well as serum IgG, IgA, C3/C4, CD4+/CD8+, and IL-17+ CD4+; and by upregulating anti-inflammatory/repair factors—including IL-4, EGF, lysozyme, IgM, and CD4+CD25+/CD4+. These findings support the clinical potential of POL for ulcerative colitis treatment.

Resumo em Inglês:

ABSTRACT Purpose: Glaucocalyxin A (GLA), a diterpenoid with antioxidative and anti-inflammatory properties, has shown vascular protective effects in preclinical models. This study aimed to evaluate whether GLA improves colonic anastomotic integrity following ischemia–reperfusion (I/R) injury. Methods: Twenty-four female Sprague Dawley rats were randomized into three groups (n = 8): control + GLA, I/R, and I/R + GLA. I/R was induced by 60-minute superior mesenteric artery occlusion and 60-minute reperfusion before end-to-end colonic anastomosis. GLA (10 mg/kg) was administered intraperitoneally. On postoperative day 7, anastomotic bursting pressure, adhesion scores, hydroxyproline, oxidative stress markers (total oxidative status, total antioxidant capacity, ischemia-modified albumin), and histopathology were evaluated. Results: The I/R + GLA group demonstrated significantly higher bursting pressure compared with the I/R group (126 versus 40 mmHg; p < 0.005). Tissue TOS levels were significantly lower in the I/R + GLA group compared with both other groups (p < 0.005). No significant differences were found in hydroxyproline levels, IMA values, or histopathological healing scores. Conclusion: GLA may support colonic anastomotic healing after I/R injury by reducing oxidative stress and could serve as a potential protective agent against anastomotic compromise.

Resumo em Inglês:

ABSTRACT Purpose: Myofascial pain syndrome (MPS) is a common cause of chronic musculoskeletal pain. Long fibular syndrome is a symptom of lower-limb MPS. Research has associated MPS with motor end plates in the innervation zone. This study aimed to identify the anatomical entry points of the superficial peroneal nerve (SPN) in the peroneal longus (PL) and peroneal brevis (PB) muscles through dissection. Methods: The PL and PB muscles of 12 cadavers were dissected to identify the nerve entry points, which were mapped and organized into quadrants. Poisson marginal distribution, identity linkage function, and Bonferroni multiple comparisons were used for statistical analysis. Statistical analysis included summary measures, Student’s and Mann–Whitney group comparisons, Pearson and Spearman correlations. Statistical significance was set at p < 0.05. Results: Quadrant I, followed by quadrant II (upper half of the PL and PB muscles), had the highest number of SPN entry points. Quadrants III and IV (lower half of the PL and PB muscles) had the lowest numbers of nerve entry points and did not differ statistically from each other. Conclusion: The SPN entrance positions in the PL and PB muscles matched literature trigger points. The anatomical relationship between trigger points can aid healthcare providers in procedures affecting muscle innervation and in pinpointing pain locations through spatial localization.

Resumo em Inglês:

ABSTRACT Purpose: To analyze the effects of polyhexamethylene biguanide (PHMB) on healing of clean surgical wounds in dogs. Methods: Thirty healthy, non-neutered dogs of different breeds underwent elective ovariohysterectomy or orchiectomy, and a 1-cm circular abdominal wound was created. Animals were divided into three groups (n = 10). Groups T1 and T2 received PHMB dressings changed once and twice daily. The control group (C) had wounds cleaned daily with saline and covered with gauze. Macroscopic evaluations were performed daily for 10 days, assessing edema, exudate, cosmetic appearance, and color. After 10 days, excisional biopsies were collected for histopathology evaluating vascular proliferation, inflammatory cells, fibroblastic proliferation, collagenization, necrosis, hyperplasia, and reepithelialization, and immunohistochemistry for reepithelialization and angiogenesis. Results: Macroscopic evaluations showed no significant differences among groups. Histopathology revealed greater collagenization in group C than in T2 (p < 0.05), while T1 did not differ from the others. Immunohistochemistry showed no differences in reepithelialization among groups. However, angiogenesis was higher in C and T2 than in T1 (p < 0.05). Conclusion: PHMB dressings neither demonstrate superior healing compared with gauze and saline cleaning nor impair healing and may represent an option for wound management in dogs.

Resumo em Inglês:

ABSTRACT Purpose: To evaluate the effect of Dermalix on anastomotic healing in a rat model of ischemic colon anastomosis. Methods: Forty rats were divided into three groups: negative control (n = 10), control (n = 15), and experimental (n = 15). Only laparotomy was performed in the negative control group. In the control group, ischemia and end-to-end colon anastomosis were performed, while in the experimental group, Dermalix was applied circumferentially around the anastomosis. On postoperative day 7, anastomotic segments were evaluated for burst pressure, adhesion, and histopathological parameters. Results: Abscess formation related to anastomotic leakage occurred in two rats in the control group and in one rat in the experimental group. Mean burst pressure was 134.7 mmHg in the control group and 194.7 mmHg in the experimental group (p = 0.005). No significant differences were observed in inflammation, epithelial regeneration, or granulation tissue formation. Neovascularization (p < 0.001) and collagenization (p = 0.032) were significantly higher in the Dermalix group. There was no significant difference in adhesion or foreign body reaction. Conclusion: Dermalix improved key histological and mechanical indicators of anastomotic healing under ischemic conditions, providing preliminary evidence of its potential as a bioactive adjunct. Further studies are warranted to confirm these findings and assess clinical relevance.

Resumo em Inglês:

ABSTRACT Purpose: Improper use of mechanical ventilation may result in ventilator-induced lung injury (VILI). This work seeks to explore the preventive impact of astaxanthin on VILI. Methods: In this study, we established the VILI rat and drug intervention model, then evaluated lung tissue damage by observing the appearance and hematoxylin-eosin staining. Oxidative stress was evaluated by determining the levels of myeloperoxidase, catalase, and malondialdehyde. Results: Our data showed that, compared with the control group, mechanical ventilation increased the mRNA and protein expression levels of interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF)-α, LC3II/I, and Beclin1, as well as the phosphorylation level of ERK1/2 in the lung tissues of VILI rats (p < 0.0001), while the expression level of P62 protein decreased (p < 0.0001). After pretreatment with astaxanthin, autophagy and inflammatory response were significantly reduced. The phosphorylation of ERK1/2 was also inhibited. Notably, these effects were reversed after using the p-ERK agonist Ro67-7476. Conclusion: Astaxanthin can inhibit autophagy levels and suppress inflammation and oxidative stress in mechanically ventilated rat lung tissue through inhibiting the MAPK/ERK signaling pathway, thus alleviating lung tissue injury. Therefore, astaxanthin may represent a promising preventive strategy for VILI.

Resumo em Inglês:

ABSTRACT Purpose: To compare the effects of captopril and losartan on inflammatory response, angiogenesis, and fibroblast activity during the early phase of wound healing in hypertensive rats. Methods: Twenty-seven paraffin-embedded skin wound samples from hypertensive rats were analyzed: control group (n = 8), losartan-treated group (n = 9), and captopril-treated group (n = 10). Histological and immunohistochemical analyses were performed on postoperative day 4. Hematoxylin-eosin staining was used to evaluate general wound structure, and immunohistochemistry with anti-leukocyte common antigen, anti-CD34, and anti-smooth muscle actin was performed to assess inflammatory cells, angiogenesis, and fibroblast activity, respectively. Results: No significant differences were observed in angiogenesis (p > 0.05) or fibroblast number (p > 0.05) between groups. However, the inflammatory reaction was significantly higher in captopril-treated (p = 0.0459) and losartan-treated (p = 0.0452) groups compared with the control group, with no significant difference between the two treated groups. Conclusion: Neither captopril nor losartan influenced angiogenesis or fibroblast proliferation in the early healing phase. However, both drugs increased inflammatory cell infiltration.

Resumo em Inglês:

ABSTRACT Purpose: To evaluate the inflammatory response, fibrotic encapsulation, tissue integration, and antibacterial effectiveness of silicone implants coated with decellularized bovine pericardium membranes, with or without vancomycin impregnation. Methods: Seventy-two Wistar rats received subcutaneous silicone implants and were allocated to six groups: uncoated silicone under aseptic conditions; uncoated silicone under infected conditions; silicone coated with decellularized bovine pericardium under aseptic conditions; silicone coated with decellularized bovine pericardium under infected conditions; silicone coated with vancomycin-impregnated pericardium under aseptic conditions; and silicone coated with vancomycin-impregnated pericardium under infected conditions. Infected groups were challenged with Staphylococcus aureus and evaluated at day 7. Aseptic groups were analyzed at 30, 60, and 180 days. Histological assessment included semi-quantitative scoring of inflammatory cells, fibroblasts, angiogenesis, implant infiltration, and resorption. Antibacterial activity was quantified by colony-forming unit counts. Data were analyzed using non-parametric statistics. Results: Vancomycin-impregnated pericardium coatings significantly reduced S. aureus colonization compared with uncoated and pericardium-only implants. At day 7, these coatings markedly attenuated neutrophil infiltration and acute inflammation. At 30 and 60 days, pericardium-coated implants exhibited lower fibroblast scores and enhanced implant infiltration compared with uncoated silicone. At 180 days, vancomycin-impregnated coatings consistently showed reduced fibrotic and inflammatory markers, despite reduced sample size. Conclusions: Decellularized bovine pericardium coatings modulate the host response to silicone implants, and vancomycin impregnation provides additional antibacterial and anti-inflammatory benefits without impairing tissue integration.

Resumo em Inglês:

ABSTRACT Purpose: The porcine model is widely used in preclinical studies of anorectal function due to its anatomical and physiological similarity to humans. However, appropriate behavioral and functional evaluation methods of anorectal segment are still lacking. Methods: This study introduces the swine anal function assessment table (SAFAT), a standardized qualitative tool developed to evaluate anorectal function. Six male Landrace × Large White pigs underwent evaluation following anorectal transplantation over up to one year. Results: The functional parameters assessed included cleanliness, fecal distribution, stool consistency, anal tone, anal skin sensitivity, anal reflexes, and other ones. Each indicator was rated using semi-quantitative scales based on behavioral observations. Conclusion: SAFAT was effective for behavioral and functional evaluation after anorectal transplantation and may improve the reproducibility and reliability of functional evaluations in swine models of major anorectal surgeries, supporting translational research in colorectal treatments.

Resumo em Inglês:

ABSTRACT Purpose: Foreign body reaction is a tissue response in which excessive reactions may lead to complications such as chronic inflammation, mesh contraction, and impaired tissue integration. The present study aimed to evaluate the effects of steroid-impregnated polypropylene mesh on foreign body reaction and fibrosis in a rat abdominal wall model. Methods: Forty adults female Wistar rats were randomly assigned into four groups (n = 10 each): polypropylene mesh in the acute period (group A), steroid-impregnated polypropylene mesh in the acute period (group AS), polypropylene mesh in the chronic period (group C), and steroid-impregnated polypropylene mesh in the chronic period (group CS). Standardized 1 × 1-cm meshes were implanted on the right rectus abdominis muscle. Acute groups were assessed at three days post-implantation, and chronic groups at nine weeks. Histopathological evaluation included grading of polymorphonuclear leukocyte infiltration, neovascularization, foreign-body giant cell reaction, muscle invasion, necrosis, and fibrosis. Immunohistochemical staining for CD15, CD68, CD3, and CD20 was performed to characterize inflammatory cell subtypes. Results: The mean grading of polymorphonuclear leukocyte infiltration, neovascularization, foreign-body reaction, muscle invasion, and necrosis showed no difference among groups, in which fibrosis levels were significantly higher in group C and group CS compared to group A (p = 0.004, p = 0.004, respectively). The fibrosis levels were also elevated in group CS than in group AS (p = 0.001, p = 0.001, respectively). Conclusion: Local corticosteroid impregnation of polypropylene mesh slightly attenuated early inflammatory responses but did not prevent chronic fibrosis.

Resumo em Inglês:

ABSTRACT Purpose: To evaluate alginate-dragon’s blood sap microbeads (DBSM) regarding biocompatibility, biodegradation, and antioxidative potential. Methods: Three DBSMs at concentrations of 1, 2, and 5% were developed by the drop spherification, and alginate-1% glycerin microbeads (GM) were used as control. Biocompatibility and biodegradation were evaluated by subcutaneous assay in 50 Swiss male mice, divided in the groups G1 (1% DBSM), G2 (2% DBSM) and G3 (5% DBSM), which were compared to C+ (1% GM) and C- (sham) at three and nine weeks. The histopathology of tissue irritation followed the ISO 10993-6 standard and the integrity of the biomaterials scored by quartiles. Metabolic analysis of intensity of catalase was carried out in the liver, kidneys, and tibias of the tested animals. Results: All microbeads were biocompatible, with less tissue irritation and greater partial resorption in G3 in subcutaneous tissue and preserved systemic antioxidant potential. Conclusion: The controlled release of dragon’s blood sap from Croton lechleri using alginate microbeads suggests a local anti-inflammatory action dependent on the concentration of the bioactive compound. Its role in repairing specialized connective tissues such as bone should be elucidated by future in-vivo orthotopic tests.

Resumo em Inglês:

ABSTRACT Purpose: To investigate the protective effects of syringic acid (SA) against testicular ischemia–reperfusion (I/R) injury during different reperfusion periods in an experimental rat model. Methods: Forty-eight male Wistar albino rats were randomly assigned to six groups: control, sham, torsion/detorsion (T/D) 4 h, T/D + SA 4 h, T/D 24 h, and T/D + SA 24 h. Testicular torsion was induced by 720° rotation of the left testis for 2 h, followed by detorsion and 4 or 24 h reperfusion. SA (10 mg/kg) was administered intraperitoneally 30 min before detorsion. Oxidative stress markers, histopathological alterations, and immunohistochemical expressions of apoptotic protease activating factor-1 (APAF-1) and inducible nitric oxide synthase were evaluated. Results: T/D significantly decreased total antioxidant status and glutathione levels while increasing myeloperoxidase activity and APAF-1/inducible nitric oxide synthase (iNOS) expressions compared with controls (p < 0.001). SA treatment restored antioxidant capacity and attenuated inflammatory and apoptotic responses (p < 0.05). Histopathological analyses demonstrated lower Cosentino scores and higher Johnsen scores in SA-treated groups than in untreated T/D groups (p < 0.05). Malondialdehyde levels showed no significant intergroup differences. Conclusion: SA attenuates testicular I/R injury by reducing oxidative stress, inflammation, and apoptosis while preserving spermatogenic function and histological integrity.

Resumo em Inglês:

ABSTRACT Purpose: This study aimed to evaluate the protective effects of enoxaparin on ovarian tissue subjected to experimental ischemia/reperfusion (I/R) injury in rats. Methods: Thirty female rats were divided into three groups: control, ischemia/reperfusion (I/R), and ischemia/reperfusion plus enoxaparin (I/R+E). Ovarian I/R injury was induced by 1 hour of ischemia followed by 1 hour of reperfusion. Rats in the I/R+E group received subcutaneous enoxaparin (0.5 mg/kg) prior to ischemia. Histopathological injury was assessed using a standardized scoring system, and total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) were measured. Results: Histopathological injury scores were significantly higher in the I/R group compared with controls (p < 0.05), with no significant difference between the I/R and I/R+E groups (p > 0.05). Biochemical analysis showed significantly higher TAS and lower OSI levels in the I/R+E group compared with the I/R group (p < 0.05), while TOS levels were comparable between groups. Conclusion: Although enoxaparin did not significantly improve histopathological injury, its beneficial effects on oxidative stress parameters suggest a protective role against oxidative stress in ovarian I/R injury.

Resumo em Inglês:

ABSTRACT Purpose: To evaluate the protective effects of nicotinamide mononucleotide (NMN), a NAD+ precursor, on kidney tissue in rats with sepsis induced by cecal ligation and puncture model. Methods: In this study, 28 female Sprague Dawley rats were randomly divided into four equal groups: control, sham, sepsis, and sepsis+NMN (500 mg/kg, i.p.). Kidney tissues taken 24 hours after the sepsis model were histopathologically evaluated under light microscopy for tubular damage, glomerular congestion, and inflammatory infiltration parameters. Results: Histopathological examination revealed severe tubular injury, marked glomerular congestion, and dense inflammatory cell infiltration in the kidney tissues of the sepsis group. In the group treated with NMN, a significant reduction in these pathological findings was observed, while the glomerular structure and tubular architecture were preserved. Semi-quantitative histopathological scoring confirmed significantly increased renal injury in the sepsis group and significant attenuation of tissue damage following NMN treatment. Conclusion: The data obtained showed that NMN may play an important cytoprotective role in sepsis-induced acute kidney injury by preserving tissue architecture. More comprehensive molecular and biochemical studies are needed to fully elucidate the therapeutic potential and mechanisms of action of NMN.

Resumo em Inglês:

ABSTRACT Purpose: To propose the 10 As decalogue technique, a structured framework for surgical bedside rounding. Methods: This narrative review and perspective piece presents a descriptive model for bedside rounding, designed for implementation in university hospitals. Literature review was done in MEDLINE via PubMed up to May 2025, using both free terms and Medical Subject Headings related to medical education, clinical rounds, and surgical training. The technique was developed based on clinical and educational principles, addressing both surgical and academic needs. Results: The decalogue consists of the following steps: anticipation, assistant team presentation, authorization, (self)appraisal, assessment, alerts, advice, agreement, annotation, and afterwards. It facilitates comprehensive case discussion, improves trainee clinical skills, and fosters empathy and trust in patient interactions. It addresses time constraints by prioritizing critical cases and enhances learning through debriefing and feedback. Challenges include managing time for multiple patients and ensuring patient comfort during public discussions, mitigated by clear authorization and sensitive communication. Conclusion: The 10 As decalogue is an effective tool for surgical bedside rounding, promoting resident education, reducing errors, and enhancing patient involvement. Its structured approach is particularly suited for academic settings, with adaptability to balance educational and clinical demands.

Resumo em Inglês:

ABSTRACT Purpose: To conduct a bibliometric analysis of the 100 most-cited articles on the use of complementary therapies for controlling inflammatory signs, symptoms, and complications after lower third molar extraction. Methods: An electronic search was performed on the Web of Science Core Collection database. A graphical bibliometric network was created in Power BI software (Microsoft, Redmond, WA, United States of America). Spearman’s correlation test was used to assess the correlation among the number of citations, journal impact factor, and the year of publication. Results: The selected articles received 4,199 citations, covering the years 1983 to 2023. Most publications occurred in 2016. Article citations averaged 41.99. The most frequent Keywords Plus terms, considering more than five occurrences, were “removal,” “pain,” “surgery,” and “trismus.” The main keywords defined by the authors, considering more than five occurrences, were “pain,” “swelling,” and “trismus.” The Asian and European continents presented the highest number of publications and citations. Randomized clinical trial was the most prevalent study type. Regarding authors’ affiliations, the University of Turin stood out in the number of publications. Conclusion: The article with the highest number of citations was published in Serbia. Turkey and Italy accounted for the highest number of publications and citation density. Although most included studies were randomized clinical trials, improving comparison and decision-making requires methodological standardization.

Resumo em Inglês:

ABSTRACT Purpose: To conduct a systematic literature review and meta-analysis to assess the efficacy of fish skin xenografts in burn treatment, comparing reepithelialization time, pain reduction, and the amount of analgesics used. Methods: This review was designed and conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and registered in PROSPERO under registration number CRD42023412250. The databases MEDLINE (via PubMed), Cochrane Library, Scientific Electronic Library Online (SciELO)/Latin American and Caribbean Health Sciences Literature (LILACS), and EMBASE were used. The literature search identified 768 articles. Through title and abstract screening, 736 were excluded, along with 16 duplicates. Sixteen articles were fully analyzed, of which six met the inclusion criteria for this review. Results: The systematic review found that patients treated with fish skin xenografts had shorter reepithelialization times and reduced pain compared to conventional treatments. The meta-analysis showed reduction in reepithelialization time for the intervention groups using fish skin grafts by 1.26 day (95% confidence interval [95%CI] -2.38 to -0.15; p < 0.00001) and a reduction in pain levels with score decreases of 3.84 (95%CI -6.42 to -1.26; p = 0.0009). The objective of assessing the number of analgesics used could not be evaluated quantitatively. Conclusion: The use of fish skin xenografts in burn patients is effective in reducing reepithelialization time and decreasing pain levels during treatment.

Resumo em Inglês:

ABSTRACT Purpose: To identify and describe mobile applications that can serve as complementary tools in the education of plastic surgery residents. Methods: A structured literature review was conducted across MEDLINE, EMBASE, ERIC, Latin American and Caribbean Health Sciences Literature (LILACS), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Search strategies used Medical Subject Headings (MeSH) terms and relevant keywords. Additional searches were performed in the App Store and Google Play to identify mobile applications related to plastic surgery education. Inclusion criteria covered studies and applications directly linked to residency training in plastic surgery. Results: Fourteen articles met eligibility criteria, and 18 mobile applications specifically related to plastic surgery education were identified. The majority was freely available and addressed topics such as surgical simulation, flap design, anatomy, and procedural guidance. Apps in English predominated across platforms. Conclusion: Mobile applications represent valuable complementary resources for plastic surgery training, supporting both theoretical learning and technical development. Their structured integration into residency curricula could enhance academic and clinical performance among residents.

Resumo em Inglês:

ABSTRACT Purpose: Hematoma remains the most frequent complication of cervicofacial surgeries. The hemostatic net (HN), a transcutaneous suture designed to minimize dead space and bleeding, has shown promise, but pooled evidence of its safety and efficacy is limited. Thus, we conducted this study to clarify the safety profile and complication rates associated with the use of HN in cervical and facial surgeries. Methods: A systematic search of MEDLINE, Embase, Scopus, Cochrane, and Web of Science was performed through August 2025. Eligible studies involved adults undergoing cervical and/or facial surgery with HN, with no restrictions on suture caliber or spacing between stitches. The primary outcome was hematoma incidence; secondary outcomes included skin necrosis, seroma, infection, persistent skin marks, patient-reported satisfaction, and other adverse events. Results: Eleven studies including 3,393 patients (2,748 HN; 645 controls) were analyzed. Single-arm meta-analysis of HN cases showed low pooled rates for hematoma (0.6%; 95% confidence interval 0.4–1.0; low certainty), skin necrosis (0.4%; 95% confidence interval 0.1–1.0; low certainty), seroma (1.5%; 95% confidence interval 0.6–4.0; low certainty), infection (0.1%; 95% confidence interval 0.0–25.5), and persistent skin marks (0.6%; 95% confidence interval 0.2–2.1). Comparative analyses showed no significant difference for hematoma (risk ratio = 0.15; 95% confidence interval 0.01–3.20; very low certainty) or seroma (risk ratio = 1.06; 95% confidence interval 0.41–2.75; low certainty). Patient-reported satisfaction data were scarce and nonspecific. Conclusion: The HN is a safe technique with very low complication rates, though evidence of superiority over standard surgery remains inconclusive due to limited certainty of meta-analyzed data, heterogeneity of surgical procedures, and the paucity of patient-reported outcomes.

Resumo em Inglês:

ABSTRACT Purpose: To perform a systematic review about microsurgical training for medical students. Methods: A systematic search was conducted in several databases. Screening was performed by two independent reviewers based on predetermined criteria, following PRISMA 2020 guidelines. Results: A total of 433 articles were obtained. After screening, 40 were included. Teaching methods were heterogeneous and restricted to a few countries. There are specific methods to assess microsurgery training, general surgical activities, learning curve and anxiety. The most used materials were surgical gloves, silicone tubes, chicken thighs and rats. Animals were not essential in early stages of education. There was a variation between one and 24 sessions regarding teaching frequency and between 3 and 120 hours of teaching period. The average age of students was 23.7, and 67.5% were men. Teaching groups had an average of 5.8 students per group. Physical activity and anxiety had negative effect on microsurgical ability gain, while caffeine had positive effect. Alcohol and sleep deprivation had no significant effect. Conclusion: Students with adequate training could achieve performance similar to that obtained by experts. Microsurgical education is realistic during medical graduation and may enable better career choices. More investigations are needed to improve this training and expand knowledge to other medical schools.

Resumo em Inglês:

ABSTRACT Purpose: To identify and compare anesthetic and analgesic strategies employed during uterine artery embolization for symptomatic leiomyomas, assessing their effectiveness in reducing postoperative pain and opioid use and evaluating complication rates. Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Searches were performed in PubMed, Embase, Web of Science, and Scientific Electronic Library Online. Randomized controlled trials and prospective cohort or case–control studies, published in the last 10 years, evaluating pain, opioid consumption, and/or complications, were included. Results: The total of 3,433 studies were screened, of which six met eligibility criteria. Superior hypogastric plexus block reduced pain and opioid use. Intra-arterial lidocaine decreased pain within 2–4 h and opioid consumption, with a transient effect; administration after vascular stasis was preferable. Controlled-release oxycodone reduced pain at 24 h and need for rescue medication without lowering mean consumption. Dexamethasone reduced pain at 12–24 h without impacting opioid use. No significant complications were reported. Conclusion: In the ischemic phase of post-uterine artery embolization pain, a superior hypogastric nerve block appears to provide the most consistent relief, with intra-arterial lidocaine representing an alternative when resources are limited. For the inflammatory phase, intravenous dexamethasone is the preferred option, whereas controlled-release oxycodone may be considered only in refractory cases.

Resumo em Inglês:

ABSTRACT Purpose: To map the experimental models of induced and spontaneous uterine leiomyomas (UL) in animals, describing induction techniques, evaluation methods, advantages, limitations, and research gaps. Methods: We conducted a systematic review of studies published between 2004 and 2024 with in-vivo animal experiments reporting UL induction or spontaneous occurrence. Data were extracted on animal species, sample size, induction methods, confirmation techniques, and reported advantages or disadvantages. Results: A total of 56 studies were included. Rats and mice were the most frequently used species. Induction methods comprised hormonal administration, genetic predisposition, chemical exposure (monosodium glutamate), ischemic injury, external stimulation, cell transplantation, xenotransplantation, and spontaneous development. A critical finding that emerged was that 60.7% of the studies failed to report confirmation of UL induction. Among the 22 studies that reported confirmation, caliper measurement was the most frequently used technique. This widespread lack of methodological rigor significantly undermines the credibility and reproducibility of many published models. Conclusion: This scoping review highlights not only the heterogeneity of UL animal models and the lack of standardized induction and evaluation protocols, but also identifies a critical gap in induction validation reporting that compromises the foundation of preclinical research in this field.

Resumo em Inglês:

ABSTRACT Purpose: To evaluate the impact of the Yellow Wave Initiative on trauma surgery education, academic skills, career choices, and educational equity among medical students from three Brazilian medical schools. Methods: This prospective longitudinal study enrolled 58 medical students from three institutions in Campinas, SP, Brazil. The intervention consisted of scientific mentorship, research methodology training, manuscript development for the 23rd European Congress of Trauma, and presentation skills workshops. Academic development, research capabilities, career intentions, and program satisfaction were assessed through post-congress electronic questionnaires using McNemar tests for paired comparisons and χ2 tests for associations. Results: Trauma league members showed higher interest in general surgery compared to non-members (61.5 vs. 22.7%, odds ratio = 10.88, p = 0.002). Significant improvements were observed across key academic skills post-intervention (all p < 0.001), including presentation abilities (from 20.8% good/very good pre to 85.4% post), research capabilities (25 to 79.2%), and academic writing (20.8 to 83.3%). Additionally, 62% of participants reported positive impact on their academic career aspirations (p = 0.006). Conclusion: The initiative enhanced academic skills and career development among Brazilian medical students, increasing engagement in trauma surgery and prevention activities while addressing educational gaps through hands-on learning.

Resumo em Inglês:

ABSTRACT Purpose: To develop and validate a thoracic limb simulator for veterinary vascular access training (TSVT), focusing vein puncture in dogs. Methods: The simulator was designed, three-dimensional printed, and filled with silicone and resin. Five experienced veterinarians, with no prior simulator experience, performed procedures including hand positioning, vein palpation, antisepsis, venipuncture, catheter insertion, and access maintenance. Evaluators completed an anonymous questionnaire with a 3-point scale and provided qualitative feedback. Results: The TSVT accurately reproduced thoracic limb and cephalic vein. All professionals reported appropriate hand positioning, vein palpation, and antisepsis. Blood collection was feasible for all evaluators, while catheter insertion was feasible for four and partially feasible for one due to resistance within the simulated vessel. Fixation and maintenance of vascular access were successfully performed by all. The simulator allowed repeated practice without live animals, supporting safe and controlled development of psychomotor skills. Conclusion: These results demonstrated that the TSVT is effective for training cephalic vein puncture in dogs, faithfully reproducing anatomical structures and enabling acquisition of clinical and psychomotor skills in a safe, ethical, and repeatable manner, representing a valuable tool for veterinary education.

Resumo em Inglês:

ABSTRACT Purpose: To present the stepwise plication of abdominal mesh (SPAM) as a standardized dynamic closure technique that combines mesh-mediated fascial traction with negative pressure wound therapy for gradual abdominal wall approximation. Methods: In this technical report, we present SPAM for progressive closure of peritoneostomy with excessive abdominal wall retraction. It involves a central mesh incision followed by progressive tightening via hemostatic clamp rotation (similar to opening a can with a key), without full-thickness mesh cut. The mesh is secured with continuous suture and covered with a non-commercial negative pressure system. Cycles are repeated every 48–72 hours until fascial closure. Results: SPAM was applied in four patients: three successful cases (52-year-old male with rectal perforation, 36-year-old female post-Hartmann evisceration, 63-year-old female with gastrojejunal anastomosis leak) achieved primary fascial closure in a median of 10 days, with well-tolerated traction, no enteroatmospheric fistula, or incisional hernia. In one failure (59-year-old male with gastrojejunal leak post-laparoscopic gastrectomy), bleeding occurred during traction (controlled surgically), yet the technique was discontinued due to progressive clinical deterioration. Conclusion: SPAM offers a practical, standardized, reproducible approach to delayed fascial closure, particularly in resource-limited settings, enabling controlled progressive approximation without mesh resection.

Resumo em Inglês:

ABSTRACT Purpose: This study described the development and preliminary evaluation of a simulator that combines a three-dimensional-printed vascular model with a camera-assisted system for training basic endovascular skills. Methods: A hollow mannequin torso housed a transparent, three-dimensional-printed aorta. Guidewire and catheter manipulation were visualized in real time using a manually controlled camera. Fifteen medical students (novices) and five vascular surgeons (experts) performed simulated tasks in two sessions. Experts also assessed realism and educational value. Results: Novices demonstrated shorter completion times across all exercises in session 2, particularly in exercise 4, with mean time decreasing from 229.3 ± 134.8 to 83.5 ± 31.1 seconds, a mean difference of 145.8 seconds (p = 0.001). Experts showed no significant improvement in most tasks, although exercise 3 improved from 115.4 ± 29.7 to 91.6 ± 21.5 seconds, a mean difference of 23.8 seconds (p = 0.012). Performance differed between groups (construct validity). Surgeons provided favorable ratings for the realism and usefulness (face and content validity). Conclusion: This preliminary device appears feasible and may facilitate early skill acquisition in low-resource educational settings without radiation exposure.

Resumo em Inglês:

ABSTRACT Purpose: To assess the usability and feasibility of augmented-reality smart glasses during simulated pediatric bladder catheterization with real-time remote specialist guidance. Methods: Thirty-five critical-care graduate healthcare professionals simulated pediatric bladder catheterization on a manikin using Vuzix M400 glasses via telemedicine. After brief familiarization, participants completed a seven-item Likert (0–7) questionnaire covering ease of use, procedural understanding, confidence/efficiency, comfort, and global acceptance. We analyzed descriptive statistics, internal consistency (Cronbach’s α), and item-domain coherence. A conceptual diagram and synthesis table complemented quantitative data. Results: Augmented-reality-guided training showed generally favorable usability perceptions. Median scores ranged 3.5–5, with strongest ratings for observation support, image quality, procedural understanding, and intention to recommend. Comfort and efficiency scored lower (median = 3.5), indicating more neutral perceptions. The instrument showed high internal consistency (α = 0.97), although this may reflect item redundancy, and item-domain alignment provided a descriptive representation of the conceptual model. Conclusion: These findings suggest that augmented-reality smart glasses are feasible and generally well accepted for simulated remotely guided training. Further controlled studies with objective performance measures are needed.

Resumo em Inglês:

ABSTRACT Purpose: To identify preoperative factors predicting surgical difficulty in laparoscopic cholecystectomy at a secondary-level hospital. Methods: A retrospective study included 697 adults undergoing laparoscopic cholecystectomy from January 2021 to June 2024. Demographic, clinical, laboratory, and ultrasound data, as well as intra- and postoperative outcomes, were collected. Operative difficulty was graded using Nassar’s scale (I–V). Logistic regression analyses identified predictors of difficult cholecystectomy (Nassar III–V). Results: Among the 697 patients (81.5% female; mean age 46.7 ± 14.0 years old; mean body mass index 29.2 ± 4.8 kg/m2), 41.4% were classified as difficult. Conversion to open surgery occurred in 1.1%. Difficult cases showed longer operative time (79.9 ± 39.3 versus 56.9 ± 19.6 minutes, p 0.01), greater use of intraoperative cholangiography (12.5 versus 3.7%, p 0.01), longer postoperative stay (p 0.01), and higher incidence of nausea/vomiting (15.2 versus 7.8%, p 0.01). Multivariate analysis identified elevated alanine transaminase (odds ratio = 2.89, 95% confidence interval 1.80–4.64, p 0.001) and gallbladder wall thickening 4 mm (odds ratio = 4.75, 95% confidence interval 2.85–7.91, p 0.001) as independent predictors. Conclusion: Elevated alanine transaminase and gallbladder wall thickening are significant predictors of difficult laparoscopic cholecystectomy. Recognizing these factors may optimize surgical planning and enhance patient safety in non-tertiary hospitals.

Resumo em Inglês:

ABSTRACT Purpose: To evaluate bone health in obese patients undergoing surgery using the Roux-en-Y gastric bypass (RYGB) technique. Methods: In a sample of 22 obese patients undergoing RYGB surgery, evaluation of bone densitometry (BD) and plasma levels of calcium, phosphorus, magnesium, vitamin D (VITD), parathyroid hormone (PTH), alkaline phosphatase, and albumin was performed. Results: Signs of potential changes in calcification were detected in plasma tests, expressed as a decrease in VITD (46.4%) and an increase in PTH (50%). Three patients presented with bone framework damage. BD was unequivocally altered in three patients. A decrease in bone density was observed in 14 and 15 patients in the lumbar and femoral regions, respectively. Conclusion: Although PTH and VITD dosages did not show a direct correlation with BD, it was observed that approximately half of the patients had altered dosages of these hormones up to five years after surgery, and there was damage to the bone health expressed by BD. Loss to follow-up may have contributed to the increased risk of developing metabolic bone disease.

Resumo em Inglês:

ABSTRACT Purpose: Trauma is a major global cause of death, with uncontrolled hemorrhage as its leading preventable cause. Damage control resuscitation (DCR) is a cornerstone strategy for hemorrhagic shock, yet implementation varies by resource availability. This study compared DCR practices between high-income countries (HICs) and low- and middle-income countries (LMICs), predominantly represented by institutions from Latin America, particularly Brazil. Methods: A cross-sectional survey of trauma care providers was conducted between 2024 and 2025, assessing DCR practices, resuscitation strategies, and adjunctive therapies. Data from a Brazilian national survey were incorporated into the LMIC cohort. Countries were classified using World Bank 2024 income criteria, and comparisons were analyzed using hierarchical logistic regression with adjustment for multiple comparisons. Results: Massive transfusion protocol availability result was significantly lower in LMICs than in HICs (47.4 vs. 89.1%; OR = 0.11, 95%CI 0.02–0.62; p(BH) < 0.001). LMICs also had reduced availability of fresh frozen plasma (OR = 0.04; p(BH) = 0.035), balanced crystalloids (OR = 0.21; p(BH) < 0.001), viscoelastic coagulation monitoring (TEG/ROTEM; OR = 0.04; p(BH) 0.001), prothrombin complex concentrate (OR = 0.01; p(BH) < 0.001), fibrinogen concentrate (OR = 0.10; p(BH) < 0.001), rapid infusers (OR = 0.04; p(BH) < 0.001), invasive temperature monitoring (OR = 0.02; p(BH) < 0.001), calcium replacement (OR = 0.17; p(BH) = 0.002), and active rewarming systems (OR = 0.21; p(BH) = 0.035). Whole blood use was lower in LMICs (5.8 vs. 17.4%) but did not reach statistical significance in the primary model (OR = 0.55, 95%CI 0.12–2.45). Tranexamic acid availability was nearly universal and did not differ between settings (96.1 vs. 97.8%). Conclusion: Although DCR principles are widely recognized, substantial disparities persist in access to critical resuscitation resources across income settings.

Resumo em Inglês:

ABSTRACT Purpose: Trauma remains a leading cause of hospital admissions worldwide, particularly in low- and middle-income countries. Brazil’s dual healthcare system reflects disparities in resource availability and clinical outcomes. This study compared epidemiological profiles of trauma patients treated at a public versus a private hospital in Salvador, Bahia, Brazil. Methods: We retrospectively analyzed 6,472 trauma-related hospitalizations from August 2021 to August 2023. Data were extracted from Hospital Information System/Department of Informatics of the Unified Health System and a private hospital database. Patients admitted under the 10th revision of the International Classification of Diseases, categories S00–T88, were included, excluding burns and orthopedic injuries. A χ2 test assessed associations between trauma mechanisms and hospitals. Results: Among the 6,472 cases, 6,342 occurred in the public hospital and 130 in the private hospital. In the public hospital, males accounted for 82.1% of the cases, and the leading causes were motorcycle crashes (21.7%) and gunshot wounds (16.2%). At the private hospital 58.4% of patients were males, with falls (50.8%) predominating among older adults. Violence-related injuries predominated in the public hospital, while falls predominated in the private hospital. Conclusion: This study revealed distinct trauma patterns in the public versus the private hospital in one Brazilian city. The public hospital treated younger male victims of violence, while the private hospital treated older patients with falls. These findings underscore the need for policies addressing trauma care disparities.

Resumo em Inglês:

ABSTRACT Purpose: We investigated the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) and combined them to create an inflammatory marker, the combined neutrophil-platelet score (CNPS), to serve as a diagnostic and predictive tool for complicated appendicitis. Methods: A retrospective analysis was conducted on the clinicopathological data of patients who underwent appendectomy. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were used to evaluate the diagnostic performance of various inflammatory parameters. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for complicated appendicitis. A prospective study was then carried out to validate the clinical utility of the CNPS. Results: In total, 322 patients were included in the retrospective analysis. Multivariate analysis identified only onset time and NLR as independent risk factors for complicated appendicitis, whereas the PLR was not. CNPS demonstrated superior diagnostic and predictive performance for complicated appendicitis compared to NLR and PLR. Moreover, after adjusting for confounders, CNPS remained an independent risk factor for complicated appendicitis. In the prospective study, 264 patients were included for analysis, and the AUC of CNPS for predicting complicated appendicitis was 0.707. Conclusion: The CNPS, combining NLR and PLR, demonstrates high diagnostic and predictive value for complicated appendicitis.

Resumo em Inglês:

ABSTRACT Purpose: Myofascial trigger points (MTPs) in the tibialis anterior muscle (TAM) are located in the upper third of the muscle and can be activated by various pathologies such as sprains, fractures, and muscle overload. Although the pathophysiology of MTPs is unclear, they often coincide with motor plates in the innervation zone. This study aimed to describe the innervation of the deep fibular nerve (DFN) into the TAM and relate it to clinically described MTPs. Methods: The TAMs of 12 cadavers were dissected from their origins to observe the exact point at which the DFN penetrates the muscle belly. Entry points were mapped by dividing the muscle into four areas. Statistical analysis was performed using a Poisson marginal distribution and identity linkage function, followed by Bonferroni multiple comparisons. Statistical analysis included summary measures, group comparisons using Student and Mann–Whitney’s tests, and Pearson and Spearman’s correlations. Statistical significance was set at p < 0.05. Results: Quadrants I and II had significantly more DFN branches than quadrants III and IV (p < 0.001), whereas quadrants I versus II and areas III versus IV showed no significant differences (p < 0.05). Conclusion: Consistent with the clinical literature, the branches of the DFN in the TAM correspond to the described areas of the MTPs. The anatomical relationships between MTPs may help explain the pathophysiology of various disorders and provide rational treatment options.

Resumo em Inglês:

ABSTRACT Purpose: Cancer-associated cachexia (CC) is characterized by involuntary weight loss and poor prognosis. Central nervous system (CNS) inflammation has been linked to CC symptoms. This study evaluated inflammatory mediators in the cerebrospinal fluid (CSF) of patients with CC. Methods: Volunteers were recruited in Santarém, PA, Brazil, and divided into three groups: patients undergoing herniorrhaphy or cholecystectomy (n = 43)—control; cancer without cachexia (CWC, n = 13); and CC (n = 49). Blood and CSF were collected before anesthetic injection. Results: CSF vascular endothelial growth factor (VEGF) and monocyte chemoattractant protein-1 (MCP-1) levels were reduced in CC (p < 0.0001; p 0.00017) and CWC (p = 0.0269; p = 0.0421) compared to control. CSF IP-10 was lower in CC (p = 0.0048). In CWC, CSF MCP-1 correlated with serum C reactive protein (rs = 0.78, p = 0.0098), leukocytes (rs = 0.72, p = 0.0235), lymphocytes (rs = -0.67, p = 0.0390) and monocytes (rs = -0.82, p = 0.0058). In CC, CSF interleukin (IL)-8 correlated with leukocytes (rs = 0.48, p = 0.0032) and MCP-1 with neutrophils (rs = 0.36, p = 0.0265) and eosinophils (rs = -0.37, p = 0.0218). CC patients showed lower quality of life than CWC (functional scale p = 0.0087; symptoms scale p = 0.0386). Conclusion: Cancer was related to changes in CSF cytokine levels, indicating that both tumor presence and cachexia modulate central inflammatory signaling. Correlations between CSF chemokines and blood immune cells suggest systemic interaction between peripheral immunity and the CNS.