Acta cirurgica brasileira最新文献

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.

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.

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.

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.

Purpose: To examine the cardioprotective effects of myrrhone against isoproterenol (ISO)-induced myocardial injury in rats.

Methods: Myocardial injury was induced in the rats through subcutaneous administration of ISO (85 mg/kg). The body weight, heart weight, electrocardiogram (ECG), cardiac, antioxidant, electrolyte, membrane-bound enzymes, antioxidant, cytokines, and inflammatory parameters were estimated. The mRNA expression of inflammatory parameters was estimated in the cardiac tissue.

Results: Myrrhone treatment significantly (p < 0.001) altered ECG parameters, body weight, heart weight, and heart weight/body weight ratio. Myrrhone significantly (p < 0.001) improved the level of 5-hydroxytryptamine (5-HT) and suppressed the level of cardiac parameters like creatine kinase-MB, creatine kinase, lactate dehydrogenase, cardiac troponin I, and cardiac troponin T. It also suppressed the level of hepatic parameters such as aspartate aminotransferase, and alanine transaminase; altered the electrolyte, membrane-bound enzymes, and antioxidant parameters. Myrrhone treatment significantly (p < 0.001) altered the level of cytokines such as tumor necrosis factor-α (TNF-α), interleukin (IL)-10, IL-1β, IL-17, and IL-6; inflammatory parameters like cyclooxygenase-2, prostaglandin, inducible nitric oxide synthetase, nuclear factor kappa-light-chain enhancer of activated B cells; matrix metalloproteinases such as 2, and 9; apoptosis parameters viz., Bcl-2-associated X protein (Bax), B-cell lymphoma 2 protein (Bcl-2), and caspase-3 parameters. Myrrhone treatment significantly (p < 0.001) altered the mRNA expression IL-6, IL-1β, IL-10, TNF-α, Bcl-2, caspase-3, Bax, and caspase-9.

Conclusion: Myrrhone exhibited the cardioprotective effect against ISO-induced myocardial injury in rats via alteration of kappa-light-chain enhancer of activated B cells (NF-κB) and Bax/Bcl-2/caspase-3 signaling.

Purpose: To compare early- and medium-term postoperative outcomes of unilateral inguinal hernia repair performed using the Lichtenstein and Prolene hernia system (PHS) techniques in a public teaching hospital.

Methods: A retrospective analysis of 897 patients undergoing primary unilateral inguinal hernioplasty (406 with Lichtenstein and 491 with PHS) from January 2011 to March 2025 was conducted. Clinical, intraoperative, and postoperative data were collected and compared. Statistical analysis included t-tests, Mann-Whitney, Fisher's exact, and χ2 tests.

Results: Groups were not entirely homogeneous in preoperative profiles. The mean age was similar (p = 0.85), with predominance of males (94.87%). The operative time was significantly shorter for the PHS group (68.83 ± 24.84 versus 76.23 ± 26.90 min; p < 0.01). No significant differences were observed in postoperative complications, chronic pain, sensory dysfunction, or recurrence. Hospitalization was less frequent with the PHS technique (4.27 versus 12.8%; p < 0.01). Greater preference for local anesthesia was observed in the PHS group (20.77 versus 4.68%; p < 0.01).

Conclusion: Both techniques proved effective and safe, but the PHS technique showed advantages regarding operative time and hospitalization rate. However, limited sample size and absence of cost and return-to-activity data restrict broader generalizations. Further prospective randomized studies are needed.

Purpose: To verify the differences in the reversibility of renal function and damage in rats of different ages with unilateral ureteral obstruction (UUO).

Methods: Sixty rats were divided into three different groups, newborns, young, and adults. Twenty-one were sham operated. After UUO, the animals were subdivided into four groups: obstruction (two weeks and sacrifice O2); UUO two weeks, obstruction release for two weeks and sacrifice (R2); UUO for four weeks and sacrifice (O4); and UUO for four weeks, obstruction release for two weeks and sacrifice (R4). Urine was collected for creatinine, urea, total protein, and albumin dosages, and kidneys for morphological studies.

Results: Younger rats presented more extensive destruction of renal parenchyma, with some remaining normal tissue healthier in comparison to older rats. The protein excretion by older rats was not different between the groups obstructed for different periods, albuminuria was progressively higher in rats obstructed for longer periods, and after relief of obstruction, there was no difference between newborn rats obstructed for different periods. The younger pyelostomized rats presented higher albumin excretion. Creatinine excretion was worsened in rats after obstruction.

Conclusion: Shorter obstruction periods lead to better prognosis, and younger rats showed better recovery after relief of obstruction than older ones.

Purpose: To investigate the potential protective effects of ononin on cecal ligation puncture (CLP) induced sepsis rat model.

Methods: CLP was used to induce sepsis in rats and then treated with ononin at doses of 25 and 50 mg/kg intraperitoneally for seven days. The daily assessment included measurements of food and water intake, as well as body weight in the different rat groups. The study also examined the effects of ononin on survival rates, level of tumor necrosis factor (TNF)-α, interleukin (IL)-16, IL-6, C-reactive protein in the serum, and markers of oxidative stress in tissue homogenates of rats. The weight of spleen and lung tissue were also estimated in ononin-treated sepsis group. Additionally, histopathological examinations of lung and liver tissues were conducted in sepsis rats using hematoxylin and eosin staining.

Results: The ononin-treated group showed significant improvements in food and water intake, as well as body weight, compared to the sepsis group of rats. Survival rate was also improved in the ononin-treated group. Ononin ameliorates oxidative stress and inflammatory mediators in sepsis rats. Histopathological changes (liver and lung tissue) were observed to be ameliorated in the group of rats treated with ononin versus the sepsis group.

Conclusion: Ononin enhances survival rate in sepsis in rats by reducing inflammation and oxidative stress.

Purpose: To investigate the protective effect of trans-anethole in experimental traumatic brain injury (TBI) in mice.

Methods: Thirty-five adult mice were divided into five groups (control, TBI, TBI+A40, TBI+A80, and TBI+A160). No treatment was performed in the control group. The treated groups (TBI+A40, TBI+A80, and TBI+A160) received 40, 80 or 160 mg/kg trans-anethole treatment, respectively. At the end of the experiment, the brains of the sacrificed animals were removed, and laboratory analyses were performed.

Results: Malondialdehyde (MDA) levels in brain tissue of TBI and TBI+A40 were significantly increased, while MDA levels of TBI+A80 and TBI were similar. TBI+A160 and control tissue MDA levels were similar (p > 0.05), significantly different from TBI (p < 0.01). Immunodensity analyses showed that there was a significant difference between the control and TBI in terms of Bax, caspase 3, tumor necrosis factor-α (TNF-α) and interleukin- (IL)-1β immunoexpression. TBI+A40 immunoexpression was similar to TBI (p > 0.05), significantly different from the control groups (p < 0.05). In TBI+A80 and TBI+A160, pro-apoptotic Bax and caspase 3, pro-inflammatory TNF-α and IL-1β levels were also significantly improved. Immunoexpression levels of TBI+A160 and control were similar (p > 0.05).

Conclusion: in our study, trans-anethole treatment had a dose-dependent neuroprotective potential against trauma-induced neurodegeneration.