Acta cirurgica brasileira最新文献

[This retracts the article doi: 10.1590/ACB360802].

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.

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.

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.

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.