Acta cirurgica brasileira最新文献

Purpose: To evaluate correlations between anthropometric tools for visceral fat assessment, including waist circumference (WC) and sagittal abdominal diameter (SAD), by computed tomography (CT)-derived visceral fat volume in patients with rectal adenocarcinoma.

Methods: This comparative cross-sectional study included 138 participants: rectal adenocarcinoma patients (group 1, n = 69) and controls (group 2, n = 69). Assessed variables were weight, body mass index (BMI), bioelectrical impedance analysis (BIA), WC, SAD, and CT-derived visceral fat volume measured with Fat Tissue (Syngo.Via VB20, Siemens). CT analysis was restricted to group 1.

Results: Median ages in groups 1 and 2 were 60 and 53 years, respectively (p < 0.0008). CT revealed sex-based differences in visceral fat: 20.91 cm3 in females and 31.29 cm3 in males (p = 0.0043). WC and SAD demonstrated statistically significant correlations with CT-derived visceral fat in group 1 (p < 0.0001).

Conclusion: WC and SAD correlated with CT-derived visceral fat in rectal adenocarcinoma patients. These exploratory findings require validation by larger studies with multivariable analyses to establish predictive value and clinical applicability.

Purpose: To evaluate the regenerative efficacy of an experimental biodegradable nerve conduit composed of polycaprolactone and açaí-derived polyurethane, used for peripheral nerve repair, in comparison with different reconstructive techniques.

Methods: Wistar rats (n = 48) were allocated into six groups (n = 8): normality (NG), denervated (DG), burial (BG), nerve autograft (NAG), açaí-based neurotube (ANG), and vein autograft (VAG). Sciatic functional index, electrophysiological parameters, and histomorphometry were assessed after 12 weeks.

Results: NAG and ANG showed significant functional recovery, with ANG being the only group to demonstrate progressive improvement (p = 0.009). Electrophysiological analysis revealed higher amplitude and lower latency in NAG, followed by ANG and VAG. Histomorphometric analysis showed increased axonal density in ANG and NAG compared to non-reconstructed groups (p = 0.004 and p = 0.007, respectively).

Conclusion: The polycaprolactone/açaí-based conduit demonstrated regenerative performance comparable to autologous nerve grafts.

Purpose: Body weight, blood glucose, and hypothalamic ghrelin receptors were monitored in an animal model of obesity after being treated with sleeve gastrectomy.

Methods: Forty-two adult male Wistar rats were randomized into two groups: a non-obese group (standard chow); and an obese group, in which obesity was induced by feeding liquid enteral formula Ensure Plus. Each group was divided according to the surgery performed (sham operation or sleeve gastrectomy) and the time of sacrifice after surgery (14 or 28 days). Body weight and capillary blood glucose were monitored throughout the pre- and postoperative periods. Microscopic sections of the parietal cortex, thalamus, hypothalamus, and hippocampus were treated by immunohistochemical reaction with polyclonal anti-ghrelin receptor antibody. Positivity was determined by identifying labeled nuclei and cytoplasm in the brain cells.

Results: Sleeve gastrectomy induced effective weight loss (p < 0.001) and reduction in the hypothalamic ghrelin receptor expression (p = 0.04). Weight loss was not directly influenced by the receptor expression. There was no significant impact on capillary glycemia.

Conclusion: Sleeve gastrectomy alters GHSR1a receptors, decreasing their expression and body weight. However, weight loss is not directly related to the GHSR1a expression status.

Purpose: To scrutinize the protective effect of alpinumisoflavone against the acute reflux esophagitis (RE) in the rats and to explore the underlying mechanism.

Methods: RAW 264.7 cells were used for in-vitro study, and MTT assay was used to access the cell viability. The cells were treated with lipopolysaccharide (LPS) and estimation the inflammatory cytokines and parameters. A surgical procedure was performed for the induction of RE followed by the oral administration of alpinumisoflavone (5, 10 and 15 mg/kg). The esophagitis lesion score, gross esophageal score, damage ratio, pH and gastric volume, NO level, alcian blue, H2O2, free iron, calcium, antioxidant, inflammatory cytokines and inflammatory parameters were estimated.

Results: Alpinumisoflavone treatment significantly (p < 0.001) suppressed cell viability and NO levels, along with a reduction in inflammatory cytokines like tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6 and inflammatory parameters such as cyclooxygenase-2 (COX-2), prostaglandin E22 (PGE2), and inducible nitric oxide synthase (iNOS) against the LPS treatment. Alpinumisoflavone treated group rats suppressed the esophagitis lesion score, gross esophageal score damage ratio, and gastric volume and improved the pH level. Alpinumisoflavone treatment significantly (p < 0.001) suppressed the level of NO level, alcian blue, H2O2, free iron and calcium. Alpinumisoflavone significantly (p < 0.001) altered the level of antioxidant parameters such as malondialdehyde, superoxide dismutase, glutathione, glutathione peroxidase, catalase; inflammatory cytokines viz., TNF-α, IL-6, IL-1β, IL-10, IL-18; and inflammatory parameters including COX-2, NF-κB, and PGE2.

Conclusion: Alpinumisoflavone ameliorates the acute reflux esophagitis via suppression of inflammatory parameters.

[This corrects the article doi: 10.1590/acb404925].

Purpose: To compare and evaluate the radiologic, clinical, and histopathologic results of the treatment methods applied in diaphyseal tibial fractures.

Methods: A complete tibial fracture was created in the tibial diaphysis in each rabbit. Experimentally generated fracture fragments were fixed by intramedullary pinning. In the control group (group I), the bone fracture area was left to heal without any treatment technique. Group II received low-energy laser therapy once daily to the surgical side for 30 days; group III, autologous bone marrow aspirated from the left proximal tibia; group IV, a combination of bone marrow obtained by aspiration and synthetic β-tricalcium phosphate (β-TCP); and in group V, a platelet-rich fibrin (PRF) membrane obtained from the central auricular artery was applied to the fracture side.

Results: In the X-ray analysis, it was determined that group IV had the fastest score increase, while group I had the lowest scores. In group IV, no lameness that persisted until the end of the study was observed in any rabbit. When the histopathological scores of the different groups were examined, it was seen that the lowest score belonged to group I, and the highest score was in group IV.

Conclusion: The highest rate of new bone formation and bone regeneration was achieved when the combination of aspirated bone marrow and β-TCP granules was applied. The experimental group with PRF membrane application exhibited the least osteogenic characteristics among all experimental groups.

Purpose: To examine the protective effect of alpinumisoflavone against streptozotocin (STZ)-induced gestational diabetes mellitus (GDM) in female rats and explored the underlying mechanisms.

Methods: Female rats were used in this study, and intraperitoneal administration of STZ (55 mg/kg) was used to induce diabetes. Body weight, blood glucose level, fetuses, placental weight, and placental index were estimated. Oral glucose tolerance test (OGTT) and insulin tolerance test (ITT) were performed. The levels of resistin, glycated hemoglobin (HbA1c), hepatic glycogen, free fatty acid (FFA), adiponectin, serum C-peptide, leptin, visfatin, intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1), lipids, oxidative stress, inflammatory cytokines, and other parameters were estimated. mRNA expression was estimated in the pancreatic tissue.

Results: Alpinumisoflavone treatment significantly (p < 0.001) enhanced body weight and fetuses and decreased placental weight and placental index. Alpinumisoflavone treatment significantly (p < 0.001) decreased blood glucose levels (BGL) and improved plasma insulin levels. Alpinumisoflavone treatment significantly (p < 0.001) suppressed the glucose and insulin levels in the OGTT and ITT. Alpinumisoflavone treatment significantly (p < 0.001) altered the levels of resistin, HbA1c, hepatic glycogen, FFA, Adiponectin, serum C-peptide, leptin, visfatin, ICAM-1, and VCAM-1; lipid parameters; oxidative stress parameters; inflammatory cytokines and inflammatory parameters, viz., cyclooxygenase-2 (COX-2), and nuclear kappa B factor (NF-κB). Alpinumisoflavone treatment significantly (p < 0.001) altered the mRNA expression levels of Toll-like receptor 4, nuclear kappa B factor65 (NF-κB65), NOD-, LRR-, pyrin domain-containing protein 3 (NLRP3), MyD88, SREBP-1, stearoyl-CoA desaturase-1 (SCD1), FAS, and ACC.

Conclusion: Alpinumisoflavone has a protective effect against STZ-induced GDM via alteration of the TLR4/MyD88/NF-κB signaling pathway.

Purpose: To investigate the optimal therapeutic sequence of rhGM-CSF combined with hypofractionated radiotherapy (HFRT) in treating mouse pancreatic cancer (PC) and explore the mechanisms.

Methods: A PC-bearing model was established. The antitumor effects were observed under rhGM-CSF, HFRT, rhGM-CSF + HFRT, rhGM-CSF&HFRT, and HFRT + rhGM-CSF treatments. Tumor histopathological changes were examined using hematoxylin and eosin (H&E) staining. FCM was employed to detect calreticulin (CRT), mDCs, CD4+, and CD8+ T cells. Enzyme-linked immunosorbent assay (ELISA) was used to measure HMGB1, adenosine triphosphate (ATP), interleukin- (IL)-2, IL-4, IL-8, IL-10, IL-12, IFN-γ, tumor necrosis factor (TNF)-α, and iNOS levels. IF staining was performed to detect CD31 and α-smooth muscle actin, and immunohistochemistry was used to detect vascular endothelial growth factor (VEGF), soluble VEGF receptor-1 (sVEGFR-1), hypoxia-inducible factor- (HIF)-1α, and HIF-2α expression.

Results: HFRT + rhGM-CSF inhibited tumor growth, promoted tumor necrosis, and increased inflammatory cell infiltration. This regimen also significantly enhanced immunogenic cell death by inducing CRT exposure and the release of HMGB1 and ATP. Furthermore, HFRT + rhGM-CSF markedly increased proportions of mDCs, CD4+ T cells, and CD8+ T cells, and upregulated expressions of IL-2, IL-8, IL-12, IFN-γ, TNF-α, and iNOS, but not IL-4 and IL-10. Additionally, rhGM-CSF synergized with HFRT to promote the normalization of blood vessels in the PC.

Conclusion: HFRT followed by rhGM-CSF had the best efficacy in PC, and the molecular mechanism may be related to immunogenic cell death.

Purpose: To analyze the geographical distribution of patients treated at a burn treatment unit (BTU) in Catanduva, São Paulo, Brazil, and examine the relationship between geographic and clinical variables.

Methods: This is a cross-sectional study that analyzed patients hospitalized for burns between January 2018 and May 2022. Data were obtained from medical records and included patients' residence city, age, and percentage of total body surface area burned (%TBSA). The data were processed using QGIS and R, and travel distances and times were calculated. Statistical analyses included bivariate and correlation tests.

Results: The total of 1,164 patients were analyzed. Most of them resided outside Catanduva, totaling 277 cities. The average distance was 179.37 km, and the average travel time was 140.94 minutes. Patients from Catanduva had an average age of 35.55 years old, and the average %TBSA was 12.15. Patients from outside Catanduva were significantly younger and had a higher %TBSA than the local patients. A weak but significant negative correlation was found between patient age and distance to the BTU (ρ = -0.14, p < 0.05), while %TBSA showed a weak positive correlation with travel distance (ρ = 0.21, p < 0.05). No significant differences were observed between the pre- and pandemic periods.

Conclusion: This study highlights regional differences in specialized burn care access and may inform policy aimed at reducing care disparities.

Purpose: To investigate the potential pleiotropic effects of liraglutide (LG), a glucagon-like-peptide-1 analog, on gastric ulcer prevention in rats with diabetes induced by streptozotocin (STZ).

Methods: We randomly divided 63 male Wistar rats into seven groups. STZ was administered intraperitoneally (IP) to the animals in the diabetic control (group STZ), diabetic control + indomethacin (INDO) (group STZI), STZ + INDO + omeprazole (group OMP), STZ + INDO + LG (0.2 mg/kg) (group 0.2LG), and STZ + INDO + LG (0.4 mg/kg) group (group 0.4LG). We administered OMP IP to group OMP, 0.2 mg/kg LG to group 0.2LG SC, 0.4 mg/kg LG to group 0.4LG SC, normal saline to non-diabetic control (sham group), group STZ, non-diabetic control + INDO (group KI), and group STZI SC. INDO was administered to the animals in groups KI, STZI, OMP, 0.2LG, and 0.4LG by gavage. Then, the caspase-3, epidermal growth factor (EGF), vascular endothelial growth factor-A (VEGF-A), prostaglandin E2 (PGE2), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), superoxide dismutase-1 (SOD-1), glutathione (GSH), and malondialdehyde (MDA) levels were studied.

Results: LG prevented INDO-induced ulcers and decreased apoptosis in the stomach tissue. It increased the SOD-1, GSH, EGF, VEGF-A, and PGE2 levels, and reduced the MDA, IL-6, and TNF-α levels. The anti-ulcer effect of LG was lower, but close to that of OMP.

Conclusion: The antioxidant, anti-inflammatory, and anti-apoptotic effects of LG, its ability to regulate EGF, VEGF-A, and PGE2 levels, and its capacity to reduce blood glucose levels in diabetic rats may contribute to its anti-ulcer effect.