Acta cirurgica brasileira最新文献

Purpose: To summarize the available evidence and answer the following question: What is the current knowledge on the performance of blood concentrates in handling sequelae after lower third molar extractions with the evidence available in systematic reviews?

Methods: An electronic search was conducted across nine databases. The study included systematic reviews with or without meta-analyses investigating the performance of blood concentrates in managing sequelae after lower third molar extractions. The four outcomes analyzed were pain, edema, mouth opening, and alveolar osteitis. The AMSTAR-2 tool assessed the methodological quality of the included systematic reviews, while ROBIS evaluated the risk of bias.

Results: The electronic search revealed 690 records, of which 15 were eligible systematic reviews for the present study. Overall, these reviews evaluated 75 primary studies published from 2007 to 2023. According to AMSTAR-2, only one systematic review presented high methodological quality. The ROBIS tool showed two systematic reviews with a low risk, and the others had a high risk of bias.

Conclusion: The current evidence is based on only one systematic review with high methodological quality and a low risk of bias, while the others exhibited a high risk of bias and low methodological quality. Therefore, the evidence regarding the efficacy of blood concentrates in controlling sequelae following lower third molar extractions is inconclusive.

Purpose: To investigate the effect of intraperitoneal treatment with low- and high-dose methotrexate (MTX) on wound healing in rats.

Methods: The study sample consisted of 54 healthy rats. Under aseptic conditions, skin wounds were created with two circular full-thickness punch tools, 10 mm in diameter, one on the right and the other one on the left of the dorsal vertebral line. The rats were randomly assigned to one of three main treatment groups. On the 0th day (2 hours before wound creation), 7th day, and 14th day, the control group received 0.3-mL saline, the low-MTX group received 3 mg/kg MTX, and the high-MTX group received 30 mg/kg MTX, all administered intraperitoneally. The wounds were evaluated seven, 14, and 21 days after injury through morphometrical, biochemical, histopathological, and immunohistochemical analyses.

Results: MTX dose-dependently decreased the degree of inflammation and angiogenesis, tissue hydroxyproline level, and HSP70 and tumor necrosis factor-α expression in the early phase of wound healing. It also suppressed epithelialization and collagen 1 expression throughout the wound-healing process.

Conclusion: The wounds treated with high-dose of MTX had statistically delayed wound closure on days 7, 14 and 21 compared to the saline group, while wounds treated with low-dose of MTX only had statistically delayed wound closure on day 14. In addition, weight loss was observed in rats treated with high-dose MTX, which was thought to reflect its toxicity. The dose-dependent adverse effect of MTX on wound healing may be due to its antiproliferative, antifibrotic, anti-inflammatory, and antiangiogenic effects.

Purpose: To explore the protective effects of borneol in myocardial ischemia-reperfusion injury (MIRI) and the mechanism of apoptosis.

Methods: Cell viability was detected by CCK-8. The total superoxide dismutase (T-SOD) and lactate dehydrogenase (LDH) leakage of cells were tested by biochemical assay kit. Detection of apoptosis was by flow cytometry. Serum levels of creatine kinase isoenzyme MB (CK-MB), LDH, and cardiac troponin I (cTnI) were detected by enzyme-linked immunosorbent assay. Myocardial infarction area and pathological changes were observed via 2,3,5-triphenyltetrazolium chloride (TTC) staining and hematoxylin and eosin staining. The expressions of apoptosis-related proteins in cells and myocardial tissues were detected by Western blot.

Results: H9c2 cell viability was significantly increased by pretreatment with 16 and 32 μg/mL of borneol. Borneol pretreatment significantly increased the T-SOD levels and reduced LDH leakage and apoptosis. In MIRI rats, borneol pretreatment significantly reduced serum levels of CK-MB, LDH and cTnI, decreased myocardial infarction area, and improved myocardial injury in different degree. Western blot results showed that borneol pretreatment significantly reduced the expression of Bcl-2-associated X protein (Bax) and Cysteine-aspartate protease-3 (Caspase-3) in cells and myocardial tissues of rats.

Conclusion: Borneol can protect myocardial injury cells and mitigate MIRI by inhibiting cardiomyocyte apoptosis.

Purpose: To characterize histologically and stereologically the hepatic steatosis in obese Zucker (fat, n = 6, with a mutation in the leptin receptor - Leprfa) and control Zucker (lean, n = 6) rats, analyzing macroscopic and microscopic differences to understand the influence of obesity on hepatic pathology.

Methods: Zucker rats were fed standard chow for 90 days. Macroscopic, qualitative, and histoquantitative (stereological) approaches were used, involving body and liver weight measurement, morphological analysis, and histopathological classification of metabolic dysfunction-associated steatotic liver disease.

Results: Zucker fat rats had higher body weight (p = 0.0022), liver weight (p = 0.0022), serum total cholesterol (p = 0.0022), and triacylglycerol (p = 0.0022) compared to Zucker lean rats. Stereological analysis showed that hepatocyte volume density (p = 0.0022) and total hepatocyte volume (p = 0.0001) were lower, and the volume density (p = 0.002) and total volume of steatosis (p = 0.002) were higher in Zucker fat rats compared to lean rats.

Conclusion: The findings indicated that obesity induces significant alterations in the hepatic morphology of Zucker rats, showing that hepatocyte volume is lower in obese animals. This study reinforces the utility of the obese Zucker rat model to investigate the effects of obesity on liver health and suggests hepatic steatosis requires therapeutic strategies focused on modulating these parameters.

Purpose: To assess the cost of traffic accidents in Brazil and the impact of age/location.

Methods: All patients admitted to a Brazilian hospital due to traffic accidents from January 2012 to December 2022 and cost of hospital services were obtained from the Department of Information Technology of the Unified Health System. Demographic data were collected in the Brazilian Institute of Geography and Statistics database. Parametric and nonparametric data were analyzed. The Kruskal-Wallis' test and a post-hoc test were used for data comparison. The ARIMA linear regression method for trend estimation.

Results: In Brazil, 1.6 million individuals were involved in traffic accidents between 2012-2022, resulting in a cumulative hospital expenditure of US$ 38 million. The average hospital admission cost during this time was US$ 239.66, but no correlation was found between the cost per capita and driver population density increase. Hospitalization in the Midwest/South was higher.

Conclusion: The economic impact of traffic accidents on the Brazilian public health system is significant. With a high number of victims admitted annually and evident regional and age-related disparities, there is a clear need for comprehensive and cost-effective healthcare strategies.

Purpose: The aims of this work were to induce anorectal anomaly in rat fetuses via the planned administration of ethylenethiourea (ETU), and to study fetuses exhibiting anorectal malformation, as well as apparently normal fetuses submitted to the effect of ETU.

Methods: Time-mated pregnant Wistar rats were randomly divided into control and experimental groups. On gestational day 10, the experimental group received 10% ETU (130 mg/kg) by gavage, whereas the control rats received vehicle only. The embryos were harvested by cesarean section on gestational day 21. The fetuses exposed to ETU were divided into two groups: affected (without any clear anorectal alterations); and the malformed (with anorectal anomaly). The neuromotor plates were identified by immunohistochemistry with acetylcholinesterase, and alterations in the sacral region were evaluated by histological and morphometric studies.

Results: We used 43 control fetuses, 82 affected fetuses, and 118 malformed fetuses in this study. The most frequent associated macroscopic anomalies were spina bifida (55 fetuses), encephalocele (20), and alterations in the lower limbs (5). The sacroiliac was malformed in 45% of the affected fetuses and in 53.2 % of the malformed fetuses.

Conclusion: ETU leads to a reduced number of motor neurons in the pelvic musculature of both the malformed and the affected rats. The enteric neurons are altered in the malformed fetuses, but not in the affected ones. Both the affected and malformed rats exhibit sacral alterations that do not interfere with neurons.

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Purpose: To identify and describe the most used surgical repair methods for traumatic injuries to peripheral nerves, as well as highlight the causes of trauma to peripheral nerves and the most prevalent traumatized nerves.

Methods: This is a systematic literature review using the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The searches were carried out in PubMED, in the time window from January 2018 to December 2022.

Results: In total, 3,687 articles were collected, of which, after applying the inclusion and exclusion filters and analyzing the risk of bias, 34 articles remained. It was observed that the age of the injury and type of nerve repair strongly influence the recovery of patients. The most identified trauma repair procedures were neurolysis, direct suturing, grafting, and nerve transfer. Among these four procedures, direct suturing is currently preferred.

Conclusion: Several repair methods can be used in peripheral nerve injuries, with emphasis on direct suturing. However, nerve transfer proves to be a differential in those cases in which repair is delayed or the first treatment options have failed, which shows that each method will be used according to the indication for each case.

Purpose: Approximately 10% of breast cancer patients with localized operable disease experience recurrence. This study aimed to evaluate patients with early-stage breast cancer (TNM I and II) who underwent surgery without the need for neoadjuvant therapy.

Methods: The total of 117 patients was included in the study: 104 without recurrence and 13 with recurrence. We analyzed various clinicopathological parameters, including body mass index, age at diagnosis, menopausal status, pesticide exposure, and tumor characteristics such as HER2 amplification, Ki67 index, molecular subtype, and histological grade.

Results: Two primary subsets were identified as being associated with disease recurrence. The first subset (PC1) was characterized by HER2 amplification and metastatic disease, while the second subset (PC2) comprised premenopausal young women exposed to pesticides who had triple-negative tumors. While some of these factors are well-documented in the literature, pesticide exposure emerged as a notable regional factor contributing to poor outcomes in breast cancer patients.

Conclusion: These findings underscored the significance of identifying local and regional risk factors when assessing recurrence risk in women with breast cancer, particularly in cases in which surgery is the primary treatment approach.