Abstract This study evaluated the effects of supplying altrenogest from day 6-12 of pregnancy on the endometrial glandular epithelium, corpora lutea (CL) morphology, and endometrial and CL gene expression. A total of 12 crossbred females (Landrace × Large White) were used. The females were assigned to 4 treatments according to a random design with a 2 × 2 factorial arrangement, with two categories (sow or gilt) and two treatments (non-treated and treated with altrenogest). On day 6 of pregnancy, animals were allocated to one of the following groups: non-treated (NT, n = 6; 3 sows and 3 gilts), and (T, n = 6; 3 sows and 3 gilts) treated daily with 20 mg of altrenogest, from day 6-12 of pregnancy. All animals were euthanized on day 13 of pregnancy. All CLs were individually weighed, and their volume were determined. The endometrial glandular density (GD), mean glandular area (MGA), and vascular density (VD) were determined by histomorphometric and immunohistochemical analyses. Endometrium samples were collected and analyzed by qRT-PCR to evaluate the abundance of transcripts for VEGF and IGF-I. Females in the T group had higher MGA (P < 0.05) compared to the NT group. There was no effect of treatment on GD or VD for both experimental groups. Sows in the T group had augmented expression of IGF-I (P < 0.05). Progestagen had no detrimental effect on CL morphology. In conclusion, altrenogest improves the uterine environment during the peri-implantation period in pigs without compromising corpora lutea development.

RESUMO Raciona l: A gastrectomia é o tratamento principal para o câncer de junção esofagogástrica (EGJ) e Siewert tipo II-III. Ela está associada à morbidade significativa. As taxas de morbidade total variam entre os diferentes estudos e poucos avaliaram a morbidade pós-operatória de acordo com a gravidade da complicação. Objetivo: Identificar os preditores de morbidade pós-operatória grave. Métodos: Este foi um estudo de coorte retrospectivo de um banco de dados prospectivo. Foram incluídos pacientes tratados com gastrectomia para câncer gástrico ou EGJ em um único centro. A morbidade severa foi definida como escore de Clavien-Dindo ≥3. Análise multivariada foi realizada para identificar preditores de morbidade grave. Resultados: Duzentos e oitenta e nove gastrectomias foram realizadas (67% homens, mediana de idade: 65 anos). A localização do tumor foi EGJ em 14%, o terço superior do estômago em 30%, o terço médio em 26% e o terço inferior em 28%. Em 196 (67%), foi realizada gastrectomia total com dissecção de linfonodos D2 em 85%. Duzentos e onze pacientes (79%) foram submetidos à gastrectomia aberta. O estado T foi T1 em 23% e T3/T4 em 68%. A mortalidade pós-operatória foi de 2,4% e a taxa de morbidade foi de 41%. A morbidade severa foi de 11% e foi representada principalmente por fístula esofagojejunal (2,4%), fístula duodenal (2,1%) e complicações respiratórias (2%). Na análise multivariada, a localização do EGJ e os tumores T3/T4 foram associados com maior morbidade pós-operatória grave. Conclusão: Morbidade pós-operatória severa após gastrectomia foi de 11%. A localização do tumor na junção esofagogástrica e o estado T3/T4 são fatores de risco para a morbidade pós-operatória grave.

ABSTRACT Background: Gastrectomy is the main treatment for gastric and Siewert type II-III esophagogastric junction (EGJ) cancer. This surgery is associated with significant morbidity. Total morbidity rates vary across different studies and few have evaluated postoperative morbidity according to complication severity. Aim: To identify the predictors of severe postoperative morbidity. Methods: This was a retrospective cohort study from a prospective database. We included patients treated with gastrectomy for gastric or EGJ cancers between January 2012 and December 2016 at a single center. Severe morbidity was defined as Clavien-Dindo score ≥3. A multivariate analysis was performed to identify predictors of severe morbidity. Results: Two hundred and eighty-nine gastrectomies were performed (67% males, median age: 65 years). Tumor location was EGJ in 14%, upper third of the stomach in 30%, middle third in 26%, and lower third in 28%. In 196 (67%), a total gastrectomy was performed with a D2 lymph node dissection in 85%. Two hundred and eleven patients (79%) underwent an open gastrectomy. T status was T1 in 23% and T3/T4 in 68%. Postoperative mortality was 2.4% and morbidity rate was 41%. Severe morbidity was 11% and was mainly represented by esophagojejunostomy leak (2.4%), duodenal stump leak (2.1%), and respiratory complications (2%). On multivariate analysis, EGJ location and T3/T4 tumors were associated with a higher rate of severe postoperative morbidity. Conclusion: Severe postoperative morbidity after gastrectomy was 11%. Esophagogastric junction tumor location and T3/T4 status are risk factors for severe postoperative morbidity.

RESUMO Racional: A gastrectomia laparoscópica tem numerosas vantagens perioperatórias, mas a sobrevivência em longo prazo após este procedimento tem sido menos estudada. Objetivo: Comparar resultados de sobrevivência, oncológica e perioperatória entre a gastrectomia completamente laparoscópica vs. aberta para câncer gástrico precoce. Método: Este estudo foi retrospectivo e os principais resultados foram a sobrevivência global e específica de cinco anos, contagem de linfonodos e taxa de ressecção R0. Resultado secundário foi a morbidade pós-operatória. Resultados: Foram incluídos 116 pacientes (59% homens, idade 68 anos, comorbidades 73%, IMC 25) que foram submetidos a 50 gastrectomias laparoscópicas e 66 gastrectomias abertas. As características demográficas, a localização do tumor, o tipo de operação, a extensão da dissecção dos linfonodos e do estágio não diferiram significativamente entre os grupos. A taxa geral de complicações foi semelhante em ambos os grupos (40% vs. 28%, p=ns) e complicações classificadas Clavien 2 (36% vs. 18%, p=0,03), respiratórias (9% vs. 0%, p=0,03) e as da parede abdominal (12% vs. 0%, p=0,009) foram significativamente menores após a gastrectomia laparoscópica. A contagem de linfonodos (21 contra 23, p=ns) e a taxa de ressecção R0 (100% vs. 96%; p=ns) não diferiram significativamente entre os grupos. A sobrevida global de cinco anos (84% vs. 87%, p=0,31) e a sobrevida específica (93% vs. 98%, p=0,20) não diferiram significativamente entre os grupos de gastrectomia laparoscópica e aberta. Conclusão: Estes resultados suportam resultados oncológicos similares e sobrevida em longo prazo para pacientes com câncer gástrico precoce após gastrectomia laparoscópica e gastrectomia aberta. Além disso, a abordagem laparoscópica está associada com morbidade menos grave e menor ocorrência de complicações respiratórias e da parede abdominal.

ABSTRACT Background: Laparoscopic gastrectomy has numerous perioperative advantages, but the long-term survival of patients after this procedure has been less studied. Aim: To compare survival, oncologic and perioperative outcomes between completely laparoscopic vs. open gastrectomy for early gastric cancer. Methods: This study was retrospective, and our main outcomes were the overall and disease-specific 5-year survival, lymph node count and R0 resection rate. Our secondary outcome was postoperative morbidity. Results: Were included 116 patients (59% men, age 68 years, comorbidities 73%, BMI 25) who underwent 50 laparoscopic gastrectomies and 66 open gastrectomies. The demographic characteristics, tumour location, type of surgery, extent of lymph node dissection and stage did not significantly differ between groups. The overall complication rate was similar in both groups (40% vs. 28%, p=ns), and complications graded at least Clavien 2 (36% vs. 18%, p=0.03), respiratory (9% vs. 0%, p=0.03) and wound-abdominal wall complications (12% vs. 0%, p=0.009) were significantly lower after laparoscopic gastrectomy. The lymph node count (21 vs. 23 nodes; p=ns) and R0 resection rate (100% vs. 96%; p=ns) did not significantly differ between groups. The 5-year overall survival (84% vs. 87%, p=0.31) and disease-specific survival (93% vs. 98%, p=0.20) did not significantly differ between the laparoscopic and open gastrectomy groups. Conclusion: The results of this study support similar oncologic outcome and long-term survival for patients with early gastric cancer after laparoscopic gastrectomy and open gastrectomy. In addition, the laparoscopic approach is associated with less severe morbidity and a lower occurrence of respiratory and wound-abdominal wall complications.

Introduction: In a previous study, a 16-hour reduction in the evaluation of the exponential law of chaotic cardiac dynamics was done, showing its effectiveness in the characterization of disease and normality. Objective: To confirm the clinical applicability of the exponential mathematical law to evaluate chaotic cardiac dynamics from the Holter registers in 16 hours, observing its diagnostic utility when reducing its evaluation time. Design: Cross-sectional observational study where the electrocardiographic parameters were evaluated using inductive mathematical methodologies with statistical confirmation. Methodology: We obtained 100 Holter records from patients with different types of pathology, and 40 Holter that were diagnosed as normal. For each Holter, a chaotic attractor was constructed, and measuring their spaces of occupation and fractal dimension, the mathematical evaluation to differentiate normality of disease was applied. Finally, we calculated measures of diagnostic concordance in accordance with the gold standard. Results: The spatial occupation of all the attractors was within the expected values; the normal records had values in the Kp grid between 205 and 423. For the records with acute disease, these values ranged from 21 y 65; and for chronic disease registries these values ranged from 104 y 195. The values of sensitivity and specificity were 100% and the Kappa coefficient was 1. Conclusion: The present study shows the clinical applicability of this methodology for the evaluation in 16 hours of continuous electrocardiographic or Holter registers.

Introducción. En un estudio previo se realizó una reducción a 16 horas en la evaluación de la ley exponencial de la dinámica cardiaca caótica, mostrando su efectividad en la caracterización de enfermedad y normalidad. Objetivo. Confirmar la aplicabilidad clínica de la ley matemática exponencial para evaluar la dinámica cardiaca caótica a partir de los registros Holter en 16 horas, observando su utilidad diagnóstica al disminuir su tiempo de evaluación. Diseño. Estudio observacional de corte trasversal donde se avaluó los parámetros electrocardiográficos mediante metodologías físico matemáticas inductivas con una confirmación estadística. Metodología. Se tomaron 100 registros Holter con diferentes tipos de patología, y 40 Holter que fueron diagnosticados como normales. Para cada Holter se construyó un atractor caótico, y midiendo sus espacios de ocupación y dimensión fractal se aplicó la evaluación matemática para diferenciar normalidad de enfermedad. Finalmente se realizaron medidas de concordancia diagnostica respecto al estándar de oro. Resultados. La ocupación espacial de todos los atractores estuvieron dentro de los valores esperados; los registros normales presentaron en la rejilla Kp valores entre 205 y 423. Para los registros con enfermedad aguda, estos valores oscilaron entre 21 y 65; y para los registros de enfermedad crónica estos valores estuvieron entre 104 y 195. Los valores de sensibilidad y especificidad fueron de 100% y el coeficiente Kappa fue de 1. Conclusión. El presente estudio muestra la aplicabilidad clínica de esta metodología para la evaluación en 16 horas de registros electrocardiográficos continuos o Holter.

The aim of this study is to develop a method of matrix synthesis for tissue engineering, capable of accelerating reparative processes and reducing the risk of infection, destined to reconstructive surgeries involving bone tissue. For this purpose the bovine bone mineral phase, hydroxyapatite, was used while retaining its dimensional structure. This is obtained from a chemical wash process followed by a thermal process that removes the entire organic components. This matrix is superficially modified with zinc oxide (ZnO), element known for its action in various biological processes and its antibacterial action. The procedure involves the intrusion of ZnO dispersions in alcohol solution-1,2,3-propanetriol, made in a thermal bath and the subsequent high temperature sintering. The degree of attachment and the Zn concentration on the hydroxyapatite matrix is determined by electron microscopy and energy spectrometry. X-ray diffraction shows that the incorporation of Zn ions in the surface forms Zn phosphates. The developed original process allows modifying in a simple way synthetic bone grafts, by providing antibacterial and osteoproliferative properties to the osteoconductive substrate.

El objetivo del presente trabajo es desarrollar un metodo de sintesis de matrices para ingenieria de tejidos, capaces de acelerar los procesos reparativos y disminuir el riesgo de infeccion, destinadas a cirugias reconstructivas que involucren el tejido oseo. A este fin se emplea la fase mineral de hueso bovino, la hidroxiapatita, conservando su estructura tridimensional. Esta se obtiene a partir de un proceso de lavado quimico, seguido de un proceso termico que elimina todos los componentes organicos. Esta matriz es modificada superficialmente con oxido de zinc (ZnO), elemento reconocido por su accion en diversos procesos biologicos y su accion antibacteriana. El procedimiento involucra la intrusion de dispersiones de ZnO en solucion de alcohol-1,2,3 propanotriol, efectuadas en un bano termico y el ulterior sinterizado a alta temperatura. El grado de fijacion y la concentracion del Zn sobre la matriz de hidroxiapatita se determinan por medio de microscopia electronica y espectrometria en energias. La difraccion de rayos X muestra que la incorporacion de los iones de Zn en la superficie forma fosfatos de Zn. El original proceso desarrollado permite modificar, en forma sencilla, injertos oseos sinteticos, otorgando capacidad antibacteriana y osteoproliferativa al sustrato osteconductor.