Abstract The objective of this study is to compare the effectiveness of dextrose-prolotherapy with other substances for pain relief in patients with primary knee osteoarthritis. The literature screening was done in January 2021 through Medline (PubMed), EMBASE, and Database of the National Institute of Health based on the following criteria: randomized clinical trials that subjected patients with primary knee osteoarthritis who underwent treatment with dextrose-prolotherapy and other substances for pain relief. Paired reviewers independently identified 3381 articles and included 8 trials that met the eligibility criteria. According to the findings of this review, participants that underwent dextrose-prolotherapy showed improvements between baseline and posterior assessments and when compared to saline injections, but when compared to other substances, the results were not clear. Although dextrose-prolotherapy is a useful treatment method by itself, it is still not possible to clearly affirm that it is superior or inferior to its counterparts. There is an urgent need for further studies to bring more evidence to the field. HIGHLIGHTS Dextrose injections promote deposition of collagen into injured structures through growth factors and inflammatory cells. Dextrose-prolotherapy is a useful treatment method, but it is not superior or inferior to its counterparts.

Abstract Introduction: The increase in the incidence of pancreatic and biliary cancers has attracted the search for methods of early detection of diseases and biomarkers. The authors propose to analyze new findings on the association between microbiota and Pancreatic Ductal Adenocarcinoma (PDAC) or Cholangiocarcinoma (CCA). Methods: This systematic review was carried out according to the items of Preferred Reports for Systematic Reviews and Protocol Meta-Analysis (PRISMA-P). This study was registered by the Prospective Register of Systematic Reviews (PROSPERO), identification code CRD42020192748 before the review was carried out. Articles were selected from the PUBMED, EMBASE, and Cochrane databases. Results: Most studies (86.67%) used 16s rRNA as a sequencing method. The main comorbidities found were diabetes mellitus, systemic arterial hypertension, and dyslipidemia. Many studies were limited by the small number of participants, but the biases were mostly low. There was very little concordance about the composition of the microbiome of different sites, for both case and control groups when compared to other studies’ results. Bile sample analysis was the one with a greater agreement between studies, as three out of four studies found Escherichia in cases of CCA. Conclusion: There was great disagreement in the characterization of both the microbiota of cases and control groups. Studies are still scarce, making it difficult to adequately assess the data in this regard. It was not possible to specify any marker or to associate any genus of microbiota bacteria with PDAC or CCA.

OBJECTIVES: To evaluate the impact of Burkholderia cepacia complex colonization in cystic fibrosis patients undergoing lung transplantation. METHODS: We prospectively analyzed clinical data and respiratory tract samples (sputum and bronchoalveolar lavage) collected from suppurative lung disease patients between January 2008 and November 2013. We also subtyped different Burkholderia cepacia complex genotypes via DNA sequencing using primers against the recA gene in samples collected between January 2012 and November 2013. RESULTS: From 2008 to 2013, 34 lung transplants were performed on cystic fibrosis patients at our center. Burkholderia cepacia complex was detected in 13 of the 34 (38.2%) patients. Seven of the 13 (53%) strains were subjected to genotype analysis, from which three strains of B. metallica and four strains of B. cenocepacia were identified. The mortality rate was 1/13 (7.6%), and this death was not related to B. cepacia infection. CONCLUSION: The results of our study suggest that colonization by B. cepacia complex and even B. cenocepacia in patients with cystic fibrosis should not be considered an absolute contraindication to lung transplantation in Brazilian centers.

RESUMO Racional: A hernioplastia laparoscópica totalmente extraperitoneal (TEP) é procedimento tecnicamente exigente. Estudos recentes identificaram o IMC como um fator independente para a dificuldade técnica durante o período de aprendizagem. Objetivo: Analisar o efeito do sobrepeso e da obesidade sobre as dificuldades técnicas na TEP. Método: Estudo prospectivo em pacientes submetidos à hernioplastia inguinal sintomática por meio da TEP. Foram analisados gênero, IMC, operação prévia, tipo de hérnia, tempo operatório e presença de complicações. A dificuldade técnica foi definida pelo tempo operatório, complicações maiores e recorrência. Os pacientes foram classificados em quatro grupos: 1) baixo peso, se menor que 18,5 kg/m²; 2) peso normal se IMC entre 18,5 e 24,9 kg/m²; 3) sobrepeso se IMC entre 25 e 29,9 kg/m²; e 4) obesos se IMC≥30 kg/m². Resultados: A coorte incluiu 190 pacientes, 185 homens e cinco mulheres. Os valores de IMC variaram de 16-36 kg/m² (média de 26 kg/m²). O tempo médio de operação foi de 55,4 min nas hérnias bilaterais (15-150) e 37,8 min nas unilaterais (13-150). O tempo cirúrgico foi estatisticamente correlacionado com o aumento do IMC nos primeiros 93 pacientes (p=0,049). Conclusão: IMC elevado e tempo operatório prolongado estão indubitavelmente correlacionados. No entanto, esta relação pode ser estatisticamente significativa apenas no período de aprendizagem. Embora várias características clínicas possam influenciar o tempo cirúrgico, ao chegar a um nível experiente, os cirurgiões parecem lidar facilmente com os desafios.

ABSTRACT Background: Laparoscopic totally extraperitoneal (TEP) hernia repair is a technically demanding procedure. Recent studies have identified BMI as an independent factor for technical difficulty in the learning period. Aim: To analyze the effect of overweight and obesity on the technical difficulties of TEP. Method: Prospective study on patients who underwent a symptomatic inguinal hernia by means of the TEP technique. Were analyzed gender, BMI, previous surgery, hernia type, operative time and complications. Technical difficulty was defined by operative time, major complications and recurrence. Patients were classified into four groups: 1) underweight, if less than 18,5 kg/m²; 2) normal range if BMI between 18,5 and 24,9 kg/m²; 3) overweight if BMI between 25-29,9 kg/m²; and 4) obese if BMI≥30 kg/m². Results: The cohort had a total of 190 patients, 185 men and 5 women. BMI values ranged from 16-36 kg/m² (average 26 kg/m²). Average operating time was 55.4 min in bilateral hernia (15-150) and 37.8 min in unilateral (13-150). Time of surgery was statistically correlated with increased BMI in the first 93 patients (p=0.049). Conclusion: High BMI and prolonged operative time are undoubtedly correlated. However, this relationship may be statistically significant only in the learning period. Although several clinical features can influence surgical time, upon reaching an experienced level, surgeons appear to easily handle the challenges.

Rheumatic diseases are very prevalent, affecting about 7 million people in North America; they affect the musculoskeletal system, often with systemic involvement and potential for serious consequences and limitation on quality of life. Clinical treatment is usually long-term and includes drugs that are considered either simple or complex and are occasionally unknown to many health professionals who do not know how to manage these patients in emergency units and surgical wards. Thus, it is important for clinicians, surgeons and anesthesiologists who are involved with rheumatic patients undergoing surgery to know the basic principles of therapy and perioperative management. This study aims to do a review of the perioperative management of the most commonly used drugs in rheumatologic patients. Manuscripts used in this review were identified by surveying MEDLINE, LILACS, EMBASE, and COCHRANE databases and included studies containing i) the perioperative management of commonly used drugs in patients with rheumatic diseases: and ii) rheumatic diseases. They are didactically discussed according to the mechanism of action and pharmacokinetics; and perioperative management. In total, 259 articles related to the topic were identified. Every medical professional should be aware of the types of drugs that are appropriate for continuous use and should know the various effects of these drugs before indicating surgery or assisting a rheumatic patient postoperatively. This information could prevent possible complications that could affect a wide range of patients.

Among the innovations for the treatment of type 1 diabetes, islet transplantation is a less invasive method of treatment, although it is still in development. One of the greatest barriers to this technique is the low number of pancreas donors and the low number of pancreases that are available for transplantation. Rodent models have been chosen in most studies of islet rejection and type 1 diabetes prevention to evaluate the quality and function of isolated human islets and to identify alternative solutions to the problem of islet scarcity. The purpose of this study is to conduct a review of islet xenotransplantation experiments from humans to rodents, to organize and analyze the parameters of these experiments, to describe trends in experimental modeling and to assess the viability of this procedure. In this study, we reviewed recently published research regarding islet xenotransplantation from humans to rodents, and we summarized the findings and organized the relevant data. The included studies were recent reports that involved xenotransplantation using human islets in a rodent model. We excluded the studies that related to isotransplantation, autotransplantation and allotransplantation. A total of 34 studies that related to xenotransplantation were selected for review based on their relevance and current data. Advances in the use of different graft sites may overcome autoimmunity and rejection after transplantation, which may solve the problem of the scarcity of islet donors in patients with type 1 diabetes.

Cardiopulmonary bypass causes an inflammatory response and consumption of coagulation factors, increasing the risk of bleeding and neurological and renal complications. Its use during lung transplantation may be due to pulmonary hypertension or associated cardiac defects or just for better exposure of the pulmonary hilum. We describe a simple technique, or open pericardium retraction, to improve hilar exposure by lifting the heart by upward retraction of the pericardial sac. This technique permits lung transplantation without cardiopulmonary bypass when bypass use is recommended only for better exposure.

RACIONAL: Dentre as correções endoscópicas das hérnias, as abordagens totalmente extraperitoneal (TEP) e transabdominal pré-peritoneal (TAPP) são amplamente aceitas como alternativas à operação aberta, fornecendo menos dor no período pós-operatório, menor tempo de permanência hospitalar e retorno precoce ao trabalho. A técnica TEP clássica requer três incisões na pele para a colocação de três trocárteres na linha média ou em triangulação. OBJETIVO: Descrever uma técnica utilizando apenas dois trocárteres para hernioplastia laparoscópica totalmente extraperitoneal (TEP). MÉTODO: Acesso extraperitoneal: são inseridos dois trocárteres sobre a linha média; um de 10 mm é inserido no subcutâneo em direção horizontal após incisão infra-umbilical transversal e, em seguida, elevado ao ângulo de 60°; outro de 5 mm é inserido ao nível do pubis com visão direta. Tempos operatórios: 1) dissecção do espaço preperitoneal: introdução da ótica laparoscópica de 0º através da incisão infra-umbilical para visualização e dissecção pré-peritoneal; pressão de insuflação inferior a 12 mmHg; 2) Dissecção de alguns reparos anatômicos: pubis, linha arqueada e vasos epigástricos inferiores; 3) reconhecimento do "triângulo da dor" e "triângulo do desastre"; 4) Inserção através do trocáter de 10 mm de tela de polipropileno de 10x15 cm para cobrir o sitio da hérnia; 5) Reposicionamento do peritônio e da borda dorsal da tela para evitar dobras ou deslocamento da tela. Não é necessária a drenagem. RESULTADOS: Esta técnica foi utilizada em nove pacientes e apresentou bom resultado sem necessidade de um cirurgião auxiliar para executá-la, apenas dois trocáteres, menos material de sutura e de curativos. Além disso, exigiu apenas duas incisões, o que proporcionou melhor resultado estético e menor dor no período pós-operatório. CONCLUSÃO: A técnica proposta utilizando dois trocárteres é uma alternativa viável, com melhora dos resultados cosméticos e financeiros.

BACKGROUND: Among endoscopic hernioplasties, totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) approach are widely accepted alternatives to open surgery, both providing less postoperative pain, hospital length of stay and early return to work. Classical TEP technique requires three skin incisions for placement of three trocars in the midline or in triangulation. AIM: To describe a technique using only two trocars for laparoscopic total extraperitoneal for inguinal hernia repair. METHOD: Extraperitoneal access: place two regular trocars on the midline. The 10 mm is inserted into the subcutaneous in horizontal direction after a transverse infra-umbilical incision and then elevated at 60º angle. The 5 mm trocar is inserted at the same level of the pubis with direct vision. Preperitoneal space dissection: introduction 0º optical laparoscope through the infra-umbilical incision for visualization and preperitoneal dissection; insufflation pressure must be below 12 mmHg. Dissection of some anatomical landmarks: pubic bone, arcuate line and inferior epigastric vessels. Exposure of "triangle of pain" and "triangle of doom". Insertion through the 10 mm trocar polypropylene mesh of 10x15 cm to cover the hernia sites. Peritoneal sac and the dorsal edge of the mesh are repositioned in order to avoid bending or mesh displacement. It is also important to remember that the drainage is not necessary. RESULTS: The 2-port TEP required less financial costs than usual because it is not necessary an auxiliary surgeon to perform the technique. Trocars, suturing material and wound dressing were spared in comparison to the classical technique. Besides, there were only two incisions, which provides a better plastic result and less postoperative pain. CONCLUSION: The TEP technique using two trocars is an alternative technique which improves cosmetic and financial outcomes.

RESUMO INTRODUÇÃO: A autoimunidade e a rejeição após o transplante ainda precisam ser superadas no desenvolvimento técnico de transplante de ilhotas para o tratamento de diabetes tipo 1. Inibir a rejeição de enxertos de ilhotas, mantendo a capacidade do enxerto para segregar insulina é uma estratégia essencial. O uso de agentes imunossupressores reduz a taxa de rejeição aguda em transplantados, mas os efeitos colaterais a longo prazo deve ser evitados. OBJETIVOS: O objetivo do presente estudo é o de organizar e analisar os parâmetros de imunossupressão envolvidos em tentativas experimentais de alotransplante em roedores. METODOLOGIA: Esta avaliação foi realizada utilizando o banco de dados PUBMED para pesquisar artigos publicados que contenham a palavra-chave "o transplante de ilhotas de roedores". Os critérios de inclusão envolveram alotransplante com ilhotas de roedores e as listas de referências das publicações recuperadas que eram elegíveis. Os critérios de exclusão incluíram isotransplante, autotransplante, e xenotransplante definido como o transplante para outras espécies. RESULTADOS: Vinte estudos relacionados ao alotransplante foram selecionados para esta revisão sistemática baseada em imunossupressão. CONCLUSÃO: Novas drogas imunossupressoras aumentaram as taxas de sobrevivência de alotransplante em roedores, reduzindo os efeitos colaterais. Os avanços na imunossupressão levantam a possibilidade de superar a autoimunidade e rejeição após alotransplante.

INTRODUCTION: Autoimmunity and rejection after transplantation must still be overcome in the technical development of islet transplantation for the treatment of type 1 diabetes. It is therefore necessary to inhibit rejection of islet grafts while maintaining the graft's ability to secrete insulin. Although the use of immunosuppressants reduces the acute rejection rate in transplant patients, long-term side effects must be prevented. OBJECTIVES: The aim of the present study is to organize and analyze the parameters of immunosuppression involved in experimental attempts of allotransplantation in rodents. METHODOLOGY: This review was performed using the Pubmed database to search for published articles containing the keywords "rodent islet transplantation". The inclusion criteria involved allotransplantation with rodents' islets and the reference lists of the publications retrieved that were eligible. The exclusion criteria involved isotransplantation, autotransplantation, and xenotransplantation such as transplantation in other species. RESULTS: Twenty studies related to allotransplantation were selected for this systematic review based on immunosuppression. CONCLUSION: New immunosuppressive drugs increased the survival rates of allotransplantation in rodents by reducing the side effects. The advances in immunosuppression raise the possibility of overcoming autoimmunity and rejection after allotransplantation.