ABSTRACT Purpose: To mitigate ischemia-reperfusion injury (IRI) triggered in solid organ transplant procedures, we aimed to evaluate the effects of multi-organ abdominal ischemic preconditioning (MAIP) in the context of renal IRI. Methods: An experimental kidney transplant model was conducted. Rats were divided into three groups: an intervention free basal group from which physiological data was collected; a control group (CT), which consisted of transplanted animals without MAIP; and a treated group, in which a MAIP protocol was implemented in the donor during the procurement of the left kidney, monitoring the recipient for 24 hours. Results: Urea, creatinine, and lactate dehydrogenase, as well as histopathological analysis (Banff: CT 1,66 ± 0,57 vs. basal 0, and MAIP 1), showed a clear trend in favor of MAIP group. Similar results were observed for tumor necrosis factor-α, interleukin-6 and CXCL10, as well as indicators of oxidative stress, with statistically significant levels for CXCL10 [0,295 ± 0,0074 arbitrary units (AU) CT and 0,0057 ± 0,0065 AU MAIP] and TBARS (2,93 ± 0,08 nmol/μg CT; and 2,49 ± 0,23 nmol/μg MAIP; p 0.05). Conclusion: The findings indicated that the MAIP exerts a protective influence on the transplanted kidneys, functioning as an IRI-protective strategy and enhancing the parameters associated with renal graft functionality.

ABSTRACT Purpose: To determine if endoscopic retrograde cholangiopancreatography (ERCP) should be performed with surgery or as a different step, on acute cholecystitis, and which strategy has the least complications and morbimortality. Methods: Various databases (PubMed, Embase, Scopus, Web of Science, Science Direct, Cochrane Central Register of Controlled Trials, CINAHL, Latin American and Caribbean Health Sciences Literature, clinical trials, Google Scholar) were searched for randomized trials comparing the different timings for ERCP and cholecystectomy. No language or time restrictions were applied. Risk of bias was assessed with RoB 2.0 (Cochrane’s Risk of Bias 2), and evidence certainty evaluated using Grading of Recommendations Assessment, Development and Evaluation. Data synthesis used R-4.1.0 Project for Statistical Computing for Windows, with meta-analysis via fixed-effects model and I2 for heterogeneity. Results: Eleven studies was used, and meta-analysis was performed independently for each outcome. Different outcomes were evaluated, with preoperative ERCP as an intervention and intraoperative ERCP as the control: length of stays (four trials with mean differences – MD = -1.44; 95% confidence interval – 95%CI -3,87–0,98); bile leak (odds ratio – OR = 0.67; 95%CI 0.11–4.09); cholangitis (OR = 1.32; 95%CI 0.29–5.98); bleeding from sphincterotomy (OR = 0.98; 95%CI 0.20–4.86); wound infection (OR = 0.33; 95%CI 0.04–3.14); incisional bleeding (OR = 0.5; 95%CI 0.04–5.70); elevated amylase activity (OR = 5.22; 95%CI 2.17–12.59); acute pancreatitis (OR = 4.61; 95%CI 1.72–12.38); operative time (MD = -6,26; 95%CI -37.24–24.73); failure rate (OR = 1.74; 95%CI 0.99–3.05); conversion (OR = 1.34; 95%CI 0.6–2.96); morbidity (OR = 2.75; 95%CI 1.7–4.47). Conclusions: Risk of bias was significant due to lack of blindness. The morbidity, pancreatitis, and elevated amylase activity outcomes were the only ones to find statistical significance and favored the intraoperative approach.

ABSTRACT Purpose: To create tridimensional (3D) anatomical models of diaphyseal fractures in dogs (3D AMDFD) and to evaluate the models from their radiographs. Methods: The study consisted of six stages: preparation of femur from a healthy dog cadaver; digitalization of the bone through a 3D scanner and creation of the base model; creation of a 3D AMDFD based on the image of the base model, 3D modeling carried out to reproduce five different types of diaphyseal fractures; printing the models produced on a 3D printer with a thermoplastic material; insertion of neodymium magnets in the fracture line to allow the assembly and disassembly of the parts; and radiography of 3D AMDFD in lateromedial and craniocaudal positions. Results: The base model and 3D AMDFD had high precision in the replication of bone structures, like the bone in natura. The radiopacity and radiolucency of the 3D AMDFD did not necessarily correspond to the bone densities found in the radiography of the natural canine femur. Conclusion: The 3D AMDFD and their respective radiographs accurately reproduced the anatomical structures and fracture lines.

ABSTRACT Purpose: To identify the prognostic variables related to the survival of patients operated on for adenocarcinoma of the rectum who underwent preoperative radiochemotherapy (RCT). Methods: We studied 70 patients from the Discipline of Surgical Gastroenterology at Escola Paulista de Medicina from 2000 to 2019, with rectal cancer located up to 10 cm from the anal verge and with stages II or III, submitted to preoperative RCT and curative surgery (R0) and with follow-up of at least 12 months. Clinical restaging was performed four to six weeks after the end of neoadjuvant treatment to characterize the degree of clinical tumor regression. Surgery by laparotomy or videolaparoscopy was performed six to 12 weeks after RCT. Primary endpoint were: overall survival (OS), disease-free survival (DFS), metastasis-free survival (MSS), and neoplasm-specific survival (SEN). These were compared with gender, age, carcinoembryonic antigen (CEA) dosage, distance from the tumor to the anal verge, radiation dose, radiotherapy-surgery interval, clinical regression, type of surgery, pT and pN TNM stage tumor, number of nodes, circumferential resection margin, and complete pathological response. Survival was assessed by Kaplan-Meier curves. Univariate and multivariate Cox analyses were calculated to identify factors associated with survival outcomes. Results: The mean follow-up time was 62 months. The pathological complete response rate was 18.6%. Univariate cox regression showed a significant relationship of CEA equal to or greater than 4 ng/mL with DFS and MFS, pT3/pT4 staging with DFS, MFS and SEN, pN1/N2 with DFS, MFS and SEN and stages II and III with DFS and MFS. Multivariate regression found that CEA, pT, and pN staging are independent prognostic factors for DFS, MFS, and SEN. Conclusion: Carcinoembryonic antigen level prior to radiotherapy, pT staging and pN staging were independent prognostic factors for survival in patients with rectal adenocarcinoma who are treated with preoperative radiochemotherapy.

ABSTRACT 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.

ABSTRACT 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.

ABSTRACT Purpose: To establish a profile of the inflammatory response in the preoperative and postoperative period of pulmonary resection of patients without postoperative complications, in order to trace the inflammatory profile of lung resection surgery. Methods: Six collections of arterial and venous blood were performed for data analysis, one sample in the preoperative, immediate postoperative, 4, 8, 24, and 48 hours after surgery. Twenty-seven patients with a median age of 63 years old, ranging from 29 to 80 years old, were included. Results: The leukocyte count showed a significant increase in the times: immediate postoperative and 4 hours after surgery, in relation to the preoperative period. Concomitantly, there was an increase in lactate, heart rate, interleukin (IL)-6 and IL-8 after 4 hours of surgery. The platelet count showed a significant decrease in 48 h, associated with an increase in IL-1β and tumor necrosis factor-α. A significant increase in IL-10 was observed in the immediate postoperative. Conclusion: The study may contribute to the search for more specific and adequate alternatives for controlling the inflammatory response. In this way, the intervention would be specific to that cytokine that causes the greatest harm to the patient, as well as to the moment of the intervention.

ABSTRACT 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.

ABSTRACT Purpose: The degenerative joint disease is a temporomandibular disorder. By analysing texture parameters, it becomes possible to characterize and differentiate various tissues, based on their textural properties according to cone-beam computed tomography (CBCT). This study evaluated degenerative diseases in the temporomandibular joint through texture analysis. Methods: Eighty images of the jaw condyle with three types of degenerative diseases, flattening, osteophytes, erosion and control group were analysed, obtained through CBCT. The analyses were carried out through texture analysis with three regions of interest (ROIs) corresponding to specific bone sites. The scans were exported to MaZda software, in which the ROIs were delimited following previously marked contours, and the co-occurrence matrix values were calculated for selected texture analysis parameters. Results: The erosion group showed a significantly different behaviour from the other groups for all analysed parameters. Conclusion: This study highlights the potential of texture analysis in characterizing medullary bone changes in condyles affected by erosion. Texture analysis allows for a more comprehensive assessment of bone condition on CBCT images. These results have implications for early detection and monitoring of degenerative changes in the temporomandibular joint, thus allowing preventive intervention and personalized treatment planning, improving the prognosis of the disease.

ABSTRACT Purpose: To evaluate whether the effectiveness of topical antiseptic solutions in restoring skin continuity solutions is related to their antimicrobial action or to their action in maintaining moisture, in dogs undergoing elective surgeries. Methods: Forty dogs, 20 males and 20 females, underwent orchiectomy and oophorectomy, respectively. Thereafter, the animals were allocated into four groups (n = 5) and treated with different topical solutions: polyhexanide 0.1% (G1), chlorhexidine digluconate 0.05% (G2), povidone-iodine 0.1% (G3), and sodium chloride 0.9% (control). Macroscopically evaluation of wounds on days 1, 5, and 10 after procedures, and hematological parameters were performed. Data were subjected to statistical analysis (p 0.05) Results: No significant differences in the macroscopic evaluation of the wounds and hematological parameters were observed among groups, in the healing of clean elective surgical wounds. However, applying a topical solution dressing to maintain a moist wound promoted adequate tissue healing. Conclusion: In our experimental conditions, moisture provided by topical antiseptic solutions is an important factor compared to the antiseptic activity of these solutions, for skin wound healing in post-surgical dressings resulting from clean, short-term elective surgeries in male and female dogs. Moreover, the type of topical antiseptic solution used does not influence the development of post-surgical infection.

ABSTRACT Purpose: To evaluate the molecular evolution of endoplasmic reticulum (ER) stress during colorectal cancer carcinogenesis. Methods: Fifty-six hairless mice were divided into two groups: control (no intervention); and carcinogenesis (treated with two doses of azoxymethane at 10 mg/kg during the third and the fourth week and dextran sodium sulfate at 2.5% for seven days in the second, fifth, and eighth week). Euthanasia occurred at the fifth, 10th, 15th, and 20th week. Colons were collected, and gene expression of ER stress markers (IRE1-α, PERK, ATF6, and CHOP) was assessed via real-time quantitative polymerase chain reaction. Results: ERN1 expression was significantly higher than the control at the 10th week (1.39 ± 0.16, p 0.05) and the 20th week (1.15 ± 0.04, p 0.01). ATF6 also showed elevated expression, significantly different at the 10th week (1.71 ± 0.29, p 0.05) and the 20th week (1.14 ± 0.06, p 0.05). PERK and CHOP expressions were significantly higher than the control in the 15th (PERK = 1.30 ± 0.12, CHOP = 1.48 ± 0.23) and 20th weeks (PERK = 1.63 ± 0.20, CHOP = 1.67 ± 0.22, p 0.05). Conclusion: Upregulation of IRN1, PERK, ATF6, and CHOP demonstrates a strong ER stress response during colorectal cancer development.

ABSTRACT Purpose: We aimed to investigate the role of gallic acid treatment on spinal cord tissues after spinal cord injury (SCI) and its relationship with endoplasmic reticulum (ER) stress by histochemical, immunohistochemical, and in-silico techniques. Methods: Thirty female Wistar albino rats were divided into three groups: sham, SCI, and SCI+gallic acid. SCI was induced by dropping a 15-g weight onto the exposed T10-T11 spinal cord segment. The SCI+gallic acid group received 25 mg/kg of gallic acid intraperitoneally daily for one week. Histopathological, immunohistochemical, and silico analyses were performed. Results: Histological analysis revealed improved neural cell survival and tissue integrity in the SCI+gallic acid group compared to the SCI group. Caspase-12 expression was significantly increased in the SCI group, indicating elevated ER stress and apoptosis. Gallic acid treatment resulted in a marked reduction in caspase-12 expression in neurons, neuroglia, and endothelial cells, suggesting decreased ER stress. Conclusion: Gallic acid exhibits significant neuroprotective effects against ER stress and cellular damage in a rat model of SCI. The in-silico analysis revealed apoptotic and immune-related pathways in which gallic acid showed neuroprotective effects by regulating caspase-12. These results suggest that gallic acid may be a promising therapeutic agent for mitigating secondary damage post-SCI.

ABSTRACT Purpose: To investigate the relationship between the cartilage acetabular index and acetabular development and secondary dysplasia. Methods: A total of 58 hips underwent intraoperative arthrography-guided open reduction or limited open reduction due to developmental hip dysplasia between 2011 and 2015 was included in the study. We evaluated patients with acetabular angle 8º as group 2. Intraoperative acetabular cartilage index measurements were performed, and patients with low and high cartilage acetabular index were divided into two groups. Results: There was a correlation between the cartilage acetabular index value, which indicates preoperative cartilage acetabular coverage, and acetabular development and secondary acetabular development. Conclusion: The cartilage acetabular index is a technically easy and uncomplicated evaluation method that can be used to estimate acetabular development and should be used routinely together with the bone acetabular index.