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Acta Cirúrgica Brasileira, Volume: 36, Número: 5, Publicado: 2021
  • Effect of IL-33 on pyroptosis of macrophages in mice with sepsis via NF-κB/p38 MAPK signaling pathway Original Article

    Ke, Jingnuan; Cai, Guolong

    Resumo em Inglês:

    ABSTRACT Purpose To demonstrate the effect of IL-33 on the macrophage pyroptosis in mice with sepsis through the NF-kB/p38 MAPK signal pathway. Methods In total, 24 C57BL/6 mice were divided into the sham operation group (sham) and the cecal ligation and puncture group (CLP). After CLP, 24 IL-33-/- mice were divided into the IL-33-/- group and the IL-33-/- intervention group. The latter group was intraperitoneally injected with IL-33. Mouse mortality was observed after CLP. Macrophage apoptosis in peritoneal lavage fluid was detected by flow cytometry. Serum inflammatory factor level was detected by ELISA. Apoptotic protein expression and NF-κB/p38 MAKP signaling pathway protein expression were detected by qRT-PCR and Western blot. Results Knocking out IL-33 significantly reduced the mortality of CLP mice, as well as the mRNA expression of IL-33 and the levels of serum inflammatory factors, including IL-33, IL-1β, and IL-18. It also reduced the rate of macrophage apoptosis and the expression of the apoptotic protein caspase-1 p10; increased the expression of IκBα; and reduced the protein expression of NF-κB and p38 MAPK. These effects were reversed after exogenous injection of IL-33. Conclusions IL-33 can increase the level of macrophage pyroptosis in mice with sepsis (by activating the NF-kB/p38MAPK signal pathway) and the mortality of these mice.
  • Evaluation of barbed suture for celiorrhaphy and subcutaneous closure in bitches with pyometra submitted to ovariohysterectomy Original Article

    Lima, Helen Cristina Gomes de; Ribeiro, Alexandre Pinto; Souza, Jéssica Ávila de; Vieira, Raphael Rogger; Fernandes, Michelly Ferreira

    Resumo em Inglês:

    ABSTRACT Purpose To evaluate the use of barbed sutures over the surgical time, the leukogram, the tissue thickness in which the sutures were employed (ultrasonography), the costs, and the possible complications in bitches with pyometra submitted to ovariohysterectomy (OH). Methods Convectional 2.0 polyglyconate suture was used in the control group (CG n = 10) and 2.0 barbed polyglyconate suture in the barbed group (BG n = 10) to perform celiorrhaphy (simple continuous pattern) and subcutaneous closure (continuous intradermal pattern). Data were assessed using paired (leukogram between 24 and 48 h within the same group) and unpaired (leukogram, surgical time, tissue thickness, and costs) Student’s t-test. The Fisher exact test was used to assess the occurrence of seroma between groups (p < 0.05). Results are shown as mean ± standard error of mean. Results The time spent to perform the celiorrhaphy (195.30 ± 17.37 s vs. 204 ± 16.00 s), subcutaneous closure (174.0 ± 15.86 s vs. 198.0 ± 15.62 s), and the total surgical time (24.30 ± 1.44 min vs. 23.00 ± 1.30 min) did not differ between BG and CG, respectively (p > 0.05). Leukogram at 48 h post-surgery did not differ between groups (p = 0.20). No differences were observed in the subcutaneous and the abdominal wall thickness (cm) assessed by ultrasonography at 48 h in BG (0.31 ± 0.04, 0.80 ± 0.05) and CG (0.34 ± 0.03, 0.72 ± 0.06), respectively. Similarly, 15 days post-surgery the same structures did not differ between BG (0.26 ± 0.02, 0.74 ± 0.08) and CG (0.26 ± 0.03, 0.64 ± 0.05) (p > 0.05). In one bitch from each group, a mild seroma was observed on one side of the surgical wound 48 h after surgery (p = 1.00). The procedures in which barbed sutures were used had an average additional cost of R$ 200.00 ± 11.66 (p < 0.0001). Conclusions Barbed suture has proven to be efficient and safe for abdominal and subcutaneous closure. However, considering its current high cost in addition thatthe surgical time of bitches with pyometra undergone OH was not reduced, no advantages were observed with theuse of barbed sutures for this type of surgery.
  • Histological evaluation of capsules formed by texturized silicone implants with and without polyester mesh coverage (Parietex®). A study on female rats Original Article

    Berger, Ralf; Ribas Filho, Jurandir Marcondes; Malafaia, Osvaldo; Nassif, Paulo Afonso Nunes; Silva, Eduardo Nascimento; Silva, Alfredo Benjamin Duarte da; Takejima, Milka; Souza, Marcelo Augusto de; Paula, Pedro Henrique de; Montemor Netto, Mário Rodrigues; Noronha, Lucia de

    Resumo em Inglês:

    ABSTRACT Purpose To evaluate capsules formed by microtextured silicone implants with and without Parietex® mesh coverage histologically. Methods Sixty Wistar rats were divided in two groups (meshed and unmeshed). Each group was, then, divided into two subgroups for evaluation at 30 and 90 days. Capsules were analyzed based on hematoxylin and eosin (HE) and picrosirius staining. Results The number of fibroblasts, neutrophils and macrophages was similar among all subgroups. There was a higher lymphocyte reaction in the 30-day meshed group (p = 0.003). Giant cell reaction, granulation tissue and neoangiogenesis were similar among the subgroups. Synovial metaplasia was milder at 90-day in the unmeshed (p = 0.002) and meshed group (p < 0.001). Capsular thickness was significantly greater in the meshed samples (30-day p < 0.001 and 90-day p < 0.001). There was a similar amount of collagen types I and III in both groups. Conclusions The mesh-covered implants produced capsules similar to the microtextured ones when analyzing inflammatory variables. Synovial metaplasia was milder at 90 than at 30 days, and the capsular thickness was significantly greater in the meshed group. A similar amount of collagen types I and III was observed. Due to these characteristics, the mesh coverage did not seem to significantly affect the local inflammatory activity.
  • Techniques of orthotopic renal transplantation. II. Size-matched porcine grafts in monkey recipients Original Article

    Takamura, Tsuyoshi; Sasaki, Hiroshi; Hirayama, Haruyuki; Kiyoshi, Akihiko; Inoue, Makoto; Matsui, Kenji; Matsumoto, Naoto; Saito, Yatsumu; Fujimoto, Toshinari; Tajiri, Susumu; Yamanaka, Shuichiro; Matsumoto, Kei; Miyawaki, Takeshi; Yokoo, Takashi; Kobayashi, Eiji

    Resumo em Inglês:

    ABSTRACT Purpose As a classical xenotransplantation model, porcine kidneys have been transplanted into the lower abdomen of non-human primates. However, we have improved upon this model by using size-matched grafting in the orthotopic position. The beneficial aspects and surgical details of our method are reported herein. Methods Donors were two newborn pigs (weighting 5 to 6 kg) and recipients were two cynomolgus monkeys (weighting, approximately, 7 kg). After bilateral nephrectomy, kidneys were cold-transported in Euro-Collins solution. The porcine kidney was transplanted to the site of a left nephrectomy and fixed to the peritoneum. Results Kidneys transplanted to the lower abdomen by the conventional method were more susceptible to torsion of the renal vein (two cases). In contrast, early-stage blood flow insufficiency did not occur in orthotopic transplants of theleft kidney. Conclusions Size-matched porcine-primate renal grafting using our method of transplanting tothe natural position of the kidneys contributes to stable post-transplant blood flow to the kidney.
  • Biomechanical evaluation of a new femoral stem design for total hip replacement in a canine model Original Article

    Faria, Luís Guilherme de; Minto, Bruno Watanabe; Shimano, Antonio Carlos; Macedo, Ana Paula; Diogo, Lucia Maria Izique; Dreibi, Rafael Manzini; Nobile, Matheus; Santos Junior, Wanderley Severo; Kawamoto, Fernando Yoiti Kitamura; Franco, Guilherme Galhardo; Dias, Luis Gustavo Gosuen Gonçalves

    Resumo em Inglês:

    ABSTRACT Purpose To evaluate the biomechanical properties of a novel total hip replacement femoral stem. Methods Eight pairs of femurs from dog cadavers were used. The femurs were separated into different groups. A novel femoral stem with a convex proximal portion (Stem B) was biomechanically evaluated and compared to awell-known veterinary collared stem (Stem A). Femoral stems were inserted into the contralateral femurs from the same dog, forming 16 constructs. A flexo-compression load was applied on the axial axis of each sample. Maximum strength, deflection, stiffness, and energy absorption were analysed. Results Group B constructs showed significantly higher values (p ? 0.05) for the variables, except stiffness. The mean maximum strength was 1,347 ± 357 N for Group A and 1,805 ± 123 N for Group B (p ? 0.0069). The mean deflection was5.54 ± 2.63 mm for Group A and 10.03 ± 3.99 mm for Group B (p ? 0.0056). For the energy variable, the force was 6,203 ± 3,488 N/mm for Group A and 12,885 ± 5,056 N/mm for Group B (p ? 0.0054). Stem B had greater maximum strength, deflection, and energy. Conclusions The new stem was effective in neutralizing the impact of axial flexion-compression stresses during biomechanical tests in cadaveric models.
  • Effects of nandrolone decanoate on femur morphology. Experimental study Original Article

    Souza, Diogo Benchimol de; Brasil, Flavia Bittencourt; Marchon, Roger Gaspar; Félix-Patrício, Bruno

    Resumo em Inglês:

    ABSTRACT Purpose To evaluate the immediate and late effects of nandrolone on femur morphology of rats. Methods Twenty-eight animals with 20 weeks of age were divided into four groups: C28, control animals that were euthanized eight weeks after the experiment started; C40, control animals euthanized 20 weeks after the experiment started; T28, treated animals receiving nandrolone during eight weeks and euthanized immediately after the treatment period; and T40, animals treated during eight weeks and euthanized 12 weeks after the end of the treatment. Treated animals received nandrolone decanoate during eight weeks and control groups received peanut oil by intramuscular injection. After euthanasia, femurs were removed, dissected, weighted and measured by digital pachymeter. Results The T40 group presented an increase on distal epiphysis diameter when compared to C40 group. There was no difference between treated and control groups in relation to body and femur absolute weight, relative weight and length of femur. There was also no difference in relation to diameter of proximal epiphysis and diameter of diaphysis among the groups. Conclusions Nandrolone decanoate does not produce significant effect on femur, exception on its distal extremity at late period. The effects of such drug may depend on the time after administration.
  • Use of hypertonic glucose (10%) in the prevention of postoperative adhesions in rats Original Article

    Nogueira Neto, João; Carmo, Alexandra de Oliveira do; Lima, Laura Sales Carvalho; Gomes, Lyvia Maria Rodrigues de Sousa; Moura, Ed Carlos Rey; Oliveira, Caio Marcio Barros de; Raymundo, Thiers Soares; Melo, George Castro Figueira de; Leal, Plinio da Cunha

    Resumo em Inglês:

    ABSTRACT Purpose To evaluate the efficacy of hypertonic glucose (10%), alone or in combination with the corticoid dexamethasone, to prevent peritoneal adhesion following hysterectomy in rats. Methods Forty-two adult rats underwent hysterectomy with peritoneal lavage: G1 – glucose (10%); G2 – glucose (10%) and dexamethasone 3 mg·kg–1; and G3 – physiological saline (PS) 0.9%. Results In the macroscopic analysis after 14 days, G1 had a median score of 1, G2 of 1, and G3 of 2.5 (p < 0.0001), G3 compared to G1 and G2. There was no difference between groups after 28 days. In the microscopic analysis, the median vascular proliferation after 14 days was 2 for G1, 1 for G2, and 3 for G3 (p = 0.0037, G3 vs. G1 and G2). After 28 days, G1 showed a median vascular proliferation score of 2, G2 of 2.5, and G3 of 3 (p < 0.0001, G3 vs. G1 and G2). Regarding the inflammatory reaction after 14 days, G1 had a median score of 2, G2 of 1, and G3 of 3 (p = 0.7916). After 28 days, G1 had a median score of 0.5 (0–1.75), G2 of 1.5, and G3 of 2.5 (p < 0.0001, G3 vs. the others and G2 vs. G1). In the evaluation of fibrosis after 14 days, G1 had a median score of 1, G2 of 1, and G3 of 2.5 (p < 0.0001, G3 vs. G1and G2). After 28 days, G1 had a median fibrosis score of 1, G2: 2, and G3: 2.5 (p < 0.0001), G3 vs. the others andG2 vs. G1). Conclusions The use of hypertonic glucose (10%) solution seems to reduce macroscopic and microscopic pelvic adhesions.
  • Development and validation of a simulator for teaching minimally invasive thoracic surgery in Brazil Technical Skill

    Martins Neto, Francisco; Moura Júnior, Luiz Gonzaga de; Rocha, Hermano Alexandre Lima; Castro Neto, Josué Viana de; Lima, Alexandre Marcelo Rodrigues; Siqueira, Rafael Pontes de; Castillo, Daniela Lima Chow; Moura, Régis Luiz Sabiá de; Valente, Acrísio Sales

    Resumo em Inglês:

    ABSTRACT Purpose To develop and validate a chest cavity simulator for teaching video-assited thoracic surgery (VATS). Methods The first phase of the study consisted of developing a chest cavity simulator. A quasi-experimental study was performed in the second phase, and 25 surgeons and residents participated in a three-stage pulmonary suture experiment. The videos were recorded and timed. Generalized linear regression models for repeated measures were used to analyze the outcome change over time. Results The chest cavity simulator consists of a console simulating the left hemithorax. Among the participants, 96% rated the design, visual aspect, positioning ergonomics, and triangulation of the portals as very good or excellent (face validity). There was a decrease in suturing time in step 1 from 435.7 ± 105 to 355.6 ± 76.8 seconds compared to step 3 (p = 0.001). The evaluation of the simulation effectiveness and performance (content validity) was rated as very good or excellent by 96% ofparticipants. The most experienced surgeon showed significant reduction in procedure time (p = 0.021) (construct validity). Conclusions The thoracic cavity simulator is realistic, showing content and construct validity, and can be used in VATS training. The simulation model allowed skill gain in the endoscopic suture.
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