Use of 3D Anorectal Ultrasonography in the Preoperative Assessment of Complex Anal Fistulas and Patterns of Healing, Failure, and Recurrence After Ligation of the Intersphincteric Fistula Tract (LIFT).

OBJECTIVES: To use three-dimensional anorectal ultrasonography (3D-US) to evaluate the outcome of ligation of the intersphincteric fistula tract (LIFT) in patients with crypto-glandular transsphincteric fistula and describing the patterns of healing, failure, and recurrence rate. METHODS: After classifying the fistula and determining the length of the sphincter muscle to be transected, the patients were submitted to LIFT. The accuracy of pre- and postoperative 3D-US with 360° endoprobe (16 MHz) with automatic scanning and clinical findings was evaluated against surgical findings. Three outcomes were considered: healing, failure (persistent anal fistula through the original external opening or intersphincteric), and recurrence (reappearance of the anal fistula). RESULTS: Sixty-three patients of both sexes were evaluated. The 3D-US assessment revealed primary healing in 50 (79.3%) patients, although in 6 (9.5%) cases healing was delayed and the cavity was without communication with the anal canal. The procedure failed in 9 (15.9%) and fistula recurred in 4 (6.3%), all of whom underwent a second surgery based on a new 3D-US, resulting in a 92.3% (12/13) healing rate on 3D-US. CONCLUSIONS: A 3D-US was found to be useful in the preoperative assessment of fistulas by quantifying the percentage of muscle to be transected, and in the postoperative assessment by identifying healing, types of failure, and recurrence. The 3D-US was accurate and consistent with surgical findings.

Spatial and Temporal analysis (2008-2017) of droughts and their effects on livestock in the Brazilian semi-arid region.

In this study a temporal analysis (2008-2017) was conducted to examine the occurrence of droughts and the spatial distribution of livestock herds in the Brazilian semi-arid region. Maps of vegetation cover, classes of normalized difference vegetation index (NDVI) and normalized difference drought index (NDDI) were used. Image processing took place on the Google Earth Engine platform along with QGIS Software (2.18). Two historical series were created to compare the variation between two herds and the dry monitoring, one called the 1st series (2008-2012) and 2nd series (2013-2017) which were compared using a paired t-test. The comparative analysis showed that the classes of extreme drought and exceptional drought covered the greatest land areas in the 2nd series, while abnormal drought covered the greatest land area in the 1st series. The analysis of herds, a reduction in the cattle herd and an increase in goat and sheep herds were noted. This study considers the efficacy of NDDI and NDVI indices to monitor the distribution of droughts in the Brazilian semi-arid region. The geoprocess of Sidra data enabled an analysis of the spatial distribution and temporal variation of the herds in the semi-arid region and how drought may have impacted livestock dynamics.

Myelopathy in sickle cell disease: a case-oriented review.

INTRODUCTION: Although neurological complications are well recognized in patients with sickle cell disease, myelopathy has been rarely described, with few reported cases of compressive and ischemic myelopathy. We present the first case report of longitudinally extensive myelitis (LETM) in SCD and review the differential diagnosis of myelopathy in these patients. CASE PRESENTATION: We report the case of a 29-year-old African-Brazilian man with SCD, who experienced a subacute flaccid paraparesis, with T2 sensory level and urinary retention. Cerebrospinal fluid analysis showed a lymphocytic pleocytosis and increased protein levels. MRI disclosed a longitudinally extensive spinal cord lesion, with a high T2/STIR signal extending from C2 to T12. We searched Medline/PubMed, Embase, Scopus, and Google Scholar databases for myelopathy in SCD patients. DISCUSSION: Spinal cord compression by vertebral fractures, extramedullary hematopoietic tissue, and Salmonella epidural abscess have been reported in SCD. We found only three case reports of spinal cord infarction, which is unexpectedly infrequent compared to the prevalence of cerebral infarction in SCD. We found only one case report of varicella-zoster myelitis and no previous report of LETM in SCD patients. Specific and time-sensitive causes of myelopathy should be considered in SCD patients. In addition to compression and ischemia, LETM is a possible mechanism of spinal cord involvement in SCD patients.

Spectral responses in rangelands and land cover change by livestock in regions of the Caatinga biome, Brazil.

This study aimed to analyze fragments of rangelands through spectral responses and land cover change by livestock in regions of the Caatinga biome through remote sensing. For spectral behavior, the surface reflectance bidirectional (SRB) and spectral indexes of vegetation were used to verify the ragelands seasonality. Land cover change detection of Ouricuri and Tauá through Landsat-8 images with a 16-day revisit interval, were processed in the Google Earth Engine platform (GEE) and software Quantum GIS version 2.18 (QGIS). In the GEE platform, annual mosaics and stacking of the spectral bands were generated for the classification of images, and in sequence the production of thematic maps in QGIS. The analysis of land cover change considered the classes: thinned Caatinga, conserved Caatinga, herbaceous vegetation, bare soil, water and others. The analysis of the spectral responses showed that the vegetation monitored in Ouricuri presented higher SRB in the infrared band and lower SRB in the red and blue bands, and that caused the pasture to produce higher vegetation indexes than the other locations. Through validation, it was observed that in Tauá, there was an overall accuracy of 91% and Kappa index of 89%, and in Ouricuri there was an overall accuracy of 90% and Kappa index of 86%, indicating excellent correctness of the classification model. The classification model proved to be effective in verifying the temporal and spatial land cover change, making it possible to identify places with the vegetation that was most affected and susceptible to degradation and generation of political support to minimize damage to the Caatinga Biome.

Percutaneous solutions for biliary stent dysfunction: pictorial essay.

Plastic and metal biliary stents can fail to function properly, such failure being due to a positioning error or to the migration, occlusion, or fracture of the stent. An obstructed biliary stent can act as a nidus, causing complications such as recurrent persistent cholangitis. It can also cause vascular complications (such as bleeding and the formation of pseudoaneurysms), perforate the liver capsule (causing biloma or abscess), or, in rare cases, cause intestinal obstruction or perforation. In this pictorial essay, we demonstrate various interventional radiology techniques for the treatment of biliary stent dysfunction in patients with obstructive biliary disease.

Disfunção das próteses biliares plásticas ou metálicas pode ser causada por migração, oclusão, mau posicionamento ou fratura. Uma prótese disfuncional na via biliar pode atuar como nidus causando complicações como colangite recorrente e persistente. Pode ainda causar complicações vasculares como formação de pseudoaneurismas ou sangramento, e além disso, perfurar a cápsula hepática causando biloma ou abscesso, ou raramente, causar obstrução intestinal e/ou perfuração. Demonstramos diferentes técnicas da radiologia intervencionista no tratamento de endopróteses biliares plásticas e metálicas disfuncionais, em pacientes com doença biliar obstrutiva.

Percutaneous solutions for biliary stent dysfunction: pictorial essay / Soluções percutâneas para próteses biliares disfuncionantes: ensaio iconográfico

Abstract Plastic and metal biliary stents can fail to function properly, such failure being due to a positioning error or to the migration, occlusion, or fracture of the stent. An obstructed biliary stent can act as a nidus, causing complications such as recurrent persistent cholangitis. It can also cause vascular complications (such as bleeding and the formation of pseudoaneurysms), perforate the liver capsule (causing biloma or abscess), or, in rare cases, cause intestinal obstruction or perforation. In this pictorial essay, we demonstrate various interventional radiology techniques for the treatment of biliary stent dysfunction in patients with obstructive biliary disease.

Resumo Disfunção das próteses biliares plásticas ou metálicas pode ser causada por migração, oclusão, mau posicionamento ou fratura. Uma prótese disfuncional na via biliar pode atuar como nidus causando complicações como colangite recorrente e persistente. Pode ainda causar complicações vasculares como formação de pseudoaneurismas ou sangramento, e além disso, perfurar a cápsula hepática causando biloma ou abscesso, ou raramente, causar obstrução intestinal e/ou perfuração. Demonstramos diferentes técnicas da radiologia intervencionista no tratamento de endopróteses biliares plásticas e metálicas disfuncionais, em pacientes com doença biliar obstrutiva.

Polymorphisms in Inflammatory Genes Modulate Clinical Complications in Patients With Sickle Cell Disease.

Sickle cell disease (SCD), the most common monogenic disease worldwide, is marked by a phenotypic variability that is, to date, only partially understood. Because inflammation plays a major role in SCD pathophysiology, we hypothesized that single nucleotide polymorphisms (SNP) in genes encoding functionally important inflammatory proteins might modulate the occurrence of SCD complications. We assessed the association between 20 SNPs in genes encoding Toll-like receptors (TLR), NK cell receptors (NKG), histocompatibility leukocyte antigens (HLA), major histocompatibility complex class I polypeptide-related sequence A (MICA) and cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), and the occurrence of six SCD clinical complications (stroke, acute chest syndrome (ACS), leg ulcers, cholelithiasis, osteonecrosis, or retinopathy). This study was performed in a cohort of 500 patients. We found that the TLR2 rs4696480 TA, TLR2 rs3804099 CC, and HLA-G, rs9380142 AA genotypes were more frequent in patients who had fewer complications. Also, in logistic regression, the HLA-G rs9380142 G allele increased the risk of cholelithiasis (AG vs. AA, OR 1.57, 95%CI 1.16-2.15; GG vs. AA, OR 2.47, 95%CI 1.34-4.64; P = 0.02). For SNPs located in the NKG2D loci, in logistic regression, the A allele in three SNPs was associated with a lower frequency of retinopathy, namely, rs2246809 (AA vs. GG: OR 0.22, 95%CI 0.09-0.50; AG vs. GG: OR 0.47, 95%CI 0.31-0.71; P = 0.004, for patients of same origin), rs2617160 (AT vs. TT: OR 0.67, 95%CI 0.48-0.92; AA vs. TT: OR 0.45, 95%CI 0.23-0.84; P = 0.04), and rs2617169 (AA vs. TT: OR 0.33, 95%CI 0.13-0.82; AT vs. TT: OR 0.58, 95%CI 0.36-0.91, P = 0.049, in patients of same SCD genotype). These results, by uncovering susceptibility to, or protection against SCD complications, might contribute to a better understanding of the inflammatory pathways involved in SCD manifestations and to pave the way for the discovery of biomarkers that predict disease severity, which would improve SCD management.

Giant appendiceal mucinous cystadenoma treated by laparoscopy: a case report and review of the literature / Cistadenoma mucinoso apendicular gigante tratado por laparoscopia: relato de caso e revisão de literatura

ABSTRACT Appendiceal mucinous cystadenoma is a rare entity, which causes appendicular mucocele. It is more frequent in women over 50 years old. In half of the cases it is asymptomatic. Tomography of the abdomen is the gold standard in its preoperative diagnosis. The treatment is surgical, with good prognosis, the complete resection evolves without appendicular rupture and extravasation. We report a case of a 64-year-old man with appendiceal mucinous cystadenoma. A laparoscopic right hemicolectomy was performed. This therapy that can be safely used to treat appendiceal mucocele, as long as it is cautious.

RESUMO O cistadenoma mucinoso apendicular é entidade rara que causa mucocele apendicular, sendo mais frequente em mulheres acima dos 50 anos. Em metade dos casos, o cistadenoma mucinoso apendicular é assintomático. A tomografia do abdome é o padrão-ouro para um diagnóstico pré-operatório. O tratamento é cirúrgico e tem bom prognóstico; a ressecção completa evolui sem ruptura apendicular e sem extravasamento. Relatamos um caso de paciente homem de 64 anos com cistadenoma mucinoso apendicular. Foi realizada hemicolectomia laparoscópica direita. Esse é um procedimento que pode ser usado com segurança no tratamento de mucocele apendicular, desde que seja executado com cautela.

DEB TACE for Intermediate and advanced HCC - Initial Experience in a Brazilian Cancer Center.

BACKGROUND: According to Barcelona Clinic Liver Cancer classification transarterial chemoembolization is indicated in patients with Hepatocellular Carcinoma in the intermediate stage. Drug-eluting microspheres can absorb and release the chemotherapeutic agent slowly for 14 days after its intra-arterial administration. This type of transarterial chemoembolization approach appears to provide at least equivalent effectiveness with less toxicity. METHODS: This is a prospective, single-center study, which evaluated 21 patients with intermediate and advanced hepatocellular carcinoma who underwent transarterial chemoembolization with drug-eluting microspheres. The follow up period was 2 years. Inclusion criteria was Child-Pugh A or B liver disease patients, intermediate or advanced hepatocellular carcinoma and performance status equal or below 2. Transarterial chemoembolization with drug-eluting microspheres was performed at 2-month intervals during the first two sessions. The third and subsequent sessions were performed according to the image findings on follow-up, on a "demand schedule". Tumor response and time to progression were evaluated along the two-year follow up period. RESULTS: Of the 21 patients 90% presented with liver cirrhosis, 62% had Barcelona Clinic Liver Cancer stage B and 38% had Barcelona Clinic Liver Cancer stage C hepatocellular carcinoma. Average tumor size was 6.9 cm. The average number of Transarterial chemoembolization with drug-eluting microspheres procedures was 3 with a total of 64 sessions. The predominant toxicity was mild. Liver function was not significantly affected in most patients. Two deaths occurred within 90 days after Transarterial chemoembolization with drug-eluting microspheres (ischemic hepatitis and hydropic decompensation). Technical success was achieved in 63 of 64 procedures. The mean hospital stay was 1.5 days. The progression free and overall survival at 1 and 2 years were 73.0% and 37.1%, 73.7% and 41.6%, respectively. CONCLUSION: Transarterial chemoembolization with drug-eluting microspheres is able to deliver significant tumor response and progression free survival rate with acceptable toxicity. Larger studies are needed to identify exactly which subset of advanced hepatocellular patients may benefit from this treatment. TRIAL REGISTRATION: study ID ISRCTN16295622. Registered October 14th 2016. Retrospectively registered. Website registration: http://www.isrctn.com/ISRCTN16295622.

Infliximab-induced autoantibodies: a multicenter study.

The purpose of this study was to assess autoantibody incidence in patients treated with infliximab for various diseases, and the development of autoimmune diseases using a multicenter, longitudinal, open-label, phase IV observational study. All patients received anti-tumor necrosis factor (anti-TNF) according to local treatment guidelines. The autoantibodies assessed before and after infliximab treatment were ANA, anti-Sm, anti-dsDNA, anticardiolipin IgM/IgG, anti-Scl70, anti-centromere B, anti-chromatin, anti-ribosomal P, anti-Sm-RNP, anti-RNP A, anti-RNP 68 kD, anti-La/SSB, anti-Ro/SSA 52 kD and 60 kD, and anti-Jo1. ANA was determined by indirect immunofluorescence on HEp-2 cells (INOVA); the remaining was assessed using BioPlexTM 2200. The Fisher exact test, Wilcoxon test, and the McNemar were used when appropriate.Two hundred eighty-six patients were included (139 with rheumatoid arthritis, 77 with ankylosing spondylitis, 29 with inflammatory bowel disease, 27 with psoriatic arthritis, and 14 with psoriasis), 167 females and 119 males, with mean age of 46.3 years. Subjects received at least five infusions of infliximab (6-month treatment). A significant difference was observed in antinuclear antibody (ANA) detection between samplings (p = 0.001). Among patients that had ANA before treatment (n = 92), six became ANA-negative, 48 had increased titers, 29 maintained, and nine decreased titers after treatment; a total of 186 patients had a positive ANA after treatment. Fine speckled nuclear pattern was most commonly observed (both before and after infliximab treatment). The number of patients with anti-dsDNA had a statistically significant increase (p = 0.003). No significant differences were noted for anticardiolipin and the remaining autoantibodies tested. Among the 286 patients included in the study, only one (0.35 %) showed clinical signs of drug-induced lupus, presenting elevated ANA and anti-dsDNA titers that normalized once treatment was discontinued. Infliximab induced the formation of autoantibodies in the combined population (ANA and anti-dsDNA with no apparent clinical importance).

Thrombotic events in patients with antiphospholipid syndrome treated with rivaroxaban: a series of eight cases.

The current treatment for antiphospholipid syndrome (APS) with thrombotic manifestation is long-term anticoagulation. Vitamin K antagonists (VKA) are usually the agents of choice. However, VKA limitations, such as unpredictable anticoagulation effects due to interaction with diet and other drugs, require regular monitoring. This may impact on patients' quality of life. Since the approval of new oral anticoagulants (NOAC) for non-valvular atrial fibrillation and deep vein thrombosis prevention, much has been speculated about its use in APS patients. We report here a series of eight APS patients with failure of thrombotic prevention during rivaroxaban use. All patients had venous thrombosis as the initial manifestation of APS, and two of them also had arterial manifestations. Three patients had triple antibody positivity. Five patients developed arterial events during the treatment with rivaroxaban. Until the results of ongoing trials of rivaroxaban for APS are presented, NOAC should not be recommended to APS patients. Our preliminary experience as well cases previously reported in the literature suggest that there is a high-risk group that is less protected with rivaroxaban, namely those with previous arterial thrombosis or triple positivity. VKA remains to be the mainstay treatment for thrombotic APS.

Lipoaspiração e embolia gordurosa: revisão de literatura / Liposuction and fat embolism: a literature review

A cirurgia de lipoaspiração é com alguma frequência relacionada a consequências dramáticas ou fatais, causando grande repercussão no meio médico e principalmente na mídia leiga. Esse fato não deve fazer com que o cirurgião plástico evite essa cirurgia, mas sim estimulá-lo a conhecer profundamente a fisiopatologia inerente ao procedimento, buscando meios embasados de realizá-lo da forma mais segura possível, reduzindo ao máximo os riscos de complicações, principalmente as mais graves. Esse artigo teve o objetivo de realizar uma revisão bibliográfica a respeito especificamente da embolia gordurosa causada pela lipoaspiração, relacionada inúmeras vezes a pós-operatórios dramáticos e fatais. Além disso, ressalta alguns cuidados preventivos para uma maior segurança com esse procedimento.

Liposuction surgery is often associated with severe or fatal consequences, causing great repercussions in the medical field, and especially in the lay media . This should not cause the plastic surgeon to avoid the procedure, but rather should promote deeper knowledge of the basic pathophysiology. All means to accomplish the surgery in the safest possible way should be utilized, to minimize the risk of complications, especially the most severe risks. This article reviews the literature on liposuction-induced fat embolism, which is often associated with severe complications in the postoperative period, and even fatal outcomes. In addition, this study highlights several preventive measures that can be adopted to ensure greater safety of this procedure.

Dor muscular e atividade de creatina quinase após ações excêntricas: uma análise de cluster / Muscle soreness and creatine kinase activity after eccentric actions: a cluster analysis / Dolor muscular y actividad de creatina kinasa tras acciones excéntricas: un análisis de cluster

INTRODUÇÃO: O exercício excêntrico máximo promove queda da capacidade de geração de força, aumento de dor muscular de início tardio (DMIT) e extravasamento de creatina quinase (CK) no sangue. No entanto, essas respostas ao exercício excêntrico demonstram alta variabilidade interindivíduos. OBJETIVOS: Classificar e analisar essas respostas segundo a vulnerabilidade individual, por meio da magnitude da redução dos níveis de força após exercício excêntrico. MÉTODOS: Dezoito sujeitos (11 homens e sete mulheres com idade entre 18 e 71 anos) saudáveis realizaram cinco séries de seis ações excêntricas máximas para flexores do cotovelo em dinamômetro isocinético (90°s- 1, amplitude de movimento de 80 a 20°). Foram analisadas contração voluntária muscular concêntrica máxima (CVM), DMIT e CK pré, pós (exceto CK), 24 h, 48 h, 72 h e 96 h após o protocolo. Os indivíduos foram classificados como "baixos" (BR) e "altos" respondedores (AR) ao pico de queda de CVM pós-exercício seguindo-se uma análise de cluster e comparação entre grupos para CVM, DMIT e CK com teste-t independente. RESULTADOS: A comparação entre BR e AR indicou maiores valores de queda de CVM para o grupo AR (AR: -30,7 ± 3,3%; BR: -14,1 ± 2,2%, p < 0,001) e maior DMIT também para o grupo AR (AR: 33,0 ± 8,6 mm; BR: 10,2 ± 2,5 mm, p = 0,033); no entanto, os valores de pico de atividade de CK não diferiram entre os grupos (AR: 232,1 ± 54,8 UI.L- 1; BR: 306,1 ± 82,3 UI.L- 1, p = 0,490). CONCLUSÃO: A classificação dos indivíduos em grupos de baixos e altos respondedores foi importante para demonstrar que o grupo mais responsivo à queda de força após exercício excêntrico ...

INTRODUCTION: Maximal eccentric exercise promotes decreases in muscular strength, increases in delayed-onset muscle soreness (DMIT) and leakage of creatine kinase (CK) in the blood. However, these responses to eccentric exercise demonstrated large inter-individual variability. OBJECTIVES: To classify and analyze these responses according to individual vulnerability through the magnitude of the reduction of strength following eccentric exercise. METHODS: Eighteen healthy subjects (11 men and seven women aged 18 to 71 years) performed five sets of six maximal isokinetic eccentric actions of the elbow flexors using an isokinetic dynamometer (90°s- 1, range of motion 80-20°). Maximum voluntary concentric muscle contraction (CVM), DMIT and CK pre-, post (except CK), 24h, 48h, 72h and 96h were analyzed after the protocol. Individuals were classified as "low" (BR) and "high" (AR) responders at the peak of CVM decrease post-exercise using a k-means cluster analysis and compared between groups for CVM, DMIT and CK with independent t-test. RESULTS: The comparison between BR and AR showed higher CVM decrease for AR (AR: -30.7±3.3%, BR: -14.1±2.2%, p<0.001) and higher DMIT also for AR group (AR: 33.0±8.6 mm; BR: 10.2±2.5 mm, p=0.033) however, the peak values of CK activity did not differ between groups (AR: 232.1±54.8 UI.L- 1, BR: 306.1±82.3 UI.L- 1, p=0.490). CONCLUSION: The classification of the subjects into low and high responders groups was important to demonstrate that the most responsive group to strength decrease after eccentric exercise also shows higher DMIT levels; notwithstanding, for creatine kinase this relation could not be established. .

INTRODUCCIÓN: El ejercicio excéntrico máximo promueve reducciones de capacidad de generación de energía, aumento de dolor muscular de aparición tardía (DMIT), y escape de creatina kinasa (CK) en la sangre. Sin embargo, estas respuestas al ejercicio excéntrico demostraron una gran variabilidad interindividual. OBJETIVOS: Clasificar y analizar las respuestas de acuerdo a la vulnerabilidad individual al grado de disminución de la fuerza después del ejercicio excéntrico. MÉTODOS: Dieciocho sujetos sanos (11 hombres y siete mujeres de entre 18 a 71 años) han realizado cinco series de seis acciones excéntricas isocinéticas máximas de los flexores del codo utilizando un dinamómetro isocinético (90º s- 1, rango de movimiento 80-20°). La contracción concéntrica muscular voluntaria máxima (CVM), DMIT y CK pre-, inmediatamente después (excepto CK), 24h, 48h, 72h y 96h fue analizada después del protocolo. Los individuos fueron clasificados en "bajos" (BR) y "altos" (AR) respondedores, conforme el pico de declinación en la CVM después del ejercicio mediante un análisis de cluster y comparados entre los grupos para la CVM, DMIT y CK con pruebas t-independientes. RESULTADOS: La comparación entre BR y AR indicó mayor disminución de la CVM para AR (AR: -30,7 ± 3,3%, BR: -14,1 ± 2,2%, p < 0,001) y mayor DMIT también para AR (AR: 33,0 ± 8,6 mm; BR : 10,2 ± 2,5 mm, p = 0,033), sin embargo, los valores de pico de actividad de la CK no difirieron entre los grupos (AR: 232,1 ± 54,8 UI.L-1, BR: 306,1 ± 82,3 UI.L-1, p = 0,490). CONCLUSIÓN: La clasificación de los sujetos en los grupos bajos y altos respondedores fue importante para demostrar que el grupo más sensible a la disminución de la fuerza después del ejercicio excéntrico ...

Avaliação oncológica após reconstrução mamária com lipoenxertia / Oncologic evaluation after breast reconstruction with fat grafting

Introdução: A reconstrução mamária é etapa fundamental no tratamento de pacientes com câncer de mama, sendo a lipoenxertia um importante recurso para melhora no resultado estético. Todavia, recentemente, alguns autores têm questionado a segurança da lipoenxertia, sugerindo que essa técnica possa aumentar o risco de recidiva tumoral local. Métodos: Estudo retrospectivo, tipo coorte transversal, realizado por meio de revisão de prontuários médicos de pacientes submetidas a reconstrução mamária com lipoenxertia pela Divisão de Cirurgia Plástica do Hospital das Clínicas da FMRP-USP, no período de 2006 a 2010. Resultados: Foram selecionadas 18 pacientes, sendo que oito (44%) apresentaram tumor do tipo histológico ductal. Três pacientes (17%) foram submetidas a quimioterapia neoadjuvante, sendo que destas, duas (11%) foram submetidas também a quimioterapia adjuvante; nove (50%) foram submetidas apenas a quimioterapia adjuvante. Onze pacientes (61%) foram submetidas a radioterapia adjuvante, e treze (72%) fizeram tratamento hormonal. Quanto à reconstrução da mama, oito pacientes (44,4%) realizaram TRAM, seis (33,3%), expansor mais prótese e quatro (22,2%), grande dorsal mais prótese. O número de sessões de lipoenxertia variou entre um e quatro. Não foi identificado nenhum caso de recidiva tumoral locorregional. Conclusão: Não foi evidenciado nenhum caso de recidiva tumoral locorregional, o que acrescenta, até o momento, confiabilidade e segurança à lipoenxertia como arsenal para os procedimentos que visam melhorar os resultados da reconstrução mamária após o tratamento oncológico.

Introduction: Breast reconstruction is an essential step in the treatment of patients with breast cancer. Fat grafting is an important resource for improved esthetic results. Recently, however, some authors have questioned the safety of fat grafting, suggestoncolóing that this technique can increase the risk of local tumor recurrence. Methods: A retrospective, cross-sectional cohort study was conducted through a review of medical records of patients who underwent breast reconstruction with fat grafting by the Plastic Surgery Division of the Clinical Hospital of the Ribeirão Preto Faculty of Medicine of the University of São Paulo (FMRP-USP), from 2006 to 2010. Results: We selected 18 patients, of whom eight (44%) had ductal carcinoma by histology. Three patients (17%) underwent neoadjuvant chemotherapy, and of these, two (11%) were also subjected to adjuvant chemotherapy. Nine (50%) received only adjuvant chemotherapy. Eleven patients (61%) underwent adjuvant radiotherapy, and thirteen (72%) had hormonal therapy. For breast reconstruction, eight patients (44.4%) underwent a transverse rectus abdominis myocutaneous (TRAM) flap procedure, six (33.3%) had an expander and prostheses, and four (22.2%) underwent a procedure with the latissimus dorsi muscle flap and prostheses. The number of fat grafting sessions ranged from one to four. No cases of locoregional recurrence of breast cancer were identified. Conclusion: There has been no evidence of locoregional recurrence to date, demonstrating that fat grafting is a reliable and safe procedure for improving the results of breast reconstruction after cancer treatment.

Comparison in responses to maximal eccentric exercise between elbow flexors and knee extensors of older adults.

OBJECTIVES: To compare the susceptibility of elbow flexors (EF) and knee extensors (KE) to eccentric exercise-induced muscle damage in older individuals, since ageing could modulate the difference in the susceptibility to muscle damage between muscles. DESIGN: Cross-sectional and cross-over study design. METHODS: Eight older (61.6 ± 1.8 years) adults performed 5 sets of 6 maximal isokinetic (90° s(-1)) eccentric contractions of the EF (range of motion: 80-20°) and KE (30-90°) with the non-dominant limb in a randomised, counterbalanced order with 2 weeks between bouts. Maximal voluntary isometric (MVC-ISO) and concentric contraction torque, optimum angle, range of motion (ROM), muscle soreness and serum creatine kinase (CK) activity were measured before, immediately after (except CK), and 24, 48, 72 and 96 h following exercise. Normalised changes in the variables following exercise were compared between EF and KE by a mixed model analysis of variance. RESULTS: Only MVC-ISO and ROM demonstrated significant group effects (p<0.05) for the comparison between EF and KE. Additionally, no significant group vs. time interactions (p>0.05) were found between EF and KE for any of the dependent variables changes. CONCLUSIONS: These results suggest that the KE of older adults are relatively as susceptible to muscle damage as their EF, or at the very least, the difference between EF and KE are small for older adults.

Immune responses to an upper body tri-set resistance training session.

The purpose of this study was to evaluate the acute immune responses to an upper body tri-set resistance training (RT) session in RT trained individuals. Eighteen young trained men (22·0 ± 1·8 years) were randomly assigned to an exercise group (EG; n = 9) or control group (CG; n = 9). The EG completed an acute tri-set RT protocol using two combinations of three exercises for the same muscle group with six to eight repetitions at 75% of one repetition maximum (1RM) for each exercise. Blood samples were collected before (Pre), and 15 min (Post) and 24 h (P24h) after the acute RT protocol to determine basal and acute total leucocytes and leucocyte subsets counting, interleukin-6 (IL-6), tumour necrosis factor-α (TNF-α) and cortisol. There were significant increases in total leucocytes, monocytes and neutrophils at Post as compared with Pre (P<0·05). Additionally, total leucocytes and monocytes were reduced even at P24h when compared to Pre (P<0·05). There were no significant changes in plasma concentrations of TNF-α, IL-6 and cortisol throughout the measured moments. As compared to CG, EG demonstrated very large effect sizes for total leucocytes, neutrophils and monocytes 15 min postprotocol and a reduction (trivial and small effect sizes) P24h. These results suggest that the tri-set RT session did not exacerbate the acute inflammatory response and might be a good option for variations in RT methods for trained individuals.

Sixteen weeks of resistance training can decrease the risk of metabolic syndrome in healthy postmenopausal women.

BACKGROUND: The postmenopausal phase has been considered an aggravating factor for developing metabolic syndrome. Notwithstanding, no studies have as yet investigated the effects of resistance training on metabolic syndrome in postmenopausal women. Thus, the purpose of this study was to verify whether resistance training could reduce the risk of metabolic syndrome in postmenopausal women. METHODS: Twenty postmenopausal women were randomly assigned to a resistance training protocol (n = 10, 53.40 ± 3.95 years, 64.58 ± 9.22 kg) or a control group (n = 10, 53.0 ± 5.7 years, 64.03 ± 5.03 kg). In the resistance training protocol, ten exercises were performed, with 3 × 8-10 maximal repetitions three times per week, and the load was increased every week. Two-way analysis of variance was used to evaluate specific metabolic syndrome Z-score, high density lipoprotein cholesterol, fasting blood glucose, triglycerides, waist circumference, blood pressure, strength, and body composition. The level of statistical significance was set at P < 0.05. RESULTS: The main results demonstrated a significant decrease of metabolic syndrome Z-score when the postmenopausal women performed resistance training (P = 0.0162). Moreover, we observed decreases in fasting blood glucose for the resistance training group (P = 0.001), and also significant improvements in lean body mass (P = 0.042, 2.46%), reduction of body fat percentage (P = 0.001, -6.75%) and noticeable increases in muscle strength after resistance training to leg press (P = 0.004, 41.29%) and bench press (P = 0.0001, 27.23%). CONCLUSION: It was concluded that resistance training performed three times a week may reduce the metabolic syndrome Z-score with concomitant decreases in fasting blood glucose, improvements in body composition, and muscle strength in postmenopausal women.