ABSTRACT
Chronic wounds, characterized by prolonged healing processes, pose a significant medical challenge with multifaceted aetiologies, including local and systemic factors. Here, it explores the complex pathogenesis of chronic wounds, emphasizing the disruption in the normal phases of wound healing, particularly the inflammatory phase, leading to an imbalance in extracellular matrix (ECM) dynamics and persistent inflammation. Senescent cell populations further contribute to impaired wound healing in chronic lesions. Traditional medical management focuses on addressing underlying causes, but many chronic wounds resist to conventional treatments, necessitating innovative approaches. Recent attention has turned to autologous orthobiologics, such as platelet-rich plasma (PRP), platelet-rich fibrin (PRF) and mesenchymal stem cells (MSCs), as potential regenerative interventions. These biologically derived materials, including bone marrow aspirate/concentrate (BMA/BMAC) and adipose tissue-derived stem cells (ADSCs), exhibit promising cytokine content and regenerative potential. MSCs, in particular, have emerged as key players in wound healing, influencing inflammation and promoting tissue regeneration. This paper reviews relevant scientific literature regarding basic science and brings real-world evidence regarding the use of orthobiologics in the treatment of chronic wounds, irrespective of aetiology. The discussion highlights the regenerative properties of PRP, PRF, BMA, BMAC and SVF, showcasing their potential to enhance wound healing. Despite advancements, further research is essential to elucidate the specific roles of each orthobiologic and determine optimal applications for different wound types. The conclusion underscores the evolving landscape in chronic wound management, with a call for more comprehensive studies to refine treatment strategies and maximize the benefits of regenerative medicine.
Subject(s)
Adipose Tissue , Cytokines , Humans , Extracellular Matrix , Inflammation , Wound HealingABSTRACT
BACKGROUND: Gender diversity in health teams is associated with better productivity. As women's participation in surgery has been growing, it is important to improve knowledge about the elements that guide their professional development. OBJECTIVES: The aim of this study was to outline the demographic and professional features of female vascular surgeons in Brazil. METHODS: A cross-sectional study was designed, in which a questionnaire was made available online for 60 days. Invitations to participate were distributed by institutional e-mail sent from the Brazilian Society of Angiology and Vascular Surgery (SBACV) to associate women surgeons. Results are presented as numbers and percentages. Odds ratios and chi-square tests were used for analysis. RESULTS: From a total of 810 invitations sent out, 281 questionnaires were completed. The most prevalent age groups were 25-35 years (n = 115) and 36-45 years (n = 114). Among those who worked exclusively in the private sector, 79.8% had at least one board certification (OR: 0.76, 95% CI: 0.65-0.89; p = 0.001). Regarding workload distribution, 64.4% and 34.2% reported that they spend more time in the clinic and hospital, respectively. Respondents with more years of experience reported a predominance of office practice (p = 0.002). Although 67.3% (n = 189) had published scientific papers, 68% (n = 191) had never held leadership roles. CONCLUSIONS: The study respondents consisted of highly qualified women surgeons with respect to training, certification, and scientific engagement, but they remain underrepresented in professional management positions. Surgical societies and health institutions should act to promote inclusive and diverse leadership.
CONTEXTO: A diversidade de gênero em equipes médicas está associada a uma melhor produtividade. Com o aumento da participação feminina na cirurgia, é importante conhecer melhor os elementos que orientam o desenvolvimento dessas profissionais. OBJETIVOS: Delinear as características demográficas e profissionais das cirurgiãs vasculares no Brasil. MÉTODOS: Estudo de caráter transversal, em que foi disponibilizado um questionário on-line por 60 dias. O convite foi enviado pelo e-mail institucional da Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV) às cirurgiãs associadas. Os resultados são apresentados como números e porcentagens. Os testes de odds ratio (OR) e do qui-quadrado foram utilizados para a análise. RESULTADOS: De 810 convites enviados, 281 questionários foram respondidos. Os grupos etários predominantes foram 25-35 anos (n = 115) e 36-45 anos (n = 114). Entre as que trabalhavam exclusivamente no setor privado, 79,8% possuíam ao menos um Título de Especialista (OR: 0,76; intervalo de confiança de 95% 0,65-0,89; p = 0,001). Em relação à distribuição da carga horária, 64,4% e 34,2% relataram que passavam mais tempo no ambulatório e no hospital, respectivamente. Entre as com mais anos de experiência, houve predomínio da prática em consultório (p = 0,002). Embora 67,3% (n = 189) tenham publicado artigos científicos, 68% (n = 191) nunca ocuparam cargos de liderança. CONCLUSÕES: As participantes do estudo consistiram em cirurgiãs altamente qualificadas em relação a treinamento, certificação e engajamento científico. No entanto, permanecem pouco representadas em cargos de gestão profissional. As sociedades cirúrgicas e as instituições de saúde devem agir para promover uma liderança inclusiva e diversa.
Subject(s)
Career Choice , Physicians, Women/trends , Surgeons/trends , Vascular Surgical Procedures/trends , Women, Working , Accreditation/trends , Adult , Attitude of Health Personnel , Brazil , Education, Medical, Graduate/trends , Female , Humans , Middle Aged , Surgeons/education , Surveys and Questionnaires , Vascular Surgical Procedures/education , Women, Working/educationABSTRACT
BACKGROUND: There has been a striking increase in female participation in the Brazilian and worldwide medical contingent, but the number of female surgeons does not follow the same trend. In addition to quantitative analysis, there is a need for further study of the determinants of choice of surgical specialty and the characteristics of professional practice. OBJECTIVES: To outline the profile of female vascular surgeons in Brazil in terms of demographic characteristics, qualifications, scientific engagement, and labor market integration. METHODS: A survey was made available online for 30 days and its link was widely circulated among female vascular surgeons. At the end of data collection, 101 valid questionnaires had been returned and their data were tabulated in Microsoft Excel spreadsheets for simple descriptive analysis. RESULTS: The profile traced was of women aged up to 45 years who have been working in the area for up to 10 years. They were predominantly trained in medical residencies or internships recognized by the specialty board. Venous surgery, Esthetic Phlebology and Vascular Ultrasound were the major fields of activity for female vascular surgeons. Although they hold degrees and author scientific publications, the proportion of leadership positions held by women remains low. More than 64% of the participants reported feeling undervalued because they were women. CONCLUSIONS: Despite the limitations of the study population, this preliminary study confirms the idea that female vascular surgeons demonstrate continuous dedication to practicing their specialty and sets a precedent so that further studies can investigate the professional practice of female vascular surgeons in greater detail, stimulating discussion of gender inequalities in medical practice.
ABSTRACT
O objetivo desse estudo foi analisar os fatores que influenciam a sobrevivência de doentes selecionados submetidos à extirpação com intenção curativa de metástases hepáticas do carcinoma colo-retal. Foram operados 41 doentes. Foi considerado critério de exclusão presença de quatro ou mais lesões hepáticas. Vinte e três (56,1por cento) enfermos eram homens e 18 (43,9por cento) mulheres. A média de idade foi 63,8 11,5 anos. A neoplasia colo-retal estava localizada no colo esquerdo em 16 (39,0por cento) doentes, no reto em 15 (36,6por cento) e no colo direito em dez (24,4por cento). Foram utilizados os seguintes modelos estatísticos: média aritmética e desvio padrão, mediana, análise de variância por regressão logística para verificação de fatores de risco e curva de Kaplan-Meier para a análise de sobrevivência de grupos. A média de sobrevivência foi de 38,9 4,5 meses (0,4 a 60,6 meses). Não houve mortalidade operatória. Quinze (36,6por cento) doentes faleceram: nove (21,9por cento) enfermos por carcinomatose peritoneal, quatro (9,6por cento) por doenças benignas e dois (4,9por cento) por causa ignorada. Vinte e seis (63,4por cento) enfermos sobreviveram à extirpação da metástase hepática, com média de sobrevivência de 19,3 meses (2 a 60,8 meses). O intervalo médio livre de doença foi de 15,3 meses. A mortalidade dos doentes com carcinoma no reto foi significativamente maior (p=0,04) do que a dos enfermos com lesões localizadas no colo direito ou esquerdo. Os autores concluíram que nesse grupo de doentes selecionados, a localização retal da neoplasia primária influenciou significativa e desfavoravelmente a sobrevivência dos enfermos submetidos à extirpação das metástases hepáticas do carcinoma colo-retal.
