Developing a genomic-based strategy to confirm microbial identity in bio-inputs containing multiple strains: an easy, fast, and low-cost multiplex PCR applied to inoculants carrying soybean Bradyrhizobium.

Brazil stands out in research, industrial development, and farmers' use of microbial inoculants, with an emphasis on getting benefits from the biological nitrogen fixation process with the soybean crop. Nowadays, about 140 million doses of inoculants are commercialized annually for the soybean in the country, and strain identification is achieved by rep-PCR, an effective but time-consuming method. Aiming to develop an easy, low-cost, and low-time-consuming method, we used a complete genome-based approach based on the unequivocal identification of unique genes present in the genomes of each of the four Bradyrhizobium strains used in commercial inoculants: Bradyrhizobium elkanii strains SEMIA 587 and SEMIA 5019, Bradyrhizobium japonicum SEMIA 5079, and Bradyrhizobium diazoefficiens SEMIA 5080. The unique pairs of primers able to amplify genomic regions of different sizes allowed the identification of the four strains in a simple multiplex polymerase chain reaction (PCR). Validation was confirmed by using single colonies, multiple cultures, and commercial inoculants. The number of labor hours of a technician was 3.08 times higher, and the final cost was 3.25 times higher in the rep-PCR than in the multiplex PCR. Most importantly, the results for multiplex PCR were obtained on the same day, in contrast with 15 days in the traditional methodology. The genomic approach developed can be easily applied to a variety of microbial inoculants worldwide, in addition to studies of ecology and evaluation of the competitiveness of the strains.

Unveiling Agricultural Biotechnological Prospects: The Draft Genome Sequence of Stenotrophomonas geniculata LGMB417.

Stenotrophomonas species are recognized as rhizobacteria that play a pivotal role in promoting plant growth by making substantial contributions to enhanced soil fertility, nutrient recycling, and phytopathogen control. Employing them as bioinputs constitutes an environmentally sound strategy, particularly within the rhizospheric community. This study revealed the draft genome sequence of Stenotrophomonas geniculata LGMB417, which was originally isolated from root samples of maize (Zea mays L.). This research assessed the potential of a bacterial strain at the molecular level through genome mining, aiming to identify genes with biotechnological significance for promoting plant growth and protection. The assembly findings indicate that strain LGMB417 possesses a genome size of 4,654,011 bp, with a G + C content of 66.50%. The draft genome sequence revealed the presence of gene clusters responsible for the synthesis of secondary metabolites and carbohydrate active enzymes (CAZymes), glycoside hydrolases (23), glycosyltransferases (18), carbohydrate esterases (5), polysaccharide lyases (2), carbohydrate-binding modules (2), and auxiliary activities (1). Several genes related to growth promotion were found in the genome, including those associated with phosphate transport and solubilization, nitrogen metabolism, siderophore production and iron transport, hormonal modulation, stress responses (such as to drought, temperature fluctuations, osmotic challenges, and oxidative conditions), and volatile organic compounds (VOCs). Subsequent phases will encompass investigations utilizing gene expression methodologies, with future explorations concentrating on facets pertinent to agricultural production, including comprehensive field studies.

Forest type modulates mammalian responses to megafires.

Although considered an evolutionary force responsible for shaping ecosystems and biodiversity, fires' natural cycle is being altered by human activities, increasing the odds of destructive megafire events. Here, we show that forest type modulates the responses of terrestrial mammals, from species to assemblage level, to a catastrophic megafire in the Brazilian Pantanal. We unraveled that mammalian richness was higher 1 year after fire passage compared to a pre-fire condition, which can be attributed to habitat modification caused by wildfires, attracting herbivores and open-area tolerant species. We observed changes in assemblage composition between burned/unburned sites, but no difference in mammalian richness or relative abundance. However, by partitioning the effects of burned area proportion per forest type (monospecific vs. polyspecific), we detected differential responses of mammals at several levels of organization, with pronounced declines in species richness and relative abundance in monospecific forests. Eighty-six percent of the species presented moderate to strong negative effects on their relative abundance, with an overall strong negative effect for the entire assemblage. Wildfires are predicted to be more frequent with climate and land use change, and if events analogous to Pantanal-2020 become recurrent, they might trigger regional beta diversity change, benefitting open-area tolerant species.

Retalho plantar medial para reconstrução de defeitos em calcanhar após ressecção de melanoma lentiginoso acral: Uma série de 7 casos / Medial plantar flap for reconstruction of heel defects after resection of acral lentiginous melanoma: A series of seven cases

Introdução: A reconstrução da região plantar ainda é um dos grandes desafios da cirurgia plástica reconstrutiva. Os tecidos dessa região apresentam características únicas e que são essenciais para a manutenção da funcionalidade do membro. De toda a região plantar, a região do calcanhar é a área de maior sustentação do peso e submetida ao maior impacto. O retalho fasciocutâneo plantar medial é uma das opções reconstrutivas, pois representa tecido semelhante e mantém a sensibilidade para a área receptora. Método: Foi realizado um estudo retrospectivo através da coleta de dados de prontuário de pacientes que realizaram reconstruções da região do calcanhar com retalho plantar medial, no período de julho de 2013 a setembro de 2019. O estudo foi aprovado pelo Comitê de Ética para Análise de Projetos de Pesquisa do HCFMUSP (Número CAAE: 56849422.0.0000.0068). Resultados: A reconstrução de calcanhar após ressecção de melanoma lentiginoso acral foi realizada em 7 pacientes. Complicações cirúrgicas foram observadas em 3 pacientes, sendo que todos eles tinham idade acima de 50 anos e/ou alguma comorbidade associada. Houve 57,1% de complicações, sendo 37,5% relacionadas ao retalho e 12,5% relacionadas à área doadora. Ocorreram 3 necroses totais de retalho (42,9%) e 1 perda total de enxerto na área doadora (14,3%). Conclusão: O retalho plantar medial se apresenta como uma boa alternativa para a realização de reconstruções oncológicas de defeitos na região plantar do pé. Contudo, deve-se ponderar a escolha do paciente ideal e lembrar que a dissecção do seu pedículo vascular não é de fácil execução.

Introduction: Resurfacing the sole is still one of the great challenges of reconstructive plastic surgery. The tissues on the sole of the foot have unique characteristics essential for maintaining the limbs functionality. The heel has the most significant weight support and is subjected to the entire soles greatest impact. The medial plantar artery flap is one of the reconstructive options, as it represents similar tissue and maintains sensitivity to the recipient area. Methods: A retrospective study was performed by collecting data from medical records of patients who underwent reconstructions of the heel with a medial plantar artery flap from July 2013 to September 2019. The study was approved by the Ethics Committee for Analysis of Research Projects of HCFMUSP (CAAE number: 56849422.0.0000.0068). Results: Heel reconstruction was performed in 7 patients after acral lentiginous melanoma excision. Surgical complications were observed in 3 patients, all of whom were aged over 50 years or have associated comorbidity. There were 57.1% of complications, 37.5% related to the flap, and 12.5% related to the donor area. There were three total flap necroses (42.9%) and one total graft loss in the donor area (14.3%). Conclusion: The medial plantar flap presents itself as a good alternative for performing oncological reconstructions of defects in the plantar region of the foot. However, the choice of the ideal patient should be considered and we must remember that the dissection of its vascular pedicle is not easily executed.

Retalho supraclavicular para reconstrução oncológica em cabeça e pescoço: Uma série de 62 casos / Supraclavicular flap for head and neck oncological reconstruction: A series of 62 cases

Introdução: A reconstrução oncológica de defeitos extensos em cabeça e pescoço impõe ao cirurgião plástico a difícil decisão entre o uso de retalhos livres e retalhos pediculados. O retalho supraclavicular é um dos principais exemplos de retalho pediculado, sendo versátil, com espessura delgada e cor semelhante à região a ser reconstruída. Método: Um estudo retrospectivo foi realizado através da coleta de dados de prontuário de pacientes internados no Instituto do Câncer do Estado de São Paulo, entre dezembro de 2010 e março de 2020. Resultados: Dentre os 62 pacientes reconstruídos com retalho supraclavicular, 37 eram do sexo masculino e 25 do sexo feminino. Cinquenta e oito pacientes (93,5%) possuíam alguma comorbidade associada. Ao todo, 27 complicações relacionadas ao retalho (43,5%) foram registradas, sendo 5 necroses totais (8%). Conclusão: O retalho supraclavicular possui importante papel nas reconstruções oncológicas de cabeça e pescoço e deve ser considerado como opção em pacientes maus candidatos a retalhos microcirúrgicos.

Introduction: The oncological reconstruction of extensive defects in the head and neck requires the plastic surgeon to make a difficult decision between the use of free flaps and pedicled flaps. The supraclavicular flap is one of the main examples of a pedicled flap, being versatile, with a thin thickness and similar color to the region to be reconstructed. Method: A retrospective study was carried out by collecting data from medical records of patients admitted to the Cancer Institute of the State of São Paulo between December 2010 and March 2020. Results: Among the 62 patients reconstructed with a supraclavicular flap, 37 were male and 25 female. Fifty-eight patients (93.5%) had some associated comorbidity. In total, 27 complications related to the flap (43.5%) were recorded, 5 of which were total necrosis (8%). Conclusion: The supraclavicular flap plays an important role in head and neck oncological reconstructions and should be considered as an option in patients who are poor candidates for microsurgical flaps.

The outstanding diversity of rhizobia microsymbionts of common bean (Phaseolus vulgaris L.) in Mato Grosso do Sul, central-western Brazil, revealing new Rhizobium species.

Common bean is considered a legume of great socioeconomic importance, capable of establishing symbioses with a wide variety of rhizobial species. However, the legume has also been recognized for its low efficiency in fixing atmospheric nitrogen. Brazil is a hotspot of biodiversity, and in a previous study, we identified 13 strains isolated from common bean (Phaseolus vulgaris) nodules in three biomes of Mato Grosso do Sul state, central-western Brazil, that might represent new phylogenetic groups, deserving further polyphasic characterization. The phylogenetic tree of the 16S rRNA gene split the 13 strains into two large clades, seven in the R. etli and six in the R. tropici clade. The MLSA with four housekeeping genes (glnII, gyrB, recA, and rpoA) confirmed the phylogenetic allocation. Genomic comparisons indicated eight strains in five putative new species and the remaining five as R. phaseoli. The average nucleotide identity (ANI) and digital DNA-DNA hybridization (dDDH) comparing the putative new species and the closest neighbors ranged from 81.84 to 92.50% and 24.0 to 50.7%, respectively. Other phenotypic, genotypic, and symbiotic features were evaluated. Interestingly, some strains of both R. etli and R. tropici clades lost their nodulation capacity. The data support the description of the new species Rhizobium cerradonense sp. nov. (CNPSo 3464T), Rhizobium atlanticum sp. nov. (CNPSo 3490T), Rhizobium aureum sp. nov. (CNPSo 3968T), Rhizobium pantanalense sp. nov. (CNPSo 4039T), and Rhizobium centroccidentale sp. nov. (CNPSo 4062T).

The Influence of the Superficial Venous System on DIEP Flap Drainage in Breast Reconstruction.

BACKGROUND: Autologous tissue has become the gold standard in breast reconstruction. The use of a deep inferior epigastric perforator (DIEP) flap has the advantages of giving a natural appearance to the reconstructed breast and being associated with lower morbidity at the donor site when compared with the transverse rectus abdominis myocutaneous flap. Venous complications such as venous thrombosis and insufficiency remain the main causes of flap loss and surgical revisions. The aim of this study was to evaluate the influence of superficial venous drainage of the DIEP flap and the addition of a second venous anastomosis have on flap survival. METHODS: This was a retrospective cohort study collected from a prospective database maintained by our institution. Data was obtained from the medical records of female patients who underwent mastectomy and breast reconstruction with a DIEP flap between March 2010 and March 2017. We evaluated 137 DIEP patients with unilateral breast reconstructions. In 64 (46.7%) the deep venous system was chosen and 73 (53.3%) had an additional superficial vein anastomosed. RESULTS: Out of the 137 patients evaluated, there were 16 (11.67%) cases of revision, 14 (10.21%) were due to venous thrombosis. Twelve cases (8.75%) of flap loss were reported. Reoperation rate was lower in the dual venous drainage group when compared with the single venous drainage group (p = 0.005), as was the rate of flap loss (p = 0.006) and reoperation due to venous thrombosis (p = 0.002). Out of the 125 DIEP flaps, fat necrosis was clinically identified in 7 (5.1%) cases, and the rate was lower in the dual venous drainage system group (p = 0.01). CONCLUSION: Dual venous drainage of a DIEP flap appears to reduce the rates of venous thrombosis, reoperation, total flap loss, and fat necrosis.

Genomes of two type strains of the Rhizobium tropici group: R. calliandrae CCGE524T and R. mayense CCGE526T.

The genome sequences of two nitrogen-fixing type strains of the Rhizobium tropici group were obtained: Rhizobium calliandrae CCGE524T and R. mayense CCGE526T. Genomic analyses confirmed their taxonomic position and identified three complete sequences of the repABC genes, indicative of three plasmids, one of them carrying symbiotic genes.

Genome Sequencing of Efficient Plant Growth-Promoting Bacteria for Lowland Rice.

The genomes of five elite strains identified as growth promoters of lowland rice (Oryza sativa L.) in Brazil were sequenced. They ranged in size from 3,695,387 bp to 5,682,101 bp, encompassing genes of saprophytic ability and stress tolerance. Genome taxonomy enabled their classification as Priestia megaterium, Bacillus altitudinis, and three putative new species of Pseudomonas, Lysinibacillus, and Agrobacterium.

Unraveling the Intrinsic Biocidal Activity of the SiO2-Ag Composite against SARS-CoV-2: A Joint Experimental and Theoretical Study.

The COVID-19 pandemic has emerged as an unprecedented global healthcare emergency, demanding the urgent development of effective materials to inactivate the SARS-CoV-2 virus. This research was planned to disclose the remarkable biocidal activity of SiO2-Ag composites incorporated into low-density polyethylene. For this purpose, a joint experimental and theoretical [based on first-principles calculations at the density functional theory (DFT) level] study is performed. Biological assays showed that this material eliminatesStaphylococcus aureusand SARS-CoV-2 virus in just 2 min. Here, we investigate a previously unexplored process that we postulate may occur along the O2 and H2O adsorption and activation processes of pure and defective SiO2-Ag surfaces for the generation of reactive oxygen species (ROS). The obtained results help us to predict the nature of ROS: superoxide anion radicals, •O2-, hydroxyl radicals, •OH, and hydroperoxyl radicals, •HO2, that destroy and degrade the structure of the SARS-COV-2 virus. This is consistent with the DFT studies, where the energetic, electronic, and magnetic properties of the intermediates show a feasible formation of ROS. Present findings are expected to provide new insights into the relationship among the structure, property, and biocidal activity of semiconductor/metal SiO2-Ag composites.

Microbiome of Nodules and Roots of Soybean and Common Bean: Searching for Differences Associated with Contrasting Performances in Symbiotic Nitrogen Fixation.

Biological nitrogen fixation (BNF) is a key process for the N input in agriculture, with outstanding economic and environmental benefits from the replacement of chemical fertilizers. However, not all symbioses are equally effective in fixing N2, and a major example relies on the high contribution associated with the soybean (Glycine max), contrasting with the low rates reported with the common bean (Phaseolus vulgaris) crop worldwide. Understanding these differences represents a major challenge that can help to design strategies to increase the contribution of BNF, and next-generation sequencing (NGS) analyses of the nodule and root microbiomes may bring new insights to explain differential symbiotic performances. In this study, three treatments evaluated in non-sterile soil conditions were investigated in both legumes: (i) non-inoculated control; (ii) inoculated with host-compatible rhizobia; and (iii) co-inoculated with host-compatible rhizobia and Azospirillum brasilense. In the more efficient and specific symbiosis with soybean, Bradyrhizobium presented a high abundance in nodules, with further increases with inoculation. Contrarily, the abundance of the main Rhizobium symbiont was lower in common bean nodules and did not increase with inoculation, which may explain the often-reported lack of response of this legume to inoculation with elite strains. Co-inoculation with Azospirillum decreased the abundance of the host-compatible rhizobia in nodules, probably because of competitiveness among the species at the rhizosphere, but increased in root microbiomes. The results showed that several other bacteria compose the nodule microbiomes of both legumes, including nitrogen-fixing, growth-promoters, and biocontrol agents, whose contribution to plant growth deserves further investigation. Several genera of bacteria were detected in root microbiomes, and this microbial community might contribute to plant growth through a variety of microbial processes. However, massive inoculation with elite strains should be better investigated, as it may affect the root microbiome, verified by both relative abundance and diversity indices, that might impact the contribution of microbial processes to plant growth.

REVERSE SURAL FLAP FOR LOWER LIMB RECONSTRUCTION.

Introduction: Reconstruction of distal wounds in lower extremities can be challenging due to the lack of tissue to perform local flaps. Fasciocutaneous and muscular flaps are some options for coverage, such as the reverse-flow fasciocutaneous sural flap. Objective: To present an 18-month experience on ankle, calcaneus, and foot reconstruction using the reverse-flow sural flap, performed by the Complex Wounds Group of the Plastic Surgery Department of the University of São Paulo Medical School. Methods: An observational, retrospective and descriptive study was performed through data survey on medical records of all patients treated between November 2018 and June 2020. Results: Nine reverse-flow fasciocutaneous sural flaps were performed. All patients were men. The mean age was 38 years old. Five patients had acute wounds for traffic collision, one electrical trauma and three chronic post-traumatic injuries. The ankle was the most common injury site (6), followed by foot (2) and calcaneus (1). Four patients had complications, three of which were partial necrosis and one distal epitheliosis. No case of total necrosis was recorded. The average hospital stay was 30.1 days. Conclusion: The reverse-flow fasciocutaneous sural flap proved to be a viable, reproducible, and reliable option for distal lower limb reconstruction. Level of Evidence IV, Case Series.

Introdução: Reconstrução de lesões distais de extremidades inferiores podem ser desafiadoras devido à limitação de tecido para retalhos locais. Retalhos fasciocutâneos e musculares são opções, como o retalho fasciocutâneo sural reverso. Objetivo: Apresentar a experiência de 18 meses do Grupo de Feridas Complexas do Serviço de Cirurgia Plástica da Faculdade de Medicina da Universidade de São Paulo no uso do retalho sural reverso para reconstruções de defeitos em tornozelo, calcâneo e pé. Métodos: Estudo observacional, retrospectivo e descritivo, com dados de prontuário de todos os casos operados no serviço entre novembro de 2018 e junho de 2020. Resultados: Foram realizados nove retalhos fasciocutâneos sural reverso. Todos os pacientes eram do sexo masculino, com idade média de 38 anos. Cinco foram vítimas de acidente automobilístico, um de trauma elétrico e três apresentavam sequelas pós-traumáticas. Seis lesões localizadas em tornozelo, dois em pé e um em calcâneo. Quatro pacientes apresentaram complicações, sendo três necroses parciais e uma epiteliólise distal. Não houve perda total de retalho. O tempo médio de hospitalização foi de 30,1 dias. Conclusão: O retalho fasciocutâneo sural reverso mostrou-se uma opção viável, reprodutível e segura para reconstrução de lesões complexas em terço distal de perna e pé. Nível de Evidência IV, Série de Casos.

Paramedian forehead flap in the treatment of nasal, non-melanoma skin cancer: a cross-sectional study.

INTRODUCTION: nose is the central point of the face and vulnerable to the occurence of non-melanoma skin cancer (NMSC), impacting on appearance. The paramedian forehead flap (PMFF) is considered the best option to treat extensive nasal defects. The objective of this study is to present the experience on PMFF for nasal reconstruction in the treatment of NMSC of a cancer referral center. METHODS: retrospective study was carried out through data from medical records of patients who underwent nasal reconstruction with PMFF due to NMSC at the Cancer Institute of the State of São Paulo (ICESP). RESULTS: 111 patients were identified, mostly ederly, with comorbidities and on initial tumors (T1 and T2). Basal cell carcinoma (BCC) was the predominant histological type. Dorsum and tip were the most affected subunitis. In addition to skin coverage, reconstruction of the lining and structural framework was also performed in half of the cases. Second intention healing was the technique of choice in closing the donor area. Pedicle division ocurred predominantly in the second operation and the median time to complete reconstruction was 6 months. There were low complication rates. CONCLUSIONS: the PMFF is safe and effective to treat nose NMSC, even in cases of high complexity. Since the treatment time can be prolonged and impact on quality of life, it is essential to emphasize and discuss this aspect with the patients before surgery.

A versatilidade e confiabilidade do retalho Keystone em reconstruções oncológicas / Versatility and reliability of the Keystone flap in oncological reconstructions

Introdução: O retalho Keystone é um retalho em ilha, de vascularização confiável e dissecção simples, descrito pela primeira vez em 2003. Apesar de suas vantagens, é ainda pouco citado na literatura especializada e longe de se tornar opção de escolha na prática clínica da cirurgia reconstrutiva. O objetivo deste artigo é apresentar a experiência de um serviço oncológico de alta complexidade no uso de retalhos Keystone em reconstruções. Métodos: Um estudo retrospectivo foi desenvolvido por meio do levantamento de dados de prontuário de pacientes operados pela equipe de Cirurgia Plástica do Instituto do Câncer do Estado de São Paulo, além de análise de registros fotográficos pré, intra e pós-operatórios. Resultados: Nove pacientes foram identificados, todos portadores de comorbidades e média de idade de 52,7 anos. Os defeitos cutâneos se seguiram após ressecções oncológicas, sendo cinco em extremidades inferiores, três em tronco e um em face. A média da área ressecada foi de 52,6cm2. As reconstruções foram realizadas sob abreviado tempo cirúrgico. Não houve complicações pós- operatórias ou perdas do retalho e o tempo de hospitalização médio foi de 2,2 dias. Conclusão: O retalho Keystone é uma opção tecnicamente simples e reprodutível para a cobertura de ferimentos de tamanhos diversos e em localizações variadas. Devido à sua confiabilidade, dissecção simples e rápida, abreviado tempo de internação e baixa morbidade à área doadora, deve ser considerado na reconstrução de feridas oncológicas de diversas localizações, em pacientes de todas as idades.

Introduction: The Keystone flap is an island flap with reliable vascularization and simple dissection, first described in 2003. Despite its distinct advantages, there are few scientific publications on this matter, and it is not a common option in the clinical practice of reconstructive surgery. This article aims to report the experience of a cancer referral center with Keystone flaps in oncological reconstructions. Methods: A retrospective study was carried out data from medical records of patients who performed oncological plastic reconstruction with keystone flaps, operated by the Surgery team of the Cancer Institute of the State of São Paulo, in addition to the analysis of pre, intra and postoperative photographic records. Results: Nine patients were identified, all with comorbidities and a mean age of 52.7. Skin defects followed after oncological resections: five in the lower extremities, three in the trunk and one in the face. The mean of the skin resected area was 52.6cm2. The reconstructions were performed under shortened surgical time. There were no postoperative complications or flap losses. The average hospital stay was 2.2 days. Conclusion: The Keystone flap is technically simple and a reproducible option for covering wounds of different sizes and locations. Due to its reliability, simple and quick dissection, shortened hospital stay and low morbidity in the donor area, it should be considered for reconstructing cancer wounds from different locations in patients of all ages.

Impacto socioeconômico da pandemia da COVID-19 entre cirurgiões plásticos do Brasil / Socioeconomic impact of the COVID-19 pandemic among plastic surgeons in Brazil

Introdução: Devido à crise sanitária mundial provocada pela disseminação da COVID-19, muitos serviços de saúde interromperam a realização de procedimentos cirúrgicos não urgentes. No cenário da Cirurgia Plástica, no qual a maioria das cirurgias são eletivas, estimam-se consequências socioeconômicas a estes especialistas. O objetivo deste estudo é dimensionar este impacto. Métodos: Os efeitos da pandemia dentro da prática clínica dos cirurgiões plásticos brasileiros foi investigada por meio de um questionário on-line, endereçado aos associados da Sociedade Brasileira de Cirurgia Plástica. Resultados: A pesquisa foi aplicada a 645 cirurgiões. A maioria dos entrevistados relatou restrições operacionais à realização de procedimentos e redução da renda, sobretudo nas regiões severamente afetadas pela pandemia. Cirurgiões plásticos com mais de 10 anos de formação foram os mais prejudicados. Elevada taxa de contaminação, sobrecarga mental, diminuição na prática de atividades físicas e uso de medicações psiquiátricas também foram relatados. Conclusão: A pandemia da COVID-19 trouxe mudanças no cenário pessoal e profissional do cirurgião plástico brasileiro. Devido à importante redução no volume de trabalho, houve impacto financeiro nos especialistas de todas as regiões do país, além de reflexos na saúde física e mental. Adaptações foram necessárias para manutenção dos atendimentos, além de exploração de novas áreas de atuação para suprir a baixa demanda de cirurgias estéticas durante a crise.

Introduction: Global sanitary crisis caused by the spread of COVID-19 induced many health services to stop performing non-urgent surgical procedures. In the scenario of plastic surgery, where most procedures are elective, socioeconomic consequences are estimated for these specialists. The objective of this study is to measure this impact. Methods: Effects of the pandemic within the clinical practice of Brazilian plastic surgeons were investigated through an online questionnaire addressed to members of the Sociedade Brasileira de Cirurgia Plástica. Results: A survey was applied to 645 surgeons. Most respondents reported operation restrictions on procedures and income reduction, especially in regions severely affected by the pandemic. Plastic surgeons with more than 10 years of experience were the most affected. High contamination rates, mental overload, decreased physical activity, and psychiatric medications have also been reported. Conclusion: COVID-19 pandemic brought changes to the personal and professional life of the Brazilian plastic surgeon. Due to the significant reduction in the workload, there were financial impacts on specialists from all country regions, besides physical and mental health issues. Adaptations were mandatory to maintain services and explore new areas of activity to supply the low demand for cosmetic surgery during the crisis.

Retalho sural reverso como alternativa à reconstrução microcirúrgica de ferimento extenso em pé após queimadura elétrica: relato de caso / Reverse sural flap as an alternative to microsurgical reconstruction of extensive foot wound after electrical burn: case report

Introdução: Apresentar um relato de caso de confecção de retalho sural reverso como alternativa ao retalho microcirúrgico na reconstrução de pé após trauma elétrico. O relato apresentado é de um paciente atendido pelos grupos de Queimaduras e Feridas Complexas do Serviço de Cirurgia Plástica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, no ano de 2020. Relato de Caso: Paciente masculino, 35 anos, sem comorbidades, vítima de trauma elétrico de alta voltagem (1300V) em domicílio, acometendo membros superiores e inferiores bilateralmente. Devido à gravidade das lesões, foi submetido a amputação transtibial à esquerda e desbridamentos seriados no membro contralateral, resultando em defeito em face medial, hálux e todo dorso do pé direito, com exposição óssea. Devido ao insucesso de reconstrução com retalho microcirúrgico de músculo vasto lateral, optou-se por reconstrução com retalho sural reverso. Evoluiu com necrose distal, sendo necessário novo desbridamento e reavanço do retalho. No seguimento, apresentou evolução favorável, e está em processo de reabilitação. Conclusão: O retalho sural reverso mostrou-se adequado para o tratamento de resgate de lesão extensa em pé após falha da terapia microcirúrgica, oferecendo cobertura estável e ótimo contorno, permitindo, assim, reabilitação satisfatória do paciente.

Introduction: To present a reverse sural flap case report as an alternative to microsurgical flap in foot reconstruction after electrical trauma. The report presented is of a patient treated by the Burns and Complex Wounds groups of the Plastic Surgery Service of the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo in 2020. Case Report: Male patient, 35 years old, without comorbidities, victim of high voltage electrical trauma (1300V) at home, affecting upper and lower limbs bilaterally. Due to the severity of the injuries, he underwent left transtibial amputation and serial debridement in the contralateral limb, resulting in a defect in the medial face, hallux and entire dorsum of the right foot, with bone exposure. Due to the failure of reconstruction with a microsurgical flap of the vastus lateralis muscle, reconstruction with a reverse sural flap was chosen. It evolved with distal necrosis, requiring new debridement and re-advancement of the flap. In the follow-up, he presented a favorable evolution and is in the process of rehabilitation. Conclusion: The reverse sural flap proved to be suitable for the salvage treatment of extensive foot injuries after the failure of microsurgical therapy, offering stable coverage and excellent contour, thus allowing satisfactory patient rehabilitation.

Genetic variation in symbiotic islands of natural variant strains of soybean Bradyrhizobium japonicum and Bradyrhizobium diazoefficiens differing in competitiveness and in the efficiency of nitrogen fixation.

Soybean is the most important legume cropped worldwide and can highly benefit from the biological nitrogen fixation (BNF) process. Brazil is recognized for its leadership in the use of inoculants and two strains, Bradyrhizobium japonicum CPAC 15 (=SEMIA 5079) and Bradyrhizobium diazoefficiens CPAC 7 (=SEMIA 5080) compose the majority of the 70 million doses of soybean inoculants commercialized yearly in the country. We studied a collection of natural variants of these two strains, differing in properties of competitiveness and efficiency of BNF. We sequenced the genomes of the parental strain SEMIA 566 of B. japonicum, of three natural variants of this strain (S 204, S 340 and S 370), and compared with another variant of this group, strain CPAC 15. We also sequenced the genome of the parental strain SEMIA 586 of B. diazoefficiens, of three natural variants of this strain (CPAC 390, CPAC 392 and CPAC 394) and compared with the genome of another natural variant, strain CPAC 7. As the main genes responsible for nodulation (nod, noe, nol) and BNF (nif, fix) in soybean Bradyrhizobium are located in symbiotic islands, our objective was to identify genetic variations located in this region, including single nucleotide polymorphisms (SNPs) and insertions and deletions (indels), that could be potentially related to their different symbiotic phenotypes. We detected 44 genetic variations in the B. japonicum strains and three in B. diazoefficiens. As the B. japonicum strains have gone through a longer period of adaptation to the soil, the higher number of genetic variations could be explained by survival strategies under the harsh environmental conditions of the Brazilian Cerrado biome. Genetic variations were detected in genes enconding proteins such as a dephospho-CoA kinase, related to the CoA biosynthesis; a glucosamine-fructose-6-phosphate aminotransferase, key regulator of the hexosamine biosynthetic pathway; a LysR family transcriptional regulator related to nodulation genes; and NifE and NifS proteins, directly related to the BNF process. We suggest potential genetic variations related to differences in the symbiotic phenotypes.

Microbiological quality analysis of inoculants based on Bradyrhizobium spp. and Azospirillum brasilense produced "on farm" reveals high contamination with non-target microorganisms.

The use of inoculants carrying diazotrophic and other plant growth-promoting bacteria plays an essential role in the Brazilian agriculture, with a growing use of microorganism-based bioproducts. However, in the last few years, some farmers have multiplied microorganisms in the farm, known as "on farm" production, including inoculants of Bradyrhizobium spp. for soybean (Glycine max L. Merrill.) and Azospirillum brasilense for corn (Zea mays L.) or co-inoculation in soybean. The objective was to assess the microbiological quality of such inoculants concerning the target microorganisms and contaminants. In the laboratory, 18 samples taken in five states were serial diluted and spread on culture media for obtaining pure and morphologically distinct colonies of bacteria, totaling 85 isolates. Molecular analysis based on partial sequencing of the 16S rRNA gene revealed 25 genera of which 44% harbor species potentially pathogenic to humans; only one of the isolates was identified as Azospirillum brasilense, whereas no isolate was identified as Bradyrhizobium. Among 34 isolates belonging to genera harboring species potentially pathogenic to humans, 12 had no resistance to antibiotics, six presented intrinsic resistance, and 18 presented non-intrinsic resistance to at least one antibiotic. One of the samples analyzed with a shotgun-based metagenomics approach to check for the microbial diversity showed several genera of microorganisms, mainly Acetobacter (~ 32% of sequences) but not the target microorganism. The samples of inoculants produced on farm were highly contaminated with non-target microorganisms, some of them carrying multiple resistances to antibiotics.

Prognostic implications of tumor-infiltrating lymphocytes in association with programmed cell death ligand 1 expression in remnant gastric cancer.

Objective: Remnant gastric cancer (RGC) is usually associated with a worse prognosis. As they are less common and very heterogeneous tumors, new prognostic and reliable determinants are required to predict patients' clinical course for RGC. This study aimed to investigate the tumor-infiltrating lymphocytes (TILs) and programmed cell death ligand 1 (PD-L1) status as prognostic biomarkers in a cohort of patients with RGC to develop an immune-related score. Methods: Patients with gastric cancer (GC) who underwent curative intent gastrectomy were retrospectively investigated. RGC resections with histological diagnosis of gastric adenocarcinoma were enrolled in the study. The risk score based on immune parameters was developed using binary logistic regression analysis. RGCs were divided into high-risk (HR), intermediate-risk (IR), and low-risk (LR) groups based on their immune score. The markers (CD3+, CD4+/CD8+ T cells and PD-L1) were selected for their potential prognostic, therapeutic value, and evaluated by immunohistochemistry (IHC). Results: A total of 42 patients with RGC were enrolled in the study. The score based on immune parameters exhibited an accuracy of 79% [the area under the receiver operating characteristic curve (AUC)=0.79, 95% confidence interval (95% CI), 0.63-0.94, P=0.002], and the population was divided into 3 prognostic groups: 10 (23.8%) patients were classified as LR, 15 (35.7%) as IR, and 17 (40.5%) as HR groups. There were no differences in clinicopathological and surgical characteristics between the three groups. In survival analysis, HR and IR groups had worse disease-free survival and overall survival rates compared to the LR group. In the multivariate analysis, lymph node metastasis and the immune score risk groups were independent factors related to worse survival. Conclusions: A scoring system with immune-related markers was able to distinguish prognostic groups of RGC associated with survival. Accordingly, tumor-infiltrating immune lymphocytes and PD-L1 status may serve as a potential prognostic biomarker for patients with RGC.

Reverse sural flap for lower limb reconstruction / Retalho sural reverso na reconstrução de membros inferiores

ABSTRACT Introduction: Reconstruction of distal wounds in lower extremities can be challenging due to the lack of tissue to perform local flaps. Fasciocutaneous and muscular flaps are some options for coverage, such as the reverse-flow fasciocutaneous sural flap. Objective: To present an 18-month experience on ankle, calcaneus, and foot reconstruction using the reverse-flow sural flap, performed by the Complex Wounds Group of the Plastic Surgery Department of the University of São Paulo Medical School. Methods: An observational, retrospective and descriptive study was performed through data survey on medical records of all patients treated between November 2018 and June 2020. Results: Nine reverse-flow fasciocutaneous sural flaps were performed. All patients were men. The mean age was 38 years old. Five patients had acute wounds for traffic collision, one electrical trauma and three chronic post-traumatic injuries. The ankle was the most common injury site (6), followed by foot (2) and calcaneus (1). Four patients had complications, three of which were partial necrosis and one distal epitheliosis. No case of total necrosis was recorded. The average hospital stay was 30.1 days. Conclusion: The reverse-flow fasciocutaneous sural flap proved to be a viable, reproducible, and reliable option for distal lower limb reconstruction. Level of Evidence IV, Case Series.

RESUMO Introdução: Reconstrução de lesões distais de extremidades inferiores podem ser desafiadoras devido à limitação de tecido para retalhos locais. Retalhos fasciocutâneos e musculares são opções, como o retalho fasciocutâneo sural reverso. Objetivo: Apresentar a experiência de 18 meses do Grupo de Feridas Complexas do Serviço de Cirurgia Plástica da Faculdade de Medicina da Universidade de São Paulo no uso do retalho sural reverso para reconstruções de defeitos em tornozelo, calcâneo e pé. Métodos: Estudo observacional, retrospectivo e descritivo, com dados de prontuário de todos os casos operados no serviço entre novembro de 2018 e junho de 2020. Resultados: Foram realizados nove retalhos fasciocutâneos sural reverso. Todos os pacientes eram do sexo masculino, com idade média de 38 anos. Cinco foram vítimas de acidente automobilístico, um de trauma elétrico e três apresentavam sequelas pós-traumáticas. Seis lesões localizadas em tornozelo, dois em pé e um em calcâneo. Quatro pacientes apresentaram complicações, sendo três necroses parciais e uma epiteliólise distal. Não houve perda total de retalho. O tempo médio de hospitalização foi de 30,1 dias. Conclusão: O retalho fasciocutâneo sural reverso mostrou-se uma opção viável, reprodutível e segura para reconstrução de lesões complexas em terço distal de perna e pé. Nível de Evidência IV, Série de Casos.