Da superfície para a profundidade: Curva de aprendizado em lifting facial profundo estendido - meus primeiros 100 casos / From Surface to Depth: Learning Curve in Extended Deep Facelift ­ my First 100 Cases

Introdução: O envelhecimento facial é um processo gradual, complexo e multifatorial. É o resultado de mudanças na qualidade, volume e posicionamento dos tecidos. Cirurgiões plásticos têm modificado sua abordagem na cirurgia do rejuvenescimento facial optando pelo plano subaponeurótico (SMAS). O objetivo deste estudo é analisar 100 casos de pacientes operados pela técnica de SMAS profundo, avaliando sua aplicabilidade e eficácia. Método: Foram avaliados 100 pacientes, submetidos a cirurgia plástica facial pela técnica de SMAS profundo - "Deep Smas", e acompanhados por 6 meses. Observou-se a satisfação dos pacientes, número de complicações, número de reoperações, riscos e vantagens da técnica. Resultados: Foram operados 100 pacientes, num período de 3 anos. A idade variou de 41 a 79 anos, sendo 95% sexo feminino. As complicações foram 8 casos (8%) de lesões de ramos do nervo facial, sendo: 4 casos lesão do zigomático, 3 casos de lesão do mandibular e 1 caso de lesão do bucal; houve 1 caso (1%) de queloide retroauricular; 1 caso (1%) de hematoma. Em relação às revisões cirúrgicas, houve 8 casos (8%) de complementação cirúrgica por insatisfação das pacientes. Houve 15% de lesões nervosas entre a 1ª e a 40ª cirurgia, 5% entre a 41ª e a 80ª, e nenhuma lesão entre o 81º e o 100º paciente. Conclusão: O lifting facial profundo ou subSMAS mostrou ser efetivo, proporcionando bons resultados estéticos. Apresenta baixa taxa de recidiva e baixa taxa de morbidade, porém, necessita de uma longa curva de aprendizagem.

Introduction: Facial aging is a gradual, complex, and multifactorial process. It is the result of changes in the quality, volume, and positioning of tissues. Plastic surgeons have modified their approach to facial rejuvenation surgery, opting for the subaponeurotic plane (SMAS). The objective of this study is to analyze 100 cases of patients operated on using the deep SMAS technique, evaluating its applicability and effectiveness. Method: 100 patients were evaluated, undergoing facial plastic surgery using the deep SMAS technique - "Deep Smas", and followed up for 6 months. Patient satisfaction, number of complications, number of reoperations, risks, and advantages of the technique were observed. Results: 100 patients were operated on over 3 years. Age ranged from 41 to 79 years, with 95% being female. The complications were 8 cases (8%) of injuries to branches of the facial nerve, of which 4 cases of zygomatic injury, 3 cases of mandibular injury, and 1 case of buccal injury; there was 1 case (1%) of post-auricular keloid; 1 case (1%) of hematoma. Regarding surgical revisions, there were 8 cases (8%) of surgical completion due to patient dissatisfaction. There were 15% of nerve injuries between the 1st and 40th surgery, 5% between the 41st and 80th, and no injuries between the 81st and 100th patient. Conclusion: Deep facial lifting or subSMAS has proven to be effective, providing good aesthetic results. It has a low recurrence rate and low morbidity rate; however, it requires a long learning curve.

Yellow fever virus investigation in tissues of vampire bats Desmodus rotundus during a wild yellow fever outbreak in Brazilian Atlantic Forest.

In the last decade a large outbreak of Yellow Fever (YF) has been observed in Brazilian Atlantic Forest region, traditionally a non-endemic area. In this scenario, the role of wild mammal species as YF reservoirs can be questioned, especially the hematophagous bat, Desmodus rotundus. So, the objective of this study was to analyze molecularly the presence of the YF virus (YFV) in hematophagous bats during a YF outbreak in Brazil. Twenty-one samples were collected from seven adult male hematophagous bats D. rotundus. As YFV is considered a viscerotropic and neurotropic virus, samples of liver, kidney and brain were collected and molecularly analyzed using the RT qPCR technique. The animals were captured according to ethical protocols during a YF outbreak in Brazil in 2017, from a region of the Brazilian Atlantic Forest. The results revealed that the analyzed tissue samples were not infected with the YFV. The negative results for this bat species allow us to infer that other animals may be reservoirs of this virus in this ecosystem and they probably have not been identified yet. Therefore, health surveillance actions are essential to monitor the role of wild animals in the YF dissemination in Brazilian Atlantic Forest and alert to the possibility of new geographic amplification of areas where YF occurs. This research encourages the new search about the role of wild animals on YFV transmission and reinforces the importance of epidemiological surveillance in the transmission of human infectious diseases.

Morphological adaptations during development of the kidneys in Vampire bats.

Tissue changes during embryonic and postnatal development are critical for the success of physiological processes later in mammalian life. Dietary transition from milk to a variety of other food items is one of the factors inducing these changes in mammal species. Blood is utilized as food by only three species of vampire bats among all living mammals. Considering its high protein content, this unique diet is known to induce several metabolic changes, including fasting susceptibility. However, changes in the renal function to meet the excretory needs associated to the blood diet are unknown. Here we aimed at investigating morphological alterations in vampires' kidneys during embryonic and post-natal development in order to better understand the evolutionary adaptations allowing sanguivory. Common vampire bats (Desmodus rotundus) were captured and had their kidneys removed for histological, morphometrical and stereological analysis. Our results showed increased glomerular area and higher glomerular and uriniferous tubules volumetric densities in adults compared to developing bats. These results, together with a higher Renal Somatic Index and a thicker inner medulla also reported for adults, support renal hypertrophy due to increased renal function in blood-feeding vampires as compared to the earlier life stages. We also report a lower foot process density and its different arrange inside the glomerular capsule in adults, indicating an adaptation to a larger extracellular volume formed by increased glomerular filtration. Taken together, kidney morphological changes reported here for vampire bats may reflect in adults' adaptations to a monotrophic strategy.

Aspects regarding renal morphophysiology of fruit-eating and vampire bats.

Bats have adapted to many different feeding habits, which are known to induce morphophysiological adaptations in several tissues, especially those particularly involved with absorption, metabolism and excretion. The common vampire bat (Desmodus rotundus) has a very unique diet (blood), which, among other challenges, seems to pose a risk to their kidneys, due to the increased nitrogen excretion imposed by their remarkably high protein meal. Fruit-eating bats (Artibeus lituratus) consume a high carbohydrate diet and may be taken as a suitable species for this dietary comparative study. Here we aimed at investigating the renal morphology and stereology, kidneys antioxidant capacity, and plasma antidiuretic hormone (ADH) concentrations in adult fruit-eating and vampire bats. Sixteen animals were captured and used in this study, being 8 adult males from each species. Our results showed higher morphological standards of glomerular area, volumetric density of glomeruli, and renal somatic index for vampire bats, as well as higher reactive species of oxygen (ROS) production, such as nitric oxide (NO), higher plasma iron reduction ability (FRAP), higher activity of the antioxidant enzyme glutathione-S-transferase (GST) and a higher malondialdehyde production (MDA) in vampires' kidneys, compared to the fruit-eating species. The activities of the antioxidant enzymes superoxide dismutase (SOD) and catalase (CAT) were higher in fruit-eating bats. Plasma ADH concentrations were not different between species. Taken together, the renal morphophysiology conditions presented by vampire bats might be associated with a high demand for nitrogenous products excretion imposed by protein and iron overload. These features may play an important role on preventing protein-overload nephropathy, allowing vampires to survive under such a unique diet.

Impacto da cirurgia bariátrica no perfil lipídico e glicêmico em pacientes obesos / Impact of bariatric surgery on lipid and glycemic profile in obese patients

A obesidade é atualmente problema de saúde pública e tem como seu principal marcador o IMC. Existem evidências consistentes de que o tratamento cirúrgico possui resultados mais favoráveis em relação a perda de peso e redução de comorbidades em comparação com intervenções comportamentais. Os objetivos deste estudo foram avaliar os impactos da cirurgia bariátrica nos parâmetros antropométricos, metabólicos e bioquímicos na obesidade. É estudo coorte retrospectivo com amostragem não probabilística por conveniência dos submetidos à cirurgia bariátrica a partir de dados de prontuários pré- e pós-operatórios. Foram analisados 75 pacientes no pré, pós-operatório de 3 meses e pós- operatório de 6 meses. Em conclusão, o colesterol total LDL e triglicerídeos tiveram decréscimo significativo no pós-operatório; o mesmo ocorreu com a glicemia em jejum, hemoglobina glicada e insulina. Assim, a cirurgia bariátrica mostrou-se eficaz na redução dos parâmetros antropométricos e metabólicos dos obesos operados.

Obesity is currently a public health problem and its main marker is BMI. There is consistent evidence that surgical treatment has more favorable results in terms of weight loss and reduction of comorbidities compared to behavioral interventions. The objectives of this study were to evaluate the impacts of bariatric surgery on anthropometric, metabolic and biochemical parameters in obesity. This is a retrospective cohort study with non-probabilistic convenience sampling of those undergoing bariatric surgery based on data from pre- and postoperative medical records. A total of 75 patients were analyzed preoperatively, in 3 and 6 months postoperatively. In conclusion, total LDL cholesterol and triglycerides had a significant decrease postoperatively; the same occurred with fasting glucose, glycated hemoglobin and insulin. Thus, bariatric surgery proved to be effective in reducing the anthropometric and metabolic parameters of obese patients undergoing surgery.

A imunoistoquímica em pacientes com proliferação acinar atípica no câncer prostático / Immunohistochemistry in patients with atypical acinar proliferation in prostatic cancer

Na análise histopatológica do câncer prostático muitas vezes pode-se deparar com lesões duvidosas pseudoneoplásicas e inconclusivas. Avaliar sua prevalência através do uso da imunoistoquímica em pacientes com proliferação acinar atípica (PAAP) pode melhorar a eficácia diagnóstica. Este estudo retrospectivo incluiu pacientes com diagnóstico de PAAP e imunoistoquímica utilizando: AMACR, 34BE12 e p63. Foram analisados 1542 pacientes positivos para PAAP em 293 pacientes (19%). Não houve diferença significativa na eficiência dos três marcadores; a sensibilidade foi de 99,7%; 100% e 100%, e a especificidade de 79,4%; 89% e 83,5%, respectivamente. O valor preditivo positivo foi em 90,3%, 94,3% e 91,3%, e o negativo em 99,3%; 100% e 100%, respectivamente. A exiguidade da área atípica foi citada em 92 (12,9%) como dificuldade para o diagnóstico. A imunoistoquímica foi capaz de elucidar o diagnóstico em 83,5% dos casos e a prevalência de adenocarcinoma prostático foi de 52,2%.

In the histopathological analysis of prostate cancer, it is often possible to come across doubtful pseudoneoplastic and inconclusive lesions. Assessing its prevalence through the use of immunohistochemistry in patients with atypical acinar proliferation (PAAP) can improve diagnostic efficacy. This retrospective study included patients diagnosed with PAAP and immunohistochemistry using: AMACR, 34BE12 and p63. A total of 1542 PAAP positivity in 293 patients (19%) were analyzed. There was no significant difference in the efficiency of the three markers. Sensitivity was 99.7%; 100% and 100%, and the specificity of 79.4%; 89% and 83.5%, respectively. The positive predictive value was in 90.3%, 94.3% and 91.3%, and the negative in 99.3%; 100% and 100%, respectively. The smallness of the atypical area was mentioned by 92 (12.9%) as a difficulty for diagnosis. Immunohistochemistry was able to elucidate the diagnosis in 83.5% of the cases and the prevalence of prostate adenocarcinoma was 52.2%.

Instabilidade microssatélite e Epstein-Barr vírus como fatores de risco para o desenvolvimento de adenocarcinoma gástrico / Microssatellite instability and Epstein-Barr viruses as risk factors for the development of gastric adenocarcinoma

Ainda que a ciência avance a passos largos, o câncer gástrico continua figurado como condição comum e letal e muitas controvérsias existem em relação aos agentes agressores que o estimulem. O objetivo deste estudo foi avaliar o grau de relação entre o Epstein-Barr vírus, a instabilidade microssatélite e o adenocarcinoma gástrico. É estudo transversal retrospectivo que consistiu na revisão de 35 laudos de pacientes com adenocarcinoma gástrico. Obteve-se blocos de parafina e lâminas histopatológicas coradas pela técnica de H&E, ambos contendo amostras com diagnóstico prévio de adenocarcinoma gástrico. Após foram testados por imunoistoquímica os biomarcadores MLH1, MSH2, MSH6 e PMS2. Em conclusão, tanto o Epstein-Barr vírus quando a instabilidade microssatélite estão presentes em proporção significativa de adenocarcinoma gástrico.

Although science advances by leaps and bounds, gastric cancer continues to figure as a common and lethal condition and many controversies exist in relation to the aggressive agents that stimulate it. The aim of this study was to evaluate the degree of relationship between Epstein-Barr virus, microsatellite instability and gastric adenocarcinoma. It is a retrospective cross-sectional study that consisted of a review of 35 reports of patients with gastric adenocarcinoma. Paraffin blocks and histopathological slides stained using the H&E technique were obtained, both containing samples with a previous diagnosis of gastric adenocarcinoma. Afterwards, the biomarkers MLH1, MSH2, MSH6 and PMS2 were tested by immunohistochemistry. In conclusion, both Epstein-Barr virus and microsatellite instability are present in a significant proportion of gastric adenocarcinoma.

Perfil epidemiológico de pacientes com câncer colorretal / Epidemiological profile of patients with colorectal cancer

O câncer colorretal é uma das neoplasias mais comuns em todo o mundo. O objetivo deste estudo foi identificar o perfil clínico e epidemiológico dos pacientes com esse câncer submetidos ao tratamento cirúrgico. Trata-se de estudo transversal descritivo realizado de forma retrospectiva com revisão de prontuários no período de janeiro de 2015 a outubro de 2020. Em conclusão, a partir dos dados dos 5 anos analisados, foi possível estruturar o perfil epidemiológico dos pacientes com diagnóstico confirmado de neoplasia colorretal atendidos pelo serviço. Podendo-se, assim, conhecer as particularidades dos pacientes, para que seja oferecido um atendimento mais direcionado, impactando de forma positiva no prognóstico de cada um.

Colorectal cancer is one of the most common neoplasms around the world. The objective of this work was to identify the clinical and epidemiological profile of patients with colorectal cancer submitted to surgical treatment. This is a descriptive cross-sectional study carried out in a retrospective manner, from January 2015 to October 2020. In conclusion, from the data of the 5 years analyzed, it was possible to structure the epidemiological profile of patients with confirmed diagnosis of colorectal neoplasia attended by the service. It can thus know the patients' particularities to be offered a more targeted service, impacting in a positive way in the prognosis of each.

Relação entre diabetes e sintomas depressivos / Relationship between diabetes and depressive symptoms

O diabete é das doenças crônicas mais recorrentes a nível mundial, e está relacionada com diversas comorbidades, dentre elas a depressão. Este estudo teve por objetivo correlacionar essa doença com transtornos depressivos. Foi realizado estudo transversal e prospectivo com 100 pacientes selecionados. A coleta de dados foi feita por aplicação de 3 questionários: um sobre o perfil socioeconômico do entrevistado; outro, sobre o tempo, tipo do diabete, tratamento e complicações; e um terceiro com 9 perguntas que avaliaram a presença de sintomas para episódio de depressão maior. Em conclusão, mostrou-se que 48% dos pacientes não apresentaram sintomas depressivos; 21% sintomas leves; 12% moderados; 9% moderadamente severo e 10% graves. Assim, foi possível verificar importante associação entre sintomas depressivos e portadores de diabete.

Diabetes is one of the most recurrent chronic diseases worldwide, and is related to several comorbidities, including depression. This study aimed to correlate this disease with depressive disorders. A cross-sectional and prospective study was carried out with 100 selected patients. Data collection was carried out by applying 3 questionnaires: one about the interviewee's socioeconomic profile; another, about time, type of diabetes, treatment and complications; and a third with 9 questions that assessed the presence of symptoms for a major depressive episode. In conclusion, it was shown that 48% of the patients did not present depressive symptoms; 21% mild symptoms; 12% moderate; 9% moderately severe and 10% severe. Thus, it was possible to verify an important association between depressive symptoms and patients with diabetes.