Bruna Olandoski Erbano

Rapid prototyping of three-dimensional biomodels as an adjuvant in the surgical planning for intracranial aneurysms

PURPOSE To fabricate a three-dimensional biomodels of intracranial aneurysms, using rapid prototyping technology, to facilitate optimal anatomical visualization of aneurysms prior to and during surgery. METHODS Four intracranial aneurysms cases were selected for this study. Using CT angiography images, the rapid prototyping process was completed using a PolyJet technology machine. The size and morphology of the prototypes were compared to brain digital subtraction arteriography of the same patients. RESULTS The biomodels reproduced the exact location and morphology of the intracranial aneurysms, particularly the necks, in life-size dimensions and exactly the same as measured by digital subtraction arteriography. The arterial segments adjacent to the aneurysm and arteries anatomically known by the surgeon were also shown, which could guide the surgeon to the aneurysmal segment. The models showed an average unit cost of US

Interaction of anemia and decrease in renal function on survival of patients with heart failure

130 and each one took an average of 20 hours to be fabricated. CONCLUSIONS It is possible to fabricate 3D physical biomodels of intracranial aneurysms from CT angiography images. These prototypes may be useful in the surgical planning for intracranial aneurysms to clarify the anatomy, define surgical techniques and facilitate the choice of suitable materials, such as clips and clip appliers.

Myocardial regeneration after implantation of porcine small intestinal submucosa in the left ventricle

heart failure Marcia Olandoski , Raphael Rodrigues de Lima , Miguel Morita Fernandes da Silva , Roberto Pecoits-Filho , Angela Olandoski Barboza , Bruna Olandoski Erbano , Lidia Zytynski Moura , Paulo Roberto Slud Brofman , Jose Rocha Faria-Neto a,b,⁎ a Center for Health and Biological Sciences, Pontificia Universidade Catolica do Parana, Brazil b Hospital Cardiologico Costantini, Brazil c Universidade Tecnologica Federal do Parana, Brazil d Faculdade Evangelica do Parana, Brazil

Dietary Interventions and Blood Pressure in Latin America - Systematic Review and Meta-Analysis

Introduction Most cardiomyocytes do not regenerate after myocardial infarction. Porcine small intestinal submucosa has been shown to be effective in tissue repair. Objective To evaluate myocardial tissue regeneration and functional effects of SIS implantation in pigs after left ventriculotomy. Methods Fifteen pigs were assigned to two groups: porcine small intestinal submucosa (SIS) (N=10) and control (N=5). The SIS group underwent a mini sternotomy, left ventriculotomy and placement of a SIS patch. The control group underwent a sham procedure. Echocardiography was performed before and 60 days after the surgical procedure. Histological analysis was performed with hematoxylin-eosin stain and markers for actin 1A4, anti sarcomeric actin, connexin43 and factor VIII. Results Weight gain was similar in both groups. Echocardiography analysis revealed no difference between groups regarding end diastolic and systolic diameters and left ventricular ejection fraction, both pre (P=0.118, P=0.313, P=0.944) and post procedure (P=0.333, P=0.522, P=0.628). Both groups showed an increase in end diastolic (P<0,001 for both) and systolic diameter 60 days after surgery (P=0.005, SIS group and P=0.004, control group). New cardiomyocytes, blood vessels and inflammatory reactions were histologically identified in the SIS group. Conclusion SIS implantation in pigs after left ventriculotomy was associated with angiomuscular regeneration and no damage in cardiac function.

Biocompatibility of Ricinus communis polymer with addition of calcium carbonate compared to titanium. Experimental study in guinea pigs

Background High blood pressure is the major risk factor for cardiovascular disease. Low blood pressure control rates in Latin American populations emphasize the need for gathering evidence on effective therapies. Objective To evaluate the effects of dietary interventions on blood pressure in Latin American populations. Methods Systematic review. Electronic databases (MEDLINE/PubMed, Embase, Cochrane Library, CINAHL, Web of Science, Scopus, SciELO, LILACS and VHL) were searched and manual search for studies published up to April 2013 was performed. Parallel studies about dietary interventions in Latin American adult populations assessing arterial blood pressure (mm Hg) before and after intervention were included. Results Of the 405 studies identified, 10 randomized controlled trials were included and divided into 3 subgroups according to the proposed dietary intervention. There was a non-significant reduction in systolic blood pressure in the subgroups of mineral replacement (-4.82; 95% CI: -11.36 to 1.73) and complex pattern diets (-3.17; 95% CI: -7.62 to 1.28). Regarding diastolic blood pressure, except for the hyperproteic diet subgroup, all subgroups showed a significant reduction in blood pressure: -4.66 mmHg (95% CI: -9.21 to -0.12) and -4.55 mmHg (95% CI: -7.04 to -2.06) for mineral replacement and complex pattern diets, respectively. Conclusion Available evidence on the effects of dietary changes on blood pressure in Latin American populations indicates a homogeneous effect of those interventions, although not significant for systolic blood pressure. Samples were small and the quality of the studies was generally low. Larger studies are required to build robust evidence.

Lipid profile and mortality after discharge of patients admitted with decompensated heart failure

Objective The aim of the present investigation was to determine whether the difference in inflammatory tissue reaction between the Riccinus communis (castor) polymer with calcium carbonate and the titanium implant is statistically significant. Methods Thirty-two Cavia porcellus were allocated into four groups of eight animals each. We implanted the two types of materials in the retroperitoneal space of all the animals. They were euthanized at 7, 20, 30 and 40 days after surgery, and an histological study of the samples was conducted. Results All implants showed characteristics of chronic inflammation regardless of the material and timepoint of evaluation. There was no statistically significant difference between Pm+CaCO3 and Ti with regard to the presence of granulation tissue, tissue congestion, histiocytes, lymphocytes, neutrophils, giant cells, and fibrosis (P> 0.05). Conclusion The castor oil polymer plus calcium carbonate implant was not statistically different from the titanium implant regarding inflammatory tissue reaction.

Regeneration of Tracheal Tissue in Partial Defects Using Porcine Small Intestinal Submucosa

Elevated cholesterol levels are associated with increased cardio-vascular morbidity and mortality in the overall population [1].Dyslipidemia is known as the main risk factor for developing coro-nary artery disease (CAD) [1–3] an important cause of heart failure(HF) [4]. Paradoxically, high serum total cholesterol (TC) levels ap-pear to be associated with a better prognosis in HF [5–7]. Althoughsome hypotheses provide biological plausibility to this paradox [8],its existence is still challenged [3]. In addition, it is not clear atwhich point in the course of HF that high TC levels may become asso-ciatedwithabetterprognosis.Inthisstudy,wesoughtto evaluatetheimpact of the lipid profile on survival of patients that have been oncehospitalized for HF and were discharged alive.Thiscohortstudywasbasedontheanalysisofrecordsfromtheelec-tronicmedicaldatabaseoftheDepartmentofHealthServicesofCuritiba(DSHC), the 8th most populous city in Brazil. Patients admitted with aprimary diagnosis of heart failure (ICD-I50) in hospitals affiliated withthe public health system in Curitiba from March 2005 to July 2006 andwho were discharged alive were considered eligible. Patients of bothgenders,aged≥18 years,whohadrecordsofweight,height,andalllab-oratory variables of interest (including hemoglobin and creatinine, forthemultivariateanalysis)wereincluded.Anemiawasdefinedashavingahemoglobinlevelofb12 dg/Lforfemalepatientsorb13 dg/Lformalepatients(WHOcriteria)inatleastoneexaminationduringthestudype-riod. Renal function was analyzed in terms of glomerular filtration rate(GFR), estimated from the Cockroft–Gault equation. Patients werefollowed from the first record of hospitalization for HF to January2008 or the date corresponding to their death, whichever came first.Death from any cause was considered to be the primary outcome. Weassumed the occurrence of death when a record was found in the mor-tality database organized by the Center of Epidemiology of the DHSC.The adjustment of ROC curves determined cutoff points associatedwith death. The log-rank test and Kaplan–Meier method wereemployed to describe and evaluate the factors associated with survivaltime. AnadjustedCox-regression model wasused toverifytheeffectofcholesterol on the risk of death, controlling for age, gender, BMI, andGFR. p-Values of b0.05 were considered statistically significant. Datawere analyzed using SPSS v.14.0.The study included data from 637 patients with HF. During themedian follow-up time of 18.1 months (0–36 months), 327 (51.3%)patients died. Clinical findings of the sample are listed in Table 1.To evaluate the impact of TC on mortality, the patients were strat-ified into three groups according to their TC level: b150, 150–189,and ≥190 mg/dL. The groups were compared with respect to age,gender, BMI, diabetes, anemia, and glomerular filtration rate (GFR).We observed a higher prevalence of anemia and male patients inthe group with TC less than 150 mg/dL.Univariateanalysisshowedthatage(p b0.001),BMI(p=0.004),GFR(pb0.001), and anemia (p=0.022) were signi ficantly correlated to theprognosisof patientswithHF( Fig.1).Therewasnoassociationbetweenrisk of death and triglyceride levels ( ≤150, 150.1 to 200, >200 mg/dL),LDL (≤70, 70.1–100, 100–160, >160 mg/dL), HDL (≤40, >40 mg/dL),diabetes, blood glucose ( b100, 100–125, >125 mg/dL), and gender.Higher levels of TC (≥190 mg/dL) correlated significantly withimproved survival in the follow-up ( Fig. 2).Themultivariatemodel(Coxregression)included,inadditiontoTC,factorssuchasage,gender,BMI,GFR,andanemia.Even inthepresenceof these variables, the group with the lowest TC (b150 mg/dL), whencompared to the highest level group (≥190 mg/dL), had a worseprognosis (HR=1.38: 95% CI: 0.96 to 1.98). Likewise, the group withcholesterol between 150 and 189 mg/dL had an increased risk ofdeath when compared to the reference group (HR=1.33: 95% CI: 1.01to 1.75) (Table 2).The results of our analysis indicate that in patients who had beenonce hospitalized for HF, high TC is independently associated with abetter prognosis, confirming this paradoxical correlation that hasbeen demonstrated in other studies [5–7]. Although most of these

KNEE ARTHROSCOPIC VISIBILITY ALTERATIONS IN OBESE AND NON-OBESE PATIENTS

Background Surgical correction of tracheal defects is a complex procedure when the gold standard treatment with primary end-to-end anastomosis is not possible. An alternative treatment may be the use of porcine small intestinal submucosa (SIS). It has been used as graft material for bioengineering applications and to promote tissue regeneration. The aim of this study was to evaluate whether SIS grafts improved tracheal tissue regeneration in a rabbit model of experimental tracheostomy. Methods Sixteen rabbits were randomized into two groups. Animals in the control group underwent only surgical tracheostomy, while animals in the SIS group underwent surgical tracheostomy with an SIS graft covering the defect. We examined tissues at the site of tracheostomy 60 days after surgery using histological analysis with hematoxylin and eosin (H&E) staining and analyzed the perimeter and area of the defect with Image-Pro® PLUS 4.5 (Media Cybernetics). Results The average perimeter and area of the defects were smaller by 15.3% (p = 0.034) and 21.8% (p = 0.151), respectively, in the SIS group than in the control group. Histological analysis revealed immature cartilage, pseudostratified ciliated epithelium, and connective tissue in 54.5% (p = 0.018) of the SIS group, while no cartilaginous regeneration was observed in the control group. Conclusions Although tracheal SIS engraftment could not prevent stenosis in a rabbit model of tracheal injury, it produced some remarkable changes, efficiently facilitating neovascularization, reepithelialization, and neoformation of immature cartilage.

Achieved systolic blood pressure in older people: a systematic review and meta-analysis

ABSTRACT Background: Obesity is a chronic disease and has become the most prevalent public health problem worldwide. The impact of obesity on knee is strong and the BMI is correlated with the different alterations. Aim: Compare surgical visualization of arthroscopic field in partial meniscectomy in obese and non-obese. Method: Sixty patients were selected, 30 obese and 30 non-obese who underwent arthroscopic partial meniscectomy. The arthroscopic surgical procedures were recorded and analyzed. For the analysis of visualization was used the Johnsons classification (2000). Results: Were analyzed 48 men and 12 women, the average age was 42.9 years with BMI between 21.56 to 40.14 kg/m2. The distribution of visibility of the surgical field according to the classification was: grade 1 - 38/60 (63.3%); grade 2 - 13/60 (21.6%); grade 3 - 6/60 (10%); grade 4 - 3/60 (5%). Conclusion: Knee arthroscopy did not show a significant difference in the visibility of arthroscopic field in obese and non-obese patients. Thus, it should not be indicated as the preferred method of diagnostic evaluation of joint changes in these patients.