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BACKGROUND AND AIMS: Remnant cholesterol (RC) and insulin resistance (IR) have been independently associated with cardiovascular risk. Here, we evaluated the role of IR and RC on cardiovascular disease (CVD) mortality. METHODS: We conducted an analysis of 16,113 individuals ≥20 years without diabetes from the National Health and Nutrition Examination Survey (NHANES-III/IV). RC levels were calculated using total cholesterol, non-HDL-c, and LDL-c; IR was defined as HOMA2-IR≥2.5 and CVD mortality as a composite of cardiovascular and cerebrovascular mortality. Multiple linear regression was used to assess the relationship between HOMA2-IR and RC and Cox regression models to assess their joint role in CVD mortality. Causally ordered mediation models were used to explore the mediating role of IR in RC-associated CVD mortality. RESULTS: We identified an association between higher HOMA2-IR and higher RC levels. The effect of IR on CVD mortality was predominant (HR 1.32, 95%CI 1.18-1.48) and decreased at older ages (HR 0.934, 95%CI 0.918-0.959) compared to RC (HR 0.983, 95%CI 0.952-1.014). Higher risk of CVD mortality was observed in individuals with IR but normal RC (HR 1.37, 95%CI 1.25-1.50) and subjects with IR and high RC (HR 1.24, 95%CI 1.13-1.37), but not in subjects without IR but high RC. In mediation models, HOMA2-IR accounted for 78.2% (95%CI 28.11-98.89) of the effect of RC levels on CVD mortality. CONCLUSIONS: Our findings suggest that RC potentiates the risk of CVD mortality through its effect on whole-body insulin sensitivity, particularly among younger individuals.

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ABSTRACT Quilombo remnant communities are areas officially recognized by the Brazilian government as historical communities founded by formerly enslaved individuals. These communities are mostly located in the endemic areas of malaria in the Brazilian Amazon. We retrospectively described the prevalence of malaria among individuals living in 32 recognized quilombo remnant communities in the Baiao and Oriximina municipalities located in the Para State. The number of malaria cases and the Annual Parasitic Incidence (API) recorded by the Brazilian malaria surveillance system (SIVEP-Malaria) from January 2005 to December 2020 were analyzed. We found that all communities registered at least one case over the 16-year period, the most frequent parasitic species being Plasmodium vivax (76.1%). During this period, 0.44% (4,470/1,008,714) of the malaria cases registered in Para State were reported in these quilombo remnant communities, with frequencies of 10.9% (856/7,859) in Baiao municipality and 39.1% (3,614/9,238) in Oriximina municipality, showing that individuals living in these rural communities are exposed to malaria. These data indicate that effective surveillance requires improved measures to identify malaria transmission among vulnerable populations living in quilombo remnant communities in the Brazilian Amazon.

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Background: The middle cerebral artery (MCA) is a common site of cerebral aneurysms and 82.6% occur at the bifurcation. When surgery is selected as a therapeutic option, it intends to clip the neck completely because if some remnant occurs, there exists the possibility of regrowth and bleeding in the short- or long-term. Methods: We analyzed one drawback of the fenestrated clips of Yasargil and Sugita types to occlude the neck totally at a specific point formed by the union of the fenestra with the blades, creating a triangular space where the aneurysm can protrude, giving place to a remnant that can lead to a future recurrence and rebleeding. We show two cases of ruptured MCA aneurysms in which a cross-clipping technique occluded a broad base and dysmorphic aneurysm using straight fenestrated clips. Results: In both cases (one using a Yasargil clip and the other with a Sugita clip), a small remnant was visualized when fluorescein videoangiography (FL-VAG) was used. In both cases, the small remnant was clipped with a 3 mm straight miniclip. Conclusion: We should be aware of this drawback when clipping aneurysms using fenestrated clips to ensure a complete obliteration of the aneurysm's neck.

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BACKGROUND: In patients with low-risk differentiated thyroid cancer (DTC), remnant ablation with radioiodine (RA) after total thyroidectomy (TT) is controversial. No benefits have been demonstrated in terms of mortality or disease-free survival. Recent evidence found that RA did not improve mid-term outcomes. PURPOSE: To evaluate initial response to treatment and long-term follow-up status in low-risk DTC patients after TT vs. TT + RA with 131I 1.11 GBq (30 mCi). METHODS: Prospective multicenter non-randomized study; 174 low-risk DTC that underwent TT were recruited an divided in two groups according to RA (87 ablated and 87 non-ablated). Response to treatment was evaluated at 6-18 months after thyroidectomy and at the end of follow-up with measurements of thyroglobulin, and anti-thyroglobulin antibodies levels, and neck ultrasonography. RESULTS: Baseline characteristics of both groups were similar. Ablated patients: median age 45.5 years, 84% females, 95.4% papillary thyroid carcinoma (PTC), mean tumor size 16 mm; non-ablated: median age 45 years, 88.5% females, 96.6% PTC, mean tumor size 14 mm. Response to initial treatment was similar between both groups, with < 2% of structural incomplete response. Final status was evaluated in 139 cases (median follow-up of 60 months). Among ablated patients, 82.8% had no evidence of disease (NED), 12% had an indeterminate response (IR) and 5% a biochemical incomplete response (BIR). Non-ablated patients had NED in 90%, IR in 8.7% and BIR in 1.2%. No statistical difference was found between groups (p = 0.29). No patient had evidence of structural disease at the end of follow-up. CONCLUSIONS: Our findings support the recommendation against routine RA in low-risk DTC patients.

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BACKGROUND: Remnant gastric cancer (RGC) is defined as a carcinoma that develops in the gastric remnant from 5 years after gastrectomy, regardless of the primary gastric disease. The pattern of lymph node dissemination in these patients is not well understood. The present study aims to understand the lymph node distribution of patients with RGC in a single center. METHODS: In a total of 1380 patients with gastric cancer, between 1998 and 2020, 43 patients operated on for RGC were analyzed. The pattern of lymph node dissemination was evaluated based on the number of dissected lymph node stations, the number of positive lymph node stations, the positivity index at each analyzed station, the number of dissected lymph nodes per patient, and the positivity index per lymph node station. RESULTS: A mean of 13.0 ± 8.1 lymph nodes were dissected. The incidence of lymph node involvement by dissected station was higher at Stations 19, 11p, 3, 4sb and 7 (50, 40, 37.5, 36 and 31.7%, respectively). Among the positive dissected stations, Station 3 with 52.2%, 4sb with 39.1% and 4sa with 34.8% were the most affected. CONCLUSION: There was no predilection for lymph node involvement when comparing the lesser and greater gastric curvature. The dissection of Stations 3, 4sb and 4sa is fundamental in surgical treatment with curative purposes. The totalization of gastrectomy with lymphadenectomy of the perigastric and supra-pancreatic stations should be the surgery of choice.

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Introdução: Blastocystis sp. é o parasito mais comum encontrado nos estudos de prevalência de parasitas intestinais em diferentes populações. Objetivo: determinar a prevalência do parasita intestinal Blastocystis sp. em moradores da comunidade quilombola Distrito Nossa Senhora Aparecida do Chumbo localizada em uma área rural do Município de Poconé-MT. Método: Trata-se de um estudo epidemiológico descritivo e quantitativo que determinou a prevalência do parasita intestinal Blastocystis sp. que ocorreu nos meses de dezembro de 2021 a maio de 2022. A amostra final foi composta por 114 participantes. Na identificação das formas evolutivas dos parasitas intestinais nas amostras fecais foi empregado o método de Hoffman. As amostras foram analisadas com auxílio do microscópio óptico e as lâminas foram coradas com lugol, para identificação das formas evolutivas dos parasitos. Para análise descritiva foi realizado a frequência absoluta e percentual. Foram realizados cálculos para determinar a prevalência total de parasitos intestinais e a prevalência por tipo de parasitas. Resultados: A prevalência total foi de 75%, deste a maior ocorrência foi apresentada por Blastocystis sp. Conclusão: Sugerimos, que a alta prevalência deste parasito que tem por via de contaminação fecal- oral, esteja associada à falta de um saneamento adequado, bem como ao acesso da água de qualidade.

Introduction: Blastocystis sp. is the most common parasite found in studies of intestinal parasite prevalence in different populations. Objective: To determine the prevalence of the intestinal parasite Blastocystis sp. in residents of the quilombola community of Distrito Nossa Senhora Aparecida do Chumbo located in a rural area of the Municipality of Poconé-MT. Method: This is a descriptive and quantitative epidemiological study that determined the prevalence of the intestinal parasite Blastocystis sp. that occurred in the months from December 2021 to May 2022. The final sample consisted of 114 participants. The Hoffman method was used to identify the evolutionary forms of the intestinal parasites in the fecal samples. The samples were analyzed with the aid of an optical microscope and the slides were stained with lugol to identify the evolutive forms of the parasites. For descriptive analysis, absolute and percentage frequency was performed. Calculations were performed to determine the total prevalence of intestinal parasites and the prevalence by type of parasites. Results: The total prevalence was 75%, of this the highest occurrence was presented by Blastocystis sp. Conclusion: We suggest, that the high prevalence of this parasite that has a fecal-oral contamination route, is associated with the lack of proper sanitation, as well as access to quality water.

Introducción: Blastocystis sp. es el parásito más común encontrado en estudios de prevalencia de parásitos intestinales en diferentes poblaciones. Objetivo: Determinar la prevalencia del parásito intestinal Blastocystis sp. en residentes de la comunidad quilombola del Distrito Nossa Senhora Aparecida do Chumbo localizada en una zona rural del Municipio de Poconé-MT. Método: Se trata de un estudio epidemiológico descriptivo y cuantitativo que determinó la prevalencia del parásito intestinal Blastocystis sp. ocurrida en los meses de diciembre de 2021 a mayo de 2022. La muestra final estuvo compuesta por 114 participantes. Se utilizó el método Hoffman para identificar las formas evolutivas de los parásitos intestinales en las muestras fecales. Las muestras se analizaron con la ayuda de un microscopio óptico y los portaobjetos se tiñeron con lugol para identificar las formas evolutivas de los parásitos. Para el análisis descriptivo se calcularon las frecuencias absolutas y porcentuales. Se realizaron cálculos para determinar la prevalencia total de parásitos intestinales y la prevalencia por tipo de parásitos. Resultados: La prevalencia total fue de 75%, de esta la mayor ocurrencia la presentó Blastocystis sp. Conclusión: Sugerimos, que la alta prevalencia de este parásito que tiene por vía de contaminación fecal-oral, está asociada a la falta de saneamiento adecuado, así como al acceso a agua de calidad.

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BACKGROUND: Sepsis is a common and deadly syndrome, accounting for more than 11 million deaths annually. To mature a deeper understanding of the host and pathogen mechanisms contributing to poor outcomes in sepsis, and thereby possibly inform new therapeutic targets, sophisticated, and expensive biorepositories are typically required. We propose that remnant biospecimens are an alternative for mechanistic sepsis research, although the viability and scientific value of such remnants are unknown. METHODS AND RESULTS: The Remnant Biospecimen Investigation in Sepsis study is a prospective cohort study of 225 adults (age ≥ 18 yr) presenting to the emergency department with community sepsis, defined as sepsis-3 criteria within 6 hours of arrival. The primary objective was to determine the scientific value of a remnant biospecimen repository in sepsis linked to clinical phenotyping in the electronic health record. We will study candidate multiomic readouts of sepsis biology, governed by a conceptual model, and determine the precision, accuracy, integrity, and comparability of proteins, small molecules, lipids, and pathogen sequencing in remnant biospecimens compared with paired biospecimens obtained according to research protocols. Paired biospecimens will include plasma from sodium-heparin, EDTA, sodium fluoride, and citrate tubes. CONCLUSIONS: The study has received approval from the University of Pittsburgh Human Research Protection Office (Study 21120013). Recruitment began on October 25, 2022, with planned release of primary results anticipated in 2024. Results will be made available to the public, the funders, critical care societies, laboratory medicine scientists, and other researchers.

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Resumen Una vasta evidencia científica de resultados de ensayos clínicos, preclínicos, epidemiológicos y genéticos, mostraron una asociación causal entre el aumento de triglicéridos (TG), lipoproteínas ricas en TG (LRT) y sus remanentes para la enfermedad cardiovascular aterosclerótica (ECA). La acumulación de LRT circulantes puede explicar, en parte, el riesgo cardiovascular residual que se observa en pacientes eficazmente tratados para reducir sus niveles de LDL; sin embargo, persiste el riesgo de ECA. Es imprescindible que en el estudio del perfil lipídico se considere la determinación o estimación de estas lipoproteínas, sumada a la medida de TG plasmáticos. El objetivo de la presente revisión fue actualizar el conocimiento acerca de los niveles incrementados de TG, de LRT y sus remanentes, brindar alternativas para su determinación y comprender los mecanismos que involucran a las LRT en el desarrollo acelerado de la aterosclerosis. La actualización de los diferentes parámetros asociados al aumento de TG y sus valores de corte o límites de decisión clínica según la clasificación del riesgo de ECA para cada paciente, permitirá el rediseño de un informe de resultados que será de gran utilidad para el médico y el paciente con respecto a las conductas preventivas y terapéuticas de la ECA.

Abstract Vast scientific evidence from clinical, preclinical, epidemiological, and genetic trial results show a causal association between increased triglycerides (TG), TG-rich lipoproteins (TRL), and their remnants for atherosclerotic cardiovascular disease (ASCVD). The accumulation of circulating LRT may explain, in part, the residual cardiovascular risk observed in patients successfully treated to reduce their LDL levels, however, the risk of ASCVD still persists. It is essential that in the assessment of the lipid profile, the determination or estimation of these lipoproteins be considered, added to the measurement of plasmatic TG. The objective of this review is to update the knowledge about the increased levels of TG, LRT and their remnants, proprovide alternatives for their determination and understand the mechanisms that involve LRT in the accelerated development of atherosclerosis. Updating the different parameters associated with increased TG and their cut-off values or clinical decision limits according to the ASCVD risk classification for each patient will allow for the redesign of a results report that will be very useful for the physician and the patient regarding the preventive and therapeutic behaviours of the ASCVD.

Resumo Vastas evidências científicas de resultados de ensaios clínicos, pré-clínicos, epidemiológicos e genéticos mostraram uma associação causal entre o aumento de triglicerídeos (TG), lipoproteínas ricas em TG (LRT) e seus remanescentes para doença cardiovascular aterosclerótica (DCA). O acúmulo de LRT circulante pode explicar, em parte, o risco cardiovascular residual observado em pacientes tratados de maneira eficaz para reduzir seus níveis de LDL, no entanto, o risco de DCA persiste. É fundamental que no estudo do perfil lipídico seja considerada a determinação ou estimativa dessas lipoproteínas, somada à dosagem de TG plasmáticos. O objetivo desta revisão foi atualizar o conhecimento sobre os níveis aumentados de TG, LRT e seus remanescentes, fornecer alternativas para sua determinação e compreender os mecanismos que envolvem as LRT no desenvolvimento acelerado da aterosclerose. A atualização dos diferentes parâmetros associados ao aumento de TG, e seus valores de corte ou limites de decisão clínica de acordo com a classificação do risco de DCE para cada paciente, permitirá o redesenho de um relatório de resultados que será muito útil para o médico e o paciente quanto às condutas preventivas e terapêuticas da DCE.

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Background: Subtotal cholecystectomy was described in 1985 as an alternative to total cholecystectomy in cases of difficult cholecystectomy. It was classified as reconstituted and fenestrated subtotal. In spite of being a viable alternative, up to 10.6% of biliary leakage is reported and 2.2% of patients present with cholecystitis of the gallbladder remnant. The objective of this report is to describe and emphasize the importance of an adequate diagnosis of complications in patients with a history of subtotal cholecystectomy. Clinical case: 72-year-old male with a history of open subtotal cholecystectomy 6 years prior to his admission to the emergency department due to right hypochondrium pain and vomiting. He had a history of biliary pancreatitis and choledocholithiasis after subtotal cholecystectomy resolved by endoscopic retrograde cholangiopancreatography (ERCP). It was decided to admit the patient and a diagnosis of cholecystitis of the gallbladder remnant was made. Laparoscopic cholecystectomy of the remnant was performed with subsequent clinical resolution. Conclusions: Although subtotal cholecystectomy may be the only option in cases of difficult cholecystectomy, it may result in future complications. The possibility of more complex surgical reinterventions should be considered. Our case report demonstrates that total cholecystectomy in cases of cholecystitis should be performed whenever possible to avoid potential complications caused by subtotal cholecystectomy.

Introducción: la colecistectomía subtotal fue descrita en 1985 como una alternativa a la colecistectomía total en casos de colecistectomía difícil. Fue clasificada como subtotal reconstituida y fenestrada. A pesar de ser una alternativa viable, se reporta hasta un 10.6% de fuga biliar y 2.2% de los pacientes presentan colecistitis del remanente vesicular. El objetivo de este reporte de caso es incluir la colecistitis del remanente vesicular como diagnóstico diferencial en pacientes con antecedente de colecistectomía subtotal y dolor abdominal. Caso clínico: hombre de 72 años con antecedente de colecistectomía subtotal abierta. Seis años antes de su ingreso, acudió a un servicio de urgencias por dolor en hipocondrio derecho y vómito. Contaba con antecedente de pancreatitis biliar y coledocolitiasis posterior a colecistectomía subtotal resueltas por colangiopancreatografía retrógrada endoscópica (CPRE). Se decidió ingresar al paciente y se integró diagnóstico de colecistitis del remanente de la vesícula biliar. Se realizó colecistectomía laparoscópica del remanente con posterior resolución clínica. Conclusiones: a pesar de que la colecistectomía subtotal puede ser la única opción en casos de colecistectomía difícil, esta puede resultar en complicaciones futuras. La posibilidad de reintervenciones quirúrgicas más complejas debe ser considerada. Con nuestro reporte de caso podemos inferir que la colecistectomía total en casos de colecistitis debe realizarse siempre que sea posible para evitar potenciales complicaciones causadas por la colecistectomía subtotal.

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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.

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PURPOSE: The Anterior cruciate ligament (ACL) remnant has been pointed out as a ligamentization enhancer. Nonetheless, the remaining tissue can be functional if it still provides some stability or nonfunctional. This study intends to compare the clinical results and knee stability of functional vs. nonfunctional remnant preservation ACL reconstruction (ACLR). METHODS: One hundred and seventy-five patients with ACL injuries were included and underwent remnant preservation ACLR. They were divided into two groups accordingly to remnant tissue functionality: functional (Group F) and nonfunctional (Group NF). Primary outcome was defined as patient reported outcomes measured with Lysholm, IKDC and Tegner continuous scales and improvements. Secondary outcomes comprised of Lachman test, anterior drawer test, pivot shift test, extension and flexion deficit, graft coverage by remnant preserved tissue and failure rate (persistent instability or new ACL lesion). Menisci lesions, cartilage lesions and time to surgery were also recorded for each group. RESULTS: One hundred and forty-four patients were available at a mean of 30.2 ± 10.1 months: 69 Functional and 75 Nonfunctional. Lysholm, IKDC and Tegner functional outcomes demonstrated no difference between the groups, Functional compared to Nonfunctional: 88.4 ± 10.5 vs. 92.2 ± 4.9, n.s. and 83.2 ± 11.3 vs. 87 ± 5.3, n.s. and 6 (5-10) vs. 6 (5-9), n.s., respectively. Lysholm and IKDC functional outcomes improvements demonstrated differences between the groups: Functional compared to Nonfunctional (39.3 ± 9.4 vs. 42.3 ± 7.4, p = 0.014 and 37.7 ± 10 vs. 41.0 ± 6.6, p = 0.032); however, they were not clinically significant. Functional group showed more stability on physical examination pre- and post-operatively (p < 0.001, p < 0.001). There was no difference regarding extension deficit (n.s.); however, functional group had more flexion deficit (p = 0.02). Nonfunctional group had better graft coverage (p = 0.001). There was no difference regarding failure rate: 4% vs. 9%, (n.s.). CONCLUSION: Both remnant preservation ACLR techniques were able to achieve satisfactory functional outcomes. A functional remnant was not related to improved functional outcomes in comparison to a nonfunctional remnant; however, it was related to less laxity pre and postoperatively and inferior graft coverage. LEVEL OF EVIDENCE: II.

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Este artigo analisa o processo de operacionalização da Política de Assistência Social a partir da perspectiva do Sistema Único de Assistência Social (SUAS). A pesquisa que originou estas reflexões utilizou como procedimento metodológico a entrevista semiestruturada, aplicada junto aos implementadores e gestores da política de assistência social. A amostragem foi restrita a municípios onde se localizam comunidades quilombolas certificados pela Fundação Cultural Palmares, no território do Vale do Mucuri, Minas Gerais, Brasil. Dessa forma, nossa investigação deteve-se nos municípios de: Carlos Chagas, Ouro Verde de Minas, Pescador, Teófilo Otoni e Ataléia. Com a sistematização dos dados, concluímos que o acesso à política de assistência social é mínimo e desconsidera a identidade coletiva desta população tradicional. Mesmo sendo a política de assistência social reconhecida como direito, ainda é ofertada apenas para aqueles que são atestados como extremamente miseráveis e não para os que dela necessitam

This article analyzes the operationalization process of the Social Assistance Policy from the perspective of SUAS. The research that gave rise to these reflections used the semi-structured interview as a methodological procedure, applied to the implementers and managers of the social assistance policy. The sampling was restricted to municipalities where quilombola communities certified by Fundação Cultural Palmares are located, in the territory of Vale do Mucuri, Minas Gerais, Brazil. Thus, our investigation was conducted in the municipalities of: Carlos Chagas, Ouro Verde de Minas, Pescador, Teófilo Otoni and Ataléia. With the systematization of the data, we conclude that access to the social assistance policy is minimal and disregards the collective identity of this traditional population. Even though the social assistance policy is recognized as a right, it is still offered only to those who are considered extremely miserable and not to those who need it, reproducing the stigma of "poor to poor policy"

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OBJECTIVE: The treatment of patients with differentiated thyroid cancer (DTC) was modified in the last decade towards a more individualized approach according to the risk of recurrence (RR). We compared the outcomes of patients with low and intermediate RR (LRR and IRR) who received or did not receive radioiodine remnant ablation (RRA) after assessing the dynamic risk. METHODS: We included 307 DTC patients with LRR and IRR submitted to total thyroidectomy. All patients were reclassified according to the dynamic risk stratification (low or high). Patients with high dynamic risk received RRA (141 patients). RESULTS: LRR patients who received RRA presented a frequency of structural incomplete response (SIR) of 5% at the end of the follow-up, compared to 2% in those who did not receive it (p=0.353). IRR patients treated with RRA had a frequency of SIR of 22%, compared to 5% in patients without RRA (p=0.008). CONCLUSION: This study demonstrates the usefulness of dynamic risk assessment to decide RRA in a cohort with a long-term follow-up. The lower prevalence of SIR at the end of the follow-up in patients who did not receive RRA highlights the adequate selection of those who would not benefit from RRA, even with an intermediate risk of recurrence.

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BACKGROUND: Remnant preservation during anterior cruciate ligament (ACL) reconstruction (ACLR) is controversial, and it is unclear whether the stump aids or obscures tibial tunnel positioning. PURPOSE/HYPOTHESIS: The aim of this study was to determine whether the rate of tibial tunnel malposition is influenced by remnant preservation. The hypothesis was that using a remnant-preserving technique to drill entirely within the tibial stump would result in a significant reduction in tibial tunnel malposition as determined by postoperative 3-dimensional computed tomography (3D-CT). STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Patients undergoing ACLR between October 2018 and December 2019 underwent surgery with a remnant-preserving technique (RP group) if they had a large stump present (>50% of the native ACL length) or if there was no remnant or if it was <50% of the native length of the ACL, they underwent remnant ablation (RA group) and use of standard landmarks for tunnel positioning. The postoperative tunnel location was reported as a percentage of the overall anteroposterior (AP) and mediolateral (ML) dimensions of the tibia on axial 3D-CT. The tunnel was classified as anatomically placed if the center lay between 30% and 55% of the AP length and between 40% and 51% of the ML length. RESULTS: Overall, 52 patients were included in the study (26 in each group). The mean tunnel positions were 36.8% ± 5.5% AP and 46.7% ± 2.9% ML in the RP group and 35.6% ± 4.8% AP and 47.3% ± 2.3% ML in the RA group. There were no significant differences in the mean AP (P = .134) and ML (P = .098) tunnel positions between the groups. Inter- and intraobserver reliability varied between fair to excellent and good to excellent, respectively. There was no significant difference in the rate of malposition between groups (RP group, 7.7%; RA group, 11.5%; P ≥ .999). CONCLUSION: Drilling entirely within the ACL tibial stump using a remnant-preserving reconstruction technique did not significantly change the rate of tunnel malposition when compared with stump ablation and utilization of standard landmarks.

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BACKGROUND: Colloid cyst treatment with purely endoscopic surgery is considered to be safe and effective. Complete capsule removal for gross total resection is usually recommended to prevent recurrence but may not always be safely feasible. Our objective was to assess the results of endoscopic surgery using mainly aspiration and coagulation without complete capsule resection and discuss the rationale for the procedure. METHODS: A retrospective review was conducted of 45 consecutive symptomatic patients with third ventricle colloid cysts that were surgically treated with purely endoscopic surgery from 1997 to 2018. RESULTS: Mean age was 35.4 years. Male-to-female ratio was 1:1. Clinical presentation included predominantly headache (80%). Transforaminal was the most used route (71.1%) followed by transeptal (24.5%) and interforniceal (4.4%). Capsule was intentionally not removed in 42 patients (93.3%) and cyst remnants were absent on postoperative MRI in 36 (85%). Mild complications occurred in 8 patients (17.8%). Surgery was statistically associated with cyst volume and ventricular size reduction. There were no serious complications, shunts or deaths. Follow-up did not show any recurrence or remnant growth that needed further treatment. CONCLUSION: Gross total resection may not be the main objective for every situation. Subtotal resection without capsule removal seems to be safer while preserving good results, especially in a limited resource environment. Remnants left behind should be followed but tend to remain clinically asymptomatic for the most part. Surgical planning allows the surgeon to choose among the different resection routes and techniques available. Decisions are predominantly based on preoperative imaging and intraoperative findings.

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BACKGROUND: Roux-en-Y gastric bypass (RYGB) is a surgery with low rate complications. However, it is not exempt from them, and 1-6% suffer complications such as postoperative bleeding. Many intraoperative techniques have been evaluated to reduce postoperative bleeding, like the oversewing or reinforcement of the staple line. This study aims to evaluate the rate of postoperative bleeding in the oversewing of the staple line of the gastric remnant group versus the stapling only group. METHODS: This is a 2-center, case-control study. We randomly selected two groups who underwent RYGB or OAGB: group A (n = 225) with oversewing from 2019 to 2020 and group B (n = 225) with stapling only between the period of 2017-2018; both groups with similar demographic characteristics. RESULTS: The overall mean age was 37.39 ± 9.6 years and mean BMI was 41.59 ± 8.6 kg/m2; the postoperative bleeding rate was significantly lower (p < 0,05) in patients with oversewing of the staple line of the gastric remnant. Operative time was shorter for the stapling only group and the difference between the mean operative time was 10.6 min. CONCLUSIONS: Oversewing the staple line of the gastric remnant significantly reduces the incidence of postoperative bleeding regardless of BMI. Being a cost-effective technique compared to others available despite the increase in operating time.

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ABSTRACT Objective: The treatment of patients with differentiated thyroid cancer (DTC) was modified in the last decade towards a more individualized approach according to the risk of recurrence (RR). We compared the outcomes of patients with low and intermediate RR (LRR and IRR) who received or did not receive radioiodine remnant ablation (RRA) after assessing the dynamic risk. Materials and methods: We included 307 DTC patients with LRR and IRR submitted to total thyroidectomy. All patients were reclassified according to the dynamic risk stratification (low or high). Patients with high dynamic risk received RRA (141 patients). Results: LRR patients who received RRA presented a frequency of structural incomplete response (SIR) of 5% at the end of the follow-up, compared to 2% in those who did not receive it (p=0.353). IRR patients treated with RRA had a frequency of SIR of 22%, compared to 5% in patients without RRA (p=0.008). Conclusions: This study demonstrates the usefulness of dynamic risk assessment to decide RRA in a cohort with a long-term follow-up. The lower prevalence of SIR at the end of the follow-up in patients who did not receive RRA highlights the adequate selection of those who would not benefit from RRA, even with an intermediate risk of recurrence.

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OBJECTIVE: The treatment of patients with differentiated thyroid cancer (DTC) was modified in the last decade towards a more individualized approach according to the risk of recurrence (RR). We compared the outcomes of patients with low and intermediate RR (LRR and IRR) who received or did not receive radioiodine remnant ablation (RRA) after assessing the dynamic risk. METHODS: We included 307 DTC patients with LRR and IRR submitted to total thyroidectomy. All patients were reclassified according to the dynamic risk stratification (low or high). Patients with high dynamic risk received RRA (141 patients). RESULTS: LRR patients who received RRA presented a frequency of structural incomplete response (SIR) of 5% at the end of the follow-up, compared to 2% in those who did not receive it (p=0.353). IRR patients treated with RRA had a frequency of SIR of 22%, compared to 5% in patients without RRA (p=0.008). CONCLUSION: This study demonstrates the usefulness of dynamic risk assessment to decide RRA in a cohort with a long-term follow-up. The lower prevalence of SIR at the end of the follow-up in patients who did not receive RRA highlights the adequate selection of those who would not benefit from RRA, even with an intermediate risk of recurrence.

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OBJETIVO: La apendicitis aguda es uno de los procedimientos quirúrgicos más aplicados en todo el mundo. Una de las complicaciones de la apendicectomía es la apendicitis del muñón. El diagnóstico de apendicitis del muñón suele retrasarse. MÉTODOS: En nuestro estudio recopilamos casos de apendicitis del muñón tras apendicectomía. Todos los casos con apendicectomía abierta y laparoscópica fueron incluidos en nuestro estudio. RESULTADOS: Entre 2008 y 2020 se examinaron 5620 pacientes apendicectomizados que fueron operados en la clínica de cirugía general. Se realizó apendicectomía en 5 pacientes por apendicitis del muñón. Uno de los pacientes con apendicitis del muñón presentó síntomas de peritonitis generalizada, otro con síntomas de íleo, el otro con síntomas de hernia de incisión encarcelada en la incisión de Mc Burney y los otros dos pacientes con síntomas de apendicitis aguda. CONCLUSIONES: Como se desprende de nuestro estudio, si bien la apendicectomía es el procedimiento quirúrgico más común y fácil de ver en la práctica quirúrgica general, es un procedimiento que aumenta la morbilidad como vemos en los pacientes con apendicitis del muñón. La tomografía abdominal parece ser el estándar de oro en el diagnóstico de la apendicitis del muñón. Los cirujanos definitivamente deben sospechar apendicitis del muñón en pacientes cuyos síntomas han mejorado, incluso con cicatrices de apendicectomía abierta. OBJECTIVE: Acute appendicitis is among the most applied surgical procedures around the world. One of the complications of appendectomy is stump appendicitis. The diagnosis of stump appendicitis is usually delayed. MATERIAL AND METHOD: In our study, we compiled cases with stump appendicitis after appendectomy. All cases with open and laparoscopic appendectomy were included in our study. RESULTS: Between 2008 and 2020, 5620 appendectomy patients who were operated in the general surgery clinic were examined. Appendectomy was performed in five patients due to stump appendicitis. One of the patients with stump appendicitis presented with symptoms of generalized peritonitis, another with symptoms of ileus, the other with symptoms of incarcerated incision hernia at the McBurney incision, and the other two patients with symptoms of acute appendicitis. CONCLUSION: As it can be understood from our study, although appendectomy is the most common and easily seen surgical procedure in general surgical practice, it is a procedure that increases morbidity as we see in patients with stump appendicitis. Abdominal tomography appears to be the gold standard in diagnosis in stump appendicitis. Surgeons should definitely suspect stump appendicitis in patients whose symptoms have improved, even with open appendectomy scarring.

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BACKGROUND: Remnant gastric cancer (RGC) is defined as a tumor that develops in the stomach after a previous gastrectomy and is generally associated with a worse prognosis. However, there little information available regarding RGCs and their prognostic factors and survival. AIM: To evaluate the clinicopathological characteristics and prognosis of RGC after previous gastrectomy for benign disease. METHODS: Patients who underwent curative resection for primary gastric cancer (GC) at our institute between 2009 and 2019 were retrospectively evaluated. All RGC resections with histological diagnosis of gastric adenocarcinoma were enrolled in this study. Primary proximal GC (PGC) who underwent total gastrectomy was selected as the comparison group. Clinical and pathological data were collected from a prospective medical database. RESULTS: A total of 41 patients with RGC and 120 PGC were included. Older age (P = 0.001), lower body mass index (P = 0.006), hemoglobin level (P < 0.001), and number of resected lymph nodes resected (LN) (P < 0.001) were associated with the RGC group. Lauren type, pathological tumor-node-metastasis, and perioperative morbimortality were similar between RGC and PGC. There was no difference in disease-free survival (P = 0.592) and overall survival (P = 0.930) between groups. LN status was the only independent factor related to survival. CONCLUSION: RGC had similar clinicopathological characteristics to PGC. Despite the lower number of resected LN, RGC had a similar prognosis.