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RESUMO Introdução: O uso da telepresença cresce com o avanço da integração de tecnologias à prática médica. No que tange a cirurgia, a comunicação à distância efetiva pode traduzir-se em um melhor cuidado perioperatório. No entanto, a percepção das partes acerca desta modalidade carece de avaliação científica. Questionários estruturados através de escalas são os instrumentos de escolha na mensuração de aspectos subjetivos. Entretanto, não há uma ferramenta validada neste molde em língua portuguesa. Nosso objetivo foi traduzir e adaptar para língua portuguesa um questionário específico de percepção sobre o uso de robôs de telepresença em visita hospitalar pós-cirúrgica. Métodos: foi realizada busca no PubMed e selecionado um conjunto de questionários validados em língua inglesa. Após, realizada a tradução para a língua portuguesa conforme as boas práticas para o processo de tradução e adaptação cultural. A autora original avaliou e aprovou a versão traduzida. Resultados: foram traduzidos três questionários autoaplicáveis e direcionados para os pacientes que recebem a visita por telepresença ou presencial e à equipe médica que acompanha as visitas com o objetivo de avaliar a visita hospitalar assistida por robô de telepresença. O conjunto utiliza a escala de Likert e contêm treze perguntas que abordam as esferas Comunicação; Dignidade e Confidencialidade; Conteúdo; Tempo; Impressões Gerais. Conclusões: este é o primeiro instrumento em língua portuguesa desenhado para avaliar a impressão de pacientes e profissionais envolvidos em rounds utilizando um robô de telepresença, tendo potencial para ser utilizado em estudos clínicos que envolvam a utilização desta tecnologia na assistência.

Muscle-splitting breast augmentation, initially described by Baxter and later popularized by Khan, has proved to be an effective technique in terms of implant coverage, bypassing, and even solving of some issues associated with the dual-plane technique. A muscle-splitting breast augmentation technique recently has been used in combination with mastopexy. However, no reports have described muscle-splitting techniques accomplished by the transaxillary route. A prospective study was conducted to evaluate the outcomes and complications of a novel approach to a specific breast augmentation technique. A total of 160 patients underwent bilateral transaxillary muscle-splitting breast augmentation between October 2007 and July 2010. All the patients were treated on an outpatient basis and received epidural anesthesia. Soft, round, textured, cohesive gel implants ranging in size from 200 to 350 ml were used. All the patients recovered quickly. To date, no infection, capsular contracture, rippling, double-bubble deformity, muscle contracture-associated deformities, or implant migration has occurred. Four patients (2.5%) experienced hematomas, all of which resolved before discharge. All the patients were discharged less than 24 h postoperatively and had an aesthetically natural result. Transaxillary muscle-splitting breast augmentation, a novel approach to a technique that has been described previously, provides consistent, satisfactory results and good reproducibility. This new approach provides an excellent anatomic final appearance with no risk of displacement, rippling, double-bubble deformity, or contracture-associated deformities. Furthermore, this technique avoids any visible scars on the breast and features a low complication rate.

Adipose tissue has been shown to produce a number of inflammatory cytokines and may play a role in the development and progression of several inflammatory diseases. Accumulation of intra-abdominal fat correlates more strongly with inflammatory disease states than does total body fat, suggesting depot-specific differences in the inflammatory potential of adipose tissue. In inflammatory bowel disease specifically, recent clinical studies suggest that patients with increased intra-abdominal fat may suffer a more aggressive clinical course. Objective: The purpose of the present study was to evaluate the significance of inflammatory cytokine production by various adipose tissue depots during acute experimental colitis. Methods: Colitis was induced in C57BL mice by addition of 2% dextran sulfate sodium (DSS) to drinking water for 5 days. Mice were sacrificed at Day 3, 7, 14, and 21 following initiation of DSS treatment. Control mice were sacrificed prior to initiation of treatment. Plasma cytokine levels at time of sacrifice were analyzed by multiplex assays. Colonic tissue damage was evaluated histologically by H&E staining. Tissue levels of cytokine mRNAwere compared between the colon, 3 adipose tissue depots (mesenteric, epididymal, and subcutaneous), kidney, and liver by qRT-PCR. Results: Histologic evidence of colitis and significantly increased plasma IL-6 levels were evident by Day 7 and peaked at Day 14. Changes in cytokine expression within the colon occurred earlier, with significant increases in TNF-a, IL-1b, and IL-6 mRNA all evident by Day 3 (P=0.016). Of the cytokines analyzed, IL-6 in the colon exhibited the most profound increase with colitis, with levels at Day 7 increased 230-fold from baseline (P=0.002). Analysis of adipose tissues from this time point revealed that while IL-6 mRNA expression in mesenteric and epididymal adipose tissue was significantly increased compared to controls, 8.6-fold (P=0.016) and 3.8-fold (P=0.004) respectively, no increase in subcutaneous adipose tissue IL-6 mRNA was observed. Multi-tissue analysis at this time point revealed that mesenteric and epididymal adipose tissue expressed significantly more IL-6 mRNA than the kidney or the liver, whose levels of IL-6 did not increase significantly from baseline. Conclusions: This study demonstrates that intra-abdominal adipose tissue is a major source of IL-6 during acute experimental colitis. The time course analysis suggests that intra-abdominal fat may have a significant impact on plasma IL-6 levels. Unlike the mesentery, the epididymal fat pad is not contiguous with the inflamed bowel and does not contain the venous or lymphatic drainage of the affected bowel. This suggests a tissue-specific response by the intra-abdominal adipose tissue, rather than merely a local lymphoid reaction to tissue damage in the colon.