Liver ischaemia–reperfusion (IR) during hepatic surgeries can lead to liver cell death via oxidative stress and the activation of immune cells, the release of cytokines, and damage-associated molecular patterns. Ascorbic acid has been shown to confer potential protective effects against IR injury, mainly due to its antioxidant properties. This study evaluated the effect of ascorbic acid infusion at different time points during hepatic IR in rats. Thirty-six male Wistar rats were divided into control and experimental groups that received the same total ascorbic acid dose at three different infusion times: before ischaemia, before reperfusion, or before both ischaemia and reperfusion. All of the animals experienced hepatic IR injury. We measured the hepatic enzymes, cytokines, and portal blood flow. Animals receiving ascorbic acid before both ischaemia and reperfusion had lower liver enzyme levels, reduced inflammation, and better portal venous flow than other animals. Divided doses of ascorbic acid before IR may be beneficial for reducing liver injury associated with IR.

Purpose: To perform a systematic review about microsurgical training for medical students. Methods: A systematic search was conducted in several databases. Screening was performed by two independent reviewers based on predetermined criteria, following PRISMA 2020 guidelines. Results: A total of 433 articles were obtained. After screening, 40 were included. Teaching methods were heterogeneous and restricted to a few countries. There are specific methods to assess microsurgery training, general surgical activities, learning curve and anxiety. The most used materials were surgical gloves, silicone tubes, chicken thighs and rats. Animals were not essential in early stages of education. There was a variation between one and 24 sessions regarding teaching frequency and between 3 and 120 hours of teaching period. The average age of students was 23.7, and 67.5% were men. Teaching groups had an average of 5.8 students per group. Physical activity and anxiety had negative effect on microsurgical ability gain, while caffeine had positive effect. Alcohol and sleep deprivation had no significant effect. Conclusion: Students with adequate training could achieve performance similar to that obtained by experts. Microsurgical education is realistic during medical graduation and may enable better career choices. More investigations are needed to improve this training and expand knowledge to other medical schools.

Background: Lung transplantation is a definitive therapeutic option for selected patients with advanced pulmonary diseases. However, long-term outcomes remain suboptimal, largely driven by immunologically mediated complications, including acute rejection and chronic lung allograft dysfunction, as well as the cumulative toxicity of lifelong immunosuppression. Methods: This study was conducted as a systematic review and meta-analysis in accordance with PRISMA recommendations. A comprehensive search of PubMed, Embase, and the Cochrane Library was performed from inception. Randomized controlled trials evaluating maintenance immunosuppressive regimens in adult lung transplant recipients were included. When appropriate, treatment effects were pooled using random-effects models and are reported as risk ratios (RR) with 95% confidence intervals (CI). Statistical heterogeneity was assessed using the I² statistic. Indirect comparisons were explored using a common comparator approach. Statistical analyses were performed using R software. Results: Twelve randomized trials were included. Rates of graft loss and all-cause mortality were broadly similar across maintenance immunosuppressive regimens. Tacrolimus-based strategies were associated with lower rates of biopsy-proven acute rejection in selected comparisons. No consistent differences were observed for chronic lung allograft dysfunction, likely reflecting limited follow-up duration. Regimens incorporating mTOR inhibitors were associated with higher rates of treatment discontinuation. Overall, findings were influenced by variability across studies and limited statistical power for several outcomes. Conclusion: Current randomized evidence does not support the superiority of any maintenance immunosuppressive regimen after lung transplantation. Rather than indicating therapeutic equivalence, these findings highlight persistent gaps in robust evidence, particularly for chronic lung allograft dysfunction, and underscore the need for adequately powered trials with longer follow-up to inform optimal post-transplant management.

Background: Small-for-size syndrome (SFSS) is a serious complication after partial liver transplantation or extended hepatectomy. Despite advances, the syndrome remains a complex entity with a multifactorial pathophysiology and a lack of standardized therapeutic approaches. Aims: This study aims to establish a translational model of porcine SFSS, integrating hemodynamic, histopathological, and molecular analyses to quantify the tissue expression of biomarkers to assess liver regeneration. Methods: Ten liver transplants were performed: eight with small (partial) for size (donors underwent a 70% hepatectomy) and two with whole liver. The recipients were followed until death (euthanasia due to severe morbidity) or for five days. Hemodynamic data, laboratory analyses, and liver tissue biopsies were collected. Immunohistochemistry was performed to assess the expression of TNF-α, IL-1β, NF-κB, and VEGF. Gene expression levels of VEGF, IL-6, IL-10, and NF-κB were quantified using reverse transcription polymerase chain reaction. Results: In the partial group, survival rates were 75% in the immediate postoperative period, 25% at 48 hours, and 12.5% at five days. Immunohistochemistry showed a significant increase in TNF-α and NF-κB proteins after reperfusion and at the end of surgery, respectively. Gene expression analysis showed a significant increase in IL-6 and IL-10 at the end of surgery. Conclusions: This study represents a methodological advance by performing the first integrated evaluation of protein and gene expression (TNF-α, IL-6, IL-1, IL-10, VEGF, and NF-κB) correlated with hemodynamic, histopathological, and functional parameters in the small-for-size pig model.

Anorectal transplantation (ART) belongs to the emerging field of vascularized composite allotransplantation. Researchers have studied this procedure experimentally for over two decades as a strategy to restore anal function in patients with severe fecal incontinence and permanent colostomy. These conditions significantly impact the quality of life and pose a global public health issue. This narrative review provides a comprehensive analysis of anorectal transplantation research, covering experimental studies in animal models, and ex vivo investigations. It examines and compares different surgical techniques, considering both procedural effectiveness and functional recovery. These experiments indicate that ART can be successfully performed from a technical standpoint. Ex vivo studies demonstrate acceptable surgical times, and studies in animal models confirm graft viability and functional restoration. Future research should refine surgical techniques, investigate neural regeneration mechanisms, and develop immunosuppressive protocols to advance the field toward clinical application. ART holds the potential to completely change the treatment of severe anorectal dysfunction and permanent colostomy, offering a definitive solution to these irreversible conditions.

Purpose: The porcine model is widely used in preclinical studies of anorectal function due to its anatomical and physiological similarity to humans. However, appropriate behavioral and functional evaluation methods of anorectal segment are still lacking. Methods: This study introduces the swine anal function assessment table (SAFAT), a standardized qualitative tool developed to evaluate anorectal function. Six male Landrace × Large White pigs underwent evaluation following anorectal transplantation over up to one year. Results: The functional parameters assessed included cleanliness, fecal distribution, stool consistency, anal tone, anal skin sensitivity, anal reflexes, and other ones. Each indicator was rated using semi-quantitative scales based on behavioral observations. Conclusion: SAFAT was effective for behavioral and functional evaluation after anorectal transplantation and may improve the reproducibility and reliability of functional evaluations in swine models of major anorectal surgeries, supporting translational research in colorectal treatments.