Analysis of the Effects of Botulinum Toxin Type A to Promote the Survival of Transverse Rectus Abdominis Myocutaneous Flaps in an Animal Model

The transverse rectus abdominis myocutaneous (TRAM) flap is one of the techniques for breast reconstruction surgery and other defects. Assuring the vascular input is the main factor that it should be ensured for the survival of the fap. Objective: The article presented is an experimental study, with the objective of evaluating the effect of the vasculature on the myocutaneous flaps of the abdominal rectum with botulinum toxin type A (TBoA) thay may improve the survival of the tissue by promoting the blood perfusion in distal parts of the flap and diminish the risk of necrosis. Material and methods: A total of 30 Wistar male rats, dissect pedicled right TRAM flap in all rats, divided into three groups: Group 1 was applied in saline solution 0.9%;Group 2 was applied in pre surgically TBoA (1 week before lifting the flap);Group 3, will apply TBOA Trans surgical. Results: Histological analysis showed: increased vascularity in group 2 TBoA compared with the saline solution with P < 0.05 statistically significant. In terms of fibrosis, inflammation and granulation tissue, there was no statistically significant difference at p = 0.6. Muscle atrophy was higher in the group of TBoA in the saline group p < 0.05. It was concluded that botulinum toxin type A prevents vasoconstriction of the vessel and promotes vasodilation subsequently lifting the muscle flap, no complications were observed in the groups with TBoA so it can be considered a safe substace and can be used for further studies.

Effect of Anti-TNF Therapy on Resistance to Insulin in Patients with Rheumatoid Arthritis

Objective: To evaluate the effect of anti-TNF therapy on resistance to insulin in patients with rheumatoid arthritis (RA) compared with patients with RA being treated with non-biological DMARDs. Methods: Inactive patients diagnosed with RA (ACR 1987 criteria) (DAS 28 2.6) were included, being treated with anti-tumor necrosis factor inhibitors (anti-TNF) (cases) and non-biological disease-modifying anti-rheumatic drugs (DMARD) (controls), without risk factors for insulin resistance (administration of steroids, body mass index > 25 kg/m2, diabetes mellitus or use of glucose lowering agents, systemic arterial hypertension or use of anti-hypertensive drugs, triglycerides > 150 mg/dl, hypercholesterolemia > 200 mg/dl, high-density lipoproteins 40 mg/dl in men and 50 mg/in women, or with lipids lowering agents, waist measurement > 88 cm in women and > 102 cm in men). We used HOMA (Homeostasis Model Assessment) to determine insulin resistance in both groups, HOMA being defined as >1 and sensitivity to insulin using QUICKI (Insulin Sensitivity Check Index), ≥0.38 being considered as normal. The Mann Whitney U was used for the statistical analysis. Results: A total of 28 patients, 15 being treated with non-biological DMARDs and 13 with anti-TNF therapy, were evaluated;89.7%, of which were women. Average age: 43.5 (range 21 - 62);the average HOMA index of the non-biological DMARD group was 1.58 (range 0.7 - 5.4), compared with patients treated with anti-TNF therapy, 1.18 (range 0.2 - 4.3) (P = 0.5). The average QUICKI index was 0.36 (range 0.30 - 0.42) in patients treated with non-biological DMARD, compared with0.37 inpatients treated with anti-TNF therapy (range 0.30 - 0.51) (P = 0.8). Conclusion: Resistance to insulin manifested itself in both groups, although there was a greater trend of less insulin resistance and greater sensitivity in the anti-TNF group;this was probably not statistically significant due to the sample size.