ROLF GEMPERLI

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Departamento de Cirurgia, Faculdade de Medicina - Docente
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/04 - Laboratório de Microcirurgia, Hospital das Clínicas, Faculdade de Medicina - Líder

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Autor: CAMARGO, Cristina Pires ×

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  • article 11 Citação(ões) na Scopus
    Botulinum toxin type A for facial wrinkles
    (2021) CAMARGO, Cristina Pires; XIA, Jun; COSTA, Caroline S.; GEMPERLI, Rolf; TATINI, Maria D. C.; BULSARA, Max K.; RIERA, Rachel
    Background Botulinum toxin type A (BontA) is the most frequent treatment for facial wrinkles, but its effectiveness and safety have not previously been assessed in a Cochrane Review. Objectives To assess the effects of all commercially available botulinum toxin type A products for the treatment of any type of facial wrinkles. Search methods We searched the following databases up to May 2020: the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We also searched five trials registers, and checked the reference lists of included studies for further references to relevant randomised controlled trials (RCTs). Selection criteria We included RCTs with over 50 participants, comparing BontA versus placebo, other types of BontA, or fillers (hyaluronic acid), for treating facial wrinkles in adults. Data collection and analysis We used standard methodological procedures expected by Cochrane. Primary outcomes were participant assessment of success and major adverse events (AEs) (eyelid ptosis, eyelid sensory disorder, strabismus). Secondary outcomes included physician assessment of success; proportion of participants with at least one AE and duration of treatment effect. We used GRADE to assess the certainty of the evidence for each outcome. Main results We included 65 RCTs, involving 14,919 randomised participants. Most participants were female, aged 18 to 65 years. All participants were outpatients (private office or day clinic). Study duration was between one week and one year. No studies were assessed as low risk of bias in all domains; the overall risk of bias was unclear for most studies. The most common comparator was placebo (36 studies). An active control was used in 19 studies. There were eight dose-ranging studies of onabotulinumtoxinA, and a small number of studies compared against fillers. Treatment was given in one cycle (54 studies), two cycles (three studies), or three or more cycles (eight studies). The treated regions were glabella (43 studies), crow's feet (seven studies), forehead (two studies), perioral (two studies), full face (one study), or more than two regions (nine studies). Most studies analysed moderate to severe wrinkles; mean duration of treatment was 20 weeks. The following results summarise the main comparisons, based on studies of one treatment cycle for the glabella. AEs were collected over the duration of these studies (over four to 24 weeks). Compared to placebo, onabotulinumtoxinA-20 U probably has a higher success rate when assessed by participants (risk ratio (RR) 19.45, 95% confidence interval (CI) 8.60 to 43.99; 575 participants; 4 studies; moderate-certainty evidence) or physicians (RR 17.10, 95% CI 10.07 to 29.05; 1339 participants; 7 studies; moderate-certainty evidence) at week four. Major AEs are probably higher with onabotulinumtoxinA-20 U (Peto OR 3.62, 95% CI 1.50 to 8.74; 1390 participants; 8 studies; moderate-certainty evidence), but there may be no difference in any AEs (RR 1.14, 95% CI 0.89 to 1.45; 1388 participants; 8 studies; low-certainty evidence). Compared to placebo, abobotulinumtoxinA-50 U has a higher participant-assessed success rate at week four (RR 21.22, 95% CI 7.40 to 60.56; 915 participants; 6 studies; high-certainty evidence); and probably has a higher physician-assessed success rate (RR 14.93, 95% CI 8.09 to 27.55; 1059 participants; 7 studies; moderate-certainty evidence). There are probably more major AEs with abobotulinumtoxinA-50 U (Peto OR 3.36, 95% CI 0.88 to 12.87; 1294 participants; 7 studies; moderate-certainty evidence). Any AE may be more common with abobotulinumtoxinA-50 U (RR 1.25, 95% CI 1.05 to 1.49; 1471 participants; 8 studies; low-certainty evidence). Compared to placebo, incobotutinumtoxinA-20 U probably has a higher participant-assessed success rate at week four (RR 66.57, 95% CI 13.50 to 328.28; 547 participants; 2 studies; moderate-certainty evidence), and physician-assessed success rate (RR 134.62, 95% CI 19.05 to 951.45; 547 participants; 2 studies; moderate-certainty evidence). Major AEs were not observed (547 participants; 2 studies; moderatecertainty evidence). There may be no difference between groups in any AEs (RR 1.17, 95% CI 0.90 to 1.53; 547 participants; 2 studies; tow-certainty evidence). AbobotulinumtoxinA-50 U is no different to onabotulinumtoxinA-20 U in participant-assessed success rate (RR 1.00, 95% CI 0.92 to 1.08, 388 participants, 1 study, high-certainty evidence) and physician-assessed success rate (RR 1.01, 95% CI 0.95 to 1.06; 388 participants; 1 study; high-certainty evidence) at week four. Major AEs are probably more likely in the abobotulinumtoxinA-50 U group than the onabotulinumtoxinA-20 U group (Peto OR 2.65, 95% CI 0.77 to 9.09; 433 participants; 1 study; moderate-certainty evidence). There is probably no difference in any AE (RR 1.02, 95% CI 0.67 to 1.54; 492 participants; 2 studies; moderate-certainty evidence). IncobotulinumtoxinA-24 U may be no different to onabotulinumtoxinA-24 U in physician-assessed success rate at week four (RR 1.01, 95% CI 0.96 to 1.05; 381 participants; 1 study; low-certainty evidence) (participant assessment was not measured). One participant reported ptosis with onabotulinumtoxinA, but we are uncertain of the risk of AEs (Peto OR 0.02, 95% CI 0.00 to 1.77; 381 participants; 1 study; very low-certainty evidence). Compared to placebo, daxibotulinumtoxinA-40 U probably has a higher participant-assessed success rate (RR 21.10, 95% CI 11.31 to 39.34; 683 participants; 2 studies; moderate-certainty evidence) and physician-assessed success rate (RR 23.40, 95% CI 12.56 to 43.61; 683 participants; 2 studies; moderate-certainty evidence) at week four. Major AEs were not observed (716 participants; 2 studies; moderatecertainty evidence). There may be an increase in any AE with daxibotulinumtoxinA compared to placebo (RR 2.23, 95% CI 1.46 to 3.40; 716 participants; 2 studies; moderate-certainty evidence). Major AEs reported were mainly ptosis; BontA is also known to carry a risk of strabismus or eyelid sensory disorders. Authors' conclusions BontA treatment reduces wrinkles within four weeks of treatment, but probably increases risk of ptosis. We found several heterogeneous studies (different types or doses of BontA, number of cycles, and different facial regions) hindering meta-analyses. The certainty of the evidence for effectiveness outcomes was high, low or moderate; for AEs, very low to moderate. Future RCTs should compare the most common BontA (onabotuli numtoxinA, abobotulinumtoxinA, incobotulinumtoxinA, daxibotulinumtoxinA, prabotulinumtoxinA) and evaluate long-term outcomes. There is a lack of evidence about the effects of multiple cycles of BontA, frequency of major AEs, duration of effect, efficacy of recently-approved BontA and comparisons with other treatments.
  • article 14 Citação(ões) na Scopus
    The impact of COVID-19 on the plastic surgery activity in a high-complexity university hospital in Brazil: the importance of reconstructive plastic surgery during the pandemic
    (2020) PAGOTTO, Vitor Penteado Figueiredo; ABBAS, Laielly; GOLDENBERG, Dov Charles; LOBATO, Rodolfo Costa; NASCIMENTO, Bruno Baptista do; MONTEIRO, Gustavo Gomes Ribeiro; CAMARGO, Cristina Pires; BUSNARDO, Fabio de Freitas; GEMPERLI, Rolf
    Background The Hospital das Clinicas - University of Sao Paulo Medical School (HCFMUSP) is the largest university hospital complex in Brazil. HCFMUSP has been converted into a reference center for coronavirus disease 2019. The Division of Plastic Surgery postponed non-essential surgeries and outpatient consultations, accomplishing new guidelines (ANG) of national and international organizations. Even with these challenges arising from the pandemic, alternatives were considered to maintain institutional characteristics. This study aims to analyze this new scenario and the impact on patients' assistance and Plastic Surgery residents training. Methods Total number of surgeries, type of procedures, and outpatient consultations in 2020, before (pre-ANG) and after (post-ANG) ANG, were compared with the same period in 2019 (2019-pre and 2020-post). Results A marked reduction in the total number of surgeries and outpatient consultations was observed in the post-ANG period. In the post-ANG period, 267 operations were performed (26.7 +/- 20.3/week), while in the 2019-post period, 1036 surgeries were performed (103.6 +/- 9.7/week) (p = 0.0002). Similarly, 1571 consultations were conducted in the post-ANG period (157.1 +/- 93.6/week), while in the 2019-post period, 3907 were performed (390.7 +/- 43.1/week) (p = 0.0003). However, in the post-ANG period, an increase in the proportion of reconstructive compared with aesthetic surgery was observed. The maintenance of highly complex procedures such as microsurgical transplants was also identified. Conclusions The predominant profile of reconstructive surgeries at the Division of Plastic Surgery allowed the continuity of procedures at all technical complexity levels, patient care maintenance, and Plastic Surgery residents training. Level of evidence: not ratable
  • article 125 Citação(ões) na Scopus
    Online learning and COVID-19: a meta-synthesis analysis
    (2020) CAMARGO, Cristina Pires; TEMPSKI, Patricia Zen; BUSNARDO, Fabio Freitas; MARTINS, Milton de Arruda; GEMPERLI, Rolf
    The COVID-19 pandemic demanded a quick shift from presential to e-learning processes. Unlike planned e-learning programs, medical schools have had to quickly deliver the entire medical curriculum using remote strategies. This study aimed to perform a meta-synthesis of previous pandemic situations and describe the experience of the Sao Paulo University School of Medicine. We searched the Cochrane Central Register of Controlled Trials, Medline, EMBASE, Lilacs, Scopus, Web of Science, and ERIC, using the following keywords: (""SARS"" OR ""severe acute respiratory syndrome"" OR ""severe acute respiratory syndrome"" OR ""Middle East Respiratory Syndrome Coronavirus"" OR ""middle east respiratory syndrome*"" OR ""MERS-CoV"" OR ""Mers"" OR ""Middle Eastern Respiratory Syndrome*"" OR ""MERS-CoV*"" OR ""coronavirus"" OR ""Coronavirus Infections"" OR ""coronavirus*"" OR ""COVID-19"" OR ""2019-nCoV"" OR ""SARS-CoV-2"") AND (""online education"" OR ""Education, Distance"" OR ""e-learning"" OR ""course online"" OR ""flipped classroom"") AND (""lockdown"" OR ""social distance"" OR ""quarantine""). The endpoints were the online platforms used for online learning, the model of class, recorded versus online interaction, duration of online lectures, and students' and teachers' perceptions of online learning. We retrieved 38 records; only seven articles studied online education methods related to the pandemic and social distancing rules. The most frequently used online platform was Zoom (R). The studies examined both synchronous and asynchronous approaches. There was no evidence regarding duration and students' and teachers' attitude. This study suggests that the online learning shift was feasible; however, because of the nature of the education shift (pandemic), future studies must further analyze the educational structure.
  • article 1 Citação(ões) na Scopus
    Light-emitting diode stimulates radiodermatitis recovery
    (2021) CAMARGO, Cristina Pires; CARVALHO, Heloisa Andrade; MALUF, Feres Camargo; SOUSA, Alexandre Agostinho da Cruz; PERIN, Paulo Otavio Maluf; PERIN, Marcela Maluf; MORAIS-BESTEIRO, Julio; GEMPERLI, Rolf
    Purpose: To evaluate the effect of light-emitting diode (LED) in an experimental mod& of radiodermatitis. Methods: Ten male Wistar rats weighing 200-250 g were analyzed. Radiation was delivered in a single dose (20 Gy with Strontium-90 dermatological plaques), two areas per animal. After 15 days, they were divided into two groups: control group (n =5) and LED group (n =5), which was treated during 21 days later (LED 660 nm, 10 min in alternate days). The endpoints were radiodermatitis scale, histological analysis HE, Picrius Sirius and the gene expression of interleukin-10 (IL-10) and matrix metalloproteinase-9 (MMP-9). Results: The LED group showed a higher number of dermal appendages (p = 0.04) and angiogenesis (p = 0.007), a tendency towards higher IL-10 (p = 0.06) and an increase in MMP-9 (p = 0.004) when compared to the control group. Conclusion: This study suggested that the use of LED for radiodermatitis increased skin regeneration.
  • conferenceObject 0 Citação(ões) na Scopus
    Effect of Light Emitted by Diode as Treatment of Radiodermatitis
    (2022) CAMARGO, Cristina Pires; CARVALHO, H. A.; GEMPERLI, R.; TABUSE, Cindy Lie; SANTOS, Pedro Henrique Gianjoppe dos; GONCALES, Lara Andressa Ordonhe; REGO, Carolina Lopo; SILVA, B. M.; TEIXEIRA, M. H. A. S.; FEITOSA, Y. O.; VIDEIRA, F. H. P.; CAMPELLO, G. A.
    Radiotherapy can cause radiodermatitis in 85-90% in oncologic patients. There are several therapeutic alternatives to treat radiodermatitis with variable results. A new option is the use of light emitted-diode (LED) to treat this condition. We analyzed twenty male Wistar rats weighing 200-250 g. All the animals underwent a radiotherapy session. After 15 days, the animals were divided into four groups: control (no treatment) and LED 630 nm, 850 nm, 630 + 850 nm. The LED treatment was applied every two days until the 21 days). We analyzed the macroscopic aspect of radiodermatitis before and after treatment. After this phase, samples were collected for histological (HE). Macro and microscopic analysis indicated positive effects with exposure to light, especially with the association between wavelengths 630 and 850 nm, resulting in a reduction in the severity of radiodermatitis to grade 2-2.5. In the histological analysis, photobiomodulation increased the division and migration of cells in the basal layer of the epidermis, demonstrating the regenerative potential of this treatment in the effects of radiotherapy, increasing the speed of epithelialization of the lesion. This study suggested that the association of 630 + 850 nm improved radiodermatitis regeneration.
  • article 1 Citação(ões) na Scopus
    Comparison of three different strategies to treat sciatic nerve regeneration: an experimental study
    (2022) SMANIOTTO, Pedro Henrique; CAMARGO, Cristina Pires; KUBRUSLY, Marcia Saldanha; GEMPERLI, Rolf
    Purpose: To compare the effect of vein conduit filled with adipose tissue stem cells (ASC) on peripheral nerve injury regeneration. Methods: We analyzed 30 male Wistar rats surgically submitted to a 5-mm gap on the sciatic nerve. Then, the animals were divided into three groups: nerve autografting (AG, n=10), autogenous inverted glycerol-conserved vein (VG, n=10), and autogenous inverted glycerol-conserved vein + ASC (VASCG, n=10). The study endpoints were neuromotor functional analysis, gastrocnemius muscle weight, and sciatic nerve graft histomorphometry analysis. In the histologic analysis, we added a control group (naive nerve). Results: Regarding functional analysis (Walking tract- score), the findings at week 3 showed a difference between the AG and the VG (-96.6 vs. -59.6, p=0.01, respectively) and between the VG and the inverted vein + VASCG (-59.9 vs. -88.92, p=0.02). At week 12, this study showed a difference between the AG and the VG (-64.8 vs. -47.3, p=0.004, respectively), and also a difference between the VG and the VASCG (-47.3 vs. -57.4, p=0.02, respectively). There was no difference in the histomorphometry analysis (nerve diameter, Schwann cells counting). The gastrocnemius muscles on the intervention side were more atrophic when compared to the gastrocnemius muscles on the control side. Conclusion: Our results suggested better functional recovery in the inverted vein group when compared to control group, and inverted vein + ASC group.
  • article 1 Citação(ões) na Scopus
    Statistical Basic Steps to Be Considered on Planning a Research
    (2018) CAMARGO, Cristina Pires; GEMPERLI, Rolf
  • article 5 Citação(ões) na Scopus
    Translation, Cross-Cultural Adaptation and Linguistic Validation of the FACE-Q Questionnaire for Brazilian Portuguese
    (2019) BUSTILLO, Adriana Margarita Buelvas; LOBATO, Rodolfo Costa; LUITGARDS, Bruno Ferreira; CAMARGO, Cristina Pires; GEMPERLI, Rolf; ISHIDA, Luiz Carlos
    BackgroundPatient-reported outcomes measurement instruments (PRO) are a good way to measure results after aesthetic procedures. FACE-Q is a systematized and standardized PRO tool and was not available in Portuguese. MethodsThis cross-sectional study included four stages: translation of FACE-Q, backtranslation, testing in patients who underwent facial aesthetic procedures and review of the questionnaires between September and December, 2018. Guidelines merging WHO and ISPOR's rules were followed. ResultsTranslation was conducted by two translators, resulting in two versions, translation A and translation B, which were reconciled to generate the first Portuguese version. Reconciliation showed inconsistencies between TA and TB in 63% (n=222) of the 353 questions, which were solved by maintaining TA in 25% of cases (n=87), TB in 27% and a new version in 11% (n=40) of the questions. Backtranslation showed written differences with the original FACE-Q in 64 (22.7%) of the 353 question, but only one case of semantic difference, which was corrected resulting in production of the second Portuguese version. Seven patients with a mean age of 35.8years were interviewed to assess the difficulty in understanding the questionnaires. Four patients had no or minor difficulties understanding the questionnaire, and the other three had difficulties and suggested changes that led to a third Portuguese version. The third version was reviewed for grammar and spelling resulting in the final Portuguese version.ConclusionA Brazilian Portuguese version of the FACE-Q questionnaire was obtained maintaining equivalency with the source instrument. This will allow cross-cultural research and comparison of results between different studies.Level of Evidence VThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
  • article 19 Citação(ões) na Scopus
    Description of a new experimental model skin flap for studying skin viability in rats
    (2014) CAMARGO, Cristina Pires; MARGARIDO, Nelson Fontana; GUANDELINI, Eduardo; VIEIRA, Guilherme Alexandre Barrucci; JACOMO, Alfredo Luiz; GEMPERLI, Rolf
    PURPOSE: To describe a new experimental flap for studying skin viability in rats. METHODS: Twenty male Wistar rats weighing between 250-300g were divided into two groups: group A - McFarlane technique, a 4 x 10cm flap was used (McFarlane); and in group B modified McFarlane technique, a 3 x 10cm flap was used. Seven days later, the animals were sacrificed and the area of necrosis was evaluated in both groups. RESULTS: Group A presented necrosis in 3% of the total area of the flap (CI: 0.01-0.05), Group B presented necrosis in 37% of the total area of the flap (CI: 0.29-0.46), (p<0.001). CONCLUSION: The modified McFarlane flap presented a larger area of necrosis and could be an adequate experimental model of skin flap viability.
  • article 0 Citação(ões) na Scopus
    How to Distinguish Best Evidence from Bias: A Basic Guide to Understanding a Systematic Review
    (2020) CAMARGO, Cristina Pires; GEMPERLI, Rolf; ROHRICH, Rod J.
    A systematic review is a powerful tool to synthesize and show concise and robust evidence for clinical practice. Thus, the inclusion of biased, low-quality studies should be avoided, for otherwise, the resulting systematic review will not reflect the best medical evidence. Because the methodology of systematic review is relatively new, this review aims to present basic rules to guide the reader's interpretation of a systematic review.