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Introdução: Por se tratar de uma falha médica com potencial implicação jurídica, a retenção inadvertida de corpos estranhos continua sendo subnotificada, o que dificulta o seu estudo e a sua compreensão. Como resultado, ainda se enfrenta um problema recorrente. Este estudo explorou a experiência de cirurgiões brasileiros em relação à retenção de corpos estranhos, analisando as suas características e consequências. Métodos: Foi enviado um questionário de preenchimento voluntário, confidencial e anônimo, por correio eletrônico, aos cirurgiões membros de nove sociedades brasileiras, durante um período de três meses. As questões analisaram a vivência dos entrevistados com os corpos estranhos, seus tipos, manifestações clínicas, diagnóstico, fatores de risco ou de proteção e implicações jurídicas. Resultados: Das 2872 submissões elegíveis, 43% dos médicos teriam deixado e 73% retirado corpos estranhos em uma ou mais ocasiões. Destes, 90% eram têxteis, 78% foram descobertos no primeiro ano e 14% eram assintomáticos. A maioria das retenções ocorreu no início da carreira profissional, em procedimentos eletivos (54%) e rotineiros (85%), porém complexos (57%). Emergência, ausência de contagem, pacientes obesos, fadiga do cirurgião e problemas relacionados às equipes cirúrgicas e aos processos foram tidos como os principais facilitadores. Os pacientes foram alertados sobre a retenção em 46% das vezes e, destes, 26% processaram os médicos ou a instituição. Conclusões: A maioria das retenções inadvertidas ocorreu nos primeiros anos de atividade profissional, em intervenções eletivas e rotineiras. Os corpos estranhos foram diagnosticados nos primeiros meses de pósoperatório, tendo sido os têxteis os mais frequentes. Os fatores de risco referidos pelos entrevistados são comuns em seus locais de trabalho, como emergências e equipes cirúrgicas incompletas, por exemplo. Menos de metade dos operados ficou ciente do evento adverso, sendo que a minoria acabou processando as instituições e/ou cirurgiões envolvidos / Background: Although there is an international mobilization to deal with unintentionally retained foreign bodies (RFB), since it is medical malpractice with potential legal implications, the cases are underreported, hindering the understanding and study of the problem. As a result, we face a recurrent and poorly understood event. This study explored the experience of brazilian surgeons on RFB and analyzed their characteristics and consequences. Study Design: In a three-month period, questionnaire was sent to surgeons members of nine brazilian societies, by electronic mail. Answering the questionnaire was volunteer. Answers were kept confidential and anonymous. The questions explored their experience with foreign bodies, FB types, clinical manifestations, diagnosis, risk and protection factors, and legal implications. Results: In 2872 eligible questionnaires, 43% of the doctors said they had already left FB and 73% had removed FB, in one or more occasions. Of these foreign bodies, 90% were textiles, 78% were discovered in the first year after the surgery and 14% remained asymptomatic. The occurrence of RFBs is more frequent in early professional career, in elective (54%) and routine (85%), but complex (57%) procedures. The main causes were emergency, lack of counting, inadequate work conditions, change of plans during the procedure and obese patients. Patients were alerted about the retention in 46% of the cases, and of these, 26% sued the doctors or the institution. Conclusion: The majority of unintentionally retained foreign bodies occurred at the beginning of the professional career, during routine surgical procedures. In general, foreign bodies caused symptoms and were diagnosed in the first year of the post-operative period. Textiles predominated. Inadequate work conditions were listed as RFB risk factors, as well as emergency surgery, for example. Less than half of the patients were aware of the adverse event and 26% sued the surgeons or the institutions involved in the procedure

Silk fibroin is a widely studied material in the context of tissue engineering. Thanks to its versatility and impressive properties, the fields where silk fibroin is used have grown. In particular, silk fibroin has proved to be useful in all the cases when an interface with living tissues is needed (e.g. biophotonics, bioelectronics). As a consequence of this increasing interest, a wide range of protocols have been developed to prepare different materials starting from cocoons. The aim of this thesis is to investigate new strategies to fabricate silk fibroin-based materials, either improving previously developed protocols or proposing new methodologies both with the purpose to overcome certain limitations of current approaches and to propose new areas of application. We choose to work on three topics: the production of patterns using photolithography on a fibroin photoresist films (fibroin photocrosslinkable photoresist, FPP), the production of sponges made from a chemically modified version of the native protein (Methacrylated fibroin, Sil-MA), and the production of a solid bulk resin made starting from the regenerated protein. In the case of the FPP (and its counterpart made of sericine, SPP) the fabrication of films and pattern was restricted to the use of harsh chemicals. In addition, the resulting material had a roughness that limits its use in optical applications, making the determination of the refractive index (RI) not possible. The novelty of our work consisted in the modification of the original protocol to make it environmentally sustainable and to decrease the roughness in order to use ellipsometry to determine the RI dispersion. The broadly used silk-based sponges can be prepared by several protocols but they all suffer of the same limitations: the sponges are stabilized only by physical crosslinking (the change from the random to the crystalline secondary structure), and there are no clear models that correlate the sponge properties to their composition. We produced a new sponge, chemically crosslinked, whose stability was ensured by the creation, of chemical bonds between the protein chains during an UV curing. This task was accomplished using a simple protocol and a statistical method to model the composition-properties relations. The possibility to obtain a bulk, non-porous solid monolith from fibroin (solid-fibroin) has been received attention only in the last few years. This material is produced by a transition from solution to solid through solvent evaporation, a very slow process that takes weeks to be completed. The advantage of this transition is that it occurs at room temperature, allowing the addition of thermally degradable molecules (e.g. enzymes). We were able to optimize a procedure to produce the same material by compression of a silk sponge at high pressure and low temperature. The advantage of this method is the lower amount of time required to produce the material, minutes instead of days.

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