Knee landmarks detection via deep learning for automatic imaging evaluation of trochlear dysplasia and patellar height.

OBJECTIVES: To develop and validate a deep learning-based approach to automatically measure the patellofemoral instability (PFI) indices related to patellar height and trochlear dysplasia in knee magnetic resonance imaging (MRI) scans. METHODS: A total of 763 knee MRI slices from 95 patients were included in the study, and 3393 anatomical landmarks were annotated for measuring sulcus angle (SA), trochlear facet asymmetry (TFA), trochlear groove depth (TGD) and lateral trochlear inclination (LTI) to assess trochlear dysplasia, and Insall-Salvati index (ISI), modified Insall-Salvati index (MISI), Caton Deschamps index (CDI) and patellotrochlear index (PTI) to assess patellar height. A U-Net based network was implemented to predict the landmarks' locations. The successful detection rate (SDR) and the mean absolute error (MAE) evaluation metrics were used to evaluate the performance of the network. The intraclass correlation coefficient (ICC) was also used to evaluate the reliability of the proposed framework to measure the mentioned PFI indices. RESULTS: The developed models achieved good accuracy in predicting the landmarks' locations, with a maximum value for the MAE of 1.38 ± 0.76 mm. The results show that LTI, TGD, ISI, CDI and PTI can be measured with excellent reliability (ICC > 0.9), and SA, TFA and MISI can be measured with good reliability (ICC > 0.75), with the proposed framework. CONCLUSIONS: This study proposes a reliable approach with promising applicability for automatic patellar height and trochlear dysplasia assessment, assisting the radiologists in their clinical practice. CLINICAL RELEVANCE STATEMENT: The objective knee landmarks detection on MRI images provided by artificial intelligence may improve the reproducibility and reliability of the imaging evaluation of trochlear anatomy and patellar height, assisting radiologists in their clinical practice in the patellofemoral instability assessment. KEY POINTS: • Imaging evaluation of patellofemoral instability is subjective and vulnerable to substantial intra and interobserver variability. • Patellar height and trochlear dysplasia are reliably assessed in MRI by means of artificial intelligence (AI). • The developed AI framework provides an objective evaluation of patellar height and trochlear dysplasia enhancing the clinical practice of the radiologists.

Contamination of equipment and surfaces in the operating room anesthesia workspace: a cross-sectional study.

BACKGROUND: Contamination of the breathing circuit and medication preparation surface of an anesthesia machine can increase the risk of cross-infection. OBJECTIVE: To evaluate the contamination of the anesthetic medication preparation surface, respiratory circuits, and devices used in general anesthesia with assisted mechanical ventilation. DESIGN AND SETTING: Cross-sectional, quantitative study conducted at the surgical center of a philanthropic hospital, of medium complexity located in the municipality of Três Lagoas, in the eastern region of the State of Mato Grosso do Sul. METHODS: Eighty-two microbiological samples were collected from the breathing circuits. After repeating the samples in different culture media, 328 analyses were performed. RESULTS: A higher occurrence of E. coli, Enterobacter spp., Pseudomonas spp., Staphylococcus aureus, and Streptococcus pneumoniae (P < 0.001) were observed. Variations were observed depending on the culture medium and sample collection site. CONCLUSION: The study findings underscore the inadequate disinfection of the inspiratory and expiratory branches, highlighting the importance of stringent cleaning and disinfection of high-touch surfaces.

Contamination of equipment and surfaces in the operating room anesthesia workspace: a cross-sectional study

ABSTRACT BACKGROUND: Contamination of the breathing circuit and medication preparation surface of an anesthesia machine can increase the risk of cross-infection. OBJECTIVE: To evaluate the contamination of the anesthetic medication preparation surface, respiratory circuits, and devices used in general anesthesia with assisted mechanical ventilation. DESIGN AND SETTING: Cross-sectional, quantitative study conducted at the surgical center of a philanthropic hospital, of medium complexity located in the municipality of Três Lagoas, in the eastern region of the State of Mato Grosso do Sul. METHODS: Eighty-two microbiological samples were collected from the breathing circuits. After repeating the samples in different culture media, 328 analyses were performed. RESULTS: A higher occurrence of E. coli, Enterobacter spp., Pseudomonas spp., Staphylococcus aureus, and Streptococcus pneumoniae (P < 0.001) were observed. Variations were observed depending on the culture medium and sample collection site. CONCLUSION: The study findings underscore the inadequate disinfection of the inspiratory and expiratory branches, highlighting the importance of stringent cleaning and disinfection of high-touch surfaces.

Imaging evaluation of patellofemoral joint instability: a review.

The multifactorial origin of anterior knee pain in patellofemoral joint disorders leads to a demanding diagnostic process. Patellofemoral misalignment is pointed out as one of the main causes of anterior knee pain. The main anatomical risk factors of patellofemoral instability addressed in the literature are trochlear dysplasia, abnormal patellar height, and excessive tibial tubercle-trochlear groove distance. Diagnostic imaging of the patellofemoral joint has a fundamental role in assessing these predisposing factors of instability. Extensive work is found in the literature regarding the assessment of patellofemoral instability, encompassing several metrics to quantify its severity. Nevertheless, this process is not well established and standardized, resulting in some variability and inconsistencies. The significant amount of scattered information regarding the patellofemoral indices to assess the instability has led to this issue. This review was conducted to collect all this information and describe the main insights of each patellofemoral index presented in the literature. Five distinct categories were created to organize the patellofemoral instability indices: trochlear dysplasia, patellar height, patellar lateralization, patellar tilt, and tibial tubercle lateralization.

Immune-Related Genetic Overlap Between Regional Gray Matter Reductions and Psychiatric Symptoms in Adolescents, and Gene-Set Validation in a Translational Model.

Adolescence is a period of vulnerability for the maturation of gray matter (GM) and also for the onset of psychiatric disorders such as major depressive disorder (MDD), bipolar disorder and schizophrenia. Chronic neuroinflammation is considered to play a role in the etiology of these illnesses. However, the involvement of neuroinflammation in the observed link between regional GM volume reductions and psychiatric symptoms is not established yet. Here, we investigated a possible common immune-related genetic link between these two phenomena in european adolescents recruited from the community. Hippocampal and medial prefrontal cortex (mPFC) were defined a priori as regions of interest (ROIs). Their GM volumes were extracted in 1,563 14-year-olds from the IMAGEN database. We found a set of 26 SNPs that correlated with the hippocampal volumes and 29 with the mPFC volumes at age 14. We formed two ROI-Related Immune-gene scores (RRI) with the inflammation SNPs that correlated to hippocampal GM volume and to mPFC GM volume. The predictive ability of both RRIs with regards to the presence of psychiatric symptoms at age 18 was investigated by correlating the RRIs with psychometric questionnaires obtained at age 18. The RRIs (but not control scores constructed with random SNPs) correlated with the presence of depressive symptoms, positive psychotic symptoms, and externalizing symptoms in later adolescence. In addition, the effect of childhood maltreatment, one of the major environmental risk factors for depression and other mental disorders, interacted with the RRI effect. We next sought to validate this finding by investigating our set of inflammatory genes in a translational animal model of early life adversity. Mice were subjected to a protocol of maternal separation at an early post-natal age. We evaluated depressive behaviors in separated and non-separated mice at adolescence and their correlations with the concomitant expression of our genes in whole blood samples. We show that in mice, early life adversity affected the expression of our set of genes in peripheral blood, and that levels of expression correlated with symptoms of negative affect in adolescence. Overall, our translational findings in adolescent mice and humans provide a novel validated gene-set of immune-related genes for further research in the early stages of mood disorders.

Systemic inflammation as a risk factor for portal vein thrombosis in cirrhosis: a prospective longitudinal study.

BACKGROUND AND AIMS: Various risk factors for portal vein thrombosis (PVT) development in patients with cirrhosis have been identified, but the role of systemic inflammatory reaction is unknown. The study aims to assess the association between markers of systemic inflammation and PVT in cirrhosis. METHODS: Between January 2014 and October 2015, 107 outpatients with cirrhosis and no PVT were recruited, and followed till February 2017. White blood cell count, serum concentrations of high-sensitive C-reactive protein, ferritin, tumor necrosis factor-alpha and interleukin-6 (IL-6) were evaluated at baseline and every 3 or 6 months till PVT diagnosis or end of follow-up. RESULTS: Median age, model for end-stage liver disease (MELD) score and follow-up period of the studied population was 55 years (IQR 46-62 years), 9.6 points (IQR 7.5-12 points) and 19 months (12-24 months), respectively. PVT developed in 10.3% of the patients. Lymphocyte count below 1.2 ´ 109/L [hazard ratio, 6.04; 95% confidence interval (CI), 1.29-28.2; P = 0.022], IL-6 above 5.5 pg/mL (hazard ratio, 5.64; 95% CI, 1.21-26.33; P = 0.028) and neutrophil-to-lymphocyte ratio (hazard ratio, 1.46; 95% CI, 1.04-2.04; P = 0.028) were associated with a higher risk of PVT development. IL-6 and lymphopenia remained associated with subsequent PVT development after adjustment for nonselective beta-blockers, spleen size, portosystemic collaterals, oesophageal varices (grade ≥2) and ascites, but also with alcohol as the cause for cirrhosis and MELD ≥13. CONCLUSION: In patients with cirrhosis, markers of systemic inflammation IL-6 and lymphopenia are predictive of PVT independently of markers of portal hypertension. These results draw our attention on a factor so far overlooked in the pathogenesis of PVT.

Gastrointestinal stromal tumor of the excluded stomach after Roux-en-Y gastric bypass: A case report and literature review.

BACKGROUND: Gastric cancer is an extremely rare condition to occur after bariatric surgery, and most of the reported cases are adenocarcinomas. Regarding gastrointestinal stromal tumors (GISTs), there are only two reported cases occurring after bariatric surgery (one after gastric banding and the other following Roux-en-Y gastric bypass (RYGB)). CASE PRESENTATION: A 48-year-old woman with previous history of obesity and type 2 diabetes, treated with a Roux-en-Y gastric bypass 2 years earlier, was referred to our center due to complains of diffuse abdominal pain and distension associated with asthenia. Magnetic resonance imaging showed a cystic-solid mass located in the right hypochondrium, measuring 19.5 × 13.5 × 16 cm, suggesting the diagnosis of a retroperitoneal tumor. Based on these findings, a laparotomy, evidencing that the larger cystic-solid tumor was originating from the excluded stomach post-RYGB. The gastrectomy of the excluded stomach was performed aside with a conventional cholecystectomy. Histopathology and immunohistochemistry confirmed to be a gastric GIST with epithelioid cells. Currently, 12 months after surgery, the patient presents no signs of recurrence. CONCLUSION: This is the second case of gastric GIST occurring after RYGB to be reported in the literature.

Accelerated rehabilitation versus conventional rehabilitation in total hip arthroplasty (ARTHA): a randomized double blinded clinical trial.

OBJECTIVES: compare an accelerated physiotherapeutic protocol to a conventional physiotherapeutic protocol in total hip arthroplasty patients. METHODS: a randomized double blinded clinical trial performed from August 2013 to November 2014. Forty-eight patients diagnosed with hip osteoarthritis submitted to a total hip arthroplasty surgery. An accelerated rehabilitation physiotherapy applied three times a day and start gait training on the first day or standard physiotherapy applied once a day and start gait training on the second or third day of hospitalization. The Merle dAubigné and Postel score (mobility, pain and gait), muscle strength force, range of motion, in hospital stay and time to start of gait training, were the outcomes. RESULTS: the mean age was 64.46 years (10.37 years standard deviation). No differences were observed in age in different genders, and the two randomization groups were homogeneous. In hospital stay was lower in the intervention group compared to the control group, 3 (3-4) days [median (interquartile range)] versus 4 (4-5) days. Time to the start of gait training was early in the intervention group compared to the control group, 1 (1-1) days versus 2 (2-2) days. Higher muscle strength values were observed in the postoperative results in the intervention group compared to the control group for internal rotation, external rotation and abduction. CONCLUSIONS: an accelerated physiotherapeutic protocol should be encouraged, because it shows favourable results in gait, muscle strength and length of hospital stay, even upon hospital discharge.

Broad Diversity of Fungi in Hospital Water.

INTRODUCTION: Some studies have reported the occurrence of microorganisms isolated from water. Considering these microorganisms, fungi are known to occur ubiquitously in the environment, including water, and some are pathogenic and may cause health problems, especially in immunocompromised individuals. The aim of this study was to identify fungi in hospital water samples and to correlate their presence with the concentration of free residual chlorine. METHODS: Water samples (100 mL) were collected from taps (n = 74) and water purifiers (n = 14) in different locations in a university hospital. Samples were filtered through a nitrocellulose membrane and placed on Sabouraud dextrose agar and incubated for 24 hours at 30°C. Fungi were identified according to established methods based on macroscopic and microscopic characteristics (filamentous) and physiological tests (yeasts). Free chlorine residual content was measured at the time of sample collection. RESULTS: Seventy species of fungi were identified in the water samples and about 56% of the water samples contained culturable fungi. Cladosporium oxysporum, Penicillium spinulosum, and Aspergillus fumigatus were the most common filamentous fungi. Aureobasidium pullulans and Candida parapsilosis were the most common yeasts. Chemical analyses revealed that free residual chlorine was present in 81.8% of the samples within recommended concentrations. Among samples from water purifiers, 92.9% showed low levels of free residual chlorine (<0.2 mg/L). There was no significant association between chlorine concentrations (either within or outside the recommended range) and the presence of filamentous fungi and yeasts. CONCLUSIONS: This study showed that hospital water can be a reservoir for fungi, some of which are potentially harmful to immunocompromised patients. Free residual chlorine was ineffective in some samples.

Partial remission in Brazilian children and adolescents with type 1 diabetes. Association with a haplotype of class II human leukocyte antigen and synthesis of autoantibodies.

OBJECTIVE: Characterization of partial remission using the insulin dose-adjusted HbA1c (IDAA1c) ≤ 9 definition in a multiethnic Brazilian population of children and adolescents with type 1 diabetes (T1D), in addition with the determination of both Class II HLA genotype and autoantibodies. METHODS: We analyzed the prevalence of partial remission in 51 new-onset T1D patients with a median time follow-up of 13 months from diagnosis. For this study, anti-GAD65, anti-IA2 and HLA class II genotyping were considered. RESULTS: Partial remission occurred in 41.2% of T1D patients until 3 months after diagnosis, mainly in those aged 5-15 years. We have demonstrated a significant increase in the haplotypes of class II HLA DRB1*0301-DQB1*0201 in children and adolescents with a partial remission phase of the disease (42.9% vs 21.7% in non-remitters, P = .0291). This haplotype was also associated with the reduction of anti-IA2 antibodies production. Homozygote DRB1*03-DQB1*0201/DRB1*03-DQB1*0201 children had the lowest prevalence of IA-2A antibodies (P = .0402). However, this association does not correlate with the time of the remission phase. CONCLUSION: Although the number of patients studied was reduced, our data suggested that the association between genetics and decrease in antibody production to certain islet auto-antigen may contribute, at least in part, to the remission phase of T1D.

Influence of environmental dust in transformation capacity of Streptococcus pneumoniae.

S. pneumoniae, commonly known as pneumococcus, is a naturally competent Gram-positive bacterium and is the major cause of pneumonia in elderly and children in developing countries. This pathogen is associated with respiratory diseases affected by pollution. The objective of this work was determining the effect of ash and environmental dust from the burning of sugarcane on pneumococci bacterial transformation. The transformation capacity of the Pn360 pneumococci strain was performed using the assays of DNA donor of mutant for luxS gene. Thus, the transformation tests were performed in contact with dust collected in the southwestern region of Brazil (important region where burning of sugar cane is present in the agriculture). The use of degradative practices in the sugar cane agriculture in Brazil was involved in the transformation capacity of the S. pneumoniae. This phenomenon includes important consequences for public health concerning to resistance acquisition and new virulence factors of this important infection. In conclusion, we obtained important results concerning the action of environmental pollution in Streptococcus pneumoniae transformation, increasing the DNA acquisition for this pathogen.

Accelerated rehabilitation versus conventional rehabilitation in total hip arthroplasty (ARTHA): a randomized double blinded clinical trial / Reabilitação acelerada versus reabilitação convencional na artroplastia total do quadril (ARTHA): um ensaio clínico randomizado, duplo cego

ABSTRACT Objectives: compare an accelerated physiotherapeutic protocol to a conventional physiotherapeutic protocol in total hip arthroplasty patients. Methods: a randomized double blinded clinical trial performed from August 2013 to November 2014. Forty-eight patients diagnosed with hip osteoarthritis submitted to a total hip arthroplasty surgery. An accelerated rehabilitation physiotherapy applied three times a day and start gait training on the first day or standard physiotherapy applied once a day and start gait training on the second or third day of hospitalization. The Merle dAubigné and Postel score (mobility, pain and gait), muscle strength force, range of motion, in hospital stay and time to start of gait training, were the outcomes. Results: the mean age was 64.46 years (10.37 years standard deviation). No differences were observed in age in different genders, and the two randomization groups were homogeneous. In hospital stay was lower in the intervention group compared to the control group, 3 (3-4) days [median (interquartile range)] versus 4 (4-5) days. Time to the start of gait training was early in the intervention group compared to the control group, 1 (1-1) days versus 2 (2-2) days. Higher muscle strength values were observed in the postoperative results in the intervention group compared to the control group for internal rotation, external rotation and abduction. Conclusions: an accelerated physiotherapeutic protocol should be encouraged, because it shows favourable results in gait, muscle strength and length of hospital stay, even upon hospital discharge.

RESUMO Objetivos: comparar um protocolo fisioterapêutico acelerado com um protocolo fisioterapêutico convencional em pacientes submetidos a artroplastia total do quadril. Métodos: ensaio clínico randomizado, duplo-cego, realizado de agosto/2013 a novembro/2014. Quarenta e oito pacientes diagnosticados com coxartrose submetidos a cirurgia de artroplastia total do quadril. Fisioterapia de reabilitação acelerada aplicada três vezes ao dia com início de marcha no primeiro dia ou fisioterapia convencional aplicada uma vez ao dia e início de marcha no segundo ou terceiro dia de hospitalização. Os escores de Merle dAubigné e Postel (mobilidade, dor e marcha), força muscular, amplitude de movimento, internação hospitalar e tempo para o início de marcha foram os desfechos. Resultados: a idade média foi 64,46 anos (desvio padrão 10,37 anos). Não foram observadas diferenças na idade nos diferentes sexos, e os grupos de randomização foram homogêneos. O tempo de internação hospitalar foi menor no grupo intervenção em comparação ao grupo controle, 3 (3-4) dias [mediana (intervalo interquartil)] versus 4 (4-5) dias. O tempo para início da marcha foi precoce no grupo de intervenção em comparação ao grupo controle, 1 (1-1) dias versus 2 (2-2) dias. Maiores valores de força muscular foram observados nos resultados pós-operatórios no grupo intervenção em comparação ao grupo controle para rotação interna, rotação externa e abdução. Conclusões: um protocolo fisioterapêutico acelerado deve ser incentivado, pois apresenta resultados favoráveis na marcha, força muscular e tempo de internação, mesmo após a alta hospitalar.

Results of Medium-Term Survival of the Non-Cemented Logical Femoral Stem.

Objective The main objective of the present study was to evaluate the clinical and radiographic results of the Logical (Baumer, Mogi Mirim, SP, Brasil) cementless femoral stem in primary total hip arthroplasties (THAs). Methods A retrospective cohort study of 632 patients submitted to primary THA with the Logical cementless femoral stem. The study period was between January 2004 and January 2015. The outcome defined to evaluate the survival of the stem was the clinical and radiographic indication of the revision hip arthroplasty or the actual revision of the femoral stem for any cause. Results Kaplan-Meier survival curves were estimated at > 95%, with a follow-up ranging from 2 to 13 years. There was a low incidence of transoperative periprosthetic fractures (0.02%). No axial migration or cortical bone atrophy was observed in the radiographic sample evaluated. Conclusions In the intermediate follow-up, there was excellent survival of the Logical cementless femoral stem. Although long-term studies are still awaited, this implant appears to be safe and promising to be used for primary THAs.

Results of Medium-Term Survival of the Non-Cemented Logical Femoral Stem / Resultados de sobrevida no médio prazo da haste femoral não cimentada Logical

Abstract Objective The main objective of the present study was to evaluate the clinical and radiographic results of the Logical (Baumer, Mogi Mirim, SP, Brasil) cementless femoral stem in primary total hip arthroplasties (THAs). Methods A retrospective cohort study of 632 patients submitted to primary THA with the Logical cementless femoral stem. The study period was between January 2004 and January 2015. The outcome defined to evaluate the survival of the stem was the clinical and radiographic indication of the revision hip arthroplasty or the actual revision of the femoral stem for any cause. Results Kaplan-Meier survival curves were estimated at > 95%, with a follow-up ranging from 2 to 13 years. There was a low incidence of transoperative periprosthetic fractures (0.02%). No axial migration or cortical bone atrophy was observed in the radiographic sample evaluated. Conclusions In the intermediate follow-up, there was excellent survival of the Logical cementless femoral stem. Although long-term studies are still awaited, this implant appears to be safe and promising to be used for primary THAs.

Resumo Objetivo Avaliar os resultados clínicos e radiográficos da haste femoral não cimentada Logical (Baumer, Mogi Mirim, SP, Brasil) nas artroplastias totais do quadril (ATQs). Método Foi realizada uma coorte retrospectiva de 632 pacientes submetidos à artroplastia primária do quadril por coxartrose nos quais foram implantadas hastes femorais não cimentadas Logical. Todos os pacientes eram provenientes do ambulatório de Cirurgia do Quadril da instituição. O período do estudo compreendeu de janeiro de 2004 a janeiro de 2015. O desfecho definido para avaliar a sobrevida da haste foi a indicação clínica e radiográfica da revisão ou a revisão propriamente dita da haste femoral por qualquer causa. Resultado Observaram-se curvas de sobrevida estimadas > 95%, com um seguimento variando de 2 até 13 anos. Houve baixa incidência de fraturas periprotéticas transoperatórias (0,02%). Não foi observada migração axial ou atrofia óssea cortical na amostra radiográfica avaliada. Conclusão Os resultados demonstram, nomédio prazo, excelente sobrevida da haste femoral não cimentada Logical. Embora ainda sejam aguardados estudos no longo prazo, este implante parece ser seguro e promissor para ser utilizado nas artroplastias primárias do quadril.

Assessment of TCF7L2 expression after bariatric surgery.

OBJECTIVE: To assess the influence of bariatric surgery on transcription factor 7-like 2 (TCF7L2) expression and its association with body mass index (BMI) and Type 2 diabetes mellitus (T2DM). METHODS: Prospective study performed between 2016 and 2018, where 26 obese patients undergoing bariatric surgery were divided into two subgroups: diabetics and non-diabetics. The RNAs were extracted from peripheral blood samples that were obtained from each patient in two different moments: before surgery and after 12 months of follow-up. The relative expression of TCF7L2 was determined according to the delta-Ct method. RESULTS: The linear regression model of BMI x delta-Ct showed a positive correlation (p = 0.037). In the subgroups, an inversely proportional relationship was found between delta-Ct and BMI in the diabetic group and a directly proportional relationship in the non-diabetic group (p>0.05 in both). In the postoperative period, the regression model was similar to the preoperative, except when analyzing the subgroups, where diabetic patients showed a directly proportional relationship (p>0.05). The relative expression of TCF7L2 showed an average of 1.16 ± 0.91, CI-95% 0.79-1.53. There was an increase in relative expression of 48% in the non-diabetic group (p = 0.021), and a decrease of 27% in the T2DM group (p>0.05) in the postoperative. There was a positive correlation between a greater decrease in BMI and increased relative expression (p = 0.027). CONCLUSION: Our results showed that generally, the TCF7L2 expression increase with a decrease in BMI, however, for patients with T2DM, it exhibits an inverse pattern, which is normalized one year after bariatric surgery.

Nonselective beta-blockers and the risk of portal vein thrombosis in patients with cirrhosis: results of a prospective longitudinal study.

BACKGROUND: Nonmalignant portal vein thrombosis is a significant event in the course of cirrhosis that can contraindicate liver transplantation and even impact survival after the surgical procedure. Risk factors are not completely known or validated and are still debated. AIM: To identify in patients with cirrhosis the risk factors for portal vein thrombosis that are assessable in clinical practice. METHODS: Between January 2014 and February 2017, 108 outpatients with cirrhosis and no portal vein thrombosis (78% Child A) were enrolled. Doppler ultrasound was performed every 3 or 6 months, for a median follow up of 19 months. RESULTS: Portal vein thrombosis developed in 11 patients. Nonselective beta-blockade (hazard ratio [HR] 10.56; 95% confidence interval [CI]: 1.35-82.73; P = 0.025), and medium or large-sized oesophageal varices (HR 5.67; 95% CI: 1.49-21.63; P = 0.011) at baseline were associated with portal vein thrombosis development. Although heart rate (P < 0.001) and portal blood flow velocity at baseline (P = 0.005) were significantly reduced by nonselective beta-blockers, they were not related to portal vein thrombosis development. CONCLUSIONS: Our findings confirm an association between portal vein thrombosis development and oesophageal varices at baseline, but suggest that the association could be explained by exposure to nonselective beta-blockers, independently from effects on heart rate and portal blood flow velocity. The mechanisms that explain portal vein thrombosis development in patients on nonselective beta-blockers require elucidation in order to optimise targeting of nonselective beta-blockade in patients with cirrhosis.

Analysis of the lipid profile of patients submitted to sleeve gastrectomy and Roux-en-Y gastric bypass. / Análise do perfil lipídico de pacientes submetidos à gastrectomia vertical e à derivação gástrica em Y de Roux.

OBJECTIVE: to compare the improvements in lipid profile in patients undergoing sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). METHODS: in a mixed cohort study, we evaluated 334 patients undergoing SG and 178 patients undergoing RYGB at the University Hospital of the Federal University of Pernambuco and at the Real Hospital Português de Beneficência, Recife, PE, Brazil. We measured serum levels of total cholesterol, LDL, HDL and triglycerides preoperatively and at three, six, 12 and 24 months follow-up. RESULTS: the SG group consisted of 58 men and 276 women. In the group submitted to RYGB, there were 64 men and 114 women. The mean age was 37.2±20.5 years in the SG group and 41.9±11.1 years in the RYGB group. The preoperative mean BMI was 39.4±2.6kg/m2 and 42.7±5.8kg/m2 for the SG and RYGB groups, respectively. In the preoperative period, 80% of the patients had at least one abnormality in the lipid profile. Two years after surgery, there was improvement in total cholesterol, LDL, HDL and triglycerides in the group submitted to RYGB. In the group submitted to SG, after two years there was improvement in total cholesterol, HDL and triglyceride levels. CONCLUSION: both techniques resulted in improvements in the lipid profile, but the RYGB was more effective.

OBJETIVO: comparar as melhorias no perfil lipídico de pacientes submetidos à gastrectomia vertical (GV) e à derivação gástrica em Y de Roux (DGYR). METÓDOS: estudo de coorte misto, em que foram avaliados 334 pacientes submetidos à GV e 178 pacientes submetidos à DGYR no Hospital das Clínicas da Universidade Federal de Pernambuco e no Real Hospital Português de Beneficência, Recife, PE, Brasil. Foram realizadas dosagens séricas de colesterol total, LDL, HDL e triglicerídeos no pré-operatório e com três, seis, 12 e 24 meses de seguimento. RESULTADOS: o grupo submetido à GV foi composto por 58 homens e 276 mulheres. No grupo submetido à DGYR, foram analisados 64 homens e 114 mulheres. A média de idade foi de 37,2±20,5 anos no grupo da GV e de 41,9±11,1 anos no grupo da DGYR. O IMC médio pré-operatório foi de 39,4±2,6kg/m2 e 42,7±5,8kg/m2, para o grupo da GV e da DGYR, respectivamente. No pré-operatório, 80% dos pacientes tinha, no mínimo, uma anormalidade no perfil lipídico. Dois anos após a cirurgia houve melhora do colesterol total, LDL, HDL e triglicerídeos no grupo submetido à DGYR. No grupo submetido à GV, após dois anos houve melhora dos níveis de colesterol total, HDL e triglicerídeos, apenas. CONCLUSÃO: ambas as técnicas resultaram em melhorias no perfil lipídico, porém a DGYR foi mais efetiva.

Clinical, laboratory and densitometric comparison of patients with coxarthrosis and femoral neck fractures. / Comparação clínica, laboratorial e densitométrica de pacientes com coxartrose e com fraturas do colo femoral.

OBJECTIVE: to compare clinical, laboratory and densitometric data from patients with osteoarthrosis and femoral neck fractures. METHODS: we conducted a cross-sectional study of patients with femoral neck fracture and hip osteoarthrosis submitted to hip arthroplasty. We collected clinical, laboratory and densitometric data. RESULTS: we included 53 patients, 22 with femoral neck fractures and 31 with osteoarthrosis. Patients with femoral neck fractures were older than patients with osteoarthrosis, with lower BMI values, bone mineral density and palmar grip strength (sarcopenic patients), being more neurologically impaired and presenting a worse ASA score. Among the various biochemical parameters analyzed, we found statistically significant differences in total serum calcium, ionized calcium, vitamin D, free thyroxine, erythrocytes, hemoglobin, hematocrit, total white blood cells, neutrophils, lymphocytes and creatinine between the two groups. Other hormones analyzed and biochemical parameters did not differ significantly, although they showed trends between the two groups. CONCLUSION: patients with femoral neck fractures are older than patients with osteoarthrosis, have a lower weight and BMI, are more debilitated, many with anemia and reduced bone mass, and have a significant decrease in total calcium, ionized calcium, vitamin D and creatinine and a significant increase in free thyroxine.

Antidepressive effects of targeting ELK-1 signal transduction.

Depression, a devastating psychiatric disorder, is a leading cause of disability worldwide. Current antidepressants address specific symptoms of the disease, but there is vast room for improvement 1 . In this respect, new compounds that act beyond classical antidepressants to target signal transduction pathways governing synaptic plasticity and cellular resilience are highly warranted2-4. The extracellular signal-regulated kinase (ERK) pathway is implicated in mood regulation5-7, but its pleiotropic functions and lack of target specificity prohibit optimal drug development. Here, we identified the transcription factor ELK-1, an ERK downstream partner 8 , as a specific signaling module in the pathophysiology and treatment of depression that can be targeted independently of ERK. ELK1 mRNA was upregulated in postmortem hippocampal tissues from depressed suicides; in blood samples from depressed individuals, failure to reduce ELK1 expression was associated with resistance to treatment. In mice, hippocampal ELK-1 overexpression per se produced depressive behaviors; conversely, the selective inhibition of ELK-1 activation prevented depression-like molecular, plasticity and behavioral states induced by stress. Our work stresses the importance of target selectivity for a successful approach for signal-transduction-based antidepressants, singles out ELK-1 as a depression-relevant transducer downstream of ERK and brings proof-of-concept evidence for the druggability of ELK-1.