The reverse Trendelenburg position in proximal ureteral stone management: A systematic review and meta-analysis.

INTRODUCTION: Ureteroscopy lithotripsy (URSL) presents a therapeutic option for patients with proximal ureteral calculi warranting active removal. This systematic review and meta-analysis aimed to assess the efficacy of the reverse Trendelenburg (RT) position during this procedure. MATERIALS: A comprehensive literature search was conducted across PubMed, Embase, and Cochrane databases to identify randomized controlled trials and observational studies comparing RT versus standard positioning (STD) in patients undergoing URSL for proximal ureteral stones. Heterogeneity was measured with the Cochran's Q test, I2 statistics, and prediction intervals (PI). A DerSimonian and Laird random-effects model was utilized for all outcomes. RESULTS: Four studies encompassing 505 patients undergoing URSL were analyzed. Among the studied participants, 293 (58%) underwent RT positioning. Overall, RT was associated with a lower average incidence of stone retropulsion (RR 0.42; 95% CI 0.27-0.65; I2=48%; PI 0.08-2.10) and a higher mean stone-free rate (RR 1.33; 95% CI 1.18-1.49; I2=0%). However, no significant difference between groups was found in the mean rate of overall complications (RR 0.76; 95% CI 0.40-1.43; I2=51%; PI 0.00-520.22) and operative time (MD -0.65; 95% CI -9.58-8.27; I2=94%; PI -111.95-110.65). In those with proximal ureteral stones undergoing RT positioning at only the 20° angle, there was a reduction in stone retropulsion without any measured heterogeneity (RR 0.35; 95% CI 0.23-0.52; I2=0%). CONCLUSION: These findings suggest that RT positioning is effective in improving outcomes for patients with proximal ureteral stones undergoing URSL, and its use should be considered during the procedure.

Preoperative α1-Blockers Impact on Outcomes of Patients Undergoing Ureteroscopy with Ureteral Access Sheaths: A Systematic Review and Meta-Analysis.

Introduction: The use of a ureteral access sheath (UAS) during ureteroscopy (URS) has been associated with the risk for ureteral injuries. Preoperative administration of α1-blockers presents a potential mitigator of such lesions by inducing ureteral relaxation, which may also contribute to improving other surgical outcomes. Methods: A comprehensive literature search was conducted across MEDLINE, Embase, and Cochrane databases for studies comparing preoperative α1-blockers administration vs its non-use in adult patients without pre-stenting undergoing URS. Binary outcomes were evaluated using risk ratios (RRs) and odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was measured with the Cochran's Q test, I2 statistics, and prediction intervals (PIs). A DerSimonian and Laird random-effects model was utilized for all outcomes. Results: Eleven studies encompassing 1074 patients undergoing URS were included, of whom 522 (48.60%) received α1-blockers before the procedure. Preoperative α1-blockers were associated with a reduction in significant ureteral injuries (RR 0.30; 95% CI 0.17-0.53; I2 = 6%; PI 0.10-0.88) and an increase in mean successful UAS insertion (OR 2.14; 95% CI 1.08-4.23; I2 = 23%; PI 0.51-8.93). In patients undergoing exclusively ureteroscopy lithotripsy (URSL), the medications also reduced total complications (RR 0.62; 95% CI 0.46-0.84; I2 = 0%) and complications graded Clavien-Dindo III or higher (RR 0.16; 95% CI 0.04-0.69; I2 = 0%), but no significant difference between groups was found in the stone-free rate (RR 1.10; 95% CI 0.86-1.40; I2 = 91%; PI 0.47-2.59). Conclusion: Preoperative α1-blockers were linked to a decrease in significant ureteral injuries with UAS use and fewer complications during URSL procedures. However, their impact on the successful insertion of a UAS remains uncertain. Consideration of administering preoperative α1-blockers in non-stented adult patients undergoing URS with UAS is advisable.

Plasmonic photocatalytic degradation of tebuconazole and 2,4-dichlorophenoxyacetic acid by Ag nanoparticles-decorated TiO2 tracked by SERS analysis.

Chemical oxidation technologies have been notably used for the mineralization of organic pollutants from aqueous effluents, been especially relevant for the degradation of pesticides. In this context, both tebuconazole (TEB) and 2,4-dichlorophenoxyacetic acid (2,4-D) pesticides were photodegraded by a combined catalyst of TiO2 and silver nanoparticles irradiated by UV-A light (λmax = 368 nm), and the experiments were tracked by surface-enhanced Raman scattering (SERS) spectroscopy. For 2,4-D, the degradation of about 70% was observed after almost 200 min, while for TEB, a decrease of 80% of the initial concentration was observed after approximately 100 min. The SERS monitoring allowed the proposal of some by-products, such as oxidized aliphatic chain and triazole from TEB besides glycolic, glyoxylic and dihydroxyacetic acids from 2,4-D. Their toxicities were predicted through ECOSAR software, verifying that most of them were not harmful to populations of fish, Daphnia and green algae. Thus, the performed oxidative process was efficient in the photodecomposition of TEB and 2,4-D pesticides, inclusive in terms of the decreasing of the toxicity of contaminated effluents.

Rabies in Callithrix sp. in the urban area of Niterói, Rio de Janeiro, Brazil.

In Brazil, rabies occurs mainly within an urban cycle, in which dogs and bats are reservoirs. This paper aims to report the occurrence of rabies in Callithrix sp. in Niterói, Rio de Janeiro, Brazil. In June 2019 a hybrid specimen was referred for diagnosis. The Direct Fluorescent Antibody, Mouse Inoculation, and Polymerase Chain Reaction tests were positive. A phylogenetic analysis was compatible with antigenic variant 3, characteristic of Desmodus rotundus. New studies should be undertaken to elucidate the real role of callitrichids in the urban rabies cycle.

Rabies in Callithrix sp. in the urban area of Niterói, Rio de Janeiro, Brazil

Abstract In Brazil, rabies occurs mainly within an urban cycle, in which dogs and bats are reservoirs. This paper aims to report the occurrence of rabies in Callithrix sp. in Niterói, Rio de Janeiro, Brazil. In June 2019 a hybrid specimen was referred for diagnosis. The Direct Fluorescent Antibody, Mouse Inoculation, and Polymerase Chain Reaction tests were positive. A phylogenetic analysis was compatible with antigenic variant 3, characteristic of Desmodus rotundus. New studies should be undertaken to elucidate the real role of callitrichids in the urban rabies cycle.

Acute appendicitis may no longer be a predominant disease of the young population.

BACKGROUND: Some authors consider acute appendicitis as the main cause of acute surgical abdomen. Incident in all ages, contemporary literature suggests that is more frequent in children and young adults, male predominantly. This study aims to test the hypothesis that the disease in question is no longer prevalent in young adults (excluding children) in the surveyed region. METHODS: 1150 cases of emergency surgery were performed and prospectively analyzed. 300 cases of appendicitis in adults were selected and variables studied. Patients under 13 years old were excluded. RESULTS: 190 patients older than 60 years had a diagnosis of acute appendicitis confirmed by biopsy. There is a predominance of males. The elderly population takes less time to seek medical assistance and has fewer complications, despite being more often admitted to the ICU due to other comorbidities. CONCLUSIONS: A trend regarding acute appendicitis epidemiology may exist. In the specific studied region acute appendicitis is no longer a disease prevalent in young adults. Surgeons and emergency physicians must be aware that acute appendicitis may no longer be predominantly common in young adults in their own specific region. Multicenter studies are needed to determine whether these data are reproduced in a geographical area of greater extent.

Cervical spondylotic myelopathy: clinical cases and physiotherapy / Mielopatia espondilótica cervical: casos clínicos e a fisioterapia / Mielopatía espondilótica cervical: casos clínicos y fisioterapia

ABSTRACT The aims of this article are to present cervical spondylotic myelopathy, a spinal condition caused by bony, ligament and disc alterations that results in spinal cord compression leading to progressive degeneration of the spinal cord, and to describe the possible physiotherapeutic interventions. The pathology has different forms of progression and affected areas, which contributes to the diversity of clinical presentations. This work presents two evaluations of three patients diagnosed with this disease, at different times, to compare the severity, the affected regions, and the evolution of each one. Subsequently, it describes the most appropriate physiotherapeutic treatment for this illness, demonstrating its wide variability according to the signs and symptoms presented. Level of Evidence: IV. Case series.

RESUMO O objetivo deste artigo é apresentar a Mielopatia Espondilótica Cervical, uma afecção da coluna vertebral causada por alterações ósseas, ligamentares e discais, que resultam na compressão medular, desencadeando a degeneração progressiva da medula, e descrever possíveis intervenções fisioterapêuticas. A patologia tem diferentes formas de progressão e áreas de comprometimento, o que contribui com a diversidade de quadros clínicos. Serão apresentadas duas avaliações de 3 pacientes com diagnóstico desta doença, em momentos diferentes, com o intuito de comparar a gravidade, as regiões comprometidas e a evolução de cada um. Posteriormente, é descrito o tratamento fisioterapêutico mais apropriado para esta doença, demonstrando também sua grande variabilidade de acordo com os sinais e sintomas apresentados. Nível de evidência: IV Tipo de estudo: Série de casos.

RESUMEN Los objetivo de este artículo son presentar la mielopatía espondilótica cervical, una afección de la columna vertebral causada por alteraciones óseas, ligamentos y discales, que resultan en la compresión medular, desencadenando la degeneración progresiva de la médula y describir posibles intervenciones fisioterapéuticas. La patología tiene diferentes formas de progresión y áreas de compromiso, lo que contribuye a la diversidad de cuadros clínicos. Se presentarán dos evaluaciones de tres pacientes con diagnóstico de esta enfermedad en momentos diferentes con el objetivo de comparar la gravedad, las regiones comprometidas y la evolución de cada uno. Posteriormente se describe el tratamiento fisioterapéutico más apropiado para esta enfermedad, demostrando también su gran variabilidad de acuerdo con los signos y síntomas presentados. Nivel de evidencia IV. Serie de casos.

Non-human primates as a reservoir for rabies virus in Brazil.

Rabies virus (RABV) does not persist in the environment as it is a very fragile agent. The primary hosts are mammalian species in the orders Carnivora and Chiroptera. Since the late 1980s, RABV has been isolated from non-human primates, Callithrix jacchus (the white-tufted marmoset), in four coastal states (Rio Grande do Norte, Ceará, Piauí and Pernambuco) in north-eastern Brazil, where this species is indigenous. The original habitat of C. jacchus consisted of two Brazilian biomes, the Atlantic Forest and the Caatinga. However, these marmosets have since adapted to other ecosystems as a result of human activities. Between 1988 and 1989, RABV isolates were obtained from white-tufted marmosets in the state of Rio Grande do Norte, but antigenic and genetic identification studies were not conducted at that time. In the following years, three additional states reported cases (Ceará, Piauí and Pernambuco). In two of these states (Ceará and Piauí), human cases of rabies transmitted by marmosets were reported. According to Brazilian Health Ministry data, at least 19 human cases in which this species was the source of infection were registered in between 1990 and 2016. Recent findings in laboratory tests of 12 rabid samples from humans and marmosets and the regional transmission among these animals for over 20 years, together with the gradual increase in the affected geographic area, support the concept of the emergence of a new RABV reservoir. Regional tourism, the wild animal trade and the cultural practice of maintaining these animals as pets, particularly in coastal regions, appear to be major risk factors for the increase in human cases. Additional epidemiological and ecological studies are required to better understand local disease dynamics and to identify ideal opportunities for prevention and control of this fatal infection.

Long-term Retrospective Study of Implants Placed after Sinus Floor Augmentation with Fresh-frozen homologous block.

AIM: The aim of this study was to analyze and follow-up implants placed in the posterior maxillary regions previously grafted with homologous bone. MATERIALS AND METHODS: Forty-one grafts with homologous bone blocks were performed in maxillary sinuses, and 121 implants were placed in premolar and molar regions approximately 6 months after the grafts. Patients were followed up for periods varying from 12 to 124 months after rehabilitation. RESULTS: The results showed two implant failures, for a 98.3% success rate during the follow-up period. DISCUSSION: The implants placed had an average torque of 40 N-cm, regardless of the, design, diameter, and length of the implants used. CONCLUSION: After following up on the implants placed in this study, we concluded that those placed in regions of the maxillary sinuses previously grafted with homologous bone blocks had high long-term success rates and met the functional masticatory requirements.

New records on the use of man-made constructions as diurnal roosts by bats from the southern Amazon in central Brazil / Novos registros sobre a utilização de construções humanas como abrigos diurnos por morcegos no sul da Amazônia Brasileira

Roosts are a key part of bat species' life stories. Information on roost use enables us to understand the biological processes underlying bat ecology and is crucial with regard to the natural-roost loss and environmental pressures related to habitat destruction that has been considered as a threat affecting bat conservation. The aim of this study was to collect new data on the diurnal artificial-roost use by bats in a landscape from the southern Amazon. We observed bat species roosting at an abandoned house in a highly fragmented ecotone between the Amazon and Cerrado biomes. We observed one Trachops cirrhosus individual roosting in physical contact with one Phyllostomus hastatus. One year later, we noticed a compositional change at this roost, in which we found a large colony of Pteronotus parnellii. These findings may shed light on the potential flexibility of the roosting requirements of these species in such landscapes. Moreover, this is one of the first records of the use of human constructions by P. parnelli in such fragmented landscapes, a bat species that until recently was thought of as being associated only with well-preserved natural roosts.

Abrigos desempenham um papel importante na história de vida dos morcegos. Informações sobre sua utilização possibilitam a compreensão dos processos biológicos associados à sua ecologia e são cruciais considerando que a perda de abrigos naturais e que as pressões ambientais relacionadas à descaracterização dos ecossistemas são ameaças para a conservação deste grupo. O objetivo desde estudo foi coletar novos dados sobre a utilização diurna de abrigos artificiais por espécies morcegos em uma região ao sul da Amazônia. Nós observamos espécies de morcegos abrigando uma casa abandonada em uma região ecotonal entre os biomas Amazônia e Cerrado. Neste local, observamos um indivíduo de Trachops cirrhosus em contato físico com um indivíduo de Phyllostomus hastatus. Após um ano, observamos uma mudança neste abrigo, no qual uma colônia de Pteronotus parnellii foi observada. Estes registros podem lançar luz sobre a possível plasticidade destas espécies com relação às suas necessidades para a utilização de abrigos nestas paisagens. O registro trazido aqui é um dos primeiros sobre a utilização de construções humanas por P. parnellii, uma espécie comumente associada a abrigos naturais e bem preservados.

Single-Joint Movements in Parkinson's Disease: A Pulse-Width and Pulse-Height Theory Review.

The process by which the brain controls single-joint movements (SJM) is still not well understood. Some studies have defined rules describing the duration and magnitude of the agonist and antagonist muscles. Therefore, the purpose of this study was to analyze scientific publications about the electromyographic characteristics of SJM performed by patients with Parkinson's disease. A bibliographical review of the years 1989-2015 was performed using keywords such as electromyography, upper limb, and Parkinson's disease. After applying the inclusion criteria, 8 articles were included for analysis. The literature indicates that despite the lack of studies, it is possible to assume that considering the SJM, those with Parkinson's disease only control the magnitude of electromyography activation, being consistent only with the pulse-height theory control.

Implantes cerâmicos em casos estéticos: uma nova possibilidade clínica / Dental ceramic implants in aesthetic cases: a new clinical possibility

A substituição de um elemento dental por um implante em pacientes que apresentam tecido gengival delgado gera uma preocupação devido à translucidez gengival, onde a coloração acinzentada do titânio pode levar ao fracasso estético do tratamento. Desta maneira, os implantes de zircônia se diferenciam principalmente por sua coloração clara, a qual se aproxima das características de cor da raiz, e por sua biocompatibilidade, além de possibilitarem a escolha do paciente por um tratamento totalmente livre de metal. Portanto, este relato de caso clínico demonstrou uma inovação técnica por meio da utilização de um implante confeccionado em zircônia para solução de um caso clínico de alta complexibilidade estética em uma paciente jovem, com fenótipo gengival delgado e alto grau de exigência estética. O caso foi finalizado com prótese cimentada e facetas metal free confeccionadas por meio de cerâmica injetada. Após a finalização do caso, concluiu-se que, apesar da desvantagem relacionada à sensibilidade técnica, o implante confeccionado em zircônia possibilitou a solução estética deste caso clínico de fenótipo gengival delgado, sem a necessidade de utilização de enxertos gengivais.

The replacement of a dental element in patients with thin gingival tissue generates a concern due to gingival translucency, where the titanium gray coloration can lead to failure of the treatment. Thus, the zirconia implants are distinguished primarily by their coloration and their biocompatibility, in addition to enabling the selection of a totally metal-free treatment. Therefore, this clinical report, showed an innovative technique using a zirconia implant in a clinical situation with high complex esthetic needs for in a young patient with thin gingival phenotype and high level of aesthetic requirement. The clinical case was concluded with cemented prosthesis and metal-free veneers made by pressed ceramics. After the end of the case, it was concluded that, despite the disadvantage related to the technical sensitivity, the zirconia implant provided an aesthetic solution of this clinical case of thin gingival phenotype, without the need of gingival grafts.

Exodontia e instalação imediata de implante na região estética com enxerto de bloco xenogênico colagênico – acompanhamento clínico e tomográfico de dez meses / Tooth extraction and immediate implant placement in the esthetic region with collagen xenogeneic bone block – a clinical and CBCT 10-month follow-up

Este artigo descreveu a filosofia de tratamento para a reposição de um incisivo central com implante em carga imediata em alvéolo pós-extração, com preenchimento do gap vestibular através do enxerto xenógeno Geistlich Bio-Oss Collagen. O bom planejamento sobre o posicionamento palatino do implante, preservação alveolar, preenchimento do gap com um biomaterial de baixa taxa de reabsorção, desenho adequado do implante e o manejo da coroa provisória sobre o implante torna possível a obtenção de resultados satisfatórios, controlados clinicamente e tomograficamente durante dez meses, onde foi possível observar a manutenção do material de enxertia e, portanto, a arquitetura gengival...

This article describes the treatment philosophy for replacement of an upper central incisor with immediate implant loading in a fresh-extraction socket, being the gap filled with Bio-Oss Collagen. Implant palatal positioning, alveolar preservation, a low resorption biomaterial for gap filling, adequate implant design, and the management of provisional crown led to satisfactory results after 10 months of clinical and CBCT controls, with the maintenance of graft and gingival architecture...

Epidemiologia molecular de surto de raiva bovina na região central do Rio Grande do Sul, 2012 / Molecular epidemiology of an outbreak of bovine rabies in central Rio Grande do Sul, Brazil, 2012

A raiva é uma doença infecciosa do sistema nervoso central de mamíferos causada pelo vírus da raiva (RabV), geralmente, transmitido pela mordedura de animais infectados. No Brasil, os morcegos hematófagos Desmodus rotundus são as principais fontes de infecção do RabV para bovinos e equinos. Este artigo descreve uma investigação epidemiológica e molecular de surtos de raiva ocorridos na região central do Rio Grande do Sul, entre maio e agosto de 2012. Nesse período, 45 casos suspeitos de raiva foram relatados em 22 pequenos rebanhos, localizados dentro de um raio de 4,7km, no município de Pinhal Grande. Desses, 32 amostras foram submetidas para diagnóstico da raiva, sendo que o RabV e/ou antígenos virais foram identificados em 27 amostras. Em um segundo momento, 11 amostras foram submetidas à transcrição reversa/reação em cadeia da polimerase (RT-PCR) para o gene da nucleoproteína (N) do RabV, seguido de sequenciamento nucleotídico e análise filogenética. Sete das 11 amostras apresentaram sequências nucleotídicas idênticas e uma apresentou mutação sinônima, não-codificante, indicando uma provável origem comum dos vírus. Por outro lado, três amostras apresentaram mutações que resultaram em alterações de aminoácidos, sugerindo uma origem diferente do vírus. Esses resultados sugerem que RabV de diferentes origens/linhagens co-circulam na região e foram envolvidos nos surtos descritos. Investigações sobre a circulação de ambos os genótipos em morcegos na região estão em andamento.

Rabies is an infectious disease of the central nervous system of mammals caused by rabies virus (RabV), generally transmitted by the bite of rabid animals. In Brazil, vampire bats Desmodus rotundus are the main reservoirs of RabV for livestock. The present study describes a molecular and epidemiological investigation of outbreaks of bovine rabies occurring in the central region of Rio Grande do Sul state, Brazil, between May and August 2012. In this period, 45 cases suspected of rabies were reported in 22 small herds, located within a 4.7km range, in the county of Pinhal Grande. From these, 32 samples were submitted to rabies diagnosis and RabV and/or viral antigens were identified in 27 samples. Subsequently, 11 brain samples were submitted to reverse transcription/polymerase chain reaction (RT-PCR) for the nucleoprotein gene (N) followed by nucleotide sequencing and phylogenetic analysis. Seven out of 11 samples yielded identical sequences; one presented a synonymous, non-coding mutation, indicating a likely common origin of the virus. However, three other samples presented nucleotide mutations which resulted in amino acid changes, suggesting a different origin of the virus. In summary, these results suggest that RabV strains of different origin/lineages co-circulate in the region and were involved in the outbreaks. Investigations on the circulation of both genotypes in bats in the region are currently underway.

Evaluation of spinopelvic balance among patients undergoing surgical treatment for lumbar disk hernia / Avaliação do equilíbrio espinopélvico em pacientes submetidos a tratamento cirúrgico de hérnia de disco lombar

OBJECTIVE: to evaluate spinopelvic balance using the pelvic incidence, sacral slope and pelvic tilt among patients with lumbar disk hernias who underwent surgical treatment. METHODS: thirty patients at the spinal services of Hospital Santa Casa de Misericórdia de Vitória and Hospital Vila Velha were evaluated by measuring their spinopelvic balance from the angles of pelvic tilt, sacral slope and pelvic incidence, with their respective means, on simple lateral-view lumbopelvic radiographs that needed to encompass the lumbar spine, sacrum and proximal third of the femur. RESULTS: the spinopelvic balance measurements obtained from the mean angles of the population studied, for pelvic incidence, sacral slope and pelvic tilt, were 45◦ , 36.9◦ and 8.1◦ , respectively. The confidence interval for the mean pelvic incidence was from 41.9 to 48.1 (95% CI), thus including a reference value that characterized it as low, for an asymptomatic population, thus confirming that the sample was extracted from a population with this characteristic. CONCLUSION: among these patients with lumbar disk hernias who underwent surgical treatment, the average spinopelvic balance was found to have pelvic incidence lower than what has been reported in the literature for an asymptomatic population...

OBJETIVO: avaliar o equilíbrio espinopélvico, por meio da incidência pélvica, do declive sacral e da versão pélvica, em pacientes portadores de hérnias discais lombares submetidos a tratamento cirúrgico. MÉTODOS: foram avaliados 30 pacientes do Serviço de Coluna Vertebral do Hospital Santa Casa de Misericórdia de Vitória e do Vila Velha Hospital, por meio da aferição do equilíbrio espinopélvico, obtido pela mensuração dos ângulos da versão pélvica, do declive sacral e da incidência pélvica, com suas respectivas médias, nas radiografias simples lombopélvicas, tipo perfil, que englobaram, obrigatoriamente, coluna lombar, sacro e terço proximal do fêmur. RESULTADOS: a medida do equilíbrio espinopélvico, obtida pela média dos ângulos na população estudada da incidência pélvica, do declive sacral e da versão pélvica, foi de 45◦ , 36,9◦ e 8,1◦ , respectivamente. O intervalo de confiança da média da incidência pélvica entre 41,9 - 48,1 (95% IC) contém o valor de referência que a caracteriza como baixa, para uma população assintomática, o que confirma que a amostra foi extraída de uma população com essa característica. CONCLUSÃO: nos pacientes portadores de hérnia discal lombar submetidos a tratamento cirúrgico foi encontrado, em média, um equilíbrio espinopélvico com incidência pélvica abaixo do encontrado na literatura para uma população assintomática...

Fração mononuclear da medula óssea para reconstrução óssea em levantamento de seio maxilar / Stem cells for bone reconstruction in sinus lifting

Introdução: a demanda por procedimentos de enxertia óssea apresenta um crescimento substancial na área de reabilitação bucal. Entretanto, os pacientes dispostos a se submeter às cirurgias reconstrutivas procuram por procedimentos menos invasivos e com um pós-operatório menos mórbido. Técnicas de reconstrução óssea menos invasivas utilizam, tradicionalmente, substitutos ósseos no sentido de alcançar esses objetivos. No entanto, novos estudos voltados à engenharia tecidual apresentam as células-tronco da medula óssea, em associação a substitutos ósseos, como potencial de melhoramento das características biológicas dos materiais de enxertia. Objetivo: apresentar um caso clínico com a utilização de um concentrado do aspirado da medula óssea autógena (com isolamento da fração mononuclear da medula óssea), associado ao Bio-Oss em um procedimento de levantamento de seio maxilar. Resultados: decorridos cinco meses do procedimento de enxertia composta (Bio-Oss + concentrado de células-tronco medulares),, foram removidas biópsias ósseas durante a cirurgia de instalação dos implantes. Após processamento, as imagens histológicas apresentaram grande quantidade de tecido mineralizado vital para um pós-operatório de cinco meses. Conclusão: o uso do concentrado da fração mononuclear da medula óssea associado ao substituto ósseo xenógeno Bio-Oss em levantamento de seio maxilar parece repercutir em adequado reparo ósseo, culminando em um menor tempo de cicatrização óssea. Porém, estudos clínicos prospectivos randomizados devem ser executados...

Introduction: The demand for bone reconstruction in oral rehabilitation has been growing substantially. However, patients willing to undergo reconstructive surgery want less invasive procedures with less postoperative morbidity. Less invasive bone reconstruction techniques have used bone substitutes to achieve these objectives. Nevertheless, recent studies about tissue engineering have demonstrated that stem cells, in combination with bone grafts, may potentially improve the biological characteristics of grafting material. Objective: To describe a clinical case of sinus elevation using autologous bone marrow aspirate resulting from the isolation of a bone marrow mononuclear fraction combined with Bio-Oss. Results: Five months after the combined grafting procedure (Bio-Oss + bone marrow stem cells), bone biopsies were harvested during implant placement surgery. Histological images revealed a large amount of vital mineralized tissue for a 5-month postoperative time. Conclusion: The clinical use of bone marrow mononuclear fraction combined with Bio-Oss - a xenogeneic bone substitute - in maxillary sinus elevation seems to result in good bone repair and shorter healing time...

Evaluation of spinopelvic balance among patients undergoing surgical treatment for lumbar disk hernia.

OBJECTIVE: to evaluate spinopelvic balance using the pelvic incidence, sacral slope and pelvic tilt among patients with lumbar disk hernias who underwent surgical treatment. METHODS: thirty patients at the spinal services of Hospital Santa Casa de Misericórdia de Vitória and Hospital Vila Velha were evaluated by measuring their spinopelvic balance from the angles of pelvic tilt, sacral slope and pelvic incidence, with their respective means, on simple lateral-view lumbopelvic radiographs that needed to encompass the lumbar spine, sacrum and proximal third of the femur. RESULTS: the spinopelvic balance measurements obtained from the mean angles of the population studied, for pelvic incidence, sacral slope and pelvic tilt, were 45°, 36.9° and 8.1°, respectively. The confidence interval for the mean pelvic incidence was from 41.9 to 48.1 (95% CI), thus including a reference value that characterized it as low, for an asymptomatic population, thus confirming that the sample was extracted from a population with this characteristic. CONCLUSION: among these patients with lumbar disk hernias who underwent surgical treatment, the average spinopelvic balance was found to have pelvic incidence lower than what has been reported in the literature for an asymptomatic population.

OBJETIVO: avaliar o equilíbrio espinopélvico, por meio da incidência pélvica, do declive sacral e da versão pélvica, em pacientes portadores de hérnias discais lombares submetidos a tratamento cirúrgico. MÉTODOS: foram avaliados 30 pacientes do Serviço de Coluna Vertebral do Hospital Santa Casa de Misericórdia de Vitória e do Vila Velha Hospital, por meio da aferição do equilíbrio espinopélvico, obtido pela mensuração dos ângulos da versão pélvica, do declive sacral e da incidência pélvica, com suas respectivas médias, nas radiografias simples lombopélvicas, tipo perfil, que englobaram, obrigatoriamente, coluna lombar, sacro e terço proximal do fêmur. RESULTADOS: a medida do equilíbrio espinopélvico, obtida pela média dos ângulos na população estudada da incidência pélvica, do declive sacral e da versão pélvica, foi de 45°, 36,9° e 8,1°, respectivamente. O intervalo de confiança da média da incidência pélvica entre 41,9 - 48,1 (95% IC) contém o valor de referência que a caracteriza como baixa, para uma população assintomática, o que confirma que a amostra foi extraída de uma população com essa característica. CONCLUSÃO: nos pacientes portadores de hérnia discal lombar submetidos a tratamento cirúrgico foi encontrado, em média, um equilíbrio espinopélvico com incidência pélvica abaixo do encontrado na literatura para uma população assintomática.

Terapia celular em regeneração óssea. Avaliação histomorfométrica de diferentes metodologias / Cell therapy on bone regeneration. An histomorphometric evaluation of different methodologies

Proposição: este estudo analisou a associação de diferentes metodologias de terapia celular a um enxerto ósseo xenógeno (Bio-Oss). Material e Métodos: 33 coelhos Nova Zelândia foram divididos, randomicamente, em cinco grupos experimentais (n=6) e um grupo controle (n=3). Foram criadas situações de defeitos ósseos bilaterais com o auxílio de fresas trefinas com 12 mm de diâmetro preenchidos – no grupo 1 com Bio-Oss; no grupo 2 com Bio-Oss enriquecido com medula óssea fresca; no grupo 3 com Bio-Oss enriquecido com a fração de células mononucleares da medula óssea; no grupo 4 com Bio-Oss enriquecido com células-tronco mesenquimais da medula óssea; e no grupo 5 com Bio-Oss enriquecido com células-tronco mesenquimais do tecido adiposo. Em cada animal, um dos defeitos ósseos foi recoberto com uma membrana colágena e o outro foi mantido sem recobrimento. Após oito semanas, os animais foram sacrificados, sendo seus ossos parietais fixados em formol 10% e processados para análise histomorfométrica. Resultados: no grupo-controle não existiu formação óssea. A histomorfometria demonstrou, para os lados sem recobrimento por membrana nos grupos de 1 a 5, TMV de 6,56 + 1,20%; 12,45 + 11,65%; 21,13 + 0,55; 27,9 + 5,79 e 16,67 + 5,0; respectivamente. O TMV para os lados com recobrimento pela membrana, nos grupos de 1 a 5, foi de 13,06 + 5,24%; 21,14 + 7,38%; 28,17 + 3,19; 28,24 + 6,17 e 17,21 + 7,3; respectivamente. Conclusão: a terapia celular pode maximizar os resultados regenerativos, normalmente propiciados por um biomaterial osseocondutor. O uso do concentrado de células mononucleares da medula óssea pareceu ser a metodologia com maior potencial para uso clínico.

Objective: this study investigated the combination of different cell therapy approaches in combination with a xenograft (Bio-Oss). Material and Methods: 33 New Zealand rabbits were randomly divided into five experimental groups (n=6) and one control group (n=3). Bilateral bone defects were created using 12 mm diameter trefin burs filled – in group 1, with Bio-Oss, in group 2 with Bio-Oss enriched with fresh bone marrow, in group 3 with Bio-Oss enriched with bone marrow mononuclear fraction, in group 4 with Bio-Oss enriched with bone marrow stem cells and, in group 5, with Bio-Oss enriched with adipose tissue stem cells. In each animal, one bone defect was covered by a collagen membrane and the other defect was not covered. After eight weeks, the animals were sacrificed and their parietal bone fixed in 10% formalin and processed for histomorphometric analysis. Results: in control group bone formation did not occur. Histomorphometry demonstrated, for the sides not covered by the collagen membrane, in groups 1, 2, 3, 4 and 5, a VMT of 6.56 + 1.20%; 12.45 + 11.65%; 21.13 + 0.55; 27.9 + 5.79 and 16.67 + 5.0, respectively. The sides covered by the collagen membrane demonstrated, in groups 1, 2, 3, 4 and 5, a VMT of 13.06 + 5.24%; 21.14 + 7.38%; 28.17 + 3.19; 28.24 + 6.17 and 17.21 + 7.3, respectively. Conclusion: cell therapy can maximize the regenerative results normally obtained by an osseoconductor biomaterial. The use of bone marrow mononuclear fraction concentration seems to be the methodology with higher potential for clinical use

In vitro and in vivo inhibition of rabies virus replication by RNA interference

Rabies is a zoonotic disease that affects all mammals and leads to more than 55,000 human deaths every year, caused by rabies virus (RABV) (Mononegavirales: Rhabdoviridae: Lyssavirus). Currently, human rabies treatment is based on the Milwaukee Protocol which consists on the induction of coma and massive antiviral therapy. The aim of this study was to assess the decrease in the titer of rabies virus both in vitro and in vivo using short-interfering RNAs. To this end, three siRNAs were used with antisense strands complementary to rabies virus nucleoprotein (N) mRNA. BHK-21 cells monolayers were infected with 1000 to 0.1 TCID50 of PV and after 2 hours the cells were transfected with each of tree RNAs in separate using Lipofectamine-2000. All three siRNAs reduced the titer of PV strain in a least 0.72 logTCID50/mL and no cytotoxic effect was observed in the monolayers treated with Lipofectamine-2000. Swiss albino mice infected with 10.000 to 1 LD of PV strain by the intracerebral route were also transfected after two hours of infection with a pool 3 siRNAs with Lipofectamine-2000 by the intracerebral route, resulting in a survival rate of 30% in mice inoculated with 100 LD50, while the same dose led to 100% mortality in untreated animals. Lipofectamine-2000 showed no toxic effect in control mice. These results suggest that intracerebral administration of siRNAs might be an effective antiviral strategy for rabies.

Antigenic and genetic characterization of rabies virus isolates from Uruguay.

After 25 years without any reported cases of rabies in Uruguay, the northern region of the country experienced an epizootic of bovine paralytic rabies in October 2007. The outbreak affected bovines and equines, and the main source of infection was the bat Desmodus rotundus, the only hematophagous species in the country. From October 2007 to July 2008, 42 bovine, 3 equine and 120 chiropteran samples were submitted to the National Veterinary Diagnostic Laboratory for rabies testing. A total of 12 samples (7 bovine, 2 equine and 3 from D. rotundus) were positive by the fluorescent antibody test, and viruses were isolated by the mouse inoculation test. The objective of this study was to compare the antigenic and genetic characteristics of these isolates and three isolates from insectivorous bats from other regions. Antigenic typing using a panel of eight monoclonal antibodies identified all 12 viruses as variant 3 (AgV3), a variant associated with D. rotundus. Two isolates from insectivorous bats (Tadarida brasiliensis and Molossus sp.) were characterized as antigenic variant 4 (AgV4) while the third, from Myotis sp., could not be characterized using this panel as its reactivity pattern did not match that of any of the known antigenic variants. Partial N-gene sequences (nt 149-1420) of these isolates were aligned with homologous sequences derived from GenBank by the CLUSTAL/W method and used to build a neighbor-joining distance tree with the Kimura 2-parameter model. All 12 isolates were genetically grouped into the D. rotundus cluster as they shared 100% identity. In the phylogenetic analysis, the three isolates from insectivorous bats segregated into three clusters: one related to T. brasiliensis, one to Myotis sp. and the other to Lasiurus sp., although the isolate associated with the latter came from a Molossus sp. specimen. These results indicate that AgV3 was associated with the outbreak of bovine paralytic rabies in Uruguay. This is the first report of rabies virus having been detected in non-hematophagous bats in this country.