Can Achilles tendinosis be treated effectively with lidocaine and glucose infiltrations, and if so, is the effect lasting? A longitudinal, observational on 27 consecutive patients.

OBJECTIVE: Our aim was to add to the small but growing body of evidence on the effectiveness of ultrasound-guided Achilles intratendinous hyperosmolar dextrose prolotherapy and introduce a novel, preceding step of paratenon hydrodissection with lidocaine in patients with chronic Achilles tendinosis resistant to rehabilitation therapy. METHODS: We conducted a longitudinal, observational study on 27 consecutive patients diagnosed with Achilles tendinosis, in whom conservative treatment, ie, physiotherapy or shock wave therapy, had failed. A 2% lidocaine paratenon anesthesia and hydrodissection was followed by ultrasound-guided, intratendinous injections of 25% glucose every 5 weeks. Visual analogue scales (VAS) were used for pain assessment at rest, for activities of daily living, and after moderate exercise at the begining and at the end of the treatment. Moreover, tendon thickness and vascularisation were recorded at baseline and final treatment consultation. Effectiveness was estimated from scoring and relative pain reduction using a 95% CI. The non-parametric Wilcoxon test and a general linear model for repeated measures were applied. Statistical significance was established as p < 0.05. RESULTS: A median of 5 (1-11) injection consultations per patient were required. Pain scores decreased significantly in all three conditions (p < 0.001). Relative reductions were 75% in pain at rest (95% CI;61-93%), 69% in pain with daily living activities (95% CI; 55-83%), and 70% in pain after moderate exercise (95% CI; 57-84%). Tendon neo-vascularisation was significantly reduced (p < 0.001). We did not observe significant changes in tendon thickness (p = 0.083). CONCLUSIONS: Achilles tendinosis treatment with paratenon lidocaine hydrodissection and subsequent prolotherapy with hyperosmolar glucose solution is safe, effective, inexpensive, and virtually painless with results maintained over time.

[Heterotopic ossification in SARS-CoV-2: Scintigraphic and radiological images]. / Osificación heterotópica en paciente con SARS-CoV-2: imágenes gammagráficas y radiológicas.

Patients with severe COVID-19 can develop painful range-of-motion restrictions of large joints due to heterotopic ossification. We present the case of a patient who developed hip pain after prolonged admission for severe COVID-19 pneumonia. Conventional radiography, computed tomography and bone scan showed extensive heterotopic ossification in the hips. It is probable that both local and systemic factors contribute to the development of heterotopic ossifications and it is necessary to rule out this entity when these patients reported joint pain. Early diagnosis is important to provide non-pharmacological interventions such as mild passive mobilization and anti-inflammatory medication and in refractory cases surgical resection of the ectopic bone is consider.

Image Registration Measures and Chronic Osteoarthritis Knee Pain Prediction: Data from the Osteoarthritis Initiative / Métricas de Registro de Imágenes y Predicción de Dolor de Rodilla por Osteoartritis Crónica: Datos de la Osteoarthritis Initiative

Abstract Osteoarthritis (OA) is the most common type of arthritis, is a growing disease in the industrialized world. OA is an incapacitate disease that affects more than 1 in 10 adults over 60 years old. X-ray medical imaging is a primary diagnose technique used on staging OA that the expert reads and quantify the stage of the disease. Some Computer-Aided Diagnosis (CADx) efforts to automate the OA detection have been made to aid the radiologist in the detection and control, nevertheless, the pain inherits to the disease progression is left behind. In this research, it's proposed a CADx system that quantify the bilateral similarity of the patient's knees to correlate the degree of asymmetry with the pain development. Firstly, the knee images were aligned using a B-spline image registration algorithm, then, a set of similarity measures were quantified, lastly, using this measures it's proposed a multivariate model to predict the pain development up to 48 months. The methodology was validated on a cohort of 131 patients from the Osteoarthritis Initiative (OAI) database. Results suggest that mutual information can be associated with K&L OAI scores, and Multivariate models predicted knee chronic pain with: AUC 0.756, 0.704, 0.713 at baseline, one year, and two years' follow-up.

Resumen La osteoartritis (OA) es el tipo de artritis más común. OA es una enfermedad limitante que afecta a 1 de 10 adultos con 60 años o más. Las imágenes de rayos-x son una técnica de diagnóstico primario que permite conocer el estado de OA, las cuales el experto lee y cuantifica así la etapa de la enfermedad. El Diagnóstico Asistido por Computadora (CADx, por sus siglas en inglés) ha buscado automatizar el diagnóstico de OA para ayudar al radiólogo en la detección y control; sin embargo, el dolor provocado por la progresión de la enfermedad es dejado atrás. En este trabajo se propone un sistema de CADx que cuantifica la similitud bilateral de las rodillas de los pacientes, con el fin de correlacionar el grado de asimetría con el dolor. Inicialmente, las imágenes de las rodillas fueron alineadas usando el algoritmo B-spline para su registro, después, un conjunto de métricas estándar fue cuantificado; finalmente, con estas métricas se propone un modelo multivariado para predecir el dolor de rodilla desarrollado en 48 meses. La metodología fue validada con 131 pacientes obtenidos de la base de datos de la Osteoarthritis Initiative (OAI). Los resultados sugieren que las métricas pueden ser asociadas con los puntajes de KellgrenLawrence; además, los modelos predicen significativamente el dolor crónico de rodilla con: AUC 0.756, 0.704 y 0.7113, al inicio, un año y dos años después, respectivamente.

HEART Score and Stress Test Emergency Department Bayesian Decision Scheme: Results from the Acute Care Diagnostic Collaboration.

BACKGROUND: Accurate identification of patients at risk of major adverse cardiac events (MACE) places a substantial burden on emergency physicians (EPs). Bayesian nomogram for risk stratification in low- to intermediate-risk cardiovascular patients has not been investigated previously. OBJECTIVE: The objective of this study was to develop a comparative diagnostic model using Bayesian statistics for exercise treadmill test (ETT) and stress echocardiogram (ECHO) to calculate post-test diagnostic risk of MACE using HEART (history, electrocardiogram, age, risk factors, and troponin) risk score as predictor of pretest probability. METHODS: Stratification was made by applying HEART scores for the prediction of MACE. Likelihood ratios (LR) were calculated using pooled sensitivity and specificity of ETT and ECHO from the American College of Cardiology Foundation/American Heart Association systematic review. Post-test probabilities were obtained after inserting HEART score and LR into Bayesian nomogram. Analysis of variance was used to assess statistical association. RESULTS: Positive LR (LR+) for ETT was 4.56 and negative LR (LR-) was 0.27; for ECHO, LR+ 5.65 and LR- 0.15. Bayesian statistical modeling post-test probabilities for LR+ and low HEART risk yielded a post-test probability for ETT of 7.75% and 9.09% for ECHO; intermediate risk gave 47.62% and 52.63%, respectively. For LR-, low HEART risk post-test probability for ETT was 0.46% and for ECHO 0.26%; intermediate risk probabilities were 4.48% and 2.49%, respectively. LR- was statistically significant in ruling out MACE with ECHO (p < 0.001), but no significant differences were seen for LR+ (p = 0.64). CONCLUSIONS: This Bayesian analysis demonstrated slight superiority of stress ECHO over ETT in low- and intermediate-risk patients in ruling out MACE.

Resistencia microtraccional de capa de adhesivo contaminada con sangre / Microtensile bond strength of adhesive layer contaminated with blood on human sound enamel

Objetivo: Evaluar la influencia de la contaminación con sangre en una capa de adhesivo formada sobre esmalte humano y su posterior descontaminación con NaOCl (2.5 por ciento) y etanol (70°) en la resistencia microtraccional. Métodos: La superficie vestibular de 80 premolares humanos fue fresada para obtener superficies planas sobre las que se aplicó un adhesivo de grabado y lavado siguiendo las indicaciones del fabricante (Adper Single Bond 2, 3M ESPE). Los premolares fueron distribuidos aleatoriamente en cuatro grupos: Grupo 1 (control), Grupo 2 (contaminación con sangre), Grupo 3 (descontaminación con NaOCl 2.5 por ciento) y Grupo 4 (descontaminación con etanol 70°). Luego, sobre cada premolar se confeccionó una corona de resina compuesta (Filtek Z350, 3M ESPE) y fueron cortados para obtener cuerpos de prueba de 1mm2 de sección transversal, los cuales fueron termociclados (5500 ciclos, 5-55°C) y traccionados hasta su límite de ruptura (Micro Tensile Tester, Bisco). Los resultados fueron analizados estadísticamente (ANOVA, Scheffe, p<0.05). Resultados: La resistencia microtraccional del Grupo 1 (24.8 MPa) fue significativamente superior al resto de los grupos (p<0.05). Las diferencias entre los grupos 2, 3 y 4 no fueron estadísticamente significativas (p>0.05). Conclusión: La contaminación con sangre de la capa de adhesivo interfiere significativamente en la resistencia microtraccional. La descontaminación con NaOCl o etanol no logró una recuperación de la resistencia microtraccional.

Aim: To evaluate the influence of blood contamination of the adhesive layer and posterior decontamination with NaOCl (2.5 percent and ethanol (70º) on microtensile bond strength on human enamel. Methods: Vestibular surfaces of eighty human premolars were grounded to obtain flat surfaces. An etch-and-rinse adhesive was applied according to the manufacturer’s instructions (Adper Single bond 2, 3M ESPE). Teeth were randomly assigned into 4 groups: Group 1 (control), Group 2 (blood contamination), Group 3 (decontamination with NaOCl 2.5 percent) and Group 4 (decontamination with ethanol 70º). Then, a 4mm composite crown (Filtek Z350) was made and the teeth were vertically sectioned to obtain 1mm cross-section stick shape specimens. Specimens were thermocycled (5500 cycles, 5-55ºC) and pulled under tension until failure (Micro Tensile Tester, Bisco). Results were statistically analyzed (ANOVA, Scheffe’s test, p<0.05). Results: Microtensile bond strength in group 1 (24.8 MPa) was significantly higher than groups 2, 3 and 4 (p<0.05). The differences between groups 2, 3 and 4 were not significant (p>0.05). Conclusion: Blood contamination significantly interferes in microtensile bond strength. Decontaminating the blood residues with NaOCl or ethanol did not show a recovery of bond strength.

Resina fluida autoadhesiva utilizada como sellante de fosas y fisuras: estudio de microinfiltración / Self-adhesive flowable composite-resin as a fissure sealant. A microleakage study

Objetivo: Evaluar la capacidad de sellado de una resina fluida autoadhesiva (Fusio Liquid Dentin, Pentron Clinical) utilizada como sellante de fosas y fisuras con distintos acondicionamientos de la superficie de esmalte. Materiales y Métodos: Se seleccionaron 140 terceros molares recientemente extraídos, los que fueron distribuidos aleatoriamente en cuatro grupos (n=35) y recibieron una técnica de acondicionamiento del esmalte y aplicación de un sellante. Se establecieron los siguientes grupos: Grupo 1, grabado ácido y aplicación de sellante (Clinpro, 3M ESPE); Grupo 2, grabado ácido y aplicación de resina autoadhesiva (Fusio Liquid Dentin, Pentron Clinical); Grupo 3, aplicación de resina autoadhesiva; Grupo 4, microarenado del esmalte y aplicación de resina autoadhesiva. Los dientes sellados fueron termociclados (500 ciclos, 5-55°C), y posteriormente sumergidos en solución de nitrato de plata amoniacal por 24 h (pH=14) y luego en revelador radiográfico (GBX, Kodak) por 8h. Posteriormente, los dientes fueron cortados para obtener 2 láminas por diente que fueron observadas bajo magnificación (4x) y analizadas digitalmente para evaluar la microinfiltración y la penetración en la fisura. Los resultados fueron analizados estadísticamente (ANOVA, Dunnett, p<0.05). Resultados: La microinfiltración del Grupo 1 (13.18 +/- 9.25 por ciento) fue significativamente menor que la de los grupos 2, 3 y 4 (p<0.05). La penetración en la fisura en el Grupo 1 (98.92 +/- 2.77 por ciento) fue mayor que en los otros grupos, siendo esta diferencia significativa sólo con el Grupo 4. Conclusión: Fusio Liquid Dentin tiene una capacidad de sellado inferior a la del sellante convencional Clinpro, independiente del acondicionamiento del esmalte que se utilice.

Aim: To evaluate the sealing ability of a self-adhesive flowable composite-resin (Fusio Liquid Dentin, Pentron Clinical) with different conditioning treatments of the enamel surface used as a fissure sealant. Materials and Method: 140 recently extracted human third molars were selected and randomly divided into four groups (n=35). Each group received an enamel conditioning treatment and a sealant application. The following groups were established: Group 1, acid etching and sealant application (Clinpro, 3M ESPE); Group 2, acid etching and self-adhesive flowable composite-resin (Fusio Liquid Dentin, Pentron Clinical); Group 3, self-adhesive flowable composite-resin; Group 4, sandblasting and self-adhesive flowable composite-resin. Sealed teeth were thermocycled (500 cycles, 5-55ºC) and immersed in ammoniacal silver nitrate solution for 24 h (ph=14). After that, the teeth were immersed in radiographic developer solution (GBX, Kodak) for 8 h. Then, the teeth were vertically sectioned to obtain two slides each that were observed under magnification (4x) and digitally analyzed to assess microleakage and sealant penetration. Results were statistically analyzed (ANOVA, Dunnett, p<0.05). Results: Microleakage of Group 1 (13.18 +/- 9.25 percent) was significantly lower than groups 2, 3 and 4 (p<0.05). Group 1 had the highest sealant penetration mean (98.92 +/- 2.77 percent). Conclusion: Fusio Liquid Dentin had a worse sealing ability than Clinpro irrespective of their enamel conditioning treatment when used as a fissure sealant. Among Fusio’s groups, acid etching was the best enamel surface conditioning treatment.

A constitutional variant in the transcription factor EP300 strongly influences the clinical outcome of patients submitted to allo-SCT.

An adequate response of the innate immune system after allo-SCT is crucial for the clinical outcome of patients submitted to this procedure. EP300 is one of the key genes of the innate immune system (IIS). We evaluated the influence of gene variant A>G rs20551 in EP300 in donor and/or recipient on clinical results after HLA-identical sibling allo-SCT. Patients with AA gene variant had a lower relapse incidence (31 vs 48%, P=0.025; odds ratio (OR)=1.6, P=0.05), attained better disease-free survival (AA: 53% vs AG+GG: 24%, P=0.001; OR=1.8, P=0.01), and better OS (AA: 53% vs AG+GG: 34%, P=0.001; OR=1.9, P=0.007). This beneficial association was more evident when AA gene variant was present in both donor and patient. In healthy individuals, AA gene variant was associated with lower IL2 production after a mitogenic stimuli, higher CD4+ cell response after CMV infection, and higher expression of innate immune genes (IRF-3 and MIF), cell cycle genes (AURKB, CCNA2 and CCNB1), lymphocyte survival genes (NFAT5 and SLC38A2), and with a lower expression of P53 compared with recessive GG gene variant. These findings suggest a beneficial effect of the AA gene variant in rs20551 on clinical outcome after allo-SCT.

[Aneurysmatic bone cyst coexisting with osteosarcoma. Radiopathologic discussion]. / Quiste óseo aneurismático coexistente con osteosarcoma. Discusión radiopatológica.

Aneurysmatic bone cysts are benign lesions of unknown origin. It has been postulated that they might occur in reaction to trauma or to a primary benign (giant cell tumor, chondroblastoma, etc.) or malignant (osteosarcoma) bone tumor that results in local hemodynamic changes. Their malignant transformation is controversial. We present a case of low grade osteosarcoma with a radiologic progression that was indistinguishable from that of an aneurysmatic bone cyst.

Global DNA methylation: a common early event in oral cancer cases with exposure to environmental carcinogens or viral agents.

INTRODUCTION: Two separate molecular pathways have been proposed for the early carcinogenic events observed in the oral cavity and pharynx: one is associated with chemical etiological factors such as smoking and drinking, and the other one is associated with HPV insertion. OBJECTIVE: A proof-of-principle study was performed to ascertain if global DNA methylation could be used to distinguish between the early molecular changes in premalignant oral lesions. METHODS: Personal histories of tobacco and alcohol use were obtained by questionnaire. HPV insertion in tumor tissue was detected by polymerase chain reaction (PCR). Global DNA methylation levels were obtained using HPLC for fraction separation and mass spectrometry for quantification. Predictive simulations were performed to explore potential associations between different etiological factors and the global DNA methylation index. Significance of results was ascertained using Pearson's Chi-squared test. RESULTS: The global methylation index was found to be 4.28 (95% CI, 4.1, 4.4) in an oral cancer case series. Pearson's chi squared test showed no statistically significant difference between cases that had smoking (p = 0.21), drinking (p = 0.31) or HPV insertion (p = 0.34) as etiologic risk factors, when compared to cases that did not. An inverse significant association between smoking and DNA methylation was observed. As the smoking effect increases, the global methylation index decreases, In addition, no associations between the probability of DNA methylation and drinking, or DNA methylation and HPV insertion were observed in simulations. CONCLUSIONS: The global DNA methylation index was shown to vary for oral cancer cases with different etiologies. Smoking was inversely correlated with DNA methylation levels when generalized linear model simulations were performed. Future studies should look at global DNA methylation alterations associated to the progression from normal to premalignant oral epithelium tissue in a cohort of smokers and nonsmokers.

Trypanosoma cruzi: Cardiac mitochondrial alterations produced by different strains in the acute phase of the infection.

The parasite Trypanosoma cruzi is the causative agent of Chagas disease. T. cruzi invasion and replication in cardiomyocytes induce cellular injuries and cytotoxic reactions, with the production of inflammatory cytokines and nitric oxide, both source of reactive oxygen species. The myocyte response to oxidative stress involves the progression of cellular changes primarily targeting mitochondria. We studied the cardiac mitochondrial structure and the enzymatic activity of citrate synthase and respiratory chain CI-CIV complexes, in Albino Swiss mice infected with T. cruzi, Tulahuen strain and SGO Z12 isolate, in two periods of the acute infection. Changes in the mitochondrial structure were detected in both infected groups, reaching values of 71% for Tulahuen and 88% for SGO Z12 infected mice, 30 days post infection. The citrate synthase activity was different according to the evolution of the infection and the parasite strain, but the respiratory chain alterations were similar with either strain.

Lead levels in primary teeth of children living in Mexico City.

OBJECTIVE: The aim of this study was to discover the lead concentration in primary teeth extracted in the peripheral clinics of the Faculty of Dentistry, UNAM (Mexico City). DESIGN: One hundred healthy primary teeth were collected from 2 to 13-year-old children (52 girls and 48 boys). Sixty-six were maxillary teeth and 34 were mandibular teeth. Lead concentrations were measured by Graphite Furnace Atomic Absorption Spectrophotometry. RESULTS: Our results indicate that lead concentration in the 10-13-year-old group (7.7 micro g/g(-1)) was higher than in the other groups. Geometric mean lead concentration was higher in girls than in boys (7.3 micro g/g(-1) and 6.3 micro g/g(-1), respectively). Maxillary teeth had higher lead concentrations than mandibular teeth and primary canines showed the highest mean lead concentration followed by incisors and molars. Teeth from children living in the south-east area (which according to the Mexico City's Pollution Center data is the more polluted area), presented the highest lead concentration but no statistically significant difference was found among teeth from the different areas. CONCLUSIONS: Our results suggest that age, gender and place of residence are not related to the lead concentration in human primary teeth. This fact seems to indicate the ubiquitous presence of lead in the whole atmosphere of Mexico City and suggests that zones of residence do not appear to influence tooth lead concentration.

Clinicopathologic characteristics of head and neck squamous cell carcinoma in Puerto Ricans

OBJECTIVE: The purpose of this study is to characterize head and neck squamous cell carcinoma (HNSCC) in the Puerto Rican population. This is a follow-up to our initial published report on the first 134 patients. Specifically, demographic characteristics, stage at presentation, initial treatment given, and rate of recurrence were studied. METHODS: Relevant data was obtained from 445 histologically confirmed HNSCC cases identified through the University of Puerto Rico School of Medicine Otolaryngology Department Head and Neck Cancer Clinics between August 1993 and January 2003. Data collected after informed consent included demographic factors (sex, age, areas of residence, income); risk factors (occupation, alcohol intake, cigarette usage); and pathological variables (tumor location, histopathology, stage at presentation, current disease status, tumor recurrence). RESULTS: The average age at diagnosis was 64.0 years (range 18-98); 84.5 per cent of the patients were male, 16 per cent were females. The most frequent anatomical sites of the primary tumor were the larynx (36.4 per cent) and the oral cavity (29.9 per cent). The majority of patients (61.1 per cent) presented with advanced stage (III-IV) disease at the time of diagnosis and over half (55.5 per cent) had moderately-differentiated tumors. Most patients had less than 12 years of formal education (81.2 per cent). Prolonged use of tobacco and alcohol identified in 88.1 per cent and 79.8 per cent of patients, respectively. The most frequent therapeutic modality used was radiation therapy followed by the combination of radiation and surgery. Twenty five percent of the cases experienced a recurrence of disease during the follow-up period. CONCLUSIONS: These findings emphasize the need for early detection programs for HNSCC in Puerto Rican patients given the high rate of advanced-stage disease at time of diagnosis. The key role of heavy alcohol intake and tobacco use as risk factors in the development of HNSCC is once again highlighted.

CENP-F gene amplification and overexpression in head and neck squamous cell carcinomas.

BACKGROUND: Antibodies against cancer-related genes have been detected in human cancers including head and neck cancers. High titers of c-Myc autoantibodies have been linked to gene amplification and tumor progression. Centromere protein-F (CENP-F) autoantibodies have been detected in patients with various cancers, suggesting similar gene alteration. METHODS: CENP-F and c-MYC amplification was assessed in 72 head and neck squamous cell carcinoma (HNSCC) patients. Tumor and matched mucosa from 22 patients were analyzed for CENP-F mRNA levels by RT-PCR. RESULTS: The larynx was the site most altered by amplification of either gene. CENP-F and c-MYC were amplified in 11% and 17% of the tumors, respectively. Coamplification was found in 7% of the tumors, most of which showed regional node involvement. CENP-F mRNA was overexpressed in 36% of tumors, and 23% of paired mucosa. CONCLUSION: Our results provide the first evidence that CENP-F gene is amplified and overexpressed in HNSCC. No correlation was noted between CENP-F amplification and clinicopathologic parameters. However, CENP-F overexpression correlated with nodal metastasis.