Tenosynovial chondromatosis of the wrist: A case report.

We report the case of an 80-year-old woman who presented with an asymptomatic slowly growing mass in the dorsal aspect of her right wrist. Radiographs revealed a snail-shaped radiopaque structure. Surgical exploration and excision revealed a calcified lesion over the extensor digitorum communis. Histopathological analysis confirmed the diagnosis of tenosynovial chondromatosis. At the last follow-up, four years after surgery, the patient was asymptomatic and free of recurrence. Practitioners and hand surgeons should be aware of the dorsal involvement and evocative radiological calcifications of tenosynovial chondromatosis, which is a rare benign soft tissue neoplasm that affects all tendon sheaths of the hand.

Conventional versus fibrin-glue-augmented arterial microanastomosis: An experimental study.

The purpose of this experimental study was to develop an alternative technique of arterial microanastomosis using only 2 stay-sutures augmented with fibrin glue, and to compare it to the conventional technique in arteries of varying diameters mimicking hand arteries. Eight anastomoses were performed in 7 male rats, including 1 anastomosis each on the 2 femoral, iliac, and carotid arteries, and 2 on the subrenal aorta. The conventional technique was used on one side and on the first aorta anastomosis, while augmented anastomoses were performed on the other side and on the second aorta. Patency was tested 10 min after unclamping; clamping time, blood loss, anastomosis quality score (out of 15 points) and artery diameter were recorded. In arteries of diameter 0.5-2.2 mm, augmented anastomoses were on average 10.7 ± 3.2 min faster to perform (p < 0.0001), with an average of 1.3 ± 0.9 g less blood loss (p < 0.0001) and an average of 2.6 ± 2.5 points higher quality score (p < 0.0001). There were no significant differences between the two techniques in terms of patency rate, regardless of artery size. However, 3 of the 7 augmented anastomoses were non-permeable in the femoral subgroup (i.e., submillimetric arteries). This straightforward technique appears to be time-saving and reliable, provided that the repaired artery is of sufficient size. Subject to clinical validation, this technique might help surgeons treating extensive hand wounds with multiple severed neurovascular bundles.

Case report of Curtobacterium isolated from a catheter tip sample misidentified as Cronobacter.

The Curtobacterium genus is a member of the family Microbacteriaceae, and Curtobacterium species are recognized as plant pathogens. The aim of this study was to investigate a dubious result of species identification for an infection located on a catheter tip of a patient with Covid-19. A strain isolated from a catheter tip sample, identified by VITEK® 2 as Cronobacter spp., was submitted to polyphasic analysis: Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS) using VITEK® MS, real-time polymerase chain reaction targeting dnaG gene, and 16S rRNA full gene Sanger sequencing analysis for confirmation. The strain presented negative result using qPCR and could not identified by MALDI-TOF MS. 16S rRNA full gene Sanger sequencing analysis identified the strain as Curtobacterium spp. The Gram-variable characteristic (Gram-negative instead of Gram-positive) of the isolated strain was the responsible for the misidentification by VITEK® 2 and VITEK® MS did not identify the strain. 16S rRNA full gene sequencing analysis identified the strain as Curtobacterium genus, but other complementary techniques are necessary to identify at species level.

Exploring ITM2A as a new potential target for brain delivery.

BACKGROUND: Integral membrane protein 2A (ITM2A) is a transmembrane protein expressed in a variety of tissues; little is known about its function, particularly in the brain. ITM2A was found to be highly enriched in human brain versus peripheral endothelial cells by transcriptomic and proteomic studies conducted within the European Collaboration on the Optimization of Macromolecular Pharmaceutical (COMPACT) Innovative Medicines Initiative (IMI) consortium. Here, we report the work that was undertaken to determine whether ITM2A could represent a potential target for delivering drugs to the brain. METHODS: A series of ITM2A constructs, cell lines and specific anti-human and mouse ITM2A antibodies were generated. Binding and internalization studies in Human Embryonic Kidney 293 (HEK293) cells overexpressing ITM2A and in brain microvascular endothelial cells from mouse and non-human primate (NHP) were performed with these tools. The best ITM2A antibody was evaluated in an in vitro human blood brain barrier (BBB) model and in an in vivo mouse pharmacokinetic study to investigate its ability to cross the BBB. RESULTS: Antibodies specifically recognizing extracellular parts of ITM2A or tags inserted in its extracellular domain showed selective binding and uptake in ITM2A-overexpressing cells. However, despite high RNA expression in mouse and human microvessels, the ITM2A protein was rapidly downregulated when endothelial cells were grown in culture, probably explaining why transcytosis could not be observed in vitro. An attempt to directly demonstrate in vivo transcytosis in mice was inconclusive, using either a cross-reactive anti-ITM2A antibody or in vivo phage panning of an anti-ITM2A phage library. CONCLUSIONS: The present work describes our efforts to explore the potential of ITM2A as a target mediating transcytosis through the BBB, and highlights the multiple challenges linked to the identification of new brain delivery targets. Our data provide evidence that antibodies against ITM2A are internalized in ITM2A-overexpressing HEK293 cells, and that ITM2A is expressed in brain microvessels, but further investigations will be needed to demonstrate that ITM2A is a potential target for brain delivery.

Restoration of thumb opposition (opponensplasty).

The authors review the therapeutic principles that must be applied when restoring the thumb opposition surgically. Among the many surgical techniques, five are featured: transfer of the flexor digitorum superficialis of the third or fourth finger, transfer of the extensor indicis proprius, transfer of the palmaris longus, translocation of the flexor palmaris longus tendon, transfer of the extensor pollicis longus. After summarizing the procedures, they emphasize the practical points that must be respected. This surgery, which cannot restore sensitivity, requires a precise assessment of the patient's wishes and information on what can be really expected.

Results of interposition arthroplasty with the Amandys® pyrocarbon implant in rheumatoid wrist at a mean 5 years' follow-up.

Management of severe joint involvement in rheumatoid wrist is controversial. The gold-standard is total wrist fusion, but total wrist replacement offers a motion-conserving alternative. The purpose of this study was to present the results of interposition arthroplasty with the Amandys® pyrocarbon implant in rheumatoid wrist. We performed a retrospective review of 28 arthroplasties for rheumatoid wrist arthritis. Eighteen females and 5 males were included, with a mean age of 55.7 years. Mean follow-up was 64 months. We measured range of motion, grip strength, and pain (on VAS). Function was evaluated preoperatively and at last follow-up with the DASH and PRWE scores. Mean range of motion in flexion-extension was maintained while mean inclination and rotational range of motion showed significant improvement. Mean grip strength increased from 10 kg to 17 kg. Mean pain score decreased from 6/10 to 2/10. Mean PRWE and QuickDASH scores decreased from 62/100 to 25/100 and from 62/100 to 36/100, respectively. Three patients underwent early reoperation to reposition a dislocated implant. No implants had to be removed. Amandys® pyrocarbon arthroplasty is a reliable alternative to total fusion or total replacement in rheumatoid wrist. Indications must be limited to well-aligned wrists with competent capsule-ligament structures.

Pyrocardan® implant after failed trapeziectomy.

The aim of this retrospective study was to analyze the medium-term results of patients treated with a pyrocarbon interposition implant (Pyrocardan®, Wright Medical™) after failed trapeziectomy. Eight female patients with an average age of 63 years were included in this single-center study. The average follow-up was 54 months (28-85 months). The average time elapsed between the trapeziectomy and the revision surgery was 116 months. Trapeziectomy failures were due to a painful scaphometacarpal and/or metacarpotrapezoid impingement. Patients were assessed radiologically and clinically for range of motion, strength (pinch and grip), pain (visual analog scale - VAS) and function (QuickDASH and PRWE scores). We found pain reduction with the mean VAS decreasing from 6.3 preoperatively to 2.5 postoperatively. Function improved with the QuickDASH and PRWE scores going from 52.9 and 49.1 preoperatively to 30.7 and 31.0 at the last follow-up, respectively. Strength and range of motion did not change significantly. Seven patients were satisfied or very satisfied with the surgery, while one patient did not experience any improvement after surgery. There was no radiological evidence of dislocation or bone reaction around the implant. Revision of failed trapeziectomy with the Pyrocardan® implant in cases of severe and painful first metacarpal subsidence is an effective solution that improves pain and function in the medium term.

Hand injuries treated at a hand emergency center during the COVID-19 lockdown.

The recent coronavirus outbreak has tested the adaptability, cooperation and organizational capabilities of our healthcare systems. Restrictions were implemented in several countries to reduce virus transmission whilst emergency departments (ED) were overwhelmed and there was shortage of healthcare providers. Given this situation and the consequences of hand injuries, we studied the epidemiology of hand injuries in an accredited FESSH emergency center during the lockdown in France (March 17 to May 10, 2020) due to the coronavirus outbreak. During this period, 1947 patients consulted for a hand injury. We found high percentages of men (63%), open wounds (70%), domestic accidents (88%) and surgical treatment being required (76%). There was a significant decrease in admissions and consultations relative to the same period in 2019. This reference data can help healthcare systems prepare for future outbreaks and similar restrictions.

Is daily walking distance affected in adolescent idiopathic scoliosis? An original prospective study using the pedometer on smartphones.

BACKGROUND DATA: Little is known about daily walking distance levels, which accounts for approximately 80% of overall physical activity per day, in adolescents with idiopathic scoliosis (AIS). OBJECTIVE: The aim of this study was to assess the level of walking distance in AIS treated by bracing or not, comparing this activity with that of a control group. We used an original method based on smartphone pedometers for studying walking distance in everyday life. METHODS: Nineteen AIS patients, aged 14.1 (13-17) years, and 25 asymptomatic patients, aged 12.9 (12-14) years were included prospectively. The 19 AIS cases comprised 9 untreated individuals and 10 with ongoing night brace treatment. The mean walking distance per day as estimated by the pedometer application on smartphones for 2 months was assessed. Weekly sports activities (hours per week) were also reported. RESULTS: During the first month, the mean walking distance was 2.58±0.65 km/day for control patients, 2.31±1.38 km/day for untreated AIS, and 3.65±0.72 km/day for AIS patients treated with a night brace. During the second month, the mean walking distance was 2.60±0.73 km/day for control patients, 2.40±1.41 km/day for untreated AIS, and 3.70±0.72 km/day for AIS patients treated with a night brace. Statistical analysis between groups showed a statistically significant difference with a higher level of daily walking distance in adolescents treated with a night brace compared with other groups. CONCLUSION: The pedometer on smartphones is a cost-effective and friendly tool to assess adolescents' level of walking distance. Our results indicate no restriction in terms of daily walking distance between adolescents without scoliosis and those with idiopathic scoliosis. LEVEL OF EVIDENCE: Level II.

Could we reduce adhesions to the intra-abdominal mesh in the first week? Experimental study with different methods of fixation.

BACKGROUND: Adhesion formation is a major problem when a mesh is exposed to intraabodminal viscera, with potential severe complications (bowel occlusion, fistulas or abscesses). New methods for preventing adhesions from a polypropylene mesh placed intra-abdominally or to solve difficult situations, such as when the peritoneum cannot be closed during a TAPP repair for an inguinal hernia, are still being seeked. This study mimics in an animal model a situation that can be found in clinical practice during laparoscopic inguinal hernioplasty. A polypropylene mesh could be exposed to the intra-abdominal cavity even when the peritoneum is closed due to different circumstances, with no options to guarantee the prosthetic material of being exposed to the intrabdominal viscera. Different options have been suggested to solve these situations, being proposed in this study to cover the visceral surface of the mesh with an absorbable sponge containing thrombin, fibrinogen, and clotting factors (Tachosil®, Nycomed, Takeda, Osaka, Japan), to assess its use as a barrier to prevent postoperative adhesion formation. MATERIAL AND METHODS: Thirty Wistar white rats (300-450 mg) were included in this study as experimental animals, being randomized into three groups (A, B, and C). We performed a bilateral prosthetic repair with conventional polypropylene mesh (2 × 2 cm, 82 kD). Prosthesis fixation was performed as follows. Group A: absorbable suture; group B: metal staples; group C: metal tackers. A piece of insulating absorbable sponge (Tachosil® 5 × 5 cm) was placed to cover the visceral surface of mesh placed at the right side of each animal. After 10 days, we performed a gross examination (by laparoscopy and laparotomy), measuring the quantity and the quality of the adhesions. Samples were taken for histopathological analysis. RESULTS: Tachosil®-treated prostheses showed a statistically significant decrease in the quality of the adhesion found (p < 0.05). In addition, a smaller quantity of adhesions was identified in barrier-treated animals, although this lacked statistical significance. The histologic analysis showed no significant differences: more edema with the untreated mesh and increased angiogenesis and a lower degree of necrosis in mesh covered with Tachosil®. CONCLUSIONS: The use of Tachosil® as a barrier material led to the absence of strong adhesions as it prevented direct contact between the mesh and the internal organs, preventing major problems associated with strong adhesions.

Unravelling intricate interactions among atmospheric bromeliads with highly overlapping niches in seasonal systems.

Biotic and abiotic interactions are important factors that explain community assembly. For example, epiphytic communities are shaped by tree traits that can act as environmental filters, but also by positive and/or negative interactions among coexisting epiphytes on a tree. Here, we studied interactions among three widespread atmospheric bromeliads with overlapping niches (Tillandsia recurvata, T. tricholepis and T. pohliana), using experimental data about facilitation through seed capture, interspecific interaction during seed germination and competition among adult individuals. We aim to understand how species interactions are reflected in the natural coexisting patterns of epiphytes in communities at high and low tree densities. Tillandsia pohliana showed higher facilitation by capturing almost all wind-dispersing seeds, and had the largest reduction in seed germination in the presence of any adult individual, also presenting a relatively high rate of adult mortality in the presence of other individuals. Our results indicate higher colonisation ability for T. pohliana and distinct strategies of rapid exploitation of T. recurvata and T. tricholepis individuals. In natural communities, the coexistence among atmospheric bromeliads may be hampered by dispersal limitations in wind-dispersed epiphytes at high tree density conditions, but a negative effect of T. recurvata on T. pohliana is still reflected in their reduced coexistence. However, competitive patterns observed in the experimental data may be overshadowed by a possible mass effect driving large communities under such conditions. Our results show the joint effect of positive interactions and high dispersal levels on the community patterns of atmospheric bromeliads.

Fingertip reconstruction by palmar bipedicular island flap in long fingers (modified neurovascular Tranquilli-Leali flap): A dual-center study.

When bone is exposed, fingertip defects may require a flap procedure. Many types are available, with little consensus about which one is best. But each one has its own disadvantages: esthetic (claw nail deformity), neurological (sensory disorders) or functional (stiffness). The purpose of this study was to evaluate a palmar bipedicular island flap (our modification of the Tranquilli-Leali flap) for fingertip reconstruction. We retrospectively analyzed the prospective data of 42 patients with a mean follow up of 16.4 months (6-30 months) operated in two hospital facilities. Thirty-three patients were men. Mean age was 39.5 years (12-83 years) and 24 (57.1%) were smokers. In 23 cases (54.8%), the trauma was work-related. A crush mechanism was identified in 29 patients (69%). According to Allen's classification of fingertip injuries, there were 26 cases of stage II, 14 cases of stage III and 2 cases of stage IV. All procedures were performed on an emergency basis, within 24 hours of the trauma. No claw nail deformity was observed. The mean discrimination in the Weber test was 3.8mm (2-6mm). The mean Total Active Motion (TAM) was 268.3° (255-275°). The patient satisfaction was graded at 8.7 on a 10-point scale. Results were considered as excellent in 15 cases and good in 23 cases. The modified palmar bipedicular island flap makes the old Tranquilli-Leali flap - which has a poor reputation in the hand surgeon community-simpler and safer to use. This flap restores proper balance between skin, bone and nail in Allen stage II and III fingertip amputations.

Is there association between chronic kidney disease and dental caries? A case-controlled study.

BACKGROUND: The purpose of this study was to assess the association between chronic kidney diseases (CKD) and dental caries. MATERIAL AND METHODS: 107 patients with CKD and 107 with no systemic alteration were randomly included. DMFT (decayed, missing, and filled teeth), plaque index, colony-forming units (CFU) of Streptococcus mutans and salivary composition (IgA total, IgA anti- Streptococcus mutans, calcium and urea) were evaluated. McNemar and Wilcoxon tests were used to compare test and control groups. Spearman test was used to correlate time of hemodialysis and variables studied. Associations between variables were evaluated by logistic regression analysis. RESULTS: The number of filled teeth, the amount of IgA anti-Streptococcus mutans, salivary urea, education level, monthly income and the amount of CFU of Streptococcus mutans were statistically different between groups. There was a positive correlation between the duration of hemodialysis (Hd) and the amount of IgA anti-Streptococcus mutans, urea in saliva, and the number of CFU of Streptococcus mutans. In the adjusted model, a higher incidence of CFU mutans streptococci, elevated salivary urea, smaller number of filled teeth, lower DMFT, and less calcium salivary were associated with CKD. CONCLUSIONS: Programs to prevent and treat oral problems and regular follow-up at the beginning of dialysis are necessary to increase patients' awareness of their condition.

Predictors and outcomes of disseminated tuberculosis in an intermediate burden setting.

SETTING: University-affiliated hospital located in Porto, North Portugal, an area with a low to intermediate incidence of tuberculosis (TB). OBJECTIVE: To identify predictors and outcomes of disseminated TB (dTB). DESIGN: A cohort of patients diagnosed with TB between 2007 and 2013 was retrospectively analysed. Patients with dTB criteria were characterized and compared to single organ TB cases. Factors independently associated with dTB were determined by multivariate logistic regression analysis. RESULTS: A total of 744 patients were analysed, including 145 with dTB. Independent risk factors for dTB were pharmacological immunosuppression (OR 5.6, 95% CI 2.8-11.3), HIV infection (OR 5.1, 95% CI 3.1-8.3), chronic liver failure or cirrhosis (OR 2.3, 95% CI 1.4-4.1) and duration of symptoms (OR 2.3, 95% CI 1.4-3.8). Compared to single organ TB, the clinical presentation of dTB patients differed by the absence of haemoptysis (OR 3.2, 95% CI 1.3-8.4) and of dyspnoea (OR 1.9, 95% CI 1.2-3.1), presence of weight loss (OR 1.8, 95% CI 1.1-2.9), night sweats (OR 1.7, 95% CI 1.1-2.7) and bilateral lung involvement (OR 4.4, 95% CI 2.8-7.1). Mortality and time until culture conversion were higher for dTB patients, although not reaching statistical significance. CONCLUSION: Immunosuppressive conditions and chronic liver failure or cirrhosis were associated with increased risk of dTB. The haematogenous spread may be dependent on longer symptomatic disease and usually progresses with bilateral lung involvement.

The impact of economic recessions on depression and individual and social well-being: the case of Spain (2006-2013).

PURPOSE: Although there is abundant evidence about the impact of economic crises on depression and other mental health problems, little is known about the protective role of variables linked to positive functioning (i.e., psychological well-being). METHODS: We analyzed data from Spain, one of the European countries most affected by the 2008-2013 economic recession, collected in Round 3 (R3, 2006) and Round 6 (R6, 2013) of the European Social Survey interviews. Both surveys included measures of psychological well-being, social well-being and depression. Both samples were nationally representative of the general population (R3: 1877 participants, 49.2% men; R6: 1889 participants, 48.9% men). RESULTS: Data from the R6 survey showed that, compared to data gathered in R3 (i.e., before the onset of the recession) Spanish citizens showed significantly less life satisfaction (95% CIs 0.37-0.63), less personal optimism (95% CIs 0.03-0.15), less social optimism (95% CIs 0.75-0.85), and higher levels of depressive symptoms (95% CIs - 0.74 to - 0.19). Structural equation modeling revealed that protective factors for depression changed in both rounds. In R3 (2006), close relationships, social optimism and social trust were significant mediators between well-being and depression. However, social optimism and social trust were no longer significant in R6 (2013), whereas close relationships remained a partial mediator of the effects of psychological well-being on depression. CONCLUSIONS: Economic crises are associated with a significant increase in depressive symptoms. Furthermore, financial crises seem to have a corrosive impact on mental health by reducing the mediating effects of positive beliefs regarding the good nature of society.

Characterization of Portuguese Centenarian Eating Habits, Nutritional Biomarkers, and Cardiovascular Risk: A Case Control Study.

BACKGROUND AND AIMS: Eating habits may contribute to longevity. We characterized the eating habits and cardiovascular risk (CVR) biomarkers in Portuguese centenarians (CENT) compared to controls. METHODS AND RESULTS: Centenarians (n = 253), 100.26 ± 1.98 years, were compared with 268 controls (67.51 ± 3.25), low (LCR) and high (HCR) CVR (QRISK®2-2016). Anthropometric and body composition were evaluated by bioimpedance. Abdominal obesity, BMI, and fat mass (FM) cut-offs were according to the WHO. Sarcopenia was defined by muscle mass index cut-off ≤ 16.7 kg/m2. Daily red meat intake, adjusted for age and gender, was sarcopenia protective (OR = 0.25, 95% CI = 0.096-0.670, P = 0.006); however, it contributes for FM excess (OR = 4.946, 95% CI = 1.471-16.626, P = 0.01), overweight, and obesity (OR = 4.804, 95% CI = 1.666-13.851, P = 0.004). This centenarian eating habit (2%) contrasts to HCR (64.3%). The history of red meat (P < 0.0001) and canned/industrialized food intakes (P < 0.0001) was associated with HCR. Basal metabolism was lower in centenarians versus LCR/HCR (CENT = 1176.78 ± 201.98; LCR = 1356.54 ± 170.65; HCR = 1561.33 ± 267.85; P < 0.0001), BMI (CENT = 21.06 ± 3.68; LCR = 28.49 ± 4.69; HCR = 29.56 ± 5.26; P < 0.0001), waist circumference (CENT = 85.29 ± 10.83; LCR = 96.02 ± 11.71; HCR = 104.50 ± 11.84; P < 0.0001), and waist-hip ratio (CENT = 0.88 ± 0.07; LCR = 0.92 ± 0.08; HCR = 1.01 ± 0.08; P < 0.0001). CENT had lower total cholesterol, LDL cholesterol, non-HDL cholesterol, and cholesterol/HDL ratio than controls. CONCLUSIONS: Frequent consumption of red meat, cholesterol, and heme iron rich may contribute to obesity and increased CVR. The low frequency of this consumption, observed in centenarians, although associated with sarcopenia, may be one of the keys to longevity.

STM-electroluminescence from clustered C3N4 nanodomains synthesized via green chemistry process.

A Scanning Tunneling Microscopy/Spectroscopy (STM/STS) and synchrotron X-ray diffraction study on clustered C3N4 nanoparticles (nanoflakes) is conducted on green-chemistry synthesized samples obtained from chitosan through high power sonication. Morphological aspects and the electronic characteristics are investigated. The observed bandgap of the nanoflakes reveals the presence of different phases in the material. Combining STM morphology, STS spectra and X-ray diffraction (XRD) results one finds that the most abundant phase is graphitic C3N4. A high density of defects is inferred from the XRD measurements. Additionally, STM-electroluminescence (STMEL) is detected in C3N4 nanoflakes deposited on a gold substrate. The tunneling current creates photons that are three times more energetic than the tunneling electrons of the STM sample. We ponder about the two most probable models to explain the observed photon emission energy: either a nonlinear optical phenomenon or a localized state emission.

Manifestation of hopping conductivity and granularity within phase diagrams of LaO1-x F x BiS2, Sr1-x La x FBiS2 and related BiS2-based compounds.

Layered BiS [Formula: see text] -based series, such as LaO [Formula: see text] F [Formula: see text] BiS [Formula: see text] and Sr [Formula: see text] La [Formula: see text] FBiS [Formula: see text] , offer ideal examples for studying normal and superconducting phase diagram of a solid solution that evolves from a nonmagnetic band-insulator parent. We constructed typical [Formula: see text] phase diagrams of these systems based on events occurring in thermal evolution of their electrical resistivity, [Formula: see text]. Overall evolution of these diagrams can be rationalized in terms of (i) Mott-Efros-Shklovskii scenario which, within the semiconducting [Formula: see text] regime ([Formula: see text] metal-insulator transition), describes the doping influence on the thermally activated hopping conductivity. (ii) A granular metal (superconductor) scenario which, within [Formula: see text], describes the evolution of normal and superconducting properties in terms of conductance g, Coulomb charging energy E c and Josephson coupling J; their joint influence is usually captured within a [Formula: see text] phase diagram. Based on analysis of the granular character of [Formula: see text], we converted the [Formula: see text] diagrams into projected g - T diagrams which, being fundamental, allow a better understanding of evolution of various granular-related properties (in particular the hallmarks of normal-state [Formula: see text] feature and superconductor-insulator transition) and how such properties are influenced by x, pressure or heat treatment.