Partial Superior Capsular Reconstruction to Augment Arthroscopic Repair of Massive Rotator Cuff Tears Using Autogenous Biceps Tendon: Effect on Retear Rate.

BACKGROUND: Massive rotator cuff tears have a high incidence of postoperative retear that can reach 90%. It is still unclear which intervention may reduce the incidence of retear and improve the functional and clinical outcomes. PURPOSE/HYPOTHESIS: The purpose of this study was to investigate the clinical and structural outcomes at 2 years after repair of reparable massive rotator cuff tears with and without the use of partial superior capsular reconstruction (pSCR), using the autologous long head of the biceps tendon (LHBT) as a graft. It was hypothesized that augmentation with a pSCR would decrease retear rates. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: The authors compared arthroscopic repair of massive posterosuperior rotator cuff tears with and without augmentation using the LHBT for pSCR between 2015 and 2017. After applying the selection criteria, 106 patients were included in the study and distributed into 2 groups of 50 and 56 patients. Patients in the first group (50 patients) underwent arthroscopic repair without use of the LHBT (AR group), and patients in the second group (56 patients) underwent arthroscopic repair with use of the LHBT for pSCR (AR-LHBT group). The structural outcome was evaluated by ultrasound at 2 years of follow-up. Function and pain were evaluated preoperatively and at the 2-year follow-up using the American Shoulder and Elbow Surgeons (ASES) score and visual analog scale (VAS). Pre- and postoperative active range of motion, including forward elevation, external rotation, and abduction, were also documented. RESULTS: No significant differences were found between groups regarding the baseline characteristics. After 24 months, both groups showed significant improvement from preoperative ASES scores, VAS score, and active range of motion (P < .01 for all). Patients in the AR-LHBT group showed significant improvements in postoperative functional and pain scores compared with the AR group in all measurements at the 2-year follow-up (ASES score: 77.23 ± 7.45 vs 71.04 ± 9.28, P < .01; VAS score: 1.64 ± 1.03 vs 2.12 ± 1.06, P < .01). Final range of motion was significantly increased for the AR-LHBT group for forward elevation (155 [interquartile range {IQR}, 150-160] vs 150 [IQR, 140-170]; P < .01) and abduction (150 [IQR, 140-157.5] vs 120 [IQR, 100-140]; P < .01), but external rotation was significantly greater for the AR group (54.43 ± 10.55 vs 59.5 ± 10.55; P < .01). Postoperative ultrasonography at the 2-year follow-up revealed a higher retear rate in the AR group than in the AR-LHBT group (46% vs 14%; P < .01). CONCLUSION: Use of the LHBT for pSCR to augment massive rotator cuff tears resulted in markedly lower retear rates and modestly improved pain and function outcomes compared with repair alone.

Different Phenotypes of Anderson-Fabry Disease Identified with Cardiac Magnetic Resonance Imaging in a Family with the Same Late-Onset Mutation.

BACKGROUND Cardiac magnetic resonance imaging (CMR) is the only noninvasive test capable of differentiating between hypertrophic cardiomyopathy (HCM) and late-onset Anderson-Fabry disease (AFD). The purpose of this report is to show how CMR led to diagnosis of AFD in 3 family members, 1 of whom previously was misdiagnosed with HCM, and how late-onset AFD can present with different cardiac phenotypes, even in a family with the same pathogenic mutation. CASE REPORT A 60-year-old man was referred because of evidence of left ventricular hypertrophy (LVH) on an electrocardiogram (ECG) that was performed to screen for cardiomyopathy. One of his siblings previously had been diagnosed with HCM and atrial fibrillation. The patient's ECG and echocardiographic findings were suspicious for HCM. CMR showed severe symmetrical LVH but tissue characterization sequences were highly suggestive of AFD cardiomyopathy. Enzymatic and genetic testing confirmed the diagnosis of late-onset AFD (presence of the GLA p.F113.L mutation). The brother of the index patient then was re-evaluated and also diagnosed with late-onset AFD. He was found to have the same pathogenic mutation but with a presentation of asymmetrical septal LVH. The daughter of the index patient was positive for the same mutation but did not have LVH. CONCLUSIONS The fact that patients with late-onset AFD can present with different LVH and fibrosis patterns, even in the presence of the same pathogenic mutation, underscores the importance of including AFD in the differential diagnosis of HCM. CMR is fundamental for differentiating between those 2 entities and defining the pathological phase of AFD. A correct diagnosis can have a substantial impact on patient management, and more so on thier families.

Role of TWEAK/Fn14 signalling pathway in lupus nephritis and other clinical settings. / Papel de la vía de señalización del TWEAK/Fn14 en la nefritis lúpica y otros escenarios clínicos.

Knowledge of the signalling pathways involved in various diseases has enabled advances in the understanding of pathophysiological, diagnostic and therapeutic models of several inflammatory and autoimmune diseases. Systemic lupus erythematosus is a widely studied autoimmune disease that can affect multiple organs, with a major impact on morbidity and mortality when it involves the kidneys. Over the past 10 years, interest in the role of the TWEAK/Fn14 signalling pathway in lupus nephritis, as well as other clinical settings, has increased. By reviewing the literature, this article assesses the role of this pathway in lupus nephritis, underlines the importance of TWEAK in urine (uTWEAK) as a biomarker of the disease and stresses the favourable results published in the literature from the inhibition of the TWEAK/Fn14 pathway as a therapeutic target in experimental animal models, demonstrating its potential application in other settings. Results of ongoing clinical trials and future research will give us a better understanding of the real benefit of blocking this pathway in the clinical course of several conditions.

CARACTERIZACIÓN QUÍMICA DE LA PELÍCULA PLATEADA DEL CAFÉ (Coffea arábica) EN VARIEDADES COLOMBIA Y CATURRA / CHEMICAL CHARACTERIZATION OF THE COFFEE SILVERSKIN (Coffea arábica) IN VARIETIES COLOMBIA AND CATURRA / CARACTERIZAÇÃO QUÍMICA DA PELÍCULA PRATEADA DE CAFÉ (Coffea arábica) EM VARIEDADES COLÔMBIA E CATURRA

La película plateada del café es un residuo que se produce en gran volumen durante los procesos de trilla y torrefacción de este. En la actualidad no se le da ningún tipo de uso, a excepción de servir como abono o combustible, aunque sería de gran utilidad para mejorar el contenido de fibra en alimentos y así facilitar el proceso digestivo, y también como un potencial antioxidante para mejorar su calidad. En el presente estudio se trabajó con dos muestras de película plateada provenientes de dos variedades de café representativas del país, Colombia y Caturra. Se hizo el análisis proximal del contenido de fibra extraída y la actividad antioxidante de la película plateada, observando que el contenido de fibra dietaria total es del 70 %, correspondiendo un 95,3 % a la fibra dietaria insoluble. Además se realizó extracción de los compuestos fenólicos, empleando un sistema metanol:acetona y la cuantificación por el método espectrofotométrico de Folin-Ciocalteau, donde se encontró que el 1,2 % de la película corresponde a estos compuestos. La actividad antioxidante fue determinada por los métodos de ABTS, FRAP y DPPH encontrándose 3,75, 7,40 y 1,22 mmol de trolox por 100 g de película plateada respectivamente, resultado comparable con otros residuos de frutas que presentan un alto potencial antioxidante. La actividad antioxidante relevante de la película plateada puede ser atribuida a algunos productos de la reacción de Maillard, como las melanoidinas. Los resultados encontrados sugieren que la película plateada del café presenta un alto potencial, como ingrediente funcional en la industria alimenticia, con el fin de posiblemente ser adicionada en alimentos de consumo masivo como pan, galletas, carnes o embutidos, en consideración de su alto contenido de fibra dietaria.

The coffe silverskin is a residue of coffee produced in large volume processes during threshing and roasting it. At present is not given any use, except to serve as fertilizer or fuel, but would be very useful to improve the fiber content in foods and to facilitate the digestive process and also as a potential antioxidant to improve quality thereof. In the present study we worked with two silverskin samples from two varieties coffee representative of our country; Colombia and Caturra. It was the proximate analysis of fiber content and antioxidant activity of the silverskin which clearly shows that the total dietary fiber content is 70 % and a high content of insoluble dietary fiber (66 %). We also carried out extraction of phenolic compounds, using a methanol:acetone and quantification by the spectrophotometric method of Folin-Ciocalteau, which found that 1,2 % of the silverskin correspond to these compounds. The antioxidant activity was determined by the ABTS, FRAP and DPPH methods, found 3,75, 7,40 and 1,22 mmol of trolox per 100 g of silverskin, respectively; the result is comparable with other wastes as some fruits shells which have a marked activity. Significant antioxidant activity of the silverskin can be attributed to certain products of the Maillard reaction, such as melanoidins. The results suggest that coffee silver film has a high potential as a functional ingredient in the food industry to be added in consumer foods such as bread, biscuits, meat or sausages, considering its high content of dietary fiber and marked antioxidant activity.

A película prateada do café é um resíduo que é produzido em grandes volumes durante os processos de separação e torrefação do mesmo. Atualmente não se lhe da nenhum tipo de uso, à exceção de servir como adubo ou combustível, apesar de que seria de grande utilidade para melhorar o conteúdo de fibra em alimentos e assim facilitar o processo digestivo e também como um potencial antioxidante para melhorar a qualidade dos mesmos. No presente estudo se trabalhou com duas amostras de película prateada provenientes de duas variedades de café representativas do nosso país, Colômbia y Caturra. Foi realizada a análise proximal do conteúdo de fibra e a atividade antioxidante da película prateada onde se mostra com claridade que o conteúdo de fibra dietética total é de 70 % e com um alto conteúdo de fibra dietética insolúvel (66 %). Adicionalmente, se realizou a extração dos compostos fenólicos, utilizando um sistema metanol:acetona e quantificação pelo método espectrofotométrico de Folin-Ciocalteau, onde se encontrou que 1,2 % da película corresponde a estes compostos. A atividade antioxidante foi determinada pelos métodos de ABTS, FRAP y DPPH encontrando se 3,75, 7,40 e 1,22 mmol de trolox por 100 g de película prateada respectivamente, resultado comparável com outros resíduos como algumas cascaras de frutas que tem uma atividade marcada. A atividade antioxidante relevante da película prateada pode ser atribuída a alguns produtos da reação de Maillard, como as melanoidinas. Os resultados encontrados sugerem que a película prateada do café apresenta um alto potencial como ingrediente funcional na indústria alimentícia com o fim de ser adicionada em alimentos de consumo massivo como o pão, bolachas, carnes ou embutidos, considerando o seu alto conteúdo de fibra dietética e marcada atividade antioxidante.