Acute calcific periarthritis in a proximal interphalangeal joint of the hand after acute trauma: a rare case.

Acute calcific periarthritis (ACP) in the interphalangeal joints of the hand is rare, with less than 100 cases reported. A rare case of ACP in a proximal interphalangeal (PIP) joint of the hand, in a young black woman, after acute trauma, is presented. She experienced severe pain and limited range of motion, and was medicated with an oral corticoid, which was followed by a rapid resolution of the symptoms. At six months, there were no signs of clinical or radiographic recurrence. Recognition of ACP allows for avoiding unnecessary treatments. In this case, treatment with corticoids might have played a role in a faster recovery.

La periartritis calcificada aguda (PCA) en las articulaciones interfalángicas de la mano es rara, con menos de 100 casos reportados. Se presenta un caso raro de PCA en una articulación interfalángica proximal (IFP) de la mano, en una mujer joven de raza negra, después de un traumatismo agudo. Experimentó dolor intenso y rango de movimiento limitado, y fue medicada con un corticoide oral, lo que fue seguido por una rápida resolución de los síntomas. A los seis meses no hubo signos de recurrencia clínica ni radiológica. El reconocimiento de PCA permite evitar tratamientos innecesarios. En este caso, el tratamiento con corticoides podría haber contribuido a una recuperación más rápida.

Motivation and anxiety during the second COVID-19 lockdown in gym exercisers: The mediating role of affects and satisfaction with life.

The present study aimed to analyze the association between motivation (self-determined and non-self-determined motivation), positive and negative affect, life satisfaction and state-anxiety in a sample of gym exercisers, during the 2nd COVID-19 lockdown in Portugal. Also, we aimed to analyze the possible mediating role of positive and negative affect and life satisfaction in the relationship between motivation and levels of state-anxiety. A total of 201 gym participants (30.42 ± 11.22) were enrolled in the present study, of which 116 (57.7%) were women and 85 (42.3%) were men. The survey included sociodemographic data as well as the subsequently validated instruments: the State-Trait Anxiety Inventory, the Positive and Negative Affect Schedule, and the Satisfaction with Life Scale. The results revealed a positive association between state-anxiety and negative affect (r = .69), controlled motivation (r = .33), and autonomous motivation (r = .25). Still, state-anxiety was negatively associated with positive affect (r = -.40) and with satisfaction with life (r = -.43),. In addition, the results of mediation analysis, revealed inconsistent mediation of positive affect and life satisfaction in the relationship between autonomous motivation and state-anxiety. However, a total mediation was observed through negative affect and life satisfaction in the relationship between controlled motivation and anxiety since the indirect effect (ß = .27) is higher than the direct effect (ß = .06). Overall, the results reinforce that positive affect and satisfaction with life could act as a possible buffer against state-anxiety in gym exercisers and, thus, should be considered in future interventions and studies.

[Unmet research and developmental needs in ophthalmology : A consensus-based road map of the European Vision Institute for 2019-2025]. / Forschungs- und Entwicklungsbedarf in der Augenheilkunde ("Unmet needs") : Ein konsensbasierter Fahrplan des European Vision Institute (EVI) für die Jahre 2019 bis 2025.

PURPOSE: To define unmet needs in ophthalmology which can realistically be addressed in the next years (2019-2025) and to describe potential avenues for research to address these challenges. METHODS: Outcomes of a consensus process within the European Vision Institute (EVI, Brussels) are outlined. Disease areas which are discussed comprise glaucoma, retinal dystrophies, diabetic retinopathy, dry eye disease, corneal diseases, cataract and refractive surgery. RESULTS: Unmet needs in the mentioned disease areas are discussed and realistically achievable research projects outlined. CONCLUSION: Considerable progress can be made in the field of ophthalmology and patient-relevant outcomes in the near future.

Ectopic pregnancies: a retrospective cohort analysis in a tertiary reference center in the Northeast Region of Brazil.

OBJECTIVE: The objective of this study was to investigate the clinical and epidemiological characteristics of patients with ectopic pregnancy admitted to a tertiary center in the Northeast Region of Brazil and the aspects related to the treatment and outcomes in these women. DESIGN: This was a retrospective cohort study of 101 patients diagnosed with ectopic pregnancy between February 2016 and February 2017. SETTING: Assis Chateaubriand Maternity School, Fortaleza, Ceará, Brazil Methods: The data collected included demographic characteristics, gynecological-obstetric history, symptoms at admission, complementary examinations [chorionic gonadotropin (β-hCG) blood test, transvaginal ultrasound, and hemoglobin level], and treatment given. RESULTS: The mean patient age was 28 ± 6.6 years (14-48 years). Abdominal pain (96%) and vaginal bleeding (82.4%) were the most prevalent symptoms. No risk factors were identified in most of the patients (53.5%), whereas the most frequently identified risk factor (16.9%) was a history of previous ectopic pregnancy. At admission, 63.4% of patients presented ruptured ectopic pregnancy and 5.9% had hemodynamic instability. Among the patients with ruptured ectopic pregnancy, 61% had already sought care at another center. With regard to the therapeutic options, 78.2% underwent surgery (27.2%, laparoscopy), 16.8% used methotrexate (MTX), and 5% underwent expectant management. Among those who received MTX, 41.2% needed subsequent surgery because of elevated blood β-hCG level (57.1%) and clinical signs of ruptured ectopic pregnancy (42.9%). CONCLUSION: The patients were admitted at an advanced stage of ectopic pregnancy, which made a more conservative and less costly treatment difficult. However, the outcomes were clinically satisfactory, with low complication rates and no maternal deaths. Keywords ectopic pregnancy, methotrexate, epidemiology, laparoscopy, laparotomy.

Use of inlet radiographs in the assessment of reduction after the surgical treatment of developmental dysplasia of the hip.

AIMS: This pilot study aimed to evaluate prospectively the use of inlet radiographs of the hip as an alternative method of the assessment of reduction after the surgical treatment of developmental dysplasia of the hip (DDH). PATIENTS AND METHODS: The children in this study underwent surgery between January 2013 and January 2015. All had inlet radiographs and CT scans post-operatively. Data were analysed by determining inter-observer reliability and intra-observer reproducibility, using the kappa value (K). Differences were settled by discussion between the two observers until a consensus was reached. The sensitivity and specificity of the radiographic and CT results were compared. A total of 26 radiographs were obtained from 23 children, with a mean age of 2.38 years (one to five). RESULTS: Similar high levels of intra- and inter-observer agreement were observed (K = 0.834, 95% confidence interval (CI)). There was a high agreement between the radiographic and CT results (K = 0.834, 5% CI), with excellent sensitivity and a specificity of 95.5%. CONCLUSION: These results suggest that inlet radiographs may be a reliable method of assessing the reduction of the hip after the surgical treatment of DDH. Cite this article: Bone Joint J 2017;99-B:697-701.

Accuracy of a method based on atomic absorption spectrometry to determine inorganic arsenic in food: Outcome of the collaborative trial IMEP-41.

A collaborative trial was conducted to determine the performance characteristics of an analytical method for the quantification of inorganic arsenic (iAs) in food. The method is based on (i) solubilisation of the protein matrix with concentrated hydrochloric acid to denature proteins and allow the release of all arsenic species into solution, and (ii) subsequent extraction of the inorganic arsenic present in the acid medium using chloroform followed by back-extraction to acidic medium. The final detection and quantification is done by flow injection hydride generation atomic absorption spectrometry (FI-HG-AAS). The seven test items used in this exercise were reference materials covering a broad range of matrices: mussels, cabbage, seaweed (hijiki), fish protein, rice, wheat, mushrooms, with concentrations ranging from 0.074 to 7.55mgkg(-1). The relative standard deviation for repeatability (RSDr) ranged from 4.1 to 10.3%, while the relative standard deviation for reproducibility (RSDR) ranged from 6.1 to 22.8%.

Comparative proteomic analysis of ductal and lobular invasive breast carcinoma.

Breast cancer is the second most common cancer worldwide and the first among women. Invasive ductal carcinoma (IDC) and invasive lobular carcinoma (ILC) are the two major histological subtypes, and the clinical and molecular differences between them justify the search for new markers to distinguish them. As proteomic analysis allows for a powerful and analytical approach to identify potential biomarkers, we performed a comparative analysis of IDC and ILC samples by using two-dimensional electrophoresis and mass spectrometry. Twenty-three spots were identified corresponding to 10 proteins differentially expressed between the two subtypes. ACTB, ACTG, TPM3, TBA1A, TBA1B, VIME, TPIS, PDIA3, PDIA6, and VTDB were upregulated in ductal carcinoma compared to in lobular carcinoma samples. Overall, these 10 proteins have a key role in oncogenesis. Their specific functions and relevance in cancer initiation and progression are further discussed in this study. The identified peptides represent promising biomarkers for the differentiation of ductal and lobular breast cancer subtypes, and for future interventions based on tailored therapy.

Determination of total cadmium, lead, arsenic, mercury and inorganic arsenic in mushrooms: outcome of IMEP-116 and IMEP-39.

The Institute for Reference Materials and Measurements (IRMM) of the Joint Research Centre (JRC), a Directorate General of the European Commission, operates the International Measurement Evaluation Program (IMEP). IMEP organises inter-laboratory comparisons in support of European Union policies. This paper presents the results of two proficiency tests (PTs): IMEP-116 and IMEP-39, organised for the determination of total Cd, Pb, As, Hg and inorganic As (iAs) in mushrooms. Participation in IMEP-116 was restricted to National Reference Laboratories (NRLs) officially appointed by national authorities in European Union member states. IMEP-39 was open to all other laboratories wishing to participate. Thirty-seven participants from 25 countries reported results in IMEP-116, and 62 laboratories from 36 countries reported for the IMEP-39 study. Both PTs were organised in support to Regulation (EC) No. 1881/2006, which sets the maximum levels for certain contaminants in food. The test item used in both PTs was a blend of mushrooms of the variety shiitake (Lentinula edodes). Five laboratories, with demonstrated measurement capability in the field, provided results to establish the assigned values (Xref). The standard uncertainties associated to the assigned values (uref) were calculated by combining the uncertainty of the characterisation (uchar) with a contribution for homogeneity (ubb) and for stability (ust), whilst uchar was calculated following ISO 13528. Laboratory results were rated with z- and zeta (ζ)-scores in accordance with ISO 13528. The standard deviation for proficiency assessment, σp, ranged from 10% to 20% depending on the analyte. The percentage of satisfactory z-scores ranged from 81% (iAs) to 97% (total Cd) in IMEP-116 and from 64% (iAs) to 84% (total Hg) in IMEP-39.

Inter-rectus distance in postpartum women can be reduced by isometric contraction of the abdominal muscles: a preliminary case-control study.

OBJECTIVES: To determine the effect of isometric contraction of the abdominal muscles on inter-rectus distance in postpartum women. DESIGN: Preliminary case-control study. SETTING: Research laboratory. PARTICIPANTS: Ten postpartum women {mean age 30 [standard deviation (SD) 4] years; mean weight 58 (SD 7) kg; mean height 159 (SD 4) cm} and 10 nulliparous (control) women [mean age 28 (SD 2) years; mean weight 56 (SD 6) kg; mean height 160 (SD 6) cm]. INTERVENTIONS: Ultrasound images from the anterior abdominal wall were recorded at rest (supine position) and during an abdominal isometric contraction, with the subject actively performing an abdominal crunch (crook lying position). Two-way analysis of variance was used to compare the inter-rectus distance between groups (postpartum vs control) and between levels of abdominal muscle activation (rest vs isometric contraction). MAIN OUTCOME MEASURES: Inter-rectus distance 2cm above the level of the umbilicus. RESULTS: The inter-rectus distance was significantly greater in the postpartum group compared with the control group [14.7 (SD 3.1) mm vs 9.6 (SD 2.8) mm; mean difference 5.1mm; 95% confidence interval (CI) 3.4 to 6.8]. The inter-rectus distance was significantly lower during isometric contraction compared with rest [10.7 (SD 3.1) mm vs 13.4 (SD 3.1) mm; mean difference 2.8mm; 95% CI 1.2 to 4.5]. No interaction was found between group and muscle contraction. CONCLUSIONS: The inter-rectus distance was significantly higher in postpartum women compared with controls, and significantly lower during isometric contraction of the abdominal muscles (abdominal crunch) compared with rest.

Setting maximum limits for trace elements in baby food in European legislation: the outcome of International Measurement Evaluation Programme®-33.

The Institute for Reference Materials and Measurements (IRMM) of the Joint Research Centre (JRC), a Directorate-General of the European Commission, operates the International Measurement Evaluation Programme® (IMEP). It organises various types of inter-laboratory comparisons in support of European Union policies. This paper presents the results of a proficiency testing exercise (PT) focusing on the determination of total cadmium (Cd) and total lead (Pb) mass fractions in baby food in support to Commission Regulation (EC) 1881/2006 of 19 December 2006 setting maximum levels for certain contaminants in foodstuffs. The test material used in this exercise was soya-based baby food formula purchased in a local pharmacy and prepared by the Reference Materials Unit of the IRMM for this exercise. Sixty-six laboratories from 23 countries registered to the exercise and 61 of them reported results. Each participant received one bottle containing approximately 15 g of test material. Participants were asked to quantify the measurands in the powder and in the reconstituted formula. Reference values independent from the participants' results were established using isotope dilution inductively coupled plasma mass spectrometry. The total Cd mass fraction was determined by IRMM and LGC Ltd (UK), while the total Pb was determined by IRMM. The standard deviation for proficiency assessment σ^ was set at 22% of the assigned value for all measurands. Laboratories were rated with z- and ζ- (zeta) scores in accordance with ISO 13528. The outcome of this exercise is clearly influenced by the very low level of Cd and Pb content in the test material which triggered: a high number of 'less than' values; overestimated values especially for Pb very likely due to contamination; and a visible method influence in the case of Pb (methods based on atomic absorption were not sensitive enough to attain such low limits of detection). The results were also evaluated with regard to the reported limit of detection and some incoherencies were observed.

Is it possible to agree on a value for inorganic arsenic in food? The outcome of IMEP-112.

Two of the core tasks of the European Union Reference Laboratory for Heavy Metals in Feed and Food (EU-RL-HM) are to provide advice to the Directorate General for Health and Consumers (DG SANCO) on scientific matters and to organise proficiency tests among appointed National Reference Laboratories. This article presents the results of the 12th proficiency test organised by the EU-RL-HM (IMEP-112) that focused on the determination of total and inorganic arsenic in wheat, vegetable food and algae. The test items used in this exercise were: wheat sampled in a field with a high concentration of arsenic in the soil, spinach (SRM 1570a from NIST) and an algae candidate reference material. Participation in this exercise was open to laboratories from all around the world to be able to judge the state of the art of the determination of total and, more in particular, inorganic arsenic in several food commodities. Seventy-four laboratories from 31 countries registered to the exercise; 30 of them were European National Reference Laboratories. The assigned values for IMEP-112 were provided by a group of seven laboratories expert in the field of arsenic speciation analysis in food. Laboratory results were rated with z and ζ scores (zeta scores) in accordance with ISO 13528. Around 85 % of the participants performed satisfactorily for inorganic arsenic in vegetable food and 60 % did for inorganic arsenic in wheat, but only 20 % of the laboratories taking part in the exercise were able to report satisfactory results in the algae test material.

Proficiency test for the determination of heavy metals in mineral feed. The importance of correctly selecting the certified reference materials during method validation.

In 2008, the International Measurement Evaluation Programme, IMEP®, organised two proficiency tests (PTs) for the determination of heavy metals in mineral feed, named IMEP-105 and IMEP-27, respectively. IMEP-105 was organised in support of the activities of the European Union Reference Laboratory for Heavy Metals in Feed and Food, and participation was restricted to the officially nominated National Reference Laboratories (NRLs). IMEP-27 was open to all interested control laboratories in the field. The test material used in the two PTs was the same and the timeframe of the two exercises overlapped. The measurands in both exercises were total Cd, Pb and As and extractable Cd and Pb, as defined in Directive 2002/32/EC of the European Parliament and the Council on undesirable substances in animal feed. Forty-nine laboratories from 25 countries reported results to the two exercises, 29 to IMEP-105 and 20 to IMEP-27. In both PTs, external reference values were used instead of consensus values derived from the participants' results. It was shown that the concentration of total and extractable Cd according to Directive 2002/32/EC were identical, while the concentration of extractable Pb was ~80% of total Pb. The main outcome of these comparisons was that an underestimation of the concentrations of the addressed measurands, in particular total Pb, took place due to an erroneous estimation of the bias of the analytical methods used by most of the participants. It appeared that the nature of the certified reference materials chosen for method validation and recovery estimation was the cause of the problem (insufficient matching of the matrix characteristics between these materials and the test sample). No significant difference between the results reported to IMEP-105 and to IMEP-27 was observed.

Ultrasonic assisted protein enzymatic digestion for fast protein identification by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Sonoreactor versus ultrasonic probe.

Two different ultrasonic energy sources, the sonoreactor and the ultrasonic probe, are compared for enzymatic digestion of proteins for protein identification by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) using the peptide mass fingerprint (PMF) procedure. Variables such as (i) trypsin/protein ratio; (ii) sonication time; (iii) ultrasound amplitude; and (iv) protein concentration are studied and compared. As a general rule, the trypsin/protein ratio and the minimum protein concentration successfully digested are similar with both ultrasonic energy sources. Results showed that the time needed to digest proteins was shorter with the ultrasonic probe, 60s versus 120s, for the same amplitude of sonication, 50%. However, lower standard deviations and cleaner MALDI-TOF-MS spectra were obtained with the sonoreactor. In addition, the sonoreactor device provided higher sample throughput (6 samples for the sonoreactor versus 1 sample for the ultrasonic probe) and easier sample handling for lower sample volumes (25 microl). Finally, a comparison of both methodologies for the specific identification of the adenylylsulphate reductase alfa subunit from a complex protein mixture from Desulfovibrio desulfuricans ATCC 27774 was done as a proof of the procedure.

Sonoreactor-based technology for fast high-throughput proteolytic digestion of proteins.

Fast (120 s) and high-throughput (more than six samples at once) in-gel trypsin digestion of proteins using sonoreactor technology has been achieved. Successful protein identification was done by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, MALDI-TOF-MS. Specific identification of the adenylylsulphate reductase alfa subunit from a complex protein mixture from Desulfovibrio desulfuricans ATCC 27774 was done as a proof of the methodology. The new sample treatment is of easy implementation, saves time and money, and can be adapted to online procedures and robotic platforms.

New findings for in-gel digestion accelerated by high-intensity focused ultrasound for protein identification by matrix-assisted laser desorption ionization time-of-flight mass spectrometry.

New findings in sample treatment based on high-intensity focused ultrasound (HIFU) for protein digestion after polyacrylamide gel electrophoresis separation are presented. The following variables were studied: (i) sample volume; (ii) sonotrode diameter; (iii) previous protein denaturation; (iv) cooling; (v) enzyme concentration; and (vi) protein concentration. Results showed that positive protein identification could be done after protein separation by gel electrophoresis through peptide mass fingerprint (PMF) in a volume as low as 25 microL. The time needed was less than 2 min and no cooling was necessary. The importance of the sonotrode diameter was negligible. On the other hand, protein denaturation before sonication was a trade-off for the success of procedure here described. The protein coverage was raised from 5 to 30%, and the number of peptides matching the proteins was also increased in a percentage ranging 10-100% when the classical overnight treatment is compared with the proposed HIFU procedure. The minimum amount of protein that can be identified using the HIFU sample treatment by matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF-MS) was 0.06 microg. The lower concentration of trypsin successfully used to obtain an adequate protein digestion was 3.6 microg/mL.

Clinical and cardiovascular alterations produced by scorpion envenomation in dogs

Scorpionism is a common problem that occurs in tropical and subtropical countries and assumes great medical-sanitary importance due to its fatal effect on sensitive individuals, being able to lead children and aged people to death. The envenomation lethal potential is responsible for the serious cardiopulmonary alterations the scorpion toxin produces in its victims. The present research evaluated the effects of Tityus serrulatus venom on dogs, using two distinct doses: a dose that simulates natural envenomation (0.4 mg/total dose), and an experimental dose (0.25 mg/kg). General clinical signs were observed at different moments after envenomation, and specific data related to the cardiopulmonary system were evaluated by systemic arterial pressure measurement, CK-MB enzymatic activity dosage, and radiographic, electrocardiographic and echocardiographic examinations. Results demonstrated that the scorpion venom, in experimental doses, was able to cause acute and reversible cardiac injury in few days, and, in the dose that simulated natural accident, it produced clinical signs of light envenomation, such as local pain, hyperesthesia, sialorrhea, vomiting, diarrhea, sneeze and prostration.

Alterações clínicas e cardiopulmonares produzidas pelo envenenamento escorpiônico em cães

O artigo não apresenta resumo.

Laparoscopic total mesorectum excision.

The main controversy of colon-rectal laparoscopic surgery comes from its use as a cancer treatment. Two points deserve special attention: the incidence of port-site tumor implantation and the possibility of performing radical cancer surgery, such as total mesorectum excision. Once these points are addressed, the laparoscopic approach will be used routinely to treat rectal cancer. To clarify these points, 32 patients with cancer of the lower rectum participated in a special protocol that included preoperative radiotherapy and laparoscopic total mesorectum excision. All data were recorded. At the same time, all data recorded from the experience of a multicenter laparoscopic group (Brazilian Colorectal Laparoscopic Surgeons - 130 patients with tumor of the lower rectum) were analyzed and compared with the data provided by our patients. Analysis of the results suggests that a laparoscopic approach allows the same effective resection as that of conventional surgery and that preoperative irradiation does not influence the incidence of intraoperative complications. The extent of lymph nodal excision is similar to that obtained with open surgery, with an average of 12.3 lymph nodes dissected per specimen. The rate of local recurrence was 3.12%. No port site implantation of tumor was noted in this series of patients with cancer of the lower rectum.