Injerto osteocondral congelado para tratamiento de lesiones de cartílago de rodilla: resultados a 7 años de seguimiento / Use of frozen osteochondral allograft for the treatment of cartilage defects of the knee. Results at seven-year follow-up

Resumen Introducción : Las lesiones osteocondrales de rodilla son una afección frecuente en jóvenes. Los trasplantes alogénicos usando injerto congelado se presentan como una opción de tratamiento en pacientes con lesiones grandes o sin zona dadora. Este trabajo buscó analizar retrospectivamente los resultados funcionales y la tasa de falla de los trasplantes osteocondrales con injerto cadavérico congelado. Métodos : Se incluyeron pacientes sometidos a tras plantes osteocondrales de rodilla con injerto cadavérico congelado en nuestra institución, entre 2014 y 2019, con dos años de seguimiento mínimo. Variables evaluadas: edad al momento de la intervención, escalas funciona les International Knee Documentation Committee (IKDC) y Lysholm pre y post operatorios, complicaciones y tasa de falla. Resultados : Incluimos 25 pacientes. La edad media fue de 43.5 años (RIQ 29-50), 45% fueron mujeres y el seguimiento promedio fue de 83 meses (DS 54.6). El ta maño promedio del defecto osteocondral fue de 4 cm2. La escala de Lysholm promedio pre y postoperatorio fue de 39 (DS 19.3) y 82 (DS 15.4) respectivamente (p < 0.01). El IKDC promedio pre y postoperatorio fue de 42 (DS 13.8) y 60 (DS 13.5) respectivamente (p < 0.01). La tasa de falla fue del 20% (n=5). Discusión : Los pacientes presentaron una mejoría postoperatoria evidenciada en los resultados funcio nales, y una tasa de falla del 20%. El uso de trasplante osteocondral congelado se presenta como un recurso útil para el tratamiento de lesiones condrales graves.

Abstract Introduction : Knee osteochondral lesions represent a frequent pathology within young active patients. One possible indication for severe lesions or in case of im possibility of harvesting an autograft is the use of fresh frozen allograft. The objective of this study was to ret rospectively analyze functional results and failure rate after osteochondral transplants using fresh frozen al lografts. Methods : We analyzed data from patients who under went knee osteochondral transplant using mosaicplasty technique with fresh frozen allografts at our institution between 2014 and 2019. We included those patients with at least two-year follow-up. Demographic characteristics such as age at the moment of intervention and size of the defect were included. Functional results were assessed using pre and postoperative Lysholm and IKDC scores. Patients who underwent a knee replacement were considered failures. Results : Twenty-five patients were included. The me dian age was 43.5 years (IQR 29-50), 45% were female and the mean follow-up was 83 months (SD 54.6). Mean osteochondral defect size was 4 cm2. Mean pre and post operative Lysholm scores were 39 (SD 19.3) and 82 (SD 15.4) respectively (p < 0.01). Mean pre and postoperative IKDC scores were 42 (SD 13.8) and 60 (SD 13.5) respec tively (p < 0.01). Five patients (20%) underwent a knee replacement afterwards and were considered failures. Discussion : Our results after a mean seven-year follow-up evidenced an overall improvement in func tional scores and a failure rate of 20%. Osteochondral transplant using fresh frozen allografts is a reliable and feasible treatment for patients with large osteochondral defects.

Predictive factors of frozen section in transoral microlaryngeal surgery for suspicious glottic lesions.

OBJECTIVE: Frozen biopsy may guide surgical intraoperative decisions. We evaluated the accuracy of frozen biopsy for diagnosing benign, dysplastic and malignant laryngeal lesions, compared to paraffin section (gold standard). METHODS: Retrospective review of the charts of all patients presenting with laryngeal lesions suspicious of malignancy, who underwent laryngeal microsurgery with frozen biopsy in our institution, between 2015 and 2020. Results of frozen biopsy and paraffin section examinations were compared. RESULTS: Among 113 samples of 89 patients, paraffin section diagnosed 23 benign, 31 dysplastic and 59 malignant lesions. The accuracy of the frozen biopsy in identifying dysplasia or malignancy was 80.5% (91/113), and greater for lesions >5 mm (78.8% × 51.5%; p = 0.009). The positive and negative predictive values, sensitivity and specificity were 95.9%, 51.3%, 78.9% and 86.9%, respectively. CONCLUSIONS: Frozen section is a reliable tool when malignancy is detected, but almost half of benign results exhibit dysplasia or malignancy in paraffin section. Other clinical parameters should be considered in intraoperative decisions to prevent undertreatment.

Association of the Specimen and Tumor Bed Margin Status with Local Recurrence and Survival in Open Partial Laryngectomy.

Background/Objectives: Positive margins are associated with locoregional recurrence in early laryngeal cancer. The aim of this study was to evaluate the impacts of specimen-driven (ex vivo) positive margins on patients with early-stage laryngeal cancer whose tumor bed (defect-driven) margins had been negative. Methods: A retrospective study was performed on 60 consecutive T1b/T2 glottic cancer patients who underwent open frontolateral laryngectomy. The intraoperative margins were obtained from the tumor bed. Their recurrence and disease-free survival were evaluated. In all cases, negative margins were obtained from the surgical bed. The impact of positive margins from the specimen was evaluated in a paraffin study. Results: Among 10 patients with positive margins in the specimen, six experienced local relapse, and among 50 patients with negative margins in the specimen, three developed recurrence. The 5-year disease-free survival rates were 37.5% and 93.9%, respectively (p < 0.001; log-rank). Even with negative margins in the surgical bed, patients with positive margins in the specimen at the final histopathological examination had a 3.5-fold higher chance of developing local recurrence than those with negative margins (HR = 13.993; 95% CI: 3.479-56.281; p < 0.001; univariate Cox regression). Conclusions: Specimen-driven positive margins represent a significant risk factor for local recurrence, even under negative margins at the tumor bed.

[Use of frozen osteochondral allograft for the treatment of cartilage defects of the knee. Results at seven-year follow-up]. / Injerto osteocondral congelado para tratamiento de lesiones de cartílago de rodilla: resultados a 7 años de seguimiento.

INTRODUCTION: Knee osteochondral lesions represent a frequent pathology within young active patients. One possible indication for severe lesions or in case of impossibility of harvesting an autograft is the use of fresh frozen allograft. The objective of this study was to retrospectively analyze functional results and failure rate after osteochondral transplants using fresh frozen allografts. METHODS: We analyzed data from patients who underwent knee osteochondral transplant using mosaicplasty technique with fresh frozen allografts at our institution between 2014 and 2019. We included those patients with at least two-year follow-up. Demographic characteristics such as age at the moment of intervention and size of the defect were included. Functional results were assessed using pre and postoperative Lysholm and IKDC scores. Patients who underwent a knee replacement were considered failures. RESULTS: Twenty-five patients were included. The median age was 43.5 years (IQR 29-50), 45% were female and the mean follow-up was 83 months (SD 54.6). Mean osteochondral defect size was 4 cm2. Mean pre and postoperative Lysholm scores were 39 (SD 19.3) and 82 (SD 15.4) respectively (p < 0.01). Mean pre and postoperative IKDC scores were 42 (SD 13.8) and 60 (SD 13.5) respectively (p < 0.01). Five patients (20%) underwent a knee replacement afterwards and were considered failures. DISCUSSION: Our results after a mean seven-year follow-up evidenced an overall improvement in functional scores and a failure rate of 20%. Osteochondral transplant using fresh frozen allografts is a reliable and feasible treatment for patients with large osteochondral defects.

Introducción: Las lesiones osteocondrales de rodilla son una afección frecuente en jóvenes. Los trasplantes alogénicos usando injerto congelado se presentan como una opción de tratamiento en pacientes con lesiones grandes o sin zona dadora. Este trabajo buscó analizar retrospectivamente los resultados funcionales y la tasa de falla de los trasplantes osteocondrales con injerto cadavérico congelado. Métodos: Se incluyeron pacientes sometidos a trasplantes osteocondrales de rodilla con injerto cadavérico congelado en nuestra institución, entre 2014 y 2019, con dos años de seguimiento mínimo. Variables evaluadas: edad al momento de la intervención, escalas funcionales International Knee Documentation Committee (IKDC) y Lysholm pre y post operatorios, complicaciones y tasa de falla. Resultados: Incluimos 25 pacientes. La edad media fue de 43.5 años (RIQ 29-50), 45% fueron mujeres y el seguimiento promedio fue de 83 meses (DS 54.6). El tamaño promedio del defecto osteocondral fue de 4 cm2. La escala de Lysholm promedio pre y postoperatorio fue de 39 (DS 19.3) y 82 (DS 15.4) respectivamente (p < 0.01). El IKDC promedio pre y postoperatorio fue de 42 (DS 13.8) y 60 (DS 13.5) respectivamente (p < 0.01). La tasa de falla fue del 20% (n=5). Discusión: Los pacientes presentaron una mejoría postoperatoria evidenciada en los resultados funcionales, y una tasa de falla del 20%. El uso de trasplante osteocondral congelado se presenta como un recurso útil para el tratamiento de lesiones condrales graves.

Diagnostic accuracy of non-contrast MRI in frozen shoulder.

INTRODUCTION: Despite being the most used exam today, few studies have evaluated the accuracy of findings on non-contrast magnetic resonance imaging (MRI). The primary objective of the study was to evaluate the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of non-contrast MRI findings in frozen shoulder, isolated and in combination. The secondary objectives were to define the interobserver and intraobserver agreement of the assessments and the odds ratio for frozen shoulder because of the various findings of MRI. METHODS: A retrospective diagnostic accuracy study comparing non-contrast MRI findings between the frozen shoulder group and the control group. Sensitivity, specificity, positive and negative predictive value, accuracy, odds ratio, interobserver and intraobserver agreement were calculated for each finding and their possible associations. RESULTS: The hyperintensity on capsule in the axillary recess presented 84% sensitivity, 94% specificity, and 89% accuracy. The obliteration of the subcoracoid fat triangle in the rotator interval had sensitivity 34%, specificity 82% and accuracy 58%. For coracohumeral ligament thickness ≥ 2 mm had specificity 66%, 48% specificity and 57% accuracy. Capsule thickness in the axillary recess ≥ 4 mm resulted in 54% sensitivity, 82% specificity, and 68% accuracy. Regarding interobserver agreement, only the posteroinferior and posterosuperior quadrants showed moderate results, and all the others showed strong reliability. The odds ratio for hyperintensity in the axillary recess was 82.3 for frozen shoulder. The association of these findings increased specificity (95%). CONCLUSION: The accuracy of non-contrast magnetic resonance imaging is high for diagnosing frozen shoulder, especially when evaluating the hyperintensity of the axillary recess. The exam has high reliability and reproducibility. The presence of an association of signs increases the specificity of the test. LEVEL OF EVIDENCE: Level III, study of diagnostic test.

Frozen-thawed embryo transfer: does the addition of low-dose choriogonadotropin alfa to progesterone in the luteal phase of artificial cycles improve the endometrium and increase the chances of pregnancy?

OBJECTIVE: Primary: To evaluate the effect of low doses of recombinant hCG (choriogonadotropin alfa) in the luteal phase of frozen-thawed embryo transfers (FET) of artificial cycles on the chances of pregnancy in patients aged ≤38years. Secondary: To assess the chances of pregnancy in the FET groups of artificial cycles using micronized vaginal progesterone (VP) versus injectable intramuscular progesterone (IMP) and the chances of pregnancy in type-1 embryo transfers (two top embryos). METHODS: This retrospective cohort study included 122 cycles of FET and compared two groups of patients aged 38 years or younger, one given hCG in the luteal phase and one not administered hCG. RESULTS: The clinical pregnancy rates (CPR) in the control and hCG groups were 45% and 45.16%, respectively (p=0.9999). The live birth rates (LBR) were 33.33% and 32.25%, respectively, (p=0.99909). The CPR in the VP group (83 patients) was 46.89% versus 41.02% in the IMP group, (p=0.5459). The LBR was 33.73% in the VP group and 30.76% in the IMP group (39 patients), (p=0.7559). CONCLUSIONS: The CPR and LBR of patients undergoing FET in groups prescribed and not prescribed low doses of recombinant hCG were similar. No significant difference was found between patients given VP or IMP.

Rotator Interval vs Posterior Approach Ultrasound-guided Corticosteroid Injections in Primary Frozen Shoulder: A Meta-analysis of Randomized Controlled Trials.

OBJECTIVE: To compare the efficacy of rotator interval (RI) vs posterior approach (PA) ultrasound (US) guided corticosteroid injections into the glenohumeral (GH) joint in primary frozen shoulder (PFS). DATA SOURCES: A systematic literature search for all relevant studies on Medline, Scopus, Embase, Web of Science, and Cochrane Central, up to January 2023 was conducted. STUDY SELECTION: Randomized controlled trials that directly compared the US-guided corticosteroid injection into the RI and GH joint using PA in patients clinically and radiographically diagnosed with PFS. DATA EXTRACTION: The primary outcome was pain, and the secondary outcomes were function, and range of motion (ROM). Two authors independently assessed the risk of bias using the Cochrane risk-of-bias tool version 2. A random-effects model and generic inverse variance method were performed. Effect sizes were estimated using mean difference (MD) and standardized mean difference (SMD). DATA SYNTHESIS: A total of 5 clinical trials involving 323 subjects were included for the meta-analysis. US-guided corticosteroid injections into the RI revealed significant pain relief (MD 1.33 [95% confidence interval (CI) 0.20 to 2.46]; P=.02) and significant functional improvement (SMD 1.31 [95% CI 0.11 to 2.51]; P=.03) compared with the PA after 12 weeks. CONCLUSION: The results suggest the injection of corticosteroid into RI space is more effective than PA after 12 weeks in improving both pain and functional scores in patients with PFS.

Evaluation of survival and functionality in frozen platelets

ABSTRACT Objective: Prolong platelet survival and functionality up to 28 days. Methods: A sample of apheresis platelets was evaluated, distributed in 3 groups according to the cryopreservative solution used: DMS05%+2%albumin; DMSO5%+NaC10,9% and DMS05%+Dextrose2%. They were then frozen at -80 °C and thawed at 7, 14 and 28 days. The in vitro survival and viability were assessed by the post-thaw platelet count and the CD41, CD61 and CD42a staining percentages by flow cytometry. The functionality was determined with the percentage of post-stimulation aggregation with INm-thrombin using the Chromo-Log490 aggregometer. The control group (CG) consisted of fresh platelets under constant agitation at 22 °C. Results: A total of 72 platelet aliquots was analyzed. The CG presented a platelet-count of 1934 ± 0.5 × 109/L and a 100% viability. The percentages of CD41, CD61 and CD42a labeling were 99, 98.5 and 96.5%, respectively. The percentage of aggregation was 99%. On day 7 of the post-freezing, the platelet count for groups 1, 2 and 3 was 1,844 ± 102, 1,856 ± 76 and 1,752 ± 226, with the viability of 98, 96 and 95%, respectively. On day 14, the counts were 1,722 ± 238, 1,649 ± 215 and 1,578 ± 223 with the viability of 96, 95 and 94% and, on day 28, they were 1,602 ± 374, 1,438.6 ± 429 and 1,406.6 ± 436, with the viability of 96, 94 and 93%, respectively. Groupl presented a higher expression of membrane antigens. Aggregation percentages were 90, 98 and 89% at day 7, 88%, 98 and 87% at day 14 and 84%, 95 and 82% at day of the 28 post-freezing, respectively, with group2 presenting the best results. Conclusion: The results support cryopreservation as a reasonable method to prolong platelet survival up to 28 days, maintaining its functionality and viability greater than 50%.

Agreement between frozen section and histopathology to detect malignancy in adnexal masses according to size and morphology by ultrasound

Abstract Objective Management of suspect adnexal masses involves surgery to define the best treatment. Diagnostic choices include a two-stage procedure for histopathology examination (HPE) or intraoperative histological analysis - intraoperative frozen section (IFS) and formalin-fixed and paraffin-soaked tissues (FFPE). Preoperative assessment with ultrasound may also be useful to predict malignancy. We aimed at determining the accuracy of IFS to evaluate adnexal masses stratified by size and morphology having HPE as the diagnostic gold standard. Methods A retrospective chart review of 302 patients undergoing IFS of adnexal masses at Hospital de Clínicas de Porto Alegre, between January2005 and September2011 was performed. Data were collected regarding sonographic size (≤10cm or >10cm), characteristics of the lesion, and diagnosis established in IFS and HPE. Eight groups were studied: unilocular lesions; septated/cystic lesions; heterogeneous (solid/cystic) lesions; and solid lesions, divided in two main groups according to the size of lesion, ≤10cm or >10cm. Kappa agreement between IFS and HPE was calculated for each group. Results Overall agreement between IFS and HPE was 96.1% for benign tumors, 96.1% for malignant tumors, and 73.3% for borderline tumors. Considering the combination of tumor size and morphology, 100% agreement between IFS and HPE was recorded for unilocular and septated tumors ≤10cm and for solid tumors. Conclusion Stratification of adnexal masses according to size and morphology is a good method for preoperative assessment. We should wait for final HPE for staging decision, regardless of IFS results, in heterogeneous adnexal tumors of any size, solid tumors ≤10cm, and all non-solid tumors >10cm.

Transfusion of non-red blood cell blood products does not reduce survival following cardiac surgery.

OBJECTIVES: The literature supports the assertion that patients undergoing cardiac surgery who receive perioperative packed red blood cell (pRBC) transfusions have increased associated mortality. The aim of the current study is to assess whether there is an association between non-pRBC blood product transfusions and increased mortality. METHODS: Data from our center's Society of Thoracic Surgeons database included patients who underwent cardiac surgery from 2010 to 2018. Patients with pRBC transfusions or circulatory arrest were excluded. Propensity matching was performed (1:1; caliper = 0.2 times the standard deviation of logit of propensity score). Kaplan-Meier estimates and Cox regression were used. Cardiac transplant, ventricular assist devices, transcatheter aortic valves, and patients who had experienced circulatory arrest were excluded from this analysis. RESULTS: A total of 8042 patients met criteria for analysis. Following propensity matching (1:1), 395 patients requiring perioperative non-pRBC blood products (platelets, fresh-frozen plasma, and cryoprecipitate) were matched with 395 nontransfusion patients, yielding equitable patient cohorts. Median follow-up was 4.5 (3.0-6.4) years. Patients received platelets (327 [82.8%]), fresh-frozen plasma (141 [35.7%]), and cryoprecipitate (60 [15.2%]). There was no significant difference in the postoperative mortality (6 [1.5%] vs 4 [1.0%]; P = .52). Reoperation (20 [5.0%] vs 8 [2.0%]; P < .02) and prolonged ventilation (36 [9.1%] vs 19 [4.8%]; P < .02) were greater in the transfusion group. Emergent operation (odds ratio [OR] 2.86 [1.72-4.78]; P < .001), intra-aortic balloon pump (OR 3.24 [1.64-6.39]; P < .001), and multivalve operation (OR 4.34 [2.83-6.67]; P < .001) were significantly associated with blood product use. Blood product transfusion (hazard ratio; 1.15 [0.89-1.48]; P = .3) was not significantly associated with increased mortality risk. There was no significant long-term survival difference between cohorts. CONCLUSIONS: Patients who undergo cardiac surgery requiring blood products alone, without pRBC transfusion, have similar postoperative and long-term survival compared with patients not requiring blood products. These data are based on a limited patient sample, and future studies will aid in improving the generalizability of these results.

Effectiveness of high-intensity laser therapy in the treatment of patients with frozen shoulder: a systematic review and meta-analysis.

The purpose of this study is to evaluate the effects of high-intensity laser therapy (HILT) in patients with frozen shoulder. PRISMA guidelines were adhered to, and a systematic search was conducted in the PubMed, Web of Science, Scopus, CINAHL, Science Direct, and PEDro databases (last update: September 4, 2023; search period: December 2022-September 2023). The inclusion criteria encompassed RCTs comparing HILT with other physical therapy interventions in frozen patients with frozen shoulders, with or without sham HILT, assessing pain intensity, shoulder ROM, and disability outcomes. The quality of the RCTs was assessed with the Cochrane Risk of Bias tool, and evidence was assessed using the GRADE approach. Five trials met the eligibility criteria and were included in the review and meta-analysis, which pooled results from the visual analog scale (VAS), goniometry, and the shoulder pain and disability index (SPADI). Mean differences (MDs) for pain intensity and disability show a pooled effect in favor of HILT both for VAS (MD = - 2.23 cm, 95% CI: - 3.25, - 1.22) and SPADI (MD = - 10.1% (95% CI = - 16.5, - 3.7), changes that are statistical (p < 0.01) and clinical. The MD for flexion (MD = 9.0°; 95% CI: - 2.36°, 20.3°; p = 0.12), abduction (MD = 3.4°; 95% CI: - 6.9°, 13.7°; p = 0.51), and external rotation (MD = - 0.95°; 95% CI: - 5.36°, 3.5°; p = 0.67) does not show statistical and clinical differences between groups after treatment. PI and disability changes were graded as important due to their clinical and statistical results. HILT into a physical therapy plan reduce pain and disability, but it does not outperform conventional physical therapy in improving shoulder ROM. It is suggested that future RCTs compare the effects of HILT and LLLT to assess their possible differences in their analgesic effects.

Effective mechanical properties of frozen hydrogel with ice inclusions.

Hydrogel exhibits attractive mechanical properties that can be regulated to be extremely tough, strong and resilient, adhesive and fatigue-resistant, thus enabling diverse applications ranging from tissue engineering scaffolds, flexible devices, to soft machines. As a liquid-filled porous material composed of polymer networks and water, the hydrogel freezes at subzero temperatures into a new material composed of polymer matrix and ice inclusions: the frozen hydrogel displays dramatically altered mechanical properties, which can significantly affect its safety and reliability in practical applications. In this study, based upon the theory of homogenization, we predicted the effective mechanical properties (e.g., Young's modulus, shear modulus, bulk modulus and Poisson ratio) of a frozen hydrogel with periodically distributed longitudinal ice inclusions. We firstly estimated its longitudinal Young's modulus, longitudinal Poisson ratio and plane strain bulk modulus using the self-consistent method, and then its longitudinal and transverse shear modulus using the generalized self-consistent method; further, the results were employed to calculate its transverse Young's modulus and transverse Poisson ratio. We validated the theoretical predictions against both finite element (FE) simulation and experimental measurement results, with good agreement achieved. We found that the estimated transverse Poisson ratio ranges from 0.3 to 0.53 and, at low volume fraction of ice inclusions, exhibits a value larger than 0.5 that exceeds the Poisson ratios of both the polymer matrix and the ice inclusion (typically 0.33-0.35). Compared with other homogenization methods (e.g., the rule of mixtures, the Halpin-Tsai equations, and the Mori-Tanaka method), the present approach is more accurate in predicting the effective mechanical properties (in particular, the transverse Poisson ratio) of frozen hydrogel. Our study provides theoretical support for the practical applications of frozen liquid-saturated porous materials such as hydrogel.

Light Microscopic, Ultrastructure Analysis and Functional Morphology of Cornu aspersum Spermatozoa Contained in the Frozen Hermaphroditic Duct / Análisis de Microscopía de Luz, Ultraestructura y Morfología Funcional de Espermatozoides de Cornu aspersum Contenidos en el Conducto Hermafrodita Congelado

SUMMARY: In this study we describe the functional morphology of Cornu aspersum (Helix aspersa), spermatozoa using light, scanning (SEM) and transmission electron (TEM) microscopies. The studies were performed with sperm located in the frozen hermaphroditic duct. Our results showed that the head presents an elongated conical shape slightly coiled in a corkscrew, with the nucleus partially covered by an acrosome, where an apical vesicle is located at the lateralized apex. This peculiar shape suggests the helical displacement movement of the spermatozoa. The head and the nucleus are slightly larger size compared to those of other gastropod species. The intermediate tract is surrounded by a mitochondrial complex and a glycogen helix. The glycogen helix is coiled helically along the intermediate tract, presenting at least five twists of glycogen helices. The complexity of both the mitochondrial complex and the glycogen helix suggests a high metabolic consumption considering the long period of time until fertilization occurs. Our findings on the detailed characterization of Cornu aspersum spermatozoa, obtained from a frozen hermaphroditic duct can contribute to a better understanding of the functional morphology of sperm and serve as a reference for future studies.

En este estudio describimos la morfología funcional de Cornu aspersum (Helix aspersa), espermatozoides utilizando microscopías de luz, barrido (SEM) y electrónica de transmisión (TEM). Los estudios se realizaron con espermatozoides localizados en el conducto hermafrodita congelado. Nuestros resultados mostraron que la cabeza presenta una forma cónica alargada ligeramente enrollada en un tirabuzón, con el núcleo parcialmente cubierto por un acrosoma, donde se ubica una vesícula apical en el ápice lateralizado. Esta peculiar forma sugiere el movimiento de desplazamiento helicoidal de los espermatozoides. La cabeza y el núcleo son de un tamaño ligeramente mayor en comparación con los de otras especies de gasterópodos. El tracto intermedio está rodeado por un complejo mitocondrial y una hélice de glucógeno. La hélice de glucógeno se enrolla helicoidalmente a lo largo del tracto intermedio, presentando al menos cinco giros de hélices de glucógeno. La complejidad tanto del complejo mitocondrial como de la hélice de glucógeno sugiere un alto consumo metabólico considerando el largo período de tiempo hasta que ocurre la fecundación. Nuestros hallazgos sobre la caracterización detallada de los espermatozoides de Cornu aspersum, obtenidos de un conducto hermafrodita congelado, pueden contribuir a una mejor comprensión de la morfología funcional de los espermatozoides y servir como referencia para futuros estudios.

ART in Latin America: the Latin American Registry, 2020.

RESEARCH QUESTION: What was the utilization, effectiveness and safety of assisted reproductive technology (ART) in Latin America during 2020? DESIGN: Retrospective collection of multinational data on ART performed by 188 institutions in 16 countries. RESULTS: Overall, 87,732 initiated cycles resulted in 12,778 deliveries and 14,582 births. The major contributors were Brazil (46.0%), Mexico (17.0%) and Argentina (16.8%). However, the highest utilization (cycles/million inhabitants) was Uruguay with 558, followed by Argentina with 490 and Panama with 425 cycles/million. Globally, women aged ≥40 years increased to 34% while women ≤34 dropped to 24.7%. After removing freeze-all cycles, the delivery rate per oocyte retrieval was 14.8% for intracytoplasmic sperm injection and 15.6% for IVF. Single-embryo transfer (SET) represented 38.3% of all fresh transfers, with delivery rate per transfer of 20.0%; this increased to 32.4% for elective SET (eSET) and 34.2% for blastocyst eSET, compared with blastocyst elective double embryo transfer (eDET) of 37.9%. However, multiple births increased from 1% in eSET to 30.5% in eDET. Perinatal mortality increased from 7.7‰ in singletons to 24.4‰ in twins and 64.0‰ in triplets. Frozen embryo transfer (FET) represented 66.6% of all transfers, with a delivery rate/transfer of 29.0%, significantly higher than 23.9% after fresh transfers at all ages (p<0.0001). Preimplantation genetic testing, reported in 8920 cycles, significantly improved delivery rate and decreased miscarriage rates at all ages (p≤0.041), including oocyte donation (p=0.002). Endometriosis was diagnosed in 28.3% of cases. The delivery rate in 5779 women after removal of peritoneal endometriosis was significantly better than tubal and endocrine factors in women aged 35-39 (p=0.0004) and women aged ≥40 (p=0.0353). CONCLUSIONS: Systematic collection and analysis of big data in a south-south cooperation model allow regional growth by implementing evidence-based reproductive decisions.

Glass wool column filtration for stallion sperm selection: A comparative analysis with the single-layer colloid centrifugation.

Glass wool column filtration (GWCF) selects human, bull, boar, dog and buffalo spermatozoa, but reports in the horse are scarce. Single-layer colloid centrifugation with Androcoll-E™ is currently the standard procedure to select good-quality equine sperm. This study was designed to assess GWCF (50 and 75 mg columns; GWCF-50 and GWCF-75, respectively) efficacy to select good-quality sperm from fresh and frozen-thawed equine semen, and to compare its performance with Androcoll-E™ colloid centrifugation. Percentage total motile (TM), progressively motile (PM), morphologically normal (MN), osmotically competent (HOS+) and acrosome-intact/osmotically competent (AI/HOS+) sperm were determined. In studies done with fresh semen samples (n = 17), suspensions subjected to GWCF-50 showed an improvement (p < .05) in PM and HOS+ sperm after selection. With GWCF-75, an increase (p < .05) in PM, MN and HOS+ sperm was observed. Results with GWCF were comparable or better than with Androcoll-E™ selection. Sperm recovery was similar between procedures for all semen parameters. Total sperm count recovery was lower after GWCF-75 (GWCF-50 = 60.0; GWCF-75 = 51.0; Androcoll-E™ = 76.0 million sperm; median; p = .013), but results on total progressive sperm count were similar (GWCF-50 = 23.0; GWCF-75 = 27.0; Androcoll-E™ = 24.0 million sperm; median; p = .3850). Using frozen-thawed semen samples (n = 16), an improvement (p < .05) in TM, PM, NM, HOS+ and AI/HOS+ sperm was observed in GWCF-75 filtrates. Results were comparable to Androcoll-E™ centrifugation, except HOS+ that increased (p < .05) only after GWCF-75. Recovery was comparable for all parameters in frozen samples. GWCF is a simple and low-cost procedure that selects equine sperm with a quality comparable to colloid centrifugation with Androcoll-E™.

Using maltodextrin and state diagrams to improve thermal transitions in tilapia fillet (Oreochromis spp.).

BACKGROUND: Tilapia (Oreochromis spp.) in the form of frozen fillets is one of the fishes with the highest commercial production levels worldwide. However, protein denaturation, membrane rupture, and lipid oxidation are commonly observed in fillets when stored at standard commercial freezing temperatures for long periods. This study proposes, for the first time, the use of maltodextrin and state diagrams to define processing strategies and suitable storage temperatures for fresh and dehydrated tilapia fillets. Differential scanning calorimetry (DSC) was used to study the effect of maltodextrin weight fractions ( W MD ) of 0, 0.4, and 0.8 on the thermal transitions of tilapia fillets as a function of solid mass fractions ( W s ). RESULTS: The glass transition temperature curve ( T g vs . W s ) and characteristic parameters of maximal freeze concentration ( T g ' , T m ' , W s ' ) of tilapia increased significantly with the addition of maltodextrin. Using developed state diagrams, freezing and storage temperatures of -22 °C, -15 °C, and -10 °C (P < 0.05) for long-term preservation were defined for tilapia fillets produced with W MD of 0, 0.4, and 0.8. CONCLUSION: Maltodextrin is an excellent alternative as a cryoprotectant and drying aid to increase the thermal parameters of tilapia fillets by achieving frozen storage temperatures above the standard commercial freezing temperature of -18 °C. © 2023 Society of Chemical Industry.

Angioedema after rt-PA infusion led to airway emergency: a case report of rescue treatment with fresh frozen plasma

Abstract The authors report the case of a 71-year-old woman presented to the Emergency Department with acute ischemic stroke. She was treated with rt-PA and interventional endovascular revascularization and developed rapidly progressing angioedema that led to emergency intubation. The standard treatment was not very effective and the swelling improved after infusion of fresh frozen plasma. Angioedema after rt-PA infusion could be a life-threatening emergency that requires quick airway management by skilled professionals. As this condition is triggered by several factors, such as unregulated histamine and bradykinin production, the traditional treatment recommended by the guidelines may not be sufficient and the use of FFP can be considered as a safe and valuable aid.

Emergent hybrid surgical approaches for non-dissecting ruptured Kommerell's aneurysm: a case report series.

BACKGROUND: Kommerell's aneurysm is a saccular or fusiform dilatation found in 3-8% of Kommerell's diverticulum cases. A non-dissecting rupture rate of 6% has been reported. If ruptured, emergent surgical correction is usually granted. However, evidence regarding the optimal surgical approach in this acute setting is scarce. In this case report series, we aim to describe our experience managing type-1 non-dissecting ruptured Kommerell's aneurysm with hybrid emergent surgical approaches. CASES PRESENTATION: From January 2005 to December 2020, three cases of type-1 non-dissecting ruptured Kommerell's aneurysm requiring emergent surgical repair were identified. The mean age was 66.67 ± 7.76 years, and 3/3 were male. The most common symptoms were atypical chest pain, dyspnoea, and headache (2/3). The mean aneurysm's diameter was 63.67 ± 5.69 mm. Frozen Elephant Trunk was the preferred surgical approach (2/3). The Non-Frozen Elephant Trunk patient underwent a hybrid procedure consisting of a supra-aortic debranching and a zone-2 stent-graft deployment. We found a mean clamp time of 140 ± 60.75 min, cardiac arrest time of 51.33 ± 3.06 min, and a hospital stay of 13.67 ± 5.51 days. The most common complications were surgical-site infection and shock (2/3). Only one patient died (1/3). CONCLUSION: Evidence of management for non-dissecting ruptured Kommerell's aneurysms is scarce. Additional, robust, and more extensive studies are required. The selection of the appropriate surgical approach is challenging, and each patient should be individualized. Frozen Elephant Trunk was feasible for patients requiring emergent surgical repair in our centre. However, other hybrid or open procedures can be performed.

Case report: Multi-site perfusion strategy for type A acute aortic dissection complicated with cerebral malperfusion.

Acute type A dissection presenting with cerebral malperfusion has high morbidity and mortality. Given the complexity of underlying vascular involvement, it is a challenging clinical scenario. Many of these patients are not deemed surgical candidates. If surgery is considered, it often requires complex aortic arch and neck vessel reconstruction. We present a 48-year-old male with an acute type A aortic dissection that presented with paraplegia and decreased level of consciousness. A Computed Tomography showed occlusion of both common carotid arteries. He was successfully treated with a multi-site perfusion strategy and a Hybrid Frozen Elephant Trunk graft to achieve fast restoration of the cerebral circulation and minimize brain ischemia and permanent neurological damage. From this case, we learn that aggressive arch and neck vessel reconstruction supported by multi-site perfusion could help improve mortality and neurological outcomes in selected patients.

Comparison of tamoxifen and hormone replacement cycle (HRT) in frozen embryo transfer. A randomized controlled trial.

OBJECTIVE: The use of frozen embryos in the treatment of infertility with assisted reproductive techniques has been increased. Different methods are used to prepare the endometrium for frozen embryo transfer (FET). The aim of this study was to compare pregnancy outcomes after treatment with tamoxifen and hormonal replacement therapy (HRT) in FET. METHODS: This randomized clinical trial was carried out with 214 infertile women in the infertility research center of Milad Hospital in Mashhad during 2018-2020. We had 84 patients receiving tamoxifen and 92 took HRT. Endometrial thickness (ET) and pregnancy outcome were measured in both groups. RESULTS: Mean infertility duration (p=0.328), number of embryos (p=0.649), FSH (p=0.390), LH (p=0.051) and LH/FSH ratio (p=0.287) as well as type of infertility (primary or secondary) (p=0.295), causes of infertility (p=0.750) and pattern of menstruation (p=0.676) were not significantly different in the two groups. Mean ET in the TMX and HRT groups were 8.72±1.45mm and 9.00±1.69mm, respectively (p=0.423). There was no statistically significant difference between chemical pregnancy (p=0.663), clinical pregnancy (p=0.994) and ongoing pregnancy (p≥0.999) in the TMX and HRT groups. CONCLUSIONS: Treatment with tamoxifen can be as effective as GnRH agonist for endometrial preparation in FET.