Functional and Radiologic Outcomes of Degenerative Versus Traumatic Full-Thickness Rotator Cuff Tears Involving the Supraspinatus Tendon.

BACKGROUND: Arthroscopic rotator cuff repair (ARCR) is among the most commonly performed orthopaedic procedures. Several factors-including age, sex, and tear severity-have been identified as predictors for outcome after repair. The influence of the tear etiology on functional and structural outcome remains controversial. PURPOSE: To investigate the influence of tear etiology (degenerative vs traumatic) on functional and structural outcomes in patients with supraspinatus tendon tears. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Patients undergoing ARCR from 19 centers were prospectively enrolled between June 2020 and November 2021. Full-thickness, nonmassive tears involving the supraspinatus tendon were included. Tears were classified as degenerative (chronic shoulder pain, no history of trauma) or traumatic (acute, traumatic onset, no previous shoulder pain). Range of motion, strength, the Subjective Shoulder Value, the Oxford Shoulder Score (OSS), and the Constant-Murley Score (CMS) were assessed before (baseline) and 6 and 12 months after ARCR. The Subjective Shoulder Value and the OSS were also determined at the 24-month follow-up. Repair integrity after 12 months was documented, as well as additional surgeries up to the 24-month follow-up. Tear groups were compared using mixed models adjusted for potential confounding effects. RESULTS: From a cohort of 973 consecutive patients, 421 patients (degenerative tear, n = 230; traumatic tear, n = 191) met the inclusion criteria. The traumatic tear group had lower mean baseline OSS and CMS scores but significantly greater score changes 12 months after ARCR (OSS, 18 [SD, 8]; CMS, 34 [SD,18] vs degenerative: OSS, 15 [SD, 8]; CMS, 22 [SD, 15]) (P < .001) and significantly higher 12-month overall scores (OSS, 44 [SD, 5]; CMS, 79 [SD, 9] vs degenerative: OSS, 42 [SD, 7]; CMS, 76 [SD, 12]) (P≤ .006). At the 24-month follow-up, neither the OSS (degenerative, 44 [SD, 6]; traumatic, 45 [SD, 6]; P = .346) nor the rates of repair failure (degenerative, 14 [6.1%]; traumatic 12 [6.3%]; P = .934) and additional surgeries (7 [3%]; 7 [3.7%]; P = .723) differed between groups. CONCLUSION: Patients with degenerative and traumatic full-thickness supraspinatus tendon tears who had ARCR show satisfactory short-term functional results. Although patients with traumatic tears have lower baseline functional scores, they rehabilitate over time and show comparable clinical results 1 year after ARCR. Similarly, degenerative and traumatic rotator cuff tears show comparable structural outcomes, which suggests that degenerated tendons retain healing potential.

Iontophoresis Improved Growth Reduction of Invasive Squamous Cell Carcinoma in Topical Photodynamic Therapy.

This study examined the potential of iontophoresis in topical photodynamic therapy (PDT) of human invasive squamous cells carcinomas (SCC). SCC was induced in nude BALB/c mice by subcutaneous injection of A431 cells. Tumor penetration and distribution of the photosensitizer tetrasulfonated zinc phthalocyanine (ZnPcS4) was investigated after 10 and 30 min of in vivo iontophoresis of a gel containing ZnPcS4. PDT was performed immediately after iontophoresis using laser at 660 nm with a dose of irradiation of 100 J/cm(2) and irradiance of 48 mW/cm(2) while tumor growth was measured for 30 days. Iontophoresis increased ZnPcS4 penetration into tumors by 6-fold after 30 min when compared with passive delivery. Confocal microscopy analysis showed that ZnPcS4 was homogeneous distributed within deep regions of the tumor after iontophoresis. Irradiation of the tumors immediately after iontophoresis showed reduction in tumor size by more than 2-fold when compared to non-treated tumors. Iontophoretic-PDT treated tumors presented large areas of necrosis. The study concluded that iontophoretic delivery of photosensitizers could be a valuable strategy for topical PDT of invasive SCC.

Chitosan microparticles for sustaining the topical delivery of minoxidil sulphate.

Given the hypothesis that microparticles can penetrate the skin barrier along the transfollicular route, this work aimed to obtain and characterise chitosan microparticles loaded with minoxidil sulphate (MXS) and to study their ability to sustain the release of the drug, attempting a further application utilising them in a targeted delivery system for the topical treatment of alopecia. Chitosan microparticles, containing different proportions of MXS/polymer, were prepared by spray drying and were characterised by yield, encapsulation efficiency, size and morphology. Microparticles selected for further studies showed high encapsulation efficiency (∼82%), a mean diameter of 3.0 µm and a spherical morphology without porosities. When suspended in an ethanol/water solution, chitosan microparticles underwent instantaneous swelling, increasing their mean diameter by 90%. Release studies revealed that the chitosan microparticles were able to sustain about three times the release rate of MXS. This feature, combined with suitable size, confers to these microparticles the potential to target and improve topical therapy of alopecia with minoxidil.

Iontophoretic transport of zinc phthalocyanine tetrasulfonic acid as a tool to improve drug topical delivery.

Phthalocyanines have been used as systemic photosensitizers because of their high affinity towards tumour tissue, and the high rates of reactive oxygen species produced when they are irradiated during photodynamic therapy. However, the topical administration of these compounds is limited by their large size, poor hydrosolubility and ionic character. This study aimed to investigate the iontophoretic delivery of charged zinc phthalocyanine tetrasulfonic acid (ZnPcS4) from a hydrophilic gel to different skin layers by means of in-vitro and in-vivo studies. Six hours of passive administration was insufficient for ZnPcS4 to cross the stratum corneum (SC) and to reach the epidermis and dermis. No positive effect was reached when anodal iontophoresis was performed, showing that the drug-electrode attraction effect was higher than the electro-osmosis contribution at a pH of 5.5. Cathodal iontophoresis, however, was able to transport significant amounts of the drug to the viable epidermis. In addition, the absence of NaCl in the formulation significantly increased (by five-fold) the amount of ZnPcS4 that crossed the SC and accumulated in the epidermis and dermis. It was possible to visualize the drug accumulation in the follicle openings and in the epidermis, even after SC removal. In-vivo experiments in rat skin showed that these results were maintained in an in-vivo model, even with only 15 min of iontophoresis. In addition, confocal analysis of the treated skin showed a homogeneous distribution of ZnPcS4 in the viable epidermis after this short period of cathodal iontophoresis.

Eficácia da compressão pneumática intermitente (CPI) nos membros inferiores sobre o fluxo sanguíneo das veias femorais comuns / Efficacy of intermittent pneumatic compression (IPC) in lower limbs on the blood flow of common femoral veins

CONTEXTO: A profilaxia do tromboembolismo venoso pode ser feita por métodos farmacológicos ou de forma mecânica, com o uso de meias antitrombo e compressão pneumática (CPI). A CPI é um método mecânico de profilaxia que merece melhor atenção da comunidade médica. OBJETIVO: Avaliar o efeito do uso de compressão pneumática intermitente (CPI) nos pés, pernas e coxas de adultos saudáveis sobre o fluxo sanguíneo nas veias femorais comuns. MÉTODOS: A amostra foi constituída de 10 voluntários (sete mulheres e três homens) adultos (20-40 anos), sem antecedente de tromboembolismo venoso. Após repouso (10 min) em decúbito dorsal, o fluxo sanguíneo era medido (três vezes) por ultra-sonografia vascular na veia femoral, a 1 cm acima da junção safeno-femoral, em ambos os membros, sem controle e com CPI no pé, perna e na coxa. A compressão (130 mmHg no pé e 45 mmHg na perna e na coxa) foi aplicada em ciclos de 11 segundos de compressão e 20-60 segundos de esvaziamento. As aferições de fluxo foram realizadas no pico de fluxo do ciclo de compressão. Os valores foram comparados por análise de variância (teste de Tukey), com p < 0,05 indicando diferença estatisticamente significante. RESULTADO: A utilização de CPI nos membros inferiores, esquerdo e direito, promoveu elevações percentuais relativas no fluxo venoso femoral de 37,6 e 70,8 por cento (pés), 143,9 e 164,7 por cento (pernas) e 132,6 e 128,9 por cento (coxas), respectivamente. As variações foram estatisticamente significantes para as aplicações nas pernas e coxas. CONCLUSÃO: A CPI melhora o fluxo sanguíneo quando aplicada na perna ou na coxa.

BACKGROUND: Prophylaxis of venous thromboembolism, a very common post-surgical complication, can be made pharmacologically or via mechanical methods, such as the use of anti-thrombosis socks and intermittent pneumatic compression (IPC). IPC is a mechanical method of prophylaxis that deserves the attention of the medical community. OBJECTIVE: To evaluate the effect of IPC on the blood flow of common femoral veins in feet, legs and thighs of healthy adults. METHODS: The sample was comprised of 10 volunteers (seven females and three males), adults (20-40 years), without history of venous thromboembolism. After a rest period (10 min), with the patient in the supine position, blood flow was measured (three times) via vascular ultrasonography at the femoral vein, 1 cm above of the saphenofemoral junction, in both limbs, without (control) and with IPC in the patient"s foot, leg and thigh. Compression (130 mmHg on foot and 45 mmHg on leg and thigh) was applied at compression cycles of 11 seconds and emptying cycles of 20-60 seconds. Blood flow evaluations were performed at compression cycle peaks. Values were compared by analysis of variance (Tukey test), p < 0.05 indicating statistically significant difference. RESULTS: Use of IPC on the left and right lower limbs caused a percentage increase in the femoral blood flow of 37.6 and 70.8 percent (feet), 143.9 and 164.7 percent (legs), and 132.6 and 128.9 percent (thighs), respectively. Variations were statistically significant for application in legs and thighs. CONCLUSION: Use of IPC improves blood flow when applied in legs or thighs.

Emprego da ecocardiografia convencional na avaliação de pacientes com miocardiopatia dilatada, candidatos à terapia de ressincronização / The use convencional echocardiography in the evaluation of patients with myocardiography, candidates to resyncronization therapy

O advento da ressincronização cardíaca (RC) representou um enorme avanço no campo da terapêutica da insuficiência cardíaca. No entanto, aproximadamente 30 por cento dos pacientes não respondem à RC, o que pode estar relacionado aos critérios de seleção. A ecocardiografia-doppler convencional vem auxiliando na seleção dos possíveis candidatos à RC, no ajuste da programação para cada paciente e na avaliação dos resultados agudos e a longo prazo.