Bidirectional Interactions between the Menstrual Cycle, Exercise Training, and Macronutrient Intake in Women: A Review.

Women have a number of specificities that differentiate them from men. In particular, the role of sex steroid hormones and the menstrual cycle (MC) significantly impact women's physiology. The literature has shown nonlinear relationships between MC, exercise, and nutritional intake. Notably, these relationships are bidirectional and less straightforward than one would suppose. For example, the theoretical implications of the MC's phases on exercise performance do not always translate into relevant practical effects. There is often a disconnect between internal measures (e.g., levels of hormone concentrations) and external performance. Furthermore, it is not entirely clear how nutritional intake varies across the MC's phases and whether these variations impact on exercise performance. Therefore, a thorough review of the existing knowledge could help in framing these complex relationships and potentially contribute to the optimization of exercise prescription and nutritional intake according to the naturally occurring phases of the MC. Throughout this review, an emerging trend is the lack of generalizability and the need to individualize interventions, since the consequences of the MC's phases and their relationships with exercise and nutritional intake seem to vary greatly from person to person. In this sense, average data are probably not relevant and could potentially be misleading.

Classification of knee arthropathy with accelerometer-based vibroarthrography.

One of the most common knee joint disorders is known as osteoarthritis which results from the progressive degeneration of cartilage and subchondral bone over time, affecting essentially elderly adults. Current evaluation techniques are either complex, expensive, invasive or simply fails into detection of small and progressive changes that occur within the knee. Vibroarthrography appeared as a new solution where the mechanical vibratory signals arising from the knee are recorded recurring only to an accelerometer and posteriorly analyzed enabling the differentiation between a healthy and an arthritic joint. In this study, a vibration-based classification system was created using a dataset with 92 healthy and 120 arthritic segments of knee joint signals collected from 19 healthy and 20 arthritic volunteers, evaluated with k-nearest neighbors and support vector machine classifiers. The best classification was obtained using the k-nearest neighbors classifier with only 6 time-frequency features with an overall accuracy of 89.8% and with a precision, recall and f-measure of 88.3%, 92.4% and 90.1%, respectively. Preliminary results showed that vibroarthrography can be a promising, non-invasive and low cost tool that could be used for screening purposes. Despite this encouraging results, several upgrades in the data collection process and analysis can be further implemented.

Percutaneous needle fasciotomy in Dupuytren's contracture: is it a viable technique?

The aim of this retrospective study was to evaluate the results of 44 percutaneous needle fasciotomies for Dupuytren's contracture, performed from March 2005 to June 2010. The mean age of the 36 patients was 58 years and the mean follow-up period was 28 months. The assessment was based on the clinical records and clinical evaluation. Pre-operative and postoperative total passive extension deficit and complications were registered. Recurrence and patient satisfaction were also noted. The results in stage I and II of Tubiana were interesting, with an average improvement of more than 70%. For more severe deformities, the correction obtained was not so satisfactory and decreased significantly over time. The cumulative rate of minor complications was significant (11/44) but there were no major complications or permanent sequelae. Most of the patients were satisfied with the result and would recommend the procedure or would be willing to repeat it if necessary. The recurrence rate was 9%. Percutaneous needle fasciotomy appeared in this study as a minimally invasive, simple and fast technique with low morbidity. These features make this technique a valid alternative in mild stages of Dupuytren's disease.

Intramedullary screw fixation of proximal fifth metatarsal fractures in athletes.

OBJECTIVE: The purpose of this study was to review the short- and long-term clinical and radiological results of intramedullary compression screw fixation of proximal fifth metatarsal fractures in athletes. METHODS: Eleven male and six female active patients with fifth metatarsal zone II and zone III fractures fixed with a 4.5-mm cannulated compression screw were evaluated by chart review, review of radiographs, and clinical evaluation. Fifteen of the patients were high-level athletes (soccer: n=11; basketball: n=1; track and field: n=3) and two were recreational-level athletes. Mean follow-up from surgery to evaluation was 54 (38-70) months. RESULTS: Mean time to healing as shown on radiographs and mean time to return to full activity after surgery were 7.3 and 7.5 weeks, respectively. All patients were able to return to their previous levels of activity. There were no reports of union delay, nonunion or refracture to date. CONCLUSION: In our patients, cannulated screw fixation of proximal fifth metatarsal fractures was a reliable procedure with low morbidity associated that provided athletes a quick return to activity. Level of Evidence I, Case Series .

Osteossíntese com parafuso intramedular nas fraturas proximais do quinto metatarsiano do atleta / Intramedullary screw fixation of proximal fifth metatarsal fractures in athletes

OBJETIVO: Avaliar os resultados clínicos e radiológicos da osteossíntese com parafuso de compressão intramedular nas fraturas proximais do quinto metatarsiano no atleta. MÉTODOS: Foram incluídos no estudo 11 homens e seis mulheres com diagnóstico de fratura das zonas II e III do quinto metatarsiano. Quinze dos pacientes praticavam esporte a nível profissional ou de alto rendimento (futebol: n=11; basquetebol: n=1; atletismo: n=3) e dois praticavam atividade esportiva regular a nível recreacional. Foram submetidos a fixação cirúrgica com parafuso canulado de compressão (4.5mm de diâmetro). Todos os pacientes foram avaliados clinicamente e através da revisão do processo clínico e dos estudos imagiológicos. O tempo médio de seguimento após a cirurgia foi 54 meses (38-70). RESULTADOS: O tempo médio de consolidação (como demonstrado pelo estudo radiológico) e de retorno à atividade esportiva foi 7.3 e 7.5 semanas, respectivamente. Todos os atletas retornaram aos níveis de atividade prévios. Não verificamos atrasos de consolidação, não-união ou refraturas à data do estudo. CONCLUSÃO: A osteossíntese com parafuso de compressão intramedular nas fraturas proximais do quinto metatarsiano demonstrou, nos nossos pacientes, ser um procedimento eficaz com taxas de morbilidade muito reduzidas e que permite ao atleta um retorno precoce à atividade esportiva. Nível de evidência I, Série de Casos.

OBJECTIVE: The purpose of this study was to review the short- and long-term clinical and radiological results of intramedullary compression screw fixation of proximal fifth metatarsal fractures in athletes. METHODS: Eleven male and six female active patients with fifth metatarsal zone II and zone III fractures fixed with a 4.5-mm cannulated compression screw were evaluated by chart review, review of radiographs, and clinical evaluation. Fifteen of the patients were high-level athletes (soccer: n=11; basketball: n=1; track and field: n=3) and two were recreational-level athletes. Mean follow-up from surgery to evaluation was 54 (38-70) months. RESULTS: Mean time to healing as shown on radiographs and mean time to return to full activity after surgery were 7.3 and 7.5 weeks, respectively. All patients were able to return to their previous levels of activity. There were no reports of union delay, nonunion or refracture to date. CONCLUSION: In our patients, cannulated screw fixation of proximal fifth metatarsal fractures was a reliable procedure with low morbidity associated that provided athletes a quick return to activity. Level of Evidence I, Case Series.

Diagnostic accuracy of combined 99mTc-sulesomab and 99mTc-nanocolloid bone marrow imaging in detecting prosthetic joint infection.

OBJECTIVE(S): Autologous-labeled leukocytes combined with sulfur colloid bone marrow scan is the current nuclear medicine gold standard for the diagnosis of prosthetic joint infection. The goal of this study is to assess the diagnostic accuracy of a new nuclear medicine modality for detecting infection in this context. METHODS: Twenty-seven patients with suspicious hip and knee arthroplasties were enrolled prospectively and underwent nuclear medicine testing using 99mTc-sulesomab and 99mTc-nanocolloids sequentially. These results were then crossed with the final diagnosis to determine the test(s) diagnostic accuracy. RESULTS: An isolated 99mTc-sulesomab scan shows 100% sensitivity (0.40-1) and negative predictive value (0.31-1) but only 20% specificity (0.05-0.48). Combining it with a 99mTc-nanocolloid bone marrow scan increases the specificity (0.75-1) and the positive predictive value (0.40-1) to 100%. Furthermore, the combined test has fewer equivocal readings and higher interreader agreement: κ test value 0.59 vs. 0.44. CONCLUSION: The results support the hypothesis that these technically simpler and ready-to-use products may be an alternative to autologous-labeled leukocytes/sulfur colloid marrow scan.

HYBRID ANKLE PROSTHESIS IN A CASE OF POST-TRAUMATIC AVASCULAR NECROSIS OF THE TALUS.

Talus fractures often lead to late post-traumatic arthrosis. In such cases, the use of latest generation, cementless prostheses has been hindered by the presence of avascular necrosis. We report the case of a 65-year-old patient who presented four years after a talus neck fracture. He had painful ankle arthrosis (AOFAS ankle-hindfoot score 19) and avascular necrosis, with collapse of the entire talar dome. Given the extent of the necrosis, it was decided to cement the talus prosthetic component. One year after the surgery, the patient shows good clinical and radiological results (AOFAS ankle-hindfoot score 87) and is satisfied with the procedure. We are not aware of any similar reports in the literature.

Prótese do tornozelo híbrida em um caso de necrose avascular pós-traumática do tálus / Hybrid ankle prosthesis in a case of post-traumatic avascular necrosis of the talus

As fraturas do astrágalo originam frequentemente artrose pós-traumática tardia. Nestes casos, a utilização de próteses do tornozelo não cimentadas de última geração tem sido evitada pela presença de necrose avascular. Relatamos o caso de um paciente com 65 anos que se apresenta quatro anos após uma fratura do colo do astrágalo. Apresentava uma artrose do tornozelo dolorosa (escala AOFAS do retropé e tornozelo 19) e necrose avascular com colapso de toda a cúpula astragalina. Dada a extensão da necrose, foi decidido cimentar o componente protésico astragalino. Um ano após a cirurgia, o paciente apresenta bom resultado clínico e radiológico (escala AOFAS do retropé e tornozelo 87) e está satisfeito com o procedimento. Não temos conhecimento de nenhum relato semelhante na literatura.

Talus fractures often lead to late post-traumatic arthrosis. In such cases, the use of latest generation, cementless prostheses has been hindered by the presence of avascular necrosis. We report the case of a 65-year-old patient who presented four years after a talus neck fracture. He had painful ankle arthrosis (AOFAS ankle-hindfoot score 19) and avascular necrosis, with collapse of the entire talar dome. Given the extent of the necrosis, it was decided to cement the talus prosthetic component. One year after the surgery, the patient shows good clinical and radiological results (AOFAS ankle-hindfoot score 87) and is satisfied with the procedure. We are not aware of any similar reports in the literature.

Empirical antibiotic therapy in prosthetic joint infections.

When dealing with prosthetic joint infections (PJI) there is often the need to start antibiotic therapy without having identified the underlying pathogen. Under these circumstances there is no consensus regarding which antibiotic to use. We aimed to produce local recommendations for empirical antibiotic treatment of PJI by describing the microbiological spectrum involved and respective antibiotic susceptibility profile. We examined the records of 75 consecutive patients that underwent surgery for prosthetic joint infection from July 2001 to December 2008. There were 49 women and 26 men with an average age of 63 years. Ninety culture results were available from 41 hips and 34 knee replacements. Staphylococcus sp. was present in most infections (72.8%) regardless of surgical site or classification. The prevalence of methicillin-resistance among staphylococci was 64.2% with no relevant difference between sub-groups. Vancomycin is 100% effective against most commonly isolated Gram positives. Gram negative pathogens were present in about 15% of all cases, especially in haematogenous and chronic infections. Carbapenems and aminoglycosides are the most effective antibiotics against these pathogens. Our results suggest that in acute post-operative infections, treatment should start with vancomycin. In chronic and haematogeneous infections, vancomycin in combination with carbapenems appears to be an effective regimen. Treatment should be adjusted as soon as preliminary or definitive microbiology results are available.

Sequelas a longo prazo de fracturas do corpo e colo do astrágalo / Long-term results of body and neck talus fractures

OBJETIVO: As fracturas do colo e corpo do astrágalo são lesões infrequentes. O objectivo deste estudo é avaliar a prevalência de sequelas a longo prazo. MÉTODOS: Foi feita uma análise retrospectiva que incluiu um total de 11 doentes sujeitos a tratamento cirúrgico por fracturas do corpo ou colo do astrágalo entre Janeiro de 1997 e Dezembro de 2005. A avaliação final foi clínica (utilizando a escala AOFAS) e radiológica. RESULTADOS: O seguimento médio foi 58,5 meses. A prevalência de lesões ósseas associadas foi de 60 por cento (6/10). O resultado AOFAS médio foi 72 [19-100] pontos. A necrose avascular e/ou artrose pós-traumática ocorreu em metade dos doentes. A qualidade da redução cirúrgica, as fracturas do corpo e a ausência de alterações degenerativas relacionaram-se com melhores resultados funcionais. As fracturas do colo, a osteonecrose e a presença de artrose pós-traumática conduziram a piores resultados. CONCLUSÃO: Há um grande potencial para sequelas tardias e compromisso funcional devido a artrose e dor crónica após esse tipo de fracturas. A redução anatómica cirúrgica é a melhor hipótese de as evitar, mas não é infalível. A taxa de necrose avascular relaciona-se com o grau de desvio inicial da fractura, mas a sua ocorrência em cada caso específico é imprevisível.

OBJECTIVES: Talar neck and body fractures are unusual fractures. The purpose of this study is to determine the prevalence of long term results. MATERIAL AND METHODS: A retrospective analysis was carried out including 11 patients that underwent surgical treatment for body or neck talus fractures between January 1997 and December 2005. Final follow-up examination included a clinical evaluation (AOFAS score) and standard radiographs. RESULTS: The mean follow-up time was 58.5 months. The prevalence of associated fractures was 60 percent (6/10). Overall AOFAS score averaged 72 [19-100]. Avascular necrosis and posttraumatic arthritis were present in half of the patients. Quality of surgical reduction, body fractures and absence of degenerative changes were correlated with better functional results. Neck fractures, osteonecrosis and posttraumatic arthritis led to inferior results. CONCLUSION: There is a great potential for long term functional impairment due to posttraumatic arthritis and chronic pain in this kind of fracture. Anatomic surgical reduction is the best chance to avoid them but it is not infallible. The avascular necrosis rate correlates with initial fracture displacement, but its occurrence in each specific case is unpredictable.

LONG-TERM RESULTS OF BODY AND NECK TALUS FRACTURES.

OBJECTIVES: Talar neck and body fractures are unusual fractures. The purpose of this study is to determine the prevalence of long term results. MATERIAL AND METHODS: A retrospective analysis was carried out including 11 patients that underwent surgical treatment for body or neck talus fractures between January 1997 and December 2005. Final follow-up examination included a clinical evaluation (AOFAS score) and standard radiographs. RESULTS: The mean follow-up time was 58.5 months. The prevalence of associated fractures was 60% (6/10). Overall AOFAS score averaged 72 [19-100]. Avascular necrosis and post-traumatic arthritis were present in half of the patients. Quality of surgical reduction, body fractures and absence of degenerative changes were correlated with better functional results. Neck fractures, osteonecrosis and posttraumatic arthritis led to inferior results. CONCLUSION: There is a great potential for long term functional impairment due to posttraumatic arthritis and chronic pain in this kind of fracture. Anatomic surgical reduction is the best chance to avoid them but it is not infallible. The avascular necrosis rate correlates with initial fracture displacement, but its occurrence in each specific case is unpredictable.

Bilateral posterior fracture-dislocation of the shoulder: Report of two cases.

Bilateral posterior fracture-dislocation of the shoulder is a very rare injury. Almost 50% of bilateral posterior dislocations are due to a convulsive seizure, rising to 90% if the dislocations are associated with fractures. Electric shock accounts for less than 5% of bilateral posterior dislocations of the shoulder. A systematization of the clinical and radiological approach, followed by an early diagnosis and proper surgical treatment is essential. Authors report 2 cases of bilateral posterior fracture-dislocation of the shoulder, one caused by a convulsive seizure and the other by an electric shock. A review of literature and a treatment protocol are also presented.