Yoga and Physical Therapy for Chronic Pain and Opioid Use Disorder Onsite in an Opioid Treatment Program: A Randomized Controlled Trial.

BACKGROUND: There is a lack of integrated treatment for chronic pain and opioid use disorder (OUD). Yoga and physical therapy (PT) may improve pain and physical function of people living with (PLW) chronic low back pain (CLBP) and may also reduce opioid craving and use, but PLW with OUD face barriers to accessing these interventions. We hypothesize that compared to treatment as usual (TAU), providing yoga and PT onsite at opioid treatment programs (OTPs) will be effective at improving pain, opioid use, and quality of life among people with CLBP and OUD, and will be cost-effective. METHODS: In this hybrid type-1 effectiveness-implementation study, we will randomly assign 345 PLW CLBP and OUD from OTPs in the Bronx, NY, to 12 weeks of onsite yoga, onsite PT, or TAU. Primary outcomes are pain intensity, opioid use, and cost-effectiveness. Secondary outcomes include physical function and overall well-being. DISCUSSION: This trial tests an innovative, patient-centered approach to combined management for pain and OUD in real-world settings. We rigorously examine the efficacy of yoga and PT onsite at OTPs as nonpharmacologic, cost-effective treatments among people with CLBP and OUD who face barriers to integrated care.

Notable correlation between serum epidermal growth factor values and inflammatory status in patients with COVID-19.

INTRODUCTION: Despite its crucial role in Epidermal Growth Factor Receptor (EGFR) activation, and the resulting impact on the health-disease process, epidermal growth factor (EGF) is an underexplored molecule in relation to how its serum concentrations relate to other analytes and clinical variables in pathological contexts. OBJECTIVE: To clarify the possible correlation between EGF and clinical and analytical variables in the context of COVID-19. METHODS: Cross-sectional observational and analytical study, in patients with virological and clinical diagnosis of COVID-19, selected by simple random sampling, admitted between August and September 2021. UMELISA-EGF commercial kits were used. RESULTS: Differences in overall EGF values were observed between groups (566.04 vs. 910.53 pg/ml, p = .0430). In COVID-19 patients, no notable correlations were observed for neutrophil, platelet, triglyceride or liver enzyme values (p > .05). Significant correlations were observed with the neutrophil-lymphocyte indicator (r = 0.4711, p = .0128) as well as with the platelet-lymphocyte index (r = 0.4553, p = .0155). Statistical results of multivariate regression analysis suggest NLR (ß = .2232, p = .0353) and PLR (ß = .2117, p = .0411) are predictors of inflammation in patients with COVID-19. CONCLUSIONS: Serum EGF concentrations in COVID-19 correlate positively with prognostic inflammatory markers of severity and could presumably act as an independent risk factor for the development of inflammation in response to new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

The construction of urban cultural and creative industries using deep learning and information management.

The ongoing transition within the Chinese economy assumes a pivotal role in shaping the landscape of the cultural and creative industries (CCI). Renowned for its environmentally sustainable attributes, coupled with high productivity, CCI has garnered considerable attention across diverse societal strata. This study endeavors to delineate the determinants influencing the developmental trajectory of CCI, with a focal point on City A as the primary subject of investigation, juxtaposed against Cities G, D, B, H, and X for comparative analysis, leveraging developmental data from the year 2021. Initially, the study elucidates the conceptual framework underpinning CCI and its intrinsic significance in facilitating urban metamorphosis. Subsequently, the positive impact of CCI through deep learning and information management technology is emphasized, and a cultural and creative recommendation model based on LSTM algorithm is constructed. Through performance evaluation, the recommendation accuracy for cultural and creative projects reaches 94.74 %. A robust developmental assessment model for CCI is then constructed via meticulous factor analysis of pertinent influencers. Employing factor analysis techniques, the study identifies two primary determinants exerting sway over CCI development: sustainable profitability factors and cultural influence factors. Noteworthy among the factors influencing CCI development within City A are fixed asset investment, cultural industry financing, the proliferation of university-based research institutions, and per capita cultural expenditure by residents. Of these, fixed asset investment, cultural industry financing, and the density of university research institutions prominently impinge upon sustainable profitability, with a discernible impact weight of 0.738 in the evaluative framework of CCI development, thus significantly shaping its trajectory. Moreover, consumer psychological factors, particularly market consumption patterns, are observed to exert a discernible influence on CCI evolution. This study augurs fresh insights into the realm of CCI development, infusing it with renewed vigor and vitality. Moreover, it underscores the inherent interdependence and positive correlation among the various research factors, offering novel perspectives and methodologies germane to the advancement of urban CCI.

Breast Cancer Patient's Outcomes after Neoadjuvant Chemotherapy and Surgery at 5 and 10 Years for Stage II-III Disease.

Introduction: Neoadjuvant chemotherapy in breast cancer offers the possibility to facilitate breast and axillary surgery; it is a test of chemosensibility in vivo with significant prognostic value and may be used to tailor adjuvant treatment according to the response. Material and Methods: A retrospective single-institution cohort of 482 stage II and III breast cancer patients treated with neoadjuvant chemotherapy based on anthracycline and taxans, plus antiHEr2 in Her2-positive cases, was studied. Survival was calculated at 5 and 10 years. Kaplan-Meier curves with a log-rank test were calculated for differences according to age, BRCA status, menopausal status, TNM, pathological and molecular surrogate subtype, 20% TIL cut-off, surgical procedure, response to chemotherapy and the presence of vascular invasion. Results: The pCR rate was 25.3% and was greater in HER2 (51.3%) and TNBC (31.7%) and in BRCA carriers (41.9%). The factors independently related to patient survival were pathology and molecular surrogate subtype, type of surgery, response to NACT and vascular invasion. BRCA status was a protective prognostic factor without reaching statistical significance, with an HR 0.5 (95%CI 0.1-1.4). Mastectomy presented a double risk of distant recurrence compared to breast-conservative surgery (BCS), supporting BCS as a safe option after NACT. After a mean follow-up of 126 (SD 43) months, luminal tumors presented a substantial difference in survival rates calculated at 5 or 10 years (81.2% compared to 74.7%), whereas that for TNBC was 75.3 and 73.5, respectively. The greatest difference was seen according to the response in patients with pCR, who exhibited a 10 years DDFS of 95.5% vs. 72.4% for those patients without pCR, p < 0001. This difference was especially meaningful in TNBC: the 10 years DDFS according to an RCB of 0 to 3 was 100%, 80.6%, 69% and 49.2%, respectively, p < 0001. Patients with a particularly poor prognosis were those with lobular carcinomas, with a 10 years DDFS of 42.9% vs. 79.7% for ductal carcinomas, p = 0.001, and patients with vascular invasion at the surgical specimen, with a 10 years DDFS of 59.2% vs. 83.6% for those patients without vascular invasion, p < 0.001. Remarkably, BRCA carriers presented a longer survival, with an estimated 10 years DDFS of 89.6% vs. 77.2% for non-carriers, p = 0.054. Conclusions: Long-term outcomes after neoadjuvant chemotherapy can help patients and clinicians make well-informed decisions.

Workplace Violence Against Primary Care Clinicians: A Narrative Review.

Workplace violence (WPV) is a commonly reported occupational hazard in healthcare and its prevalence is increasing. WPV occurs in all types of practice settings, but little is known about WPV in primary care settings in the United States (US). Because primary care practice settings differ from the inpatient settings, further examination of WPV in primary care is warranted. Our objective was to summarize the available literature highlight important gaps. We conducted a search using Pubmed and OVID for US studies of WPV in US-based adult primary care practices. Studies including only pediatric populations were excluded. Due to the lack of available literature conducted in US primary care settings, we expanded our search to include international studies. We identified 70 studies of which 5 were US based. Due to the lack of significant numbers of US-based studies, we opted to conduct a narrative review of all available studies. The evidence shows that WPV is a common occurrence in primary care settings in many countries and that the majority of primary care clinicians have experienced at least some form of non-physical violence in their careers. Most of the studies conducted were cross-sectional in design and reported on both non-physical and physical forms of WPV. There was not a consistent trend between genders in experiencing the major forms of WPV, but women were consistently more likely to be subjected to sexual harassment. Potential root causes for WPV could generally be categorized as patient-level, clinician-level, clinical encounter specific, and operational root causes. While most WPV was found to be non-physical, it still had significant emotional and job-related impacts on clinicians. These troubling results highlight the need for further studies to be conducted in the US.

Patient Satisfaction with Nonopioid Postoperative Analgesia in Head and Neck Surgery: A Prospective Randomized Trial.

OBJECTIVE: To evaluate patients' satisfaction with opioid versus opioid-sparing postoperative analgesia in patients undergoing outpatient head and neck surgery. STUDY DESIGN: Prospective randomized trial. SETTING: Tertiary care academic hospital. METHODS: Adult patients undergoing outpatient head and neck surgery were randomly assigned to 1 of 3 analgesic regimens. First- and second-line medications were the following by group (1) Hydrocodone-acetaminophen with ibuprofen, (2) ibuprofen with hydrocodone-acetaminophen, and (3) ibuprofen with acetaminophen. Preoperative counseling was provided to patients regarding expected pain and proper medication use. Postoperative questionnaires were administered to assess satisfaction. RESULTS: One hundred three patients were enrolled in the study (mean age, 56.5 years; women, 75 [73%]). The mean satisfaction score with the pain regimen assigned was similar between the 3 groups (scale 0-10, [7.7, 8.3, 8.5, P = .46]). A similar percentage of patients in each group reported that surgery was more painful than anticipated (25%, 32%, 26%, P = .978), and a similar percentage of patients reported willingness to utilize the same analgesic regimen following future surgeries (75%, 83%, 76%, P = .682). Additional questions evaluating the side effect profile, maximum and minimum pain scores, and difficulty of recovery were not statistically different between the 3 groups. CONCLUSION: In the postoperative population for outpatient head and neck surgeries, there was no significant difference in patient satisfaction and pain control between the opioid and nonopioid arms. Providers should discuss opioid-sparing regimens preoperatively with patients and describe them as effective in providing adequate pain control without a significant impact on patient's perception of care.

The Prevalence of Missing Incidents and Their Antecedents Among Older Adult MedicAlert Subscribers: Retrospective Descriptive Study.

BACKGROUND: With the population aging, the number of people living with dementia is expected to rise, which, in turn, is expected to lead to an increase in the prevalence of missing incidents due to critical wandering. However, the estimated prevalence of missing incidents due to dementia is inconclusive in some jurisdictions and overlooked in others. OBJECTIVE: The aims of the study were to examine (1) the demographic, psychopathological, and environmental antecedents to missing incidents due to critical wandering among older adult MedicAlert Foundation Canada (hereinafter MedicAlert) subscribers; and (2) the characteristics and outcomes of the missing incidents. METHODS: This study used a retrospective descriptive design. The sample included 434 older adult MedicAlert subscribers involved in 560 missing incidents between January 2015 and July 2021. RESULTS: The sample was overrepresented by White older adults (329/425, 77.4%). MedicAlert subscribers reported missing were mostly female older adults (230/431, 53.4%), living in urban areas with at least 1 family member (277/433, 63.8%). Most of the MedicAlert subscribers (345/434, 79.5%) self-reported living with dementia. MedicAlert subscribers went missing most frequently from their private homes in the community (96/143, 67.1%), traveling on foot (248/270, 91.9%) and public transport (12/270, 4.4%), during the afternoon (262/560, 46.8%) and evening (174/560, 31.1%). Most were located by first responders (232/486, 47.7%) or Good Samaritans (224/486, 46.1%). Of the 560 missing incidents, 126 (22.5%) were repeated missing incidents. The mean time between missing incidents was 11 (SD 10.8) months. Finally, the majority of MedicAlert subscribers were returned home safely (453/500, 90.6%); and reports of harm, injuries (46/500, 9.2%), and death (1/500, 0.2%) were very low. CONCLUSIONS: This study provides the prevalence of missing incidents from 1 database source. The low frequency of missing incidents may not represent populations that are not White. Despite the low number of missing incidents, the 0.2% (1/500) of cases resulting in injuries or death are devastating experiences that may be mitigated through prevention strategies.

Factors associated with a history of critical wandering among Medic-Alert subscribers.

BACKGROUND: Critical wandering occurs when an individual living with dementia leaves a location and is unaware of place or time. Critical wandering incidents are expected to increase with the growing prevalence of persons living with dementia worldwide. We investigated the association between demographic, psychopathological, and environmental factors and a history of critical wandering among Medic-Alert subscribers, both with and without dementia. METHODS: Our retrospective study included data of 25,785 Canadian Medic-Alert subscribers who were aged 40 years or older. We used multivariable logistic regression analysis to examine the associations between a history of critical wandering and dementia status as psychopathological independent variable, controlled by demographic (age, ethnic background, sex at birth, Canadian languages spoken) and environmental (living arrangement, population density) factors. RESULTS: The overall study sample comprised of mainly older adults (77.4%). Medic-Alert subscribers who were older, male sex at birth, living with dementia, of a minority ethnic group and who did not have proficiency in an official Canadian language had a higher likelihood of a history of critical wandering. Residing in an urban environment, in an institution or with a family member, were environmental factors associated with a higher likelihood of a history of critical wandering. CONCLUSIONS: People living with dementia experience a higher likelihood of a history of critical wandering compared to those without dementia. Medic-Alert and similar organizations can develop algorithms based on the associated factors that can be used to flag risks of critical wandering. This can inform preventative strategies at the individual and community levels.

Incarceration history and opioid use among adults living with HIV and chronic pain: a secondary analysis of a prospective cohort study.

BACKGROUND: Adults living with HIV have disproportionately high chronic pain, prescription opioid use, history of substance use, and incarceration. While incarceration can have long-lasting health impacts, prior studies have not examined whether distant (>1 year prior) incarceration is associated with opioid use for chronic pain, or with opioid misuse or opioid use disorder among people living with HIV and chronic pain. METHODS: We conducted a secondary analysis of a prospective cohort study of adults living with HIV and chronic pain. The independent variables were any distant incarceration and drug-related distant incarceration (both dichotomous). Dependent variables were current long-term opioid therapy, current opioid misuse, and current opioid use disorder. A series of multivariate logistic regression models were conducted, adjusting for covariates. RESULTS: In a cohort of 148 participants, neither distant incarceration nor drug-related incarceration history were associated with current long-term opioid therapy. Distant incarceration was associated with current opioid misuse (AOR 3.28; 95% CI: 1.41-7.61) and current opioid use disorder (AOR 4.40; 95% CI: 1.54-12.56). Drug-related incarceration history was also associated with current opioid misuse (AOR 4.31; 95% CI: 1.53-12.17) and current opioid use disorder (AOR 7.28; 95% CI: 2.06-25.71). CONCLUSIONS: The positive associations of distant incarceration with current opioid misuse and current opioid use disorder could indicate a persistent relationship between incarceration and substance use in people living with HIV and chronic pain. Additional research on opioid use among formerly incarcerated individuals in chronic pain treatment is needed.

The Legacy of President Lázaro Cárdenas for Health Care Reform in Today's Mexico.

Mexican President Andrés Manuel López Obrador's historic election victory in 2018 marked a sharp break from past decades of neoliberal socioeconomic policies. López Obrador campaigned on the promise of deep reform, with health care high on his agenda. The public health care sector had been decimated by decades of budget cuts, eroding workers' morale and patients' confidence, and crippling all aspects of the system. This article looks back to the creation of the nation's public health care system in the early twentieth century during the administration of President Lázaro Cárdenas (1934-1940). This "universal" system was designed to implement a central social justice goal of the Mexican Revolution of health care for all. The program rested on two pillars: providing care to the nation's vast, impoverished rural population and actively engaging communities in their own health care. Our objective is to critically assess the two presidents' health care initiatives within the distinct historical contexts of their administrations.

Risk Factors Associated with Missing Incidents among Persons Living with Dementia: A Scoping Review.

Worldwide, over 55-million people have dementia, and the number will triple by 2050. Persons living with dementia are exposed to risks secondary to cognitive challenges including getting lost. The adverse outcomes of going missing include injuries, death, and premature institutionalization. In this scoping review, we investigate risk factors associated with going missing among persons living with dementia. We searched and screened studies from four electronic databases (Medline, CINAHL, Embase, and Scopus), and extracted relevant data. We identified 3,376 articles, of which 73 met the inclusion criteria. Most studies used quantitative research methods. We identified 27 variables grouped into three risk factor domains: (a) demographics and personal characteristics, (b) health conditions and symptoms, and (c) environmental and contextual antecedents. Identification of risk factors associated with getting lost helps to anticipate missing incidents. Risk factors can be paired with proactive strategies to prevent incidents and inform policies to create safer communities.

Trajectories of Opioid Misuse and Opioid Use Disorder Among Adults With Chronic Pain and HIV: An Observational Study.

OBJECTIVES: In a longitudinal cohort of patients with HIV and chronic pain, we sought to (1) identify trajectories of opioid misuse and opioid use disorder (OUD) symptoms, and to (2) determine whether prescription opioid dose was associated with symptom trajectories. METHODS: We leveraged an existing 12-month longitudinal observational study, Project PIMENTO, of persons living with HIV and chronic pain who received care at a hospital system in the Bronx, New York. A quota sampling strategy was used to ensure variability of prescribed opioid use in the recruited sample. Research interviews occurred quarterly and assessed opioid behaviors and criteria for OUD. To describe symptom trajectories, we conducted 2 separate longitudinal latent class analyses to group participants into (1) opioid misuse and (2) OUD trajectories. Finally, we used multinomial logistic regression models to examine the relationship between baseline prescription opioid dose and symptom trajectories. RESULTS: Of 148 total participants, at baseline 63 (42.6%) had an active opioid prescription, 69 (46.6%) met the criteria for current opioid misuse, and 44 (29.7%) met the criteria for current OUD. We found 3 opioid misuse and 3 OUD symptom trajectories, none of which showed worsened symptoms over time. In addition, we found that higher prescription opioid dose at baseline was associated with a greater OUD symptom trajectory. CONCLUSIONS: Opioid misuse and OUD were common but stable or decreasing over time. Although these results are reassuring, our findings also support prior studies that high-dose opioid therapy is associated with greater OUD symptoms.

Sociodemographic factors associated with the success or failure of anti-tuberculosis treatment in the Chiapas Highlands, Mexico, 2019-2022.

OBJECTIVE: To estimate the incidence rate of tuberculosis (TB) in the Highlands (Tsotsil-Tseltal) region of Chiapas and to analyze sociodemographic factors that might influence the success of anti-TB treatment from the period of January 2019 to June 2022. METHODS: Retrospective study in which the TB databases of the National Epidemiological Surveillance System (SINAVE) were analyzed. TB incidence rates were calculated based on the number of registered TB cases and estimated annual populations. The success-failure of anti-TB treatment was analyzed according to sociodemographic indicators, degree of concentration of indigenous population of the municipality of residence and admission to SINAVE. RESULTS: Two hundred thirty-three cases were analyzed. The variables associated to a lower success rate of treatment against TB were: living in a municipality with high-very high concentration of indigenous population, being indigenous, having a primary school education or lower, and agricultural occupation. The number of TB diagnosed from 2020-2022 and the incidence rates from 2020-2021 decreased significantly compared to 2019. CONCLUSIONS: It is necessary to strengthen the follow-up of TB cases in the region, mainly in areas with high-very high indigenous concentration, in people with low levels of education and engaged in agricultural work.

Rewarding Effects of the Hallucinogen 4-AcO-DMT Administration and Withdrawal in Rats: A Challenge to the Opponent-Process Theory.

According to the opponent-process theory of drug addiction, the intake of an addictive substance initiates two processes: a rapid primary process that results in the drug's rewarding effects, and a slower opponent process that leads to the aversive motivational state of drug aftereffects. This aversive state is integral in the desire, pursuit, and maintenance of drug use, potentially leading to dependence and addiction. However, current observational and experimental evidence suggests that the administration of a 5-hydroxytryptamine receptors-type 2A (5-HT2A) agonist, while capable of inducing a positive mental state in humans, may not generate the behavioral patterns typically associated with drugs of abuse. In this study, we found that administering the 5-HT2A agonist 4-Acetoxy-N,N-dimethyltryptamine fumarate (4-AcO-DMT) did not result in place preference in male rats compared to control saline administration 24 h later, after the drug has been cleared from the organism. However, in a modified place preference test where only the acute motivational effects of the drug were evaluated (excluding withdrawal), 4-AcO-DMT was found to be rewarding. Furthermore, in another modified place preference test where only the motivational effects of drug withdrawal were evaluated (excluding the acute effects of drug administration), the 24-hour aftereffect of 5-HT2A agonist administration also resulted in a robust place preference. Therefore, while 4-AcO-DMT administration was able to induce place preference, its 24-hour aftereffect also produced a strong reward. In the counterbalanced test, this reward from the aftereffect effectively overshadowed its acute rewarding properties, which could potentially create a false impression that 4-AcO-DMT lacks motivational properties. This suggests that 5-HT2A agonist administration follows a different dynamic than that proposed by the opponent-process theory of motivation and implies that the administration of 5-HT2A agonists may lead to behavioral patterns less typical of drugs associated with addiction.

[Características demográficas y clínicas de los pacientes sometidos a artroscopia del manguito rotador del hombro: estudio observacional.] / Demographic and clinical characteristics of patients undergoing rotator cuff arthroscopy of the shoulder: an observational study.

OBJECTIVE: The most common cause of shoulder pain is clinical pictures related to rotator cuff problems. One of the most common treatments is arthroscopic surgery. The objective was to describe the clinical and epidemiological characteristics of patients undergoing this type of surgery in Spain. METHODS: A descriptive, observational and cross-sectional study with ninety participants was carried out. Data on age, sex, performance of work activity with overuse of upper limbs, body mass index (BMI), smoking habit, diagnosis of diabetes, performance of physical-sports activity and history of pre-surgical treatments were collected. Finally, a descriptive analysis of the variables and an analysis of correlations were carried out, using the Pearson and Spearman statistical test according to the type of variable. RESULTS: The mean age was 57.21 years with a standard deviation (SD) of 8.5 (95% CI, 55.41-59.00). Regarding their BMI, the mean was 28.49 with a SD of 4.9 (95% CI, 27.49-29.53), with 35.6% being obese (BMI greater than 30). The medical diagnosis of the subjects was 51.1% total rotator cuff tear. On the other hand, the intensity of physical activity was one hour or less per week in 87.8% of the sample. Finally, in relation to the previous physiotherapy treatment, 69.7% of the subjects had received some type of intervention. CONCLUSIONS: The demographic and clinical characteristics found are consistent with those of other previously studied populations, and the association factors between them endorse the previously mentioned risk factors, with advanced age gaining special importance.

OBJETIVO: La causa más común de dolor de hombro son los cuadros clínicos relacionados con problemas del manguito rotador. Uno de los tratamientos más habituales es la cirugía artroscópica. El objetivo del estudio fue describir las características clínicas y epidemiológicas de los pacientes sometidos a este tipo de cirugías en España. METODOS: Se realizó un estudio de tipo descriptivo, observacional y de corte transversal con noventa participantes. Se recogieron los datos de edad, sexo, realización de actividad laboral con sobreuso de miembros superiores (MMSS), índice de masa corporal (IMC), consumo de tabaco, diagnóstico de diabetes, realización de actividad física-deportiva y antecedentes de tratamientos prequirúrgicos. Finalmente, se realizó un análisis descriptivo de las variables y un análisis de correlaciones, mediante la prueba estadística de Pearson y Spearman según el tipo de variable. RESULTADOS: La media de edad fue de 57,21 años con una desviación estándar (DE) de 8,5 (Intervalo de Confianza [IC] del 95%, 55,41-59,00). En cuanto a su IMC, la media fue de 28,49 con una DE de 4,9 (IC del 95%, 27,49-29,53), siendo el 35,6% personas con obesidad (IMC mayor de 30). El diagnóstico médico de los sujetos fue en un 51,1% de rotura total del manguito rotador. Por otro lado, la intensidad de realización de actividad física fue de una hora o menos a la semana en el 87,8% de la muestra. Por último, en relación con el tratamiento previo de fisioterapia, el 69,7% de los sujetos habían recibido algún tipo de intervención. CONCLUSIONES: Las características demográficas y clínicas encontradas están en consonancia con las de otras poblaciones estudiadas previamente, y los factores de asociación entre ellas refrendan los factores de riesgo ya señalados previamente (edad, obesidad, sobreuso de MMSS), cobrando especial importancia la edad avanzada.

Effect of Injury to the Lateral Meniscotibial Ligament and Meniscofibular Ligament on Meniscal Extrusion: Biomechanical Evaluation of the Capsulodesis and Centralization Techniques in a Porcine Knee Model.

Background: Previous biomechanical studies of the meniscotibial ligament have determined that it contributes to meniscal stability. An injury to it can cause the meniscus to extrude, and reconstruction of that ligament significantly reduces extrusion. Purpose: To assess the biomechanical effects of sectioning the lateral meniscotibial ligament (LMTL) and the meniscofibular ligament (MFL) with respect to the radial mobility of the lateral meniscus and to evaluate the biomechanical effects of the capsulodesis and centralization techniques. Study Design: Controlled laboratory study. Methods: The lateral meniscus of 22 porcine knees was evaluated. They were mounted on a testing apparatus to apply muscle and ground-reaction forces. The meniscus was evaluated at 30° and 60° of knee flexion using 2 markers placed on the posterior cruciate ligament and the lateral meniscus after applying an axial compression of 200 N to the knee joint. Measurements were recorded under 5 conditions: intact lateral meniscus, injury of the LMTL, subsequent injury of the MFL, the use of the open capsulodesis technique, and the reconstruction of the LMTL and the MFL with the centralization technique. Results: The distance between the 2 markers was significantly greater in the extrusion group (combined lesion of the LMTL and MFL) than in the intact or reconstruction groups (capsulodesis and centralization techniques; P < .001 in all cases). In the cases of load application, no significant differences were observed between the control group (intact meniscus) and the groups on which the reconstruction techniques were performed. There were also no differences when comparing the results obtained between both reconstruction techniques. In all settings, the distance between the 2 markers increased with the increase in the knee flexion angle. Conclusion: In a porcine model, the LMTL and the MFL participated as restrictors of the radial mobility of the lateral meniscus during loading. Their injury caused a significant increase in lateral meniscal extrusion, and the centralization and the capsulodesis procedures were able to reduce extrusion. Clinical Relevance: This study demonstrates the capacity of the LMTL and the MFL to restrict the radial mobility of the lateral meniscus during loading and how it is affected when they are injured.

3D print model for surgical planning in a case of recurrent osteoblastic osteosarcoma of the left maxilla. A case report.

Osteosarcoma (OS) of the head and neck is a rare and aggressive disease characterized by the formation of osteoid by malignant osteoblasts. The mandible or maxilla are the most common sites of presentation. Radiologically, these tumors show considerable, destructive growth with periosteal reaction, which can suggest the diagnosis of OS. 3D printing, as an emerging technology, can play a role in orthopedic oncology by providing patient-specific 3D printed models to improve surgical planning and facilitate patient understanding. We present the case of a male in his early 30s with a final histological diagnosis of recurrent osteosarcoma of the left maxilla, where a 3D printed model was helpful for the diagnostic workup, surgical planning, and the procedure.

Case report: A combination of nitroglycerin and adenosine proves effective in repairing a cerebral arteriovenous malformation.

Hemorrhage secondary to rupture of a brain arteriovenous malformations (AVM) is one of the initial manifestations, and the main cause of, morbidity and mortality in patients with this condition. Current treatment strategies include endovascular embolization with the goal of AVM obliteration and neurological preservation. In the transvenous endovascular embolization procedure, adenosine is the preferred agent to induce temporary hypotension and allow adequate AVM embolization. We describe the intraoperative management of an adenosine-resistant 38 year-old male who underwent a successful intracranial AVM embolization after concomitant administration of gradually increasing doses of nitroglycerin. This report suggests that nitroglycerin infusion can be combined with adenosine boluses to create a pronounced and dose-dependent hypotension in patients partially unresponsive to adenosine alone.

Características demográficas y clínicas de los pacientes sometidos a artroscopia del manguito rotador del hombro: estudio observacional / Demographic and clinical characteristics of patients undergoing rotator cuff arthroscopy of the shoulder: an observational study

Fundamentos: La causa más común de dolor de hombro son los cuadros clínicos relacionados con problemas del manguitorotador. Uno de los tratamientos más habituales es la cirugía artroscópica. El objetivo del estudio fue describir las característicasclínicas y epidemiológicas de los pacientes sometidos a este tipo de cirugías en España. Métodos: Se realizó un estudio de tipo descriptivo, observacional y de corte transversal con noventa participantes. Se recogieronlos datos de edad, sexo, realización de actividad laboral con sobreuso de miembros superiores (MMSS), índice de masa corporal (IMC),consumo de tabaco, diagnóstico de diabetes, realización de actividad física-deportiva y antecedentes de tratamientos prequirúrgicos.Finalmente, se realizó un análisis descriptivo de las variables y un análisis de correlaciones, mediante la prueba estadística de Pearson y Spearman según el tipo de variable.Resultados: La media de edad fue de 57,21 años con una desviación estándar (DE) de 8,5 (Intervalo de Confianza [IC] del 95%,55,41-59,00). En cuanto a su IMC, la media fue de 28,49 con una DE de 4,9 (IC del 95%, 27,49-29,53), siendo el 35,6% personas conobesidad (IMC mayor de 30). El diagnóstico médico de los sujetos fue en un 51,1% de rotura total del manguito rotador. Por otro lado,la intensidad de realización de actividad física fue de una hora o menos a la semana en el 87,8% de la muestra. Por último, en relacióncon el tratamiento previo de fisioterapia, el 69,7% de los sujetos habían recibido algún tipo de intervención. Conclusiones: Las características demográficas y clínicas encontradas están en consonancia con las de otras poblacionesestudiadas previamente, y los factores de asociación entre ellas refrendan los factores de riesgo ya señalados previamente (edad,obesidad, sobreuso de MMSS), cobrando especial importancia la edad avanzada.(AU)

Background: The most common cause of shoulder pain is clinical pictures related to rotator cuff problems. One of the mostcommon treatments is arthroscopic surgery. The objective was to describe the clinical and epidemiological characteristics of patientsundergoing this type of surgery in Spain. Methods: A descriptive, observational and cross-sectional study with ninety participants was carried out. Data on age, sex, perfor-mance of work activity with overuse of upper limbs, body mass index (BMI), smoking habit, diagnosis of diabetes, performance of physi-cal-sports activity and history of pre-surgical treatments were collected. Finally, a descriptive analysis of the variables and an analysis ofcorrelations were carried out, using the Pearson and Spearman statistical test according to the type of variable.Results: The mean age was 57.21 years with a standard deviation (SD) of 8.5 (95% CI, 55.41-59.00). Regarding their BMI, the meanwas 28.49 with a SD of 4.9 (95% CI, 27.49-29.53), with 35.6% being obese (BMI greater than 30). The medical diagnosis of the subjectswas 51.1% total rotator cuff tear. On the other hand, the intensity of physical activity was one hour or less per week in 87.8% of thesample. Finally, in relation to the previous physiotherapy treatment, 69.7% of the subjects had received some type of intervention. Conclusions: The demographic and clinical characteristics found are consistent with those of other previously studied populations,and the association factors between them endorse the previously mentioned risk factors, with advanced age gaining special importance.(AU)

Actitudes hacia el aborto deseado en estudiantes de ciencias de la salud chilenos / Attitudes towards wanted abortion among Chilean health sciences students

Introducción: La interrupción del embarazo mediando principalmente la voluntad de la mujer, es decir, cuando una mujer desea abortar para terminar su embarazo por cualquier razón, es un procedimiento controversial. Las actitudes individuales de los profesionales de la salud hacia este procedimiento influirían sobre la aceptación o el rechazo de realizarlo y, por ende, afectarían su acceso en el sistema de salud. Objetivo: Relacionar actitudes hacia la interrupción del embarazo con características sociodemográficas y académicas de estudiantes chilenos de enfermería, medicina y obstetricia y puericultura. Método: Estudio cuantitativo con diseño observacional, transversal y descriptivo. Reclutamos estudiantes universitarios con un muestreo no probabilístico. Recolectamos datos mediante cuestionarios virtuales autoadministrados. Preguntamos por la intención de realizar o asistir un aborto médico o quirúrgico frente a 15 escenarios distintos y creamos un índice con estas respuestas. Calculamos estadísticas descriptivas básicas y creamos modelos de regresión lineal. Consideramos significancia estadística si p < 0,05. Resultados: Participaron 229, 306 y 233 estudiantes de enfermería, medicina y obstetricia y puericultura, respectivamente (en total, 768). En el modelo de regresión lineal múltiple, declararse cristiano (β = −0,248) y afirmar que la religión es muy o totalmente importante en la vida (β = −0,269) se asociaron más fuertemente y de manera inversa y significativa con el índice de intención de realizar o asistir un aborto médico o quirúrgico. Conclusiones: La religión es un factor que influiría decisivamente sobre las actitudes hacia la interrupción del embarazo. Los escenarios más positivamente valorados podrían explicarse considerando que las leyes reflejarían los valores predominantes de una sociedad.

Introduction: Termination of pregnancy mediated primarily by the womans will, i.e., when a woman wishes to have an abortion to terminate her pregnancy for any reason, is a controversial procedure. The individual attitudes of health professionals towards this procedure would affect the degree of acceptance or rejection of performing this procedure and, therefore, would affect its accessibility in the health system. Objective: To relate attitudes towards abortion with sociodemographic and academic characteristics of Chilean nursing, medicine and midwifery students. Method: Quantitative study with observational, cross-sectional and descriptive design. We recruited university students with non-probabilistic sampling. We collected data through self-administered virtual questionnaires. We asked about the intention to perform an abortion in 15 different scenarios and created an index with these responses. We calculated basic descriptive statistics and created linear regression models. We considered statistical significance if p < 0.05. Results: 229, 306 and 233 students from nursing, medicine and midwifery participated, respectively (total: 768). In the multiple linear regression model, declaring oneself a Christian (β = −0.248) and stating that religion is very or totally important in life (β = −0.269) were inversely and significantly associated with the index of intention to perform an abortion. Conclusions: Religion is a factor that would decisively influence attitudes toward termination of pregnancy. The more positively valued scenarios could be explained by considering that laws would reflect the predominant values of a society.