Radiological diagnosis of prevalent osteoporotic vertebral fracture on radiographs: an interim consensus from a group of experts of the ESSR osteoporosis and metabolism subcommittee.

When a low-energy trauma induces an acute vertebral fracture (VF) with clinical symptoms, a definitive diagnosis of osteoporotic vertebral fracture (OVF) can be made. Beyond that, a "gold" radiographic standard to distinguish osteoporotic from non-osteoporotic VFs does not exist. Fracture-shaped vertebral deformity (FSVD) is defined as a deformity radiographically indistinguishable from vertebral fracture according to the best of the reading radiologist's knowledge. FSVD is not uncommon among young populations with normal bone strength. FSVD among an older population is called osteoporotic-like vertebral fracture (OLVF) when the FSVD is likely to be associated with compromised bone strength. In more severe grade deformities or when a vertebra is collapsed, OVF diagnosis can be made with a relatively high degree of certainty by experienced readers. In "milder" cases, OVF is often diagnosed based on a high probability rather than an absolute diagnosis. After excluding known mimickers, singular vertebral wedging in older women is statistically most likely an OLVF. For older women, three non-adjacent minimal grade OLVF (< 20% height loss), one minimal grade OLVF and one mild OLVF (20-25% height loss), or one OLVF with ≥ 25% height loss, meet the diagnosis of osteoporosis. For older men, a single OLVF with < 40% height loss may be insufficient to suggest the subject is osteoporotic. Common OLVF differential diagnoses include X-ray projection artifacts and scoliosis, acquired and developmental short vertebrae, osteoarthritic wedging, oncological deformities, deformity due to high-energy trauma VF, lateral hyperosteogeny of a vertebral body, Cupid's bow, and expansive endplate, among others.

Efficacy of radiofrequency in lumbar facet joint pain: a systematic review and meta-analysis of placebo-controlled randomized controlled trials.

BACKGROUND: Lumbar facet joint pain (LFJP) is one of the main causes of chronic low back pain (LBP) and can be treated using radiofrequency (RF) sensory denervation. The aim of this work is to analyze the efficacy of RF in LFJP through a systematic review and meta-analysis of randomized controlled trials (RCTs) with placebo control. MATERIALS AND METHODS: A systematic search was conducted in the Medline (PubMed), Scopus, Web of Science databases, and the Cochrane Central Register of Controlled Trials (CENTRAL). The variables of interest were pain, functional status, quality of life (QoL), and global perceived effect (GPE) measured at different time intervals: short (< 3 months), medium (> 3 and < 12 months), and long term (> 12 months). RESULTS: Eight RCTs with placebo control were included. RF showed significant benefits over placebo in pain relief in the short (MD - 1.01; 95% CI - 1.98 to -0.04; p = 0.04), medium (MD - 1.42; 95% CI - 2.41 to - 0.43; p = 0.005), and long term (MD - 1.12; 95% CI - 1.57 to - 0.68; p < 0.001), as well as improvement in functional disability in the short (SMD - 0.94; 95% CI - 1.73 to - 0.14; p = 0.02) and long term (SMD - 0.74; 95% CI - 1.09 to - 0.39; p < 0.001). No statistically significant differences were observed in QoL or quantitative GPE, but benefits for RF were observed in dichotomous GPE in the medium (OR 0.19; 95% CI 0.07-0.52; p = 0.001) and long term (OR 0.22; 95% CI 0.06-0.78; p = 0.02). Subgroup analyses showed more benefits for RF in LBP < 1 year in the short term and in RCTs that did not require performing an MRI for patient selection. CONCLUSIONS: RF demonstrated significant improvement in pain and functionality, but the benefits in terms of QoL and GPE are inconclusive. Future clinical trials should investigate the long-term effects of RF, its impact on quality of life, and define appropriate criteria for patient selection.

The Educational Impact of Radiology in Anatomy Teaching: A Field Study Using Cross-Sectional Imaging and 3D Printing for the Study of the Spine.

INTRODUCTION: Cross-sectional imaging and 3D printing represent state-of-the-art approaches to improve anatomy teaching compared to traditional learning, but their use in medical schools remains limited. This study explores the utility of these educational tools for teaching normal and pathological spinal anatomy, aiming to improve undergraduate medical education. MATERIALS AND METHODS: A field study was conducted on a cohort of undergraduate medical students who were exposed to anatomy lessons of the spine considering three learning paradigms: traditional learning, cross-sectional imaging examinations, and 3D printed models. 20 students (intervention group) received the three approaches, and other 20 students (control group) received the conventional (traditional) approach. The students were examined through a multiple-choice test and their results were compared to those of a control group exposed to traditional learning matched by age, sex and anatomy grades. In addition, students in the experimental group were assessed for their satisfaction with each learning method by means of an ad hoc questionnaire. RESULTS: Students exposed to cross-sectional imaging and 3D printing demonstrated better knowledge outcomes compared to the control group. They showed high satisfaction rates and reported that these technologies enhanced spatial understanding and facilitated visualization of specific pathologies. However, limitations such as the representativeness of non-bone conditions in 3D printed models and the need for further knowledge on imaging fundamentals were highlighted. CONCLUSION: Cross-sectional imaging and 3D printing offer valuable tools for enhancing the teaching of spinal anatomy in undergraduate medical education. Radiologists are well positioned to lead the integration of these technologies, and further research should explore their potential in teaching anatomy across different anatomical regions.

Ultrasound guided injections in ankle and foot.

Ultrasound guidance is particularly useful for percutaneous injections in the diagnosis and management of painful conditions of the ankle and foot. The injectates used include steroids and local anesthetics, such as lidocaine, mepivacaine, bupivacaine, ropivacaine, and platelet-rich plasma. Osteoarthritis is the main indication for joint injections. Joints amenable to being injected include the tibiotalar, subtalar, midtarsal, and metatarsophalangeal joints. Tendon injections mainly involve the Achilles, peroneus, extensors, and tibialis tendons, while plantar fascia injections are useful for treating plantar fasciitis and plantar fibromatosis. Forefoot injections include joint arthritis, intermetatarsal bursitis, and Morton neuroma. The standardized approaches and doses reviewed in this paper are based on the authors' experience and can lead to high success in symptomatic relief for various conditions. These injections can be curative or serve as a guide to identify the source of pain when surgery or other therapeutic options are planned.

Factors influencing vertebral collapse in osteoporotic vertebral fractures: a case-control study of symptomatic patients attended in the emergency department.

This study aimed to identify risk factors for the collapse of osteoporotic vertebral fractures (OVFs). We analyzed data from conventional radiography and computed tomography in patients with OVFs and found that older age and two radiological measurements were predictive for vertebral collapse. These factors can be useful for clinical practice. PURPOSE: To identify risk factors for collapse of osteoporotic vertebral fractures (OVF) on computed tomography (CT) and conventional radiography (CR). METHODS: This is a retrospective case-control study including a series of patients with OVF diagnosed at the emergency department of our institution from January to September 2019. Inclusion criteria were to have standing CR and supine CT within 2 weeks after the diagnosis of OVF and a follow-up CR at 6 months or later. We evaluated different imaging measurements at the initial diagnostic examinations, including vertebral height loss, local kyphosis, vertebral density, and fracture type according to the grading systems of Genant, Sugita, Association of Osteosynthesis (AO) Spine, and the German Society for Orthopaedics and Trauma. Vertebral collapse was defined as loss of ≥ 50% of vertebral area or height. Cases and controls were defined as OVFs which collapse and do not collapse, respectively, on follow-up. RESULTS: Fifty-six patients were included in the study, with a mean age of 72.6 ± 1.2 years, including 48 women. Twenty-five (44.6%) OVFs developed collapse on follow-up. None of the fracture classification systems were found to be predictive of collapse. Multivariate analysis showed that older age, increased density ratio (≥ 2) between the fractured and non-fractured vertebral bodies, and a ≥ 6% difference in posterior vertebral height (PVH) loss between standing CR and supine CT exhibited 88% discriminative power in predicting vertebral collapse. CONCLUSIONS: Age over 72.5 years, a density ratio ≥ 2 between the fractured and non-fractured vertebral bodies, and a difference equal to or higher than 6% in PVH loss between standing CR and supine CT, are risk factors for developing vertebral collapse after OVF.

Persistence of a Frameshifting Deletion in SARS-CoV-2 ORF7a for the Duration of a Major Outbreak.

Australia experienced widespread COVID-19 outbreaks from infection with the SARS-CoV-2 Delta variant between June 2021 and February 2022. A 17-nucleotide frameshift-inducing deletion in ORF7a rapidly became represented at the consensus level (Delta-ORF7aΔ17del) in most Australian outbreak cases. Studies from early in the COVID-19 pandemic suggest that frameshift-inducing deletions in ORF7a do not persist for long in the population; therefore, Delta-ORF7aΔ17del genomes should have disappeared early in the Australian outbreak. In this study, we conducted a retrospective analysis of global Delta genomes to characterise the dynamics of Delta-ORF7aΔ17del over time, determined the frequency of all ORF7a deletions worldwide, and compared global trends with those of the Australian Delta outbreak. We downloaded all GISAID clade GK Delta genomes and scanned them for deletions in ORF7a. For each deletion we identified, we characterised its frequency, the number of countries it was found in, and how long it persisted. Of the 4,018,216 Delta genomes identified globally, 134,751 (~3.35%) possessed an ORF7a deletion, and ORF7aΔ17del was the most common. ORF7aΔ17del was the sole deletion in 28,014 genomes, of which 27,912 (~99.6%) originated from the Australian outbreak. During the outbreak, ~87% of genomes were Delta-ORF7aΔ17del, and genomes with this deletion were sampled until the outbreak's end. These data demonstrate that, contrary to suggestions early in the COVID-19 pandemic, genomes with frameshifting deletions in ORF7a can persist over long time periods. We suggest that the proliferation of Delta-ORF7aΔ17del genomes was likely a chance founder effect. Nonetheless, the frequency of ORF7a deletions in SARS-CoV-2 genomes worldwide suggests they might have some benefit for virus transmission.

Ghost Fat: Altered Female Body Perception After Bariatric Surgery.

Body perception is an individual's ability to recognize their body in attitudinal and/or dimensional aspects. We investigated women's body perceptions before and after bariatric surgery. Participants were 31 women (M age = 36.23, SD = 7.95 years old) with an average pre-operative body mass index of 44.58 (SD = 4.65) kg/m2. We collected anthropometric and body perception measures (attitudinal body image [ABI] and dimensional body image [DBI]) before bariatric surgery and 30, 60, 90, and 120 days after it. There was an average decrease of 21.09% in participants' body weight over the 120 days. Regarding ABI, 51.61% of participants had high body dissatisfaction before surgery, and this proportion of dissatisfied participants decreased to 3.23% 120 days after surgery. We observed no statistically significant differences in DBI perceptions. Fast weight loss caused by bariatric surgery appeared to generate a perception of ghost fat. Somatosensory interventions and/or a longer follow-up are needed to alter this persistent distortion of body dimensions.

The microbiome in HLA-B27-associated disease: implications for acute anterior uveitis and recommendations for future studies.

The pathogenesis of human leukocyte antigen (HLA)-B27-associated diseases such as acute anterior uveitis (AAU) and ankylosing spondylitis (AS) remains poorly understood, though Gram-negative bacteria and subclinical bowel inflammation are strongly implicated. Accumulating evidence from animal models and clinical studies supports several hypotheses, including HLA-B27-dependent dysbiosis, altered intestinal permeability, and molecular mimicry. However, the existing literature is hampered by inadequate studies designed to establish causation or uncover the role of viruses and fungi. Moreover, the unique disease model afforded by AAU to study the gut microbiota has been neglected. This review critically evaluates the current literature and prevailing hypotheses on the link between the gut microbiota and HLA-B27-associated disease. We propose a new potential role for HLA-B27-driven altered antibody responses to gut microbiota in disease pathogenesis and outline recommendations for future well-controlled human studies, focusing on AAU.

Strategic Encounters in Innovation and Regulation: Healthcare Transformation in the Era of Digital Connectivity Comment on "What Managers Find Important for Implementation of Innovations in the Healthcare Sector - Practice Through Six Management Perspectives".

Healthcare innovations emerge and develop in institutionally dense selective environments. New projects and propositions in healthcare sectoral ecosystems can be understood as product-service compacts, that is, complex solutions that dynamically integrate tangible and intangible elements in close interaction with users' needs and the evolving regulatory context under uncertainty and ambiguity. We advance the concept of "strategic encounters" to encapsulate, capitalise and extend the contribution by Palm and Fischier's on the key enabling managerial factors for healthcare innovation implementation under conditions of imperfect foresight. We intertwine creative assemblages that shape the formation of knowledge-intensive activities at the operators' level with scope of sectoral level interventions to underscore how the opportunities and constraints can enhance innovation for the common good. We use the case of digital data health regulatory agendas as illustration. We argue that this broader perspective on healthcare transformation is theoretically pertinent and practically useful, for management and policy.

Incremento de las capacidades físicas equilibrio y marcha en adultos mayores con Parkinson / Aumento das habilidades físicas, equilíbrio e marcha em idosos com Parkinson / Increase in physical capacities balance and gait in elderly with Parkinson

RESUMEN El restablecimiento de las facultades motrices es uno de los fines de la rehabilitación. Mediante este se pretende determinar la efectividad de un Programa de ejercicios físicos en las capacidades físicas equilibrio-marcha de personas con Parkinson, del área especializada, municipio Cienfuegos. En el estudio, predominó el sexo masculino, la muestra n=29, el promedio de edad x ̅=71,7, con desviación estándar S=6,9. El estudio se realizó mediante un diseño prospectivo, experimental, preexperimento con pretest y postest; se compararon las distribuciones de frecuencias y porcentajes de los indicadores equilibrio, marcha y nivel de conocimiento, evaluados en dos momentos. Se correlacionó y evaluó la independencia entre las variables edad, sexo y equilibrio-marcha y nivel de conocimientos en función de buscar relaciones en variables categóricas de diferentes subtipos. En los subtipos iguales, fueron aplicados los estadísticos Ji-cuadrado de Pearson, Gamma y Tau b de Kendall; se asume una normalidad en la distribución de los datos y una p=0,05, mediante el programa estadístico IBM SPSS para Windows versión 21.0. Prevalece predominio del sexo masculino, 55 % y las edades de 65-74 años, y en el sexo femenino, 75-84 años. El programa reflejó cambios en las dimensiones de los diferentes indicadores de las variables en estudio. En conclusión, el programa evidenció cambios significativos en las capacidades físicas equilibrio y marcha de adultos mayores con Parkinson y en el nivel de conocimiento de familiares, pero no existieron relaciones de dependencia entre las variables sociodemográficas y el equilibrio-marcha.

RESUMO A restauração das capacidades motoras é um dos objectivos da reabilitação. O Objetivo deste estudo era determinar a eficácia de um programa de exercício físico sobre o equilíbrio físico e a capacidade de andar das pessoas com doença de Parkinson na área especializada do município de Cienfuegos. O estudo foi predominantemente masculino, a amostra n=29, a idade média x ̅=71,7, com desvio padrão S=6,9. O estudo foi conduzido utilizando um desenho prospectivo, experimental, pré-experimental com pré-teste e pós-teste; as distribuições de frequência e percentagens dos indicadores de equilíbrio, marcha e nível de conhecimento, avaliados em dois pontos no tempo, foram comparados. A independência entre as variáveis idade, sexo e equilíbrio-gait e nível de conhecimento foi correlacionada e avaliada a fim de procurar relações em variáveis categóricas de diferentes subtipos. Em subtipos iguais, foram aplicadas as estatísticas Qui-quadrado de Pearson, Gamma e Tau b de Kendall; a normalidade da distribuição de dados e p=0,05 foram assumidos, utilizando o programa estatístico IBM SPSS para Windows versão 21.0. A prevalência era predominantemente masculina, 55%, e a idade de 65-74 anos, e feminina, 75-84 anos. O programa refletiu alterações nas dimensões dos diferentes indicadores das variáveis em estudo. Em conclusão, o programa mostrou mudanças significativas nas capacidades físicas de equilíbrio e marcha em adultos mais velhos com doença de Parkinson e no nível de conhecimento dos membros da família, mas não houve relações de dependência entre as variáveis sociodemográficas e o equilíbrio-gait.

ABSTRACT Restoration of motor faculties is one of the goals of rehabilitation. Through this, it is intended to determine the effectiveness of a physical exercise program in the balance-gait physical capacities of people with Parkinson's, from the specialized area Cienfuegos municipality. In the study, the male sex predominated, the sample n=29, the average age x ̅=71,7, with standard deviation S=6.9. The study was carried out using a prospective, experimental, pre-experiment with pre-test and post-test design; the distributions of frequencies and percentages of the indicators balance, gait and level of knowledge, evaluated in two moments, were compared. The independence between the variables age, sex and balance-gait and level of knowledge was correlated and evaluated based on looking for relationships in categorical variables of different subtypes. In the same subtypes, Pearson's Chi-square, Gamma and Kendall's Tau b statistics were applied; a normality in the distribution of the data and a p=0.05 is assumed, by means of the statistical program IBM SPSS for Windows version 21.0. Predominance of the male sex prevails, 55% and the ages of 65-74 years, and in the female sex, 75-84 years. The program reflected changes in the dimensions of the different indicators of the variables under study. In conclusion, the program showed significant changes in the physical capacities, balance and gait of elderly with Parkinson and in the level of knowledge of relatives, but there were no dependency relationships between sociodemographic variables and balance-gait.

The value of magnetic resonance imaging and computed tomography in the study of spinal disorders.

Computed tomography (CT) and magnetic resonance imaging (MRI) have replaced conventional radiography in the study of many spinal conditions, it is essential to know when these techniques are indicated instead of or as complementary tests to radiography, which findings can be expected in different clinical settings, and their significance in the diagnosis of different spinal conditions. Proper use of CT and MRI in spinal disorders may facilitate diagnosis and management of spinal conditions. An adequate clinical approach, a good understanding of the pathological manifestations demonstrated by these imaging techniques and a comprehensive report based on a universally accepted nomenclature represent the indispensable tools to improve the diagnostic approach and the decision-making process in patients with spinal pain. Several guidelines are available to assist clinicians in ordering appropriate imaging techniques to achieve an accurate diagnosis and to ensure appropriate medical care that meets the efficacy and safety needs of patients. This article reviews the clinical indications of CT and MRI in different pathologic conditions affecting the spine, including congenital, traumatic, degenerative, inflammatory, infectious and tumor disorders, as well as their main imaging features. It is intended to be a pictorial guide to clinicians involved in the diagnosis and treatment of spinal disorders.

Long-term comparison between blind and ultrasound-guided corticoid injections in Morton neuroma.

OBJECTIVES: This work compares the effectiveness of blind versus ultrasound (US)-guided injections for Morton neuroma (MN) up to 3 years of follow-up. METHODS: This is an evaluator-blinded randomised trial in which 33 patients with MN were injected by an experienced orthopaedic surgeon based on anatomical landmarks (blind injection, group 1) and 38 patients were injected by an experienced musculoskeletal radiologist under US guidance (group 2). Patients were assessed using the visual analogue scale and the Manchester Foot Pain and Disability index (MFPDI). Injections consisted of 1 ml of 2% mepivacaine and 40 mg triamcinolone acetonide in each web space with MN. Up to 4 injections were allowed during the first 3 months of follow-up. Follow-up was performed by phone calls and/or scheduled consultations at 15 days, 1 month, 45 days, 2 months, 3 months, 6 months and 1, 2 and 3 years. Statistical analysis was performed using unpaired Student's t tests. RESULTS: No differences in age or clinical measures were found at presentation between group 1 (VAS, 8.5 ± 0.2; MFPDI, 40.9 ± 1.1) and group 2 (VAS, 8.4 ± 0.2; MFPDI, 39.8 ± 1.2). Improvement in VAS was superior in group 2 up to 3 years of follow-up (p < 0.05). Improvement in MFPDI was superior in group 2 from 45 days to 2 years of follow-up (p < 0.05). Satisfaction with the treatment was higher in group 2 (87%) versus group 1 (59.1%) at 3 years of follow-up. CONCLUSION: Ultrasound-guided injections lead to a greater percentage of long-term improvement than blind injections in MN. KEY POINTS: • Ultrasound-guided corticosteroid injections in Morton neuroma provide long-term pain relief in more than 75% of patients. • Ultrasound-guided injections in Morton neuroma led to greater long-term pain relief and less disability than blind injections up to 3 years of follow-up. • The presence of an ipsilateral neuroma is associated with worse long-term disability score.

Radiographic diagnosis of osteoporotic vertebral fractures. An updated review

The radiological diagnosis of osteoporotic vertebral fractures (OVFs) is of major importance considering its therapeutic and prognostic implications. Both radiologists and clinicians have the opportunity to diagnose OVFs in daily clinical practice due to the widespread use of spine and chest radiography. However, several studies have reported an under-diagnosis of OVFs, particularly by a lack of consensus on the diagnostic criteria. Therefore, up-to-date knowledge of the most relevant approaches for the diagnosis of OVFs is necessary for many physicians. This article aims to review the most commonly used classification systems in the diagnosis of OVFs based on conventional radiography. We discuss their rationale, advantages and limitations, as well as their utility according to the context. This review will provide a concise yet useful understanding of the typology of OVFs, their clinical significance and prognosis. Finally, we include anatomical variations that can be confused with OVFs by non-experts.

Radiographic diagnosis of osteoporotic vertebral fractures. An updated review.

The radiological diagnosis of osteoporotic vertebral fractures (OVFs) is of major importance considering its therapeutic and prognostic implications. Both radiologists and clinicians have the opportunity to diagnose OVFs in daily clinical practice due to the widespread use of spine and chest radiography. However, several studies have reported an under-diagnosis of OVFs, particularly by a lack of consensus on the diagnostic criteria. Therefore, up-to-date knowledge of the most relevant approaches for the diagnosis of OVFs is necessary for many physicians. This article aims to review the most commonly used classification systems in the diagnosis of OVFs based on conventional radiography. We discuss their rationale, advantages and limitations, as well as their utility according to the context. This review will provide a concise yet useful understanding of the typology of OVFs, their clinical significance and prognosis. Finally, we include anatomical variations that can be confused with OVFs by non-experts.

Efecto de programa de ejercicios físicos para la fuerza de extremidades inferiores en adultos mayores

RESUMEN Fundamento: el envejecimiento es un proceso caracterizado por la pérdida progresiva de capacidades físicas, cognitivas, biológicas y psicosociales. Los programas de ejercicios físicos específicos, en personas mayores estimulan el equilibrio, la fuerza, la marcha y protegen de las caídas y sus efectos. La actividad física favorece el mantenimiento de la independencia funcional de los adultos mayores. Objetivo: determinar el efecto de un programa de ejercicios físicos para aumentar la fuerza de extremidades inferiores en adultos mayores. Métodos: se realizó un estudio que se correspondió con un diseño pre-experimental, con pre y pos-test y un grupo de control. La muestra n=30, la edad =72,3 y desviación estándar S=7,0. Se aplicaron los test: Levántate y anda, Pasos sobre y por encima de un escalón de 15,2 cm. Estadísticamente, se realizó un análisis descriptivo de datos y comparación, según la distribución de frecuencias y porcentajes de indicadores de fuerza; se determinó correlación e independencia entre variables: fuerza, sexo, edad y padecimientos, mediante los estadísticos de correlación Chi-cuadrado de Pearson, R de Pearson y Correlación de Spearman. Se aplicó Chi-cuadrado de Pearson, Gamma y Tau-b de Kendall, con normalidad en la distribución de los datos y confianza p=0,05, por medio del programa estadístico IBM SPSS para Windows versión 21.0. Resultados: se demostraron cambios significativos en la fuerza de miembros inferiores de adultos mayores y ninguna dependencia entre las variables sociodemográficas relacionadas, p>0,05, excepto en la relación padecimientos y test: Levántate y anda p<0,05, que evidenció dependencia entre fuerza de extremidades inferiores y padecimientos cardiovasculares. Conclusiones: el programa aumenta la fuerza en miembros inferiores de adultos mayores, con relación de dependencia entre fuerza de extremidades inferiores y padecimientos cardiovasculares.

ABSTRACT Background: aging is a process characterized by the progressive loss of physical, cognitive, biological and psychosocial capacities. Specific physical exercise programs for older people stimulate balance, strength, and gait and protect against falls and their effects. Physical activity favors the maintenance of functional independence in older adults. Objective: to determine the effect of a physical exercise program to increase lower extremity strength in older adults. Methods: a study was carried out that corresponded to a pre-experimental design, with pre and post-test and a control group. The sample n=30, age=72.3 and standard deviation S=7.0. The tests were applied: Get up and walk, Steps on and over a 15.2 cm step. Statistically, a descriptive analysis of data and comparison was carried out, according to the distribution of frequencies and percentages of strength indicators; correlation and independence between variables were determined: strength, sex, age and illnesses, using Pearson's Chi-square correlation statistics, Pearson's R and Spearman's Correlation. Chi-square of Pearson, Gamma and Tau-b of Kendall were applied, with normality in the data distribution and confidence p=0.05, through the statistical program IBM SPSS for Windows version 21.0. Results: significant changes were shown in the strength of the lower limbs of older adults and no dependence between the related sociodemographic variables, p>0.05, except in the relationship between conditions and the Get up and walk test p<0.05, which showed dependence between lower extremity strength and cardiovascular disease. Conclusions: the program increases the strength in the lower limbs of older adults, with a dependency relationship between the strength of the lower limbs and cardiovascular diseases.

Chondroblastoma treatment by radiofrequency thermal ablation: Initial experience and implementation.

PURPOSE: To present our experience on the implementation of radiofrequency thermal ablation (RFA) for the treatment of chondroblastoma. MATERIALS AND METHODS: This case series includes 12 patients (10 males) with chondroblastoma using RFA under CT guidance. Tumours were located in the humeral head (3), femoral head (2), distal femoral epiphysis (4), tibial epiphysis (2) and calcaneus (1). Tumour size ranged from 12 to 60 mm (median: 33 mm). According to tumour size and location, monopolar electrode's active tip ranged from 1 to 3 cm. Dry and perfused ablation mode was used to treat smaller (6) and larger (6) lesions, respectively. Cementation was also made in 5 cases. Technical success was considered if the tumour was treated according to the protocol and complete ablation was achieved. Clinical success was assessed according to a visual analogue scale. RESULTS: Technical success was achieved in 11 of 13 cases (83%) afters the first treatment. After a second treatment in the 2 failed cases, pain control was achieved in all cases eventually (100% of clinical success). Follow-up MRI demonstrated resolution of oedema in all cases, as well as a necrotic area extending beyond the outer edge of the lesion in all cases except one. Radiography or CT showed stability of the lesions, with increased sclerosis and no cortex collapse. In one case, a 4 cm shortening of the humerus was observed at the end of skeletal development (7 years after treatment). In another case, early hip osteoarthritis was developed (15 years after treatment). No other long-term complications were observed. CONCLUSION: Successful treatment of chondroblastoma can be achieved by RFA. Cementoplasty adds strength to the ablated bone in weight bearing areas. MRI hallmarks associated with clinical success were resolution of bone marrow edema, and area of necrosis extending beyond the tumour edge. Radiography and CT proved to be useful in demonstrating cortex integrity.

Serine 26 in Early Growth Response-1 Is Critical for Endothelial Proliferation, Migration, and Network Formation.

Background Vascular endothelial cell proliferation, migration, and network formation are key proangiogenic processes involving the prototypic immediate early gene product, Egr-1 (early growth response-1). Egr-1 undergoes phosphorylation at a conserved Ser26 but its function is completely unknown in endothelial cells or any other cell type. Methods and Results A CRISPR/Cas9 strategy was used to introduce a homozygous Ser26>Ala mutation into endogenous Egr-1 in human microvascular endothelial cells. In the course of generating mutant cells, we produced cells with homozygous deletion in Egr-1 caused by frameshift and premature termination. We found that Ser26 mutation in Egr-1, or Egr-1 deletion, perturbed endothelial cell proliferation in models of cell counting or real-time growth using the xCELLigence System. We found that Ser26 mutation or Egr-1 deletion ameliorated endothelial cell migration toward VEGF-A165 (vascular endothelial growth factor-A) in a dual-chamber model. On solubilized basement membrane preparations, Ser26 mutation or Egr-1 deletion prevented endothelial network (or tubule) formation, an in vitro model of angiogenesis. Flow cytometry further revealed that Ser26 mutation or Egr-1 deletion elevated early and late apoptosis. Finally, we demonstrated that Ser26 mutation or Egr-1 deletion increased VE-cadherin (vascular endothelial cadherin) expression, a regulator of endothelial adhesion and signaling, permeability, and angiogenesis. Conclusions These findings not only indicate that Egr-1 is essential for endothelial cell proliferation, migration, and network formation, but also show that point mutation in Ser26 is sufficient to impair each of these processes and trigger apoptosis as effectively as the absence of Egr-1. This highlights the importance of Ser26 in Egr-1 for a range of proangiogenic processes.