High copper levels induce premature senescence in 3T3-L1 preadipocytes.

Copper (Cu) dyshomeostasis has been linked to obesity and related morbidities and also to aging. Cu levels are higher in older or obese individuals, and adipose tissue (AT) Cu levels correlate with body mass index. Aging and obesity induce similar AT functional and structural changes, including an accumulation of senescent cells. To study the effect of Cu-mediated stress-induced premature senescent (Cu-SIPS) on preadipocytes, 3T3-L1 cell line was exposed to a subcytotoxic concentration of copper sulfate. After Cu treatment, preadipocytes acquired typical senescence characteristics including diminished cell proliferation, cell and nuclei enlargement and increased lysosomal mass (higher Lamp2 expression and a slight increased number of cells positive for ß-galactosidase associated with senescence (SA-ß-Gal)). Cell cycle arrest was due to upregulation of p16Ink4aInk4a and p21Waf1/Cip1. Accordingly, protein levels of the proliferation marker KI67 were reduced. Cu-SIPS relates with oxidative stress and, in this context, an increase of SOD1 and HO-1 expression was detected in Cu-treated cells. The mRNA expression of senescence-associated secretory phenotype factors, such as Mmp3, Il-6 and Tnf-α, increased in Cu-SIPS 3T3-L1 cells but no effect was observed on the expression of heterochromatin-associated protein 1(HP1). Although the downregulation of Lamin B1 expression is considered a hallmark of senescence, Cu-SIPS cells presented higher levels of Lamin B1. The dysregulation of nuclear lamina was accompanied by an increase of nuclear blebbing, but not of micronuclei number. To conclude, a Cu-SIPS model in 3T3-L1 preadipocytes is here described, which may be an asset to the study of AT dysregulation observed in obesity and aging.

Tenoscopy for the Treatment of Hand Intratendinous Ganglion: Technique Description and Case Report.

Synovial or ganglion cysts are the most common soft tissue tumors of the wrist and hand and can arise from joints or tendons. Intratendinous synovial cysts, in contrast, are rare and their pathogenesis is still a matter of debate. The treatment of synovial cysts of articular origin using arthroscopy is commonly used with good results. For cysts of tendon origin, that is, extra-articular, when located at the ankle, shoulder, knee, and wrist, endoscopic treatment has also been described in a procedure called tenoscopy. We describe the technique and the good results using tenoscopy for a patient treated for an intratendinous synovial cyst located at the extensor communis tendon of the third digit. It is a reproducible, safe technique with low morbidity, and the patient has had no complications or recurrence.

The effect of the interproximal contour of single external hexagon implant restorations on the prevalence of peri-implantitis: A retrospective study.

PURPOSE: The objective of this retrospective study was to evaluate the effect of the interproximal contour of single external hexagon implant restorations on the prevalence of peri-implantitis. MATERIAL AND METHODS: Records of 96 patients and 148 external hexagon (EH) implants with time in function ranging from 1 to 17 years were included in the study. The most recent clinical and radiographic data were collected from records and the prevalence of peri-implantitis was defined according to the 2017 World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions. Marginal bone level (MBL), emergence angle (EA), emergence profile (EP), and crown/implant platform horizontal ratio (CIHR) were obtained from periapical radiographs. Dichotomous variables at the patient- and implant level were compared with association tests. Mann-Whitney U-Test was performed to compare continuous quantitative values between the studied groups. Binomial logistic regression was conducted to identify risk indicators associated with the peri-implantitis event at the patient- and implant level, with the significance level set at 5% for all tests. RESULTS: Nineteen patients (19.2%) and 24 implants (16.2%) with a mean time in function of 5.0 ± 4.7 years were classified as having peri-implantitis. No statistically significant differences concerning gender, mean age, implant location in the jaw, or time in function were observed between patients with or without peri-implantitis (p > 0.05). Of 24 implants with peri-implantitis 10 (41.7%) displayed EA ≤ 30° (16.4%) while 14 (58.3%) presented EA > 30° with no statistical difference between the groups (p > 0.05). No statistically significant associations were identified between EA, EP, or CIHR and the prevalence of peri-implantitis. CONCLUSION: The findings seem to indicate that the EA, EP, and CIHR of single restorations over external hexagon implants are not associated with the presence of peri-implantitis. However, prospective studies with larger samples are required to better ascertain such an association in the long term.

Illustrated identification key to females of the genus Sabethes Robineau-Desvoidy recorded from Brazil (Diptera: Culicidae), in dichotomous and interactive formats, including an updated list of species and new records for the states.

Female mosquitoes of the genus Sabethes Robineau-Desvoidy, 1827 are implicated in the transmission of several arboviruses, including yellow fever virus. Here, we present an illustrated species identification key for females of the genus Sabethes recorded in Brazil, except Sa. nitidus Theobald, 1901 and Sa. harbachi Nascimento-Pereira, Guimares, Loureno-de-Oliveira & Motta, 2021 as only the males of these species are known. The key is available in dichotomous and interactive formats. An updated list of the Sabethes species of Brazil and new occurrence records for the states of the country are provided. The type localities of four speciesSa. glaucodaemon (Dyar & Shannon, 1925), Sa. amazonicus Gordon & Evans, 1922, Sa. belisarioi Neiva, 1908 and Sa. soperi Lane & Cerqueira, 1942are corrected or restricted.

Comparison of the efficiency of initial dental alignment with Invisalign® aligners changed every 7 or 14 days in mature adults: Randomized clinical trial.

OBJECTIVE: To compare the anterior crowding correction after sequential use of the first 5 aligners between two aligner exchange protocols (7 and 14 days) in mature adult patients. MATERIALS AND METHODS: Thirty-six patients over 35 years who received orthodontic treatment with Invisalign® were randomly allocated to two different aligner replacement sequence protocols: Group 1: exchange every 7 days (n = 18); and Group 2: exchange every 14 days (n = 18). All patients were scanned with iTero Element 5D® (Align Technology) in two treatment times: at pre-treatment (T1) and after using the first five aligners (T2). Little's Irregularity Index (LII) and arch widths were evaluated with OrthoCAD software. Intra and intergroup comparisons were performed with the dependent and independent t-tests. The results were considered significant for P < .05. RESULTS: Thirty-five patients completed the study. Both groups' maxillary and mandibular Irregularity Indexesi were significantly lower at T2. There was no significant difference in inter-canine, inter-premolar, and intermolar distances. G2 (14 days) presented a greater decrease in mandibular irregularity than G1 (7 days). CONCLUSION: Both exchange protocols (7 and 14 days) effectively correct anterior crowding in the initial phase of orthodontic treatment with aligners in mature adult patients. However, the 14-day exchange protocol provided a greater correction in mandibular anterior crowding in the evaluated period than the 7-day exchange protocol.

Integrated Relaxation Pressure and Its Diagnostic Ability May Vary According to the Conditions Used for HREM Recording.

Integrated Residual Pressure (IRP) measured under conditions alternative to supine single swallows may provide clinically useful information regarding EGJ relaxation. This study aimed to compare IRP values obtained under different situations and explore their potential clinical utility. We analyzed and compared the values of IRP obtained from healthy volunteers and patients with suspected achalasia during supine single swallows (Ssup-IRP), sitting single swallows (Ssit-IRP), supine multiple rapid swallows (Msup-IRP), and sitting multiple rapid swallows (Msit-IRP). We analyzed the HREM recordings of 40 healthy volunteers and 53 patients with suspected achalasia. The four metrics were significantly different from each other in healthy volunteers (Ssup-IRP > Msup-IRP > Ssit-IRP > Msit-IRP) and their corresponding 95th percentiles were substantially distinct (Ssup-IRP: 25.3 mmHg, Ssit-IRP: 20.9 mmHg, Msup-IRP: 15.9 mmHg, and Msit-IRP: 11.9 mm Hg, respectively). Complete agreement among the four metrics in predicting abnormal IRP was found in 39 of the 47 patients with suspected achalasia who completed the protocol. Optimal cutoffs derived from ROC curve analysis demonstrated ≥ 0.95 specificities for detection of impaired EGJ relaxation among patients with suspected achalasia. Among the eight patients with suspected achalasia with normal Ssup-IRP, five demonstrated abnormal Msit-IRP and four abnormal Ssit-IRP. Significant differences of IRP exist depending on the measurement situation, indicating that correct interpretation of IRP values requires specific cutoffs for each situation.The sensitivities of Ssit-IRP and Msit-IRP in detecting defective EGJ relaxation appear to be slightly higher than that of Ssup-IRP.

Anatomical study of first palmar intermetacarpal flap in cadavers and application for congenital first web contracture in a child with Apert's syndrome.

INTRODUCTION: Reconstructing severe first web contractures often involves using either pedicled forearm flaps, which can cause extensive scarring, or free flaps, which can be highly complex. In this study, we present a local palmar hand flap that overcomes both of these challenges. METHODS: Ten fresh upper limbs were examined after arterial injection with colored latex. The study focused on identifying the most distal palmar vascular cutaneous branches suitable for designing an elliptical cutaneous flap over the volar intermetacarpal area. This flap's width was approximately 50% of the width of the thenar eminence. Additionally, we present the case of an 8-year-old child with a type 1 Upton's Apert's hand, which exhibited a severe first web contracture. RESULTS: In seven cadaver hands, one distal cutaneous perforator was found, while in three hands, two perforators were identified. These perforators originated from the thumb radial collateral artery six times, pollex princeps three times, index radial collateral vessels twice, and thumb ulnar collateral vessels twice. The mean perforator diameter was 0.5 mm (ranging from 0.4 to 0.6 mm), and the mean perforator length was 10 mm (ranging from 0.8 to 12 mm). Using this flap bilaterally in our patient resulted in a straightforward procedure that created a broad and functional first web. A total-thickness skin graft was necessary to cover the proximal thenar area, and fortunately, no complications arose. A wide first web with an intermetacarpal angle of 40° ultimately was obtained scoring 8 on the kapandji. CONCLUSIONS: The first palmar intermetacarpal flap presents itself as a reasonable and uncomplicated option for addressing significant moderate-to-severe first web contractures.

Copaifera langsdorffii Desf. tree oleoresin-induced antinociception recruits µ1- and κ -opioid receptors in the ventrolateral columns of the periaqueductal gray matter.

Popular medicine has been using oleoresin from several species of copaíba tree for the treatment of various diseases and its clinical administration potentially causes antinociception. Electrical stimulation of ventrolateral (vlPAG) and dorsolateral (dlPAG) columns of the periaqueductal gray matter also causes antinociception. The aim this study was to verify the antinociceptive effect of oleoresin extracted from Copaifera langsdorffii tree and to test the hypothesis that oleoresin-induced antinociception is mediated by µ1- and κ-opioid receptors in the vlPAG and dlPAG. Nociceptive thresholds were determined by the tail-flick test in Wistar rats. The copaíba tree oleoresin was administered at different doses (50, 100 and 200 mg/kg) through the gavage technique. After the specification of the most effective dose of copaíba tree oleoresin (200 mg/kg), rats were pretreated with either the µ1-opioid receptor selective antagonist naloxonazine (at 0.05, 0.5 and 5 µg/ 0.2 µl in vlPAG, and 5 µg/ 0.2 µl in dlPAG) or the κ-opioid receptor selective antagonist nor-binaltorphimine (at 1, 3 and 9 nmol/ 0.2 µl in vlPAG, and 9 nmol/ 0.2 µl in dlPAG). The blockade of µ1 and κ opioid receptors of vlPAG decreased the antinociception produced by copaíba tree oleoresin. However, the blockade of these receptors in dlPAG did not alter copaíba tree oleoresin-induced antinociception. These data suggest that vlPAG µ1 and κ opioid receptors are critically recruited in the antinociceptive effect produced by oleoresin extracted from Copaifera langsdorffii.

El impacto de la pandemia de COVID-19 en los nuevos casos de tuberculosis en pacientes hospitalizados / The Impact of COVID-19 Pandemic on New Active Tuberculosis in Hospitalized Patients

Objectives: The COVID-19 pandemic has affected the global fight against Tuberculosis, although its impact is not fully known. We aimed to analyse the impact of the COVID-19 pandemic on the diagnosis and hospital care of tuberculosis patients. Material and Method: We conducted a retrospective study in a Portuguese 804-bed hospital between March 2019 and March 2021. We compared the number of new diagnoses of active Tuberculosis in hospitalized patients in the 12-month period before (group A) and after (group B) the surge of COVID-19 in Portugal (March 2020), as well as patients’ clinical characteristics. Results: There were a total of 24.675 hospital admissions, of which 158 were due to new active tuberculosis. There were 60 new diagnoses of active tuberculosis in the first year of the COVID-19 pandemic (group B), compared to 98 in the previous year (group A) (0.5% vs. 0.8%, respectively, p=0.004). Gender distribution, age, symptoms at presentation and affected organs were similar in both groups. During the COVID-19 pandemic, there was a significant median 3-day delay in diagnosis after hospital admission (p=0.047) and a total of 18% of tuberculosis cases were co-infected with SARS-CoV-2 in the first month of antituberculosis therapy. Conclusion: During the first year of the COVID-19 pandemic, hospitalised patients were 37% less likely to have a diagnosis of new active TB, compared to the previous year. Our study highlights the concern about underdiagnosis and diagnostic delay of active TB during the COVID-19 pandemic and the need for studies and policies addressing this matter. (AU)

Objetivos: Analizar el impacto de la pandemia de COVID-19 en el diagnóstico y la atención hospitalaria de los pacientes con tuberculosis. Método: Estudio retrospectivo en un hospital portugués de 804 camas entre marzo de 2019 y marzo de 2021. Comparamos el número de nuevos diagnósticos de tuberculosis activa en pacientes hospitalizados en el período de 12 meses antes y después el repunte de la COVID-19 en Portugal (marzo 2020), así como las características clínicas de los pacientes. Resultados: Se incluyeron 24.675 ingresos hospitalarios, de los cuales 158 fueron por tuberculosis activa nueva. Se observó 60 nuevos diagnósticos de tuberculosis activa en el primer año de la pandemia COVID-19 (grupo B), frente a los 98 del año anterior (grupo A) (p=0,004). La distribución por género, edad, presentación y órganos afectados fueron similares. Durante la pandemia de COVID-19, hubo una mediana de retraso significativo de 3 días en el diagnóstico después del ingreso hospitalario (p=0,047) y un total del 18 % de los casos de tuberculosis se infectaron con SARS-CoV-2 en el primer mes de terapia antituberculosa. Conclusión: Durante el primer año de la pandemia COVID-19, los pacientes hospitalizados tuvieron 37% menos de probabilidad de tener un diagnóstico nuevo de TB. Nuestro estudio destaca la preocupación por el infradiagnóstico y el retraso en el diagnóstico de la TB activa durante la pandemia COVID-19 y la necesidad de estudios y políticas que aborden este tema. (AU)

Mercury concentration in larvae of Eustrongylides sp (Nematoda: Dioctophymatoidea) from fish of the Brazilian Amazon / Concentración de mercurio en larvas de Eustrongylides sp (Nematoda: Dioctophymatoidea) en peces de la Amazonía brasileña

Abstract Introduction: Chemical pollution represents a great concern to aquatic organisms, especially fish. Metals enter the aquatic environment from a variety of sources, including natural biogeochemical cycles and anthropogenic sources such as industrial and residential effluents, mining and atmospheric sources. Objective: To describe the Eustrongylides sp. larvae and the interaction with their fish hosts as indicators of mercury (Hg) contamination in the Brazilian Amazon, and the distribution of Hg in the internal organs of fish species Hoplias malabaricus and Pygocentrus nattereri collected in oxbow lakes on the Tapajós River, in the municipality of Santarém, in the state of Pará. Methods: Total Hg was analyzed using the Direct Hg Analyzer - DMA-80. Concentrations of Hg in Eustrongylides sp. were compared with those found in the tissues/organs of the hosts H. malabaricus and P. nattereri. Hg concentrations in the host/parasite system were statistically compared using Principal Component Analysis. The bioconcentration factor (BCF) was calculated to assess the bioaccumulation capacity of metals in Eustrongylides sp. larvae, comparing the concentration of Hg in the parasite with that accumulated in the musculature of infected hosts. Results: Hg concentrations in all tissues/organs analyzed were higher in the parasitic species Eustrongylides sp. larvae when compared with those found in tissues/organs of H. malabaricus and P. nattereri. There was an inversely proportional relationship, showing that when Eustrongylides sp. larvae are present, the concentration in the parasite is higher than in the musculature of host fish H. malabaricus and P. nattereri. The BCF of Hg was found by comparing Eustrongylides sp. larvae/H. malabaricus muscle and was observed during a flood (BCF Hg = 15 364). Conclusions: The results confirm the greater bioaccumulative capacity of Eustrongylides sp. compared to its host. The data indicated the viability of using Eustrongylides sp. larvae in biomonitoring programs. It is worth mentioning that fish samples for Hg analysis must be free of parasites since their presence can alter the results.

Resumen Introducción: La contaminación química del hábitat acuático representa un gran peligro para organismos acuáticos, especialmente para peces. Los metales ingresan al ambiente acuático desde una variedad de fuentes, incluidos los ciclos biogeoquímicos naturales y fuentes antropogénicas, como efluentes industriales y residenciales, minería y fuentes atmosféricas. Objetivo: Describir las especies de Eustrongylides sp. y la interacción con sus peces hospederos como indicadores de contaminación por mercurio en la Amazonía brasileña, y la distribución en los órganos internos de las especies de peces Hoplias malabaricus y Pygocentrus nattereri recolectadas en cochas del Río Tapajós, en el municipio de Santarém, del estado de Pará. Métodos: El Hg total se analizó utilizando el Direct Hg Analyzer - DMA-80. Las concentraciones de Eustrongylides sp. se compararon con las encontrados en los tejidos/órganos de los hospederos H. malabaricus y P. nattereri. Las concentraciones en el sistema hospedero/parásito se compararon estadísticamente utilizando el análisis de componentes principales. Se calculó el factor de bioconcentración (BCF) para evaluar la capacidad de bioacumulación de metales en larvas de Eustrongylides sp., comparando la concentración en el parásito con la acumulada en la musculatura de los hospederos infectados. Resultados: Las concentraciones de Hg en todos los tejidos/órganos analizados fueron mayores en las larvas de la especie parasitaria Eustrongylides sp. en comparación con las encontradas en los tejidos/órganos de H. malabaricus y P. nattereri. Hubo una relación inversamente proporcional, mostrando que cuando las larvas de Eustrongylides sp. están presentes, la concentración en el parásito es mayor que en la musculatura de los peces hospederos H. malabaricus y P. nattereri. El BCF de Hg se encontró comparando Eustrongylides sp. larvas/ músculo H. malabaricus y se observó durante una inundación (BCF Hg = 15 364). Conclusiones: Los resultados confirman la mayor capacidad bioacumulativa de Eustrongylides sp. en comparación con su hospedero. Los datos indicaron la viabilidad de utilizar larvas de Eustrongylides sp. en programas de biomonitoreo. Cabe mencionar que las muestras de pescado para análisis de Hg deben estar libres de parásitos ya que su presencia puede alterar los resultados.

Biological and behavioral features and colonization of the sylvatic mosquito Sabethes identicus (Diptera: Culicidae).

Mosquitoes of the genus Sabethes are exclusively sylvatic species occurring in Central and South Americas, where they play a role in the transmission of arbovirus. Sabethes identicus, a common bamboo-breeder species, has been found naturally infected with yellow fever virus. Our study aimed to describe biological and behavioral features of Sa. identicus in the laboratory, as well as establish and standardize an isolated colony for experimental assays. We tested different larval densities and evaluated larval and pupal development time, oviposition behavior, egg production, and longevity. We also shot and video-documented bionomics and behavioral aspects of the mosquitoes in the field and laboratory. A colony with more than 30 generations was achieved. Embryogenesis of Sa. identicus is completed in about three days with a 79% hatch rate, while larval and pupal development takes approximately 15-17 and nine days, respectively. The mosquito's entire life cycle lasts approximately 30 days. Adult females could survive 71 days, and each individual laid an average of 88 eggs over their lifetime; 50% of females and males survived 37 and 24 days, respectively. Hematophagy peaks as early as the first week of emergence. The net content of a bamboo internode influenced the choice for oviposition, with the average number of eggs laid in those containing rearing water with larval and pupal exuviae being significantly higher than when they had only dechlorinated water or water with yeast. We documented for the first time an ecological association of weevils and Sa. identicus, where the oviposition of the latter depends on the weevil creating a hole in the bamboo wall for egg-laying purposes. Video recordings revealed for the first time the peculiar movements of gravid females during egg-throwing into tiny bamboo holes, as well as the laborious escape of newly emerged adults from the bamboo cavity, and mating behavior.

Proteomic analysis of stimulated saliva in gastroesophageal reflux disease patients with and without erosive tooth wear: Observational study.

OBJECTIVE: To evaluate the difference in the proteomic profile of stimulated saliva in patients with gastroesophageal reflux disease (GERD) with (GE) and without (GNE) erosive tooth wear (ETW), regarding both human and bacterial proteins. METHODS: Stimulated saliva (SS) was collected from 16 patients (8/group). Samples were centrifuged at 4.500 g for 15 min under refrigeration to remove all debris. The supernatant from each saliva sample was taken and frozen at -80 °C. After extracting the proteins, they were submitted to reverse phase liquid chromatography and mass spectrometry (nLC-ESI-MS/MS). Label-free proteomic quantification was performed using Protein Lynx Global Service (PLGS) software (p < 0.05) for human and bacterial proteins. RESULTS: In total, 67 human proteins were common for GNE and GE groups. GNE group presented, compared to GE group, increase in proteins that confer antimicrobial and acid resistant properties, such as cystatins, histatin and immunoglobulins. However, GNE group had a marked decrease in subunits of hemoglobin (α, ß and delta). Regarding bacterial proteins, for SS, 7 and 10 unique proteins were identified in the GE and GNE groups, respectively. They are related to protein synthesis and energy metabolism and interact with human proteins typically found in saliva and supramolecular complexes of the acquired pellicle. CONCLUSIONS: Our data indicate that the stimulation of the salivary flow increases acid resistant and antimicrobial proteins in saliva, which might protect against ETW. CLINICAL SIGNIFICANCE: This pioneer study showed important differences in the human and bacterial proteome of SS in patients with GERD with or without ETW.

Pharmacomagnetography assessment of the prokinetic effect on metronidazole absorption.

OBJECTIVES: This study aimed to evaluate the effects of prucalopride, a prokinetic agent that acts as a potent serotonin agonist of 5-HT4 receptors, on gastric emptying and small bowel transit and assess its impact on the absorption of metronidazole. METHODS: Six healthy volunteers, three men and three women, aged between 20 and 27 years, with a body weight ranging from 50 to 80 kg, were enrolled in this study. The pharmacokinetics and gastrointestinal transit parameters were evaluated simultaneously through pharmacomagnetography assessment, combining alternating current biosusceptometry and blood analysis. KEY FINDINGS: The results showed that prucalopride enhances gastric emptying and small bowel transit when administered orally and significantly impacts the rate of metronidazole absorption, leading to enhanced bioavailability and rapid therapeutic response. CONCLUSION: Pharmacomagnetography assessment allows simultaneous tracking of transit by images and is a valuable method for analysing drug absorption using multiple instruments.

Four single implant-supported crowns replacing the maxillary incisors: A retrospective report of 10 cases with 2-9 years of follow-up.

OBJECTIVE: This retrospective case series aimed to assess the stability of the papilla around four single crowns supported by narrow-diameter implants replacing all maxillary incisors. Secondary objectives included assessment of marginal bone level stability, incidence of technical and biological complications, and patient satisfaction. MATERIALS AND METHODS: Individuals with four adjacent implants in maxillary incisor sites, placed with a 3 mm inter-implant distance and rehabilitated with single crowns were included. Retrospective data were obtained from photographs and radiographs taken at the delivery of the prosthesis (baseline-T0). Patients were then recalled (≥2 years after T0) for clinical and radiographic examination (follow-up-T1). Photographs were obtained and patient satisfaction was assessed using a visual analogue scale. Papilla height and marginal bone level were compared over time. RESULTS: Data from 10 patients with medium-low smile lines and rehabilitated with 40 implants, in function for 5.4 ± 1.9 years, were analyzed. The papilla height between implants (T0: 2.3 ± 0.9 mm; T1: 2.6 ± 0.7 mm; p = .011) and between tooth and implant (T0: 3.4 ± 0.9 mm; T1: 3.8 ± 0.8 mm; p = .025) increased significantly over the years. The marginal bone level remained stable over time (T0: 0.88 ± 0.57 mm; T1: 0.71 ± 0.67 mm; p = .007). Patients were highly satisfied (97.7 ± 0.3%) with the treatment outcome. CONCLUSION: Within its limitations, this study demonstrated that four single implant-supported crowns placed at maxillary incisor sites may exhibit soft tissue and marginal bone stability over a long period of time. This treatment approach, however, should be restricted to few patients as it requires a proper case selection and skillful execution of all surgical and prosthetic steps.

Intracranial Pressure Evaluation in Swine During Full-Endoscopic Lumbar Spine Surgery.

BACKGROUND: Neurological complications during full-endoscopic spine surgery (FESS) might be attributed to intracranial pressure (ICP) increase due to continuous saline infusion (CSI). Understanding CSI and ICP correlation might modify irrigation pump usage. This study aimed to evaluate invasive ICP during interlaminar FESS; correlate ICP with irrigation pump parameters (IPPs); evaluate ICP during saline outflow occlusion, commonly used to control bleeding and improve the surgeon's view; and, after durotomy, simulate accidental dural tear. METHODS: Five swine were monitored, submitted to total intravenous anesthesia, and positioned ventrally. A parenchymal catheter was installed through a skull burr for ICP monitoring. Lumbar interlaminar FESS was performed until exposure of neural structures. CSI was used within progressively higher IPPs (A [60 mm Hg, 350 mL/minute] to D [150 mm Hg, 700 mL/minute]), and ICP was documented. During each IPP, different situations were grouped: intact dura with open channels (A1-D1) or occlusion test (A2-D2); dural tear with open channels (Ax1-Dx1) or occlusion test (Ax2-Dx2). ICP <20 mm Hg was defined as safe. RESULTS: Basal average ICP was 8.1 mm Hg. Adjustment in total intravenous anesthesia or suspension of tests was necessary due to critical ICP or animal discomfort. It was safe to operate with all IPPs with opened drainage channels (A1-D1) even with dural tear (Ax1-Dx1). Several occlusion tests (A2-D2, Ax2-Dx2) caused ICP increase (e.g., 86.1 mm Hg) influenced by anesthetic state and hemodynamics. CONCLUSIONS: During FESS, CSI might critically raise ICP. Keeping drainage channels open, with ideal anesthetic state, ICP remains safe even with high IPPs, despite dural tear. Drainage occlusions can quickly raise ICP, being even more severe with higher IPPs. Total intravenous anesthesia may protect from ICP increase and may allow longer drainage occlusion or higher IPPs.

360-degree Arthroscopic Management of Scaphoid Pseudarthrosis: Description of Technique and Indications.

Nonunion remains one of the main complications of scaphoid fractures, with no consensus being reached as to the best surgical technique for scaphoid pseudoarthrosis. Thus, different types of procedures for bone stability and biological stimulus for consolidation have been described. The use of arthroscopy for scaphoid pseudoarthrosis has advantages as it allows for treating associated injuries, preserving wrist proprioception by minimizing damage to the joint capsule and ligaments and not deteriorating the already fragile scaphoid vasculature, leading to a quick recovery. Arthroscopy was initially indicated for stable scaphoid pseudoarthroses, being used in all patterns of this condition, including unstable ones and those with flexion collapse. However, most scientific articles describe the use of arthroscopy only through the dorsal portals, creating technical difficulty in complete debridement of the site of pseudarthrosis and in placing bone graft. This study describes the 360-degree technique, which standardizes arthroscopy in scaphoid pseudoarthrosis treatment, allowing, with the use of dorsal, volar, and radial portals, direct approach to the entire circumference of the nonunion site, facilitating the debridement of the injury site, the correction of the scaphoid deformity, and the placement of a graft directly on the site of the defect, mainly in its volar region after correction of the flexion deformity. The 360-degree technique aims to help and standardize the arthroscopic procedure for scaphoid pseudarthrosis, creating a routine with defined surgery stages. Additional portals allow complete access to the entire nonunion site and better positioning of the bone graft under direct view.

Mutations in Structural Genes of the Mitochondrial Complex IV May Influence Breast Cancer.

Although it has gained more attention in recent years, the relationship between breast cancer (BC) and mitochondrial oxidative phosphorylation (OXPHOS) is still not well understood. Importantly, Complex IV or Cytochrome C Oxidase (COX) of OXPHOS is one of the key players in mitochondrial balance. An in silico investigation of mutations in structural genes of Complex IV was conducted in BC, comprising 2107 samples. Our findings show four variants (rs267606614, rs753969142, rs199476128 and rs267606884) with significant pathogenic potential. Moreover, we highlight nine genes (MT-CO1, MT-CO2, MT-CO3, CO4I2, COX5A, COX5B, COX6A2, COX6C and COX7B2) with a potential impact on BC.

Intramedullary Fixation with Cannulated Screw After Resection of Enchondroma in the Hand: Technique Description and Case Series.

Purpose: Enchondromas are primary, benign bone neoplasms that arise from intramedullary proliferation of hyaline cartilage cells. Slow and progressive in growth, enchondromas can lead to bone destruction, deformities, and fractures. The treatment of enchondromas remains controversial. We hereby describe the technique for bone fixation using headless intramedullary screws (HISs) after enchondroma resection in the long bones of the hand. Methods: From January 2018 to June 2021, all patients treated with HISs after the resection of enchondroma of the hand were retrospectively assessed and included in the study. The series comprised four patients with a minimum postoperative follow-up period of 12 months. Postoperative functional results were measured according to Takigawa criteria and postoperative radiographic results were graded according to the Tordai system. Results: After tumor resection and screw fixation, one patient had autologous bone grafting from the iliac crest, and another had the defect filled with calcium phosphate cement. All patients were followed up for at least 12 months, and the mean healing time of the pathologic fracture was 5 weeks. There were neither complications related to the procedure nor the need for a second surgery. Conclusions: We describe the technique of intramedullary headless screws for bone fixation after enchondroma resection in the long bones of the hand, as well as the excellent functional, cosmetic, and radiographic results of four patients treated with the technique presented herewith. Type of study/level of evidence: Therapeutic IV.

Two year follow-up of distal unruptured intracranial aneurysms treated with a surface modified flow diverter under prasugrel monotherapy.

BACKGROUND: A new generation of modified surface flow diverters (FDs) and monotherapy using new antiplatelets may reduce both ischemic and hemorrhagic complications during the treatment of intracranial aneurysms. Previous preliminary safety analysis of distal unruptured intracranial aneurysms treated with the FD p48 MW HPC (phenox-Wallaby, Bochum, Germany) under antiplatelet monotherapy with prasugrel showed promising results. However, the long term outcomes of distal intracranial aneurysms treated with FDs under antiplatelet monotherapy are not known. METHODS: This was a single center, prospective, pivotal, open single arm study. The primary (safety) endpoint was absence of any new neurological deficits after treatment until the 24 month follow-up. The primary (efficacy) endpoint was the incidence of complete aneurysm occlusion 24 months after treatment. The secondary (efficacy) endpoints were any incidence of aneurysm dome reduction 24 months after treatment. RESULTS: 21 patients harboring 27 distal aneurysms of the anterior circulation were included. No patient had neurologic deficits in the time from treatment to the 24 month follow-up. Complete aneurysm occlusion occurred in 20 (74%) of 27 aneurysms at the 24 month follow-up. Four aneurysms (14.8%) had dome reduction, and three aneurysms (11.1%) remained unchanged. CONCLUSIONS: In this pilot trial, treatment of distal unruptured intracranial aneurysms with an FD under monotherapy with prasugrel, followed by monotherapy with aspirin, appeared to be safe and effective. Randomized studies with long term follow-up are needed to confirm these results.