Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.155.130
Filtrar
1.
Einstein (Sao Paulo) ; 18: eAO4784, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31553356

RESUMEN

OBJECTIVE: To evaluate the effect of three types of muscular resistance training on adiposity, inflammation levels and insulin activity in Swiss mice with fat-rich diet-induced obesity. METHODS: Lean and obese male Swiss mice were selected and allocated to one of eight groups comprising eight mice each, as follows: standard diet + no training; standard diet + muscular resistance training; standard diet + hypertrophy training; standard diet + strength training; high-fat diet + no training; high-fat diet + muscular resistance training; high-fat diet + hypertrophy training; high-fat diet + strength training. The training protocol consisted of stair climbing for a 10-week period. Blood samples were collected for lactate analysis, glucose level measurement and insulin tolerance test. After euthanasia, adipose tissues were removed and weighed for adiposity index determination. Fragments of epididymal adipose tissue were then embedded for histological analysis or homogenized for tumor necrosis factor alpha level determination using the ELISA method. RESULTS: Ausency of differences in total training volume and blood lactate levels overall emphasize the similarity between the different resistance training protocols. Body weight loss, reduced adipocyte area and lower adiposity index were observed in trained obese mice, regardless of training modality. Different training protocols also improved insulin sensitivity and reduced inflammation levels. CONCLUSION: Resistance training protocols were equally effective in reducing body fat, inflammation levels and insulin resistance in obese mice.


Asunto(s)
Adiposidad/fisiología , Hipertrofia/fisiopatología , Inflamación/fisiopatología , Resistencia a la Insulina/fisiología , Ejercicios de Estiramiento Muscular/métodos , Obesidad/fisiopatología , Condicionamiento Físico Animal/fisiología , Tejido Adiposo Blanco/fisiopatología , Animales , Glucemia/análisis , Peso Corporal/fisiología , Dieta Alta en Grasa , Ensayo de Inmunoadsorción Enzimática , Masculino , Ratones , Ratones Obesos , Reproducibilidad de los Resultados , Entrenamiento de Resistencia/métodos , Factores de Tiempo , Factor de Necrosis Tumoral alfa/análisis
2.
Einstein (Sao Paulo) ; 18: eAO4876, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31576909

RESUMEN

OBJECTIVE: To investigate the effects of sericin extracted from silkworm Bombyx mori cocoon on morphophysiological parameters in mice with obesity induced by high-fat diet. METHODS: Male C57Bl6 mice aged 9 weeks were allocated to one of two groups - Control and Obese, and fed a standard or high-fat diet for 10 weeks, respectively. Mice were then further subdivided into four groups with seven mice each, as follows: Control, Control-Sericin, Obese, and Obese-Sericin. The standard or high fat diet was given for 4 more weeks; sericin (1,000mg/kg body weight) was given orally to mice in the Control-Sericin and Obese-Sericin Groups during this period. Weight gain, food intake, fecal weight, fecal lipid content, gut motility and glucose tolerance were monitored. At the end of experimental period, plasma was collected for biochemical analysis. Samples of white adipose tissue, liver and jejunum were collected and processed for light microscopy analysis; liver fragments were used for lipid content determination. RESULTS: Obese mice experienced significantly greater weight gain and fat accumulation and had higher total cholesterol and glucose levels compared to controls. Retroperitoneal and periepididymal adipocyte hypertrophy, development of hepatic steatosis, increased cholesterol and triglyceride levels and morphometric changes in the jejunal wall were observed. CONCLUSION: Physiological changes induced by obesity were not fully reverted by sericin; however, sericin treatment restored jejunal morphometry and increased lipid excretion in feces in obese mice, suggesting potential anti-obesity effects.


Asunto(s)
Fármacos Antiobesidad/uso terapéutico , Dieta Alta en Grasa , Obesidad/tratamiento farmacológico , Sericinas/uso terapéutico , Tejido Adiposo/patología , Animales , Fármacos Antiobesidad/farmacología , Peso Corporal/efectos de los fármacos , Colesterol/análisis , Dieta Alta en Grasa/efectos adversos , Ingestión de Alimentos/efectos de los fármacos , Hígado Graso/patología , Tránsito Gastrointestinal/efectos de los fármacos , Prueba de Tolerancia a la Glucosa , Hígado/metabolismo , Masculino , Ratones Endogámicos C57BL , Ratones Obesos , Obesidad/etiología , Obesidad/fisiopatología , Reproducibilidad de los Resultados , Sericinas/farmacología , Factores de Tiempo , Resultado del Tratamiento , Triglicéridos/análisis , Aumento de Peso/efectos de los fármacos
3.
Einstein (Sao Paulo) ; 18: eGS4442, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31576910

RESUMEN

OBJECTIVE: To analyze the legal demands of tiotropium bromide to treat chronic obstructive pulmonary disease. METHODS: We included secondary data from the pharmaceutical care management systems made available by the Paraná State Drug Center. RESULTS: Public interest civil action and ordinary procedures, among others, were the most common used by the patients to obtain the medicine. Two Health Centers in Paraná (Londrina and Umuarama) concentrated more than 50% of the actions. The most common specialty of physicians who prescribed (33.8%) was pulmonology. There is a small financial impact of tiotropium bromide on general costs with medicines of the Paraná State Drug Center. However, a significant individual financial impact was observed because one unit of the medicine represents 38% of the Brazilian minimum wage. CONCLUSION: Our study highlights the need of incorporating this medicine in the class of long-acting anticholinergic bronchodilator in the Brazilian public health system.


Asunto(s)
Broncodilatadores/economía , Medicamentos Esenciales/provisión & distribución , Necesidades y Demandas de Servicios de Salud/legislación & jurisprudencia , Rol Judicial , Enfermedad Pulmonar Obstructiva Crónica/economía , Bromuro de Tiotropio/economía , Brasil , Medicamentos Esenciales/economía , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Accesibilidad a los Servicios de Salud/tendencias , Necesidades y Demandas de Servicios de Salud/economía , Necesidades y Demandas de Servicios de Salud/tendencias , Humanos , Programas Nacionales de Salud , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Estudios Retrospectivos , Estadísticas no Paramétricas , Factores de Tiempo
4.
Rev Bras Epidemiol ; 22Suppl 1(Suppl 1): e190007, 2019.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31576983

RESUMEN

OBJECTIVE: To analyze the pattern of spatial distribution of hepatitis B virus (HBV) cases and the mortality attributed to this disease throughout the Brazilian territory, in 2005, 2016 and 2017. METHODS: This is an ecological study of spatial analysis, using data from the Information System for Notifiable Diseases and the Brazilian Mortality Information System. HBV detection and mortality rates were analyzed. The spatial analysis from 2005 to 2017 was held through the Global Moran's Index (I) for global data and the Local Indicators of Spatial Association (LISA) for the 5,564 municipalities of the country. RESULTS: The North region stands out with the highest HBV detection and mortality rates in the country. The Global Moran's I showed a spatial correlation of HBV cases in Brazil, and the LISA Map evidenced the presence of hotspots or spatial clusters (high-high type), mainly in the North region and also in some municipalities of Santa Catarina, Paraná, Rio Grande do Sul, Espírito Santo, São Paulo and Rio de Janeiro. CONCLUSION: The spatial analysis of the HBV distribution pattern in Brazil shows areas with a large concentration of cases, particularly in the North of the country and in other points distributed throughout the national territory. These data reinforce the urgency of intervention actions related to prevention, diagnosis and treatment of hepatitis B.


Asunto(s)
Virus de la Hepatitis B , Hepatitis B/mortalidad , Brasil/epidemiología , Ciudades/epidemiología , Geografía , Humanos , Mortalidad/tendencias , Prevalencia , Análisis Espacio-Temporal , Factores de Tiempo
5.
Bone Joint J ; 101-B(10): 1307-1312, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31564143

RESUMEN

AIMS: In order to determine whether and for whom serial radiological evaluation is necessary in one-part proximal humerus fractures, we set out to describe the clinical history and predictors of secondary displacement in patients sustaining these injuries. PATIENTS AND METHODS: Between January 2014 and April 2016, all patients with an isolated, nonoperatively treated one-part proximal humerus fracture were prospectively followed up. Clinical and radiological evaluation took place at less than two, six, 12, and 52 weeks. Fracture configuration, bone quality, and comminution were determined on the initial radiographs. Fracture healing, secondary displacement, and treatment changes were recorded during follow-up. RESULTS: In 100 patients (59 female, 41 male; mean age 57 years), 91 of the fractures (91%) remained stable. In five of nine patients (55%) with secondary displacement, surgery was recommended. Comminution, present in 23 patients (23%), was identified as a predictor of secondary displacement (p < 0.001). Patients' age, sex, fracture configuration, and bone quality were not associated with secondary displacement (p ≥ 0.438). Nonoperative treatment resulted in a mean absolute Constant score (CS) of 80 (49 to 98), relative CS of 101% (63% to 138%), median subjective shoulder value of 95% (interquartile range (IQR) 90% to 100%), and median EuroQol five-dimensional questionnaire score of 0.89 (IQR 0.80 to 1.00) with bone union in all cases at one-year follow-up. CONCLUSION: Radiological re-evaluation was only necessary in patients presenting with comminution and may be redundant for 77% of patients with one-part proximal humerus fractures. Nonoperative treatment of one-part proximal humerus fractures remains the mainstay of treatment with a low rate of secondary surgery, a high union rate, and good clinical results. Cite this article: Bone Joint J 2019;101-B:1307-1312.


Asunto(s)
Tratamiento Conservador/métodos , Curación de Fractura/fisiología , Radiografía/estadística & datos numéricos , Sistema de Registros , Fracturas del Hombro/diagnóstico por imagen , Procedimientos Innecesarios/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Fijación de Fractura/métodos , Humanos , Puntaje de Gravedad del Traumatismo , Modelos Logísticos , Masculino , Persona de Mediana Edad , Radiografía/métodos , Fracturas del Hombro/terapia , Estadísticas no Paramétricas , Factores de Tiempo
7.
Bone Joint J ; 101-B(10): 1199-1208, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31564148

RESUMEN

AIMS: We compared implant and patient survival following intraoperative periprosthetic femoral fractures (IOPFFs) during primary total hip arthroplasty (THA) with matched controls. PATIENTS AND METHODS: This retrospective cohort study compared 4831 hips with IOPFF and 48 154 propensity score matched primary THAs without IOPFF implanted between 2004 and 2016, which had been recorded on a national joint registry. Implant and patient survival rates were compared between groups using Cox regression. RESULTS: Ten-year stem survival was worse in the IOPFF group (p < 0.001). Risk of revision for aseptic loosening increased 7.2-fold following shaft fracture and almost 2.8-fold after trochanteric fracture (p < 0.001). Risk of periprosthetic fracture of the femur revision increased 4.3-fold following calcar-crack and 3.6-fold after trochanteric fracture (p < 0.01). Risk of instability revision was 3.6-fold after trochanteric fracture and 2.4-fold after calcar crack (p < 0.001). Risk of 90-day mortality following IOPFF without revision was 1.7-fold and 4.0-fold after IOPFF with early revision surgery versus uncomplicated THA (p < 0.001). CONCLUSION: IOPFF increases risk of stem revision and mortality up to ten years following surgery. The risk of revision depends on IOPFF subtype and mortality risk increases with subsequent revision surgery. Surgeons should carefully diagnose and treat IOPFF to minimize fracture progression and implant failure. Cite this article: Bone Joint J 2019;101-B:1199-1208.


Asunto(s)
Artroplastia de Reemplazo de Cadera/efectos adversos , Osteoartritis de la Cadera/cirugía , Fracturas Periprotésicas/cirugía , Sistema de Registros , Reoperación/métodos , Factores de Edad , Anciano , Artroplastia de Reemplazo de Cadera/métodos , Estudios de Casos y Controles , Inglaterra , Femenino , Fracturas del Fémur/diagnóstico por imagen , Fracturas del Fémur/cirugía , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Irlanda del Norte , Osteoartritis de la Cadera/diagnóstico por imagen , Fracturas Periprotésicas/diagnóstico por imagen , Fracturas Periprotésicas/epidemiología , Modelos de Riesgos Proporcionales , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Medición de Riesgo , Factores Sexuales , Factores de Tiempo , Resultado del Tratamiento , Reino Unido , Gales
8.
Bone Joint J ; 101-B(10): 1186-1191, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31564149

RESUMEN

AIMS: In previous studies, we identified multiple factors influencing the survivorship of hip resurfacing arthroplasties (HRAs), such as initial anatomical conditions and surgical technique. In addition, the University of California, Los Angeles (UCLA) activity score presents a ceiling effect, so a better quantification of activity is important to determine which activities may be advisable or detrimental to the recovered patient. We aimed to determine the effect of specific groups of sporting activities on the survivorship free of aseptic failure of a large series of HRA. PATIENTS AND METHODS: A total of 661 patients (806 hips) representing 77% of a consecutive series of patients treated with metal-on-metal hybrid HRA answered a survey to determine the types and amounts of sporting activities they regularly participated in. There were 462 male patients (70%) and 199 female patients (30%). Their mean age at the time of surgery was 51.9 years (14 to 78). Their mean body mass index (BMI) was 26.5 kg/m2 (16.7 to 46.5). Activities were regrouped into 17 categories based on general analogies between these activities. Scores for typical frequency and duration of the sessions were used to quantify the patients' overall time spent engaging in sporting activities. Impact and cycle scores were computed. Multivariable models were used. RESULTS: We found no association between any category of activity and a decrease in survivorship. Impact and hip cycle scores also failed to show any association with revision for aseptic failure or wear. CONCLUSION: Return to sporting activities after surgery is safe for patients treated with well-designed and well-implanted HRA. Cite this article: Bone Joint J 2019;101-B:1186-1191.


Asunto(s)
Artroplastia de Reemplazo de Cadera/métodos , Ejercicio/fisiología , Prótesis Articulares de Metal sobre Metal , Seguridad del Paciente/estadística & datos numéricos , Volver al Deporte/estadística & datos numéricos , Adulto , Factores de Edad , Anciano , Artroplastia de Reemplazo de Cadera/rehabilitación , California , Estudios Transversales , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Análisis Multivariante , Pronóstico , Falla de Prótesis , Calidad de Vida , Medición de Riesgo , Factores Sexuales , Encuestas y Cuestionarios , Supervivencia , Factores de Tiempo
9.
Bone Joint J ; 101-B(10): 1280-1284, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31564150

RESUMEN

AIMS: A number of methods have been described to remove a well-fixed humeral implant as part of revision shoulder arthroplasty. These include the use of cortical windows and humeral osteotomies. The router bit extraction technique uses a high-speed router bit to disrupt the bone-implant interface. The implant is then struck in a retrograde fashion with a square-tip impactor and mallet. The purpose of this study was to determine the characteristics and frequency of the different techniques needed for the removal of a well-fixed humeral stem in revision shoulder arthroplasty. PATIENTS AND METHODS: Between 2010 and 2018, 288 revision shoulder arthroplasty procedures requiring removal of a well-fixed humeral component were carried out at a tertiary referral centre by a single surgeon. The patient demographics, indications for surgery, and method of extraction were collected. RESULTS: Of the 288 revisions, 284 humeral stems (98.6%) were removed using the router bit extraction technique alone. Four humeral stems (1.39%) required an additional cortical window. Humeral osteotomy was not necessary in any procedure. Most of the humeral stems removed (78.8%) were cementless. Of the four humeral stems that required a cortical window, three involved removal of a hemiarthroplasty. Two were cemented and two were cementless. CONCLUSION: The router bit extraction technique removed a well-fixed humeral component in a very high proportion of patients (98.6%). This method allows surgeons to avoid more invasive approaches involving a cortical window or humeral osteotomy, and their associated complications. Cite this article: Bone Joint J 2019;101-B:1280-1284.


Asunto(s)
Artroplastía de Reemplazo de Hombro/efectos adversos , Remoción de Dispositivos/métodos , Hemiartroplastia/métodos , Falla de Prótesis , Anciano , Artroplastía de Reemplazo de Hombro/métodos , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Recuperación de la Función/fisiología , Sistema de Registros , Estudios Retrospectivos , Medición de Riesgo , Prótesis de Hombro/efectos adversos , Centros de Atención Terciaria , Factores de Tiempo , Resultado del Tratamiento
10.
Bone Joint J ; 101-B(10): 1285-1291, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31564154

RESUMEN

AIMS: Currently, periprosthetic fractures are excluded from the American Society for Bone and Mineral Research (ASBMR) definition of atypical femoral fracture (AFFs). This study aims to report on a series of periprosthetic femoral fractures (PFFs) that otherwise meet the criteria for AFFs. Secondary aims were to identify predictors of periprosthetic atypical femoral fractures (PAFFs) and quantify the complications of treatment. PATIENTS AND METHODS: This was a retrospective case control study of consecutive patients with periprosthetic femoral fractures between 2007 and 2017. Two observers identified 16 PAFF cases (mean age 73.9 years (44 to 88), 14 female patients) and 17 typical periprosthetic fractures in patients on bisphosphonate therapy as controls (mean age 80.7 years (60 to 86, 13 female patients). Univariate and multivariate analysis was performed to identify predictors of PAFF. Management and complications were recorded. RESULTS: Interobserver agreement for the PAFF classification was excellent (kappa = 0.944; p < 0.001). On univariate analysis compared with controls, patients with PAFFs had higher mean body mass indices (28.6 kg/m2 (sd 8.9) vs 21.5 kg/m2 (sd 3.3); p = 0.009), longer durations of bisphosphonate therapy (median 5.5 years (IQR 3.2 to 10.6) vs 2.4 years (IQR 1.0 to 6.4); p = 0.04), and were less likely to be on alendronate (50% vs 94%; p = 0.02) with an indication of secondary osteoporosis (19% vs 0%; p = 0.049). Duration of bisphosphonate therapy was an independent predictor of PAFF on multivariate analysis (R2 = 0.733; p = 0.05). Following primary fracture management, complication rates were higher in PAFFs (9/16, 56%) than controls (5/17, 29%; p = 0.178) with a relative risk of any complication following PAFF of 1.71 (95% confidence interval (CI) 0.77 to 3.8) and of reoperation 2.56 (95% CI 1.3 to 5.2). CONCLUSION: AFFs do occur in association with prostheses. Longer duration of bisphosphonate therapy is an independent predictor of PAFF. Complication rates are higher following PAFFs compared with typical PFFs, particularly of reoperation and infection. Cite this article: Bone Joint J 2019;101-B:1285-1291.


Asunto(s)
Artroplastia de Reemplazo de Cadera/efectos adversos , Difosfonatos/efectos adversos , Osteoporosis/tratamiento farmacológico , Fracturas Periprotésicas/inducido químicamente , Fracturas Periprotésicas/cirugía , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/métodos , Estudios de Casos y Controles , Intervalos de Confianza , Difosfonatos/uso terapéutico , Relación Dosis-Respuesta a Droga , Femenino , Fracturas del Fémur/inducido químicamente , Fracturas del Fémur/cirugía , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Análisis Multivariante , Variaciones Dependientes del Observador , Osteoporosis/complicaciones , Fracturas Periprotésicas/diagnóstico por imagen , Estudios Retrospectivos , Medición de Riesgo , Factores de Tiempo , Estados Unidos
11.
Bone Joint J ; 101-B(10): 1209-1217, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31564156

RESUMEN

AIMS: There is an increasing demand for hip arthroplasty in China. We aimed to describe trends in in-hospital mortality after this procedure in China and to examine the potential risk factors. PATIENTS AND METHODS: We included 210 450 patients undergoing primary hip arthroplasty registered in the Hospital Quality Monitoring System in China between 2013 and 2016. In-hospital mortality after hip arthroplasty and its relation to potential risk factors were assessed using multivariable Poisson regression. RESULTS: During the study period, 626 inpatient deaths occurred within 30 days after hip arthroplasty. Mortality decreased from 2.9% in 2013 to 2.6% in 2016 (p for trend = 0.02). Compared with their counterparts, old age, male sex, and divorced or widowed patients had a higher rate of mortality (all p < 0.05). Risk ratio (RR) for mortality after arthroplasty for fracture was two-fold higher (RR 2.0, 95% confidence interval (CI) 1.5 to 2.6) than that for chronic disease. RRs for mortality were 3.3 (95% CI 2.7 to 3.9) and 8.2 (95% CI 6.5 to 10.4) for patients with Charlson Comorbidity Index (CCI) of 1 to 2 and CCI ≥ 3, respectively, compared with patients with CCI of 0. The rate of mortality varied according to geographical region, the lowest being in the East region (1.8%), followed by Beijing (2.1%), the North (2.9%), South-West (3.6%), South-Central (3.8%), North-East (4.1%), and North-West (5.2%) regions. CONCLUSION: While in-hospital mortality after hip arthroplasty in China appears low and declined during the study period, discrepancies in mortality after this procedure exist according to sociodemographic factors. Healthcare resources should be allocated more to underdeveloped regions to further reduce mortality. Cite this article: Bone Joint J 2019;101-B:1209-1217.


Asunto(s)
Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/mortalidad , Causas de Muerte , Mortalidad Hospitalaria/tendencias , Sistema de Registros , Factores de Edad , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/métodos , China , Estudios de Cohortes , Bases de Datos Factuales , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Distribución de Poisson , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/fisiopatología , Falla de Prótesis , Estudios Retrospectivos , Factores Sexuales , Factores de Tiempo , Resultado del Tratamiento
12.
Bone Joint J ; 101-B(10): 1218-1229, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31564157

RESUMEN

AIMS: Abnormal femoral torsion (FT) is increasingly recognized as an additional cause for femoroacetabular impingement (FAI). It is unknown if in-toeing of the foot is a specific diagnostic sign for increased FT in patients with symptomatic FAI. The aims of this study were to determine: 1) the prevalence and diagnostic accuracy of in-toeing to detect increased FT; 2) if foot progression angle (FPA) and tibial torsion (TT) are different among patients with abnormal FT; and 3) if FPA correlates with FT. PATIENTS AND METHODS: A retrospective, institutional review board (IRB)-approved, controlled study of 85 symptomatic patients (148 hips) with FAI or hip dysplasia was performed in the gait laboratory. All patients had a measurement of FT (pelvic CT scan), TT (CT scan), and FPA (optical motion capture system). We allocated all patients to three groups with decreased FT (< 10°, 37 hips), increased FT (> 25°, 61 hips), and normal FT (10° to 25°, 50 hips). Cluster analysis was performed. RESULTS: We found a specificity of 99%, positive predictive value (PPV) of 93%, and sensitivity of 23% for in-toeing (FPA < 0°) to detect increased FT > 25°. Most of the hips with normal or decreased FT had no in-toeing (false-positive rate of 1%). Patients with increased FT had significantly (p < 0.001) more in-toeing than patients with decreased FT. The majority of the patients (77%) with increased FT walk with a normal foot position. The correlation between FPA and FT was significant (r = 0.404, p < 0.001). Five cluster groups were identified. CONCLUSION: In-toeing has a high specificity and high PPV to detect increased FT, but increased FT can be missed because of the low sensitivity and high false-negative rate. These results can be used for diagnosis of abnormal FT in patients with FAI or hip dysplasia undergoing hip arthroscopy or femoral derotation osteotomy. However, most of the patients with increased FT walk with a normal foot position. This can lead to underestimation or misdiagnosis of abnormal FT. We recommend measuring FT with CT/MRI scans in all patients with FAI. Cite this article: Bone Joint J 2019;101-B:1218-1229.


Asunto(s)
Artroscopía/métodos , Pinzamiento Femoroacetabular/cirugía , Imagen Tridimensional , Metatarso Valgo/diagnóstico por imagen , Metatarso Varo/diagnóstico por imagen , Osteotomía/efectos adversos , Adulto , Análisis de Varianza , Distribución de Chi-Cuadrado , Estudios de Cohortes , Femenino , Pinzamiento Femoroacetabular/diagnóstico por imagen , Fémur/fisiopatología , Estudios de Seguimiento , Humanos , Modelos Lineales , Imagen por Resonancia Magnética/métodos , Masculino , Metatarso Valgo/epidemiología , Metatarso Varo/epidemiología , Persona de Mediana Edad , Osteotomía/métodos , Prevalencia , Rango del Movimiento Articular/fisiología , Estudios Retrospectivos , Medición de Riesgo , Factores de Tiempo , Tomografía Computarizada por Rayos X/métodos , Anomalía Torsional/diagnóstico por imagen , Resultado del Tratamiento , Adulto Joven
13.
Bone Joint J ; 101-B(10): 1300-1306, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31564159

RESUMEN

AIMS: The primary aim of this study was to develop a reliable, effective radiological score to assess the healing of humeral shaft fractures, the Radiographic Union Score for HUmeral fractures (RUSHU). The secondary aim was to assess whether the six-week RUSHU was predictive of nonunion at six months after the injury. PATIENTS AND METHODS: Initially, 20 patients with radiographs six weeks following a humeral shaft fracture were selected at random from a trauma database and scored by three observers, based on the Radiographic Union Scale for Tibial fractures system. After refinement of the RUSHU criteria, a second group of 60 patients with radiographs six weeks after injury, 40 with fractures that united and 20 with fractures that developed nonunion, were scored by two blinded observers. RESULTS: After refinement, the interobserver intraclass correlation coefficient (ICC) was 0.79 (95% confidence interval (CI) 0.67 to 0.87), indicating substantial agreement. At six weeks after injury, patients whose fractures united had a significantly higher median score than those who developed nonunion (10 vs 7; p < 0.001). A receiver operating characteristic curve determined that a RUSHU cut-off of < 8 was predictive of nonunion (area under the curve = 0.84, 95% CI 0.74 to 0.94). The sensitivity was 75% and specificity 80% with a positive predictive value (PPV) of 65% and a negative predictive value of 86%. Patients with a RUSHU < 8 (n = 23) were more likely to develop nonunion than those with a RUSHU ≥ 8 (n = 37, odds ratio 12.0, 95% CI 3.4 to 42.9). Based on a PPV of 65%, if all patients with a RUSHU < 8 underwent fixation, the number of procedures needed to avoid one nonunion would be 1.5. CONCLUSION: The RUSHU is reliable and effective in identifying patients at risk of nonunion of a humeral shaft fracture at six weeks after injury. This tool requires external validation but could potentially reduce the morbidity associated with delayed treatment of an established nonunion. Cite this article: Bone Joint J 2019;101-B:1300-1306.


Asunto(s)
Curación de Fractura/fisiología , Fracturas no Consolidadas/diagnóstico por imagen , Fracturas del Húmero/cirugía , Radiografía/métodos , Adulto , Factores de Edad , Tratamiento Conservador/métodos , Bases de Datos Factuales , Femenino , Estudios de Seguimiento , Fijación de Fractura/métodos , Fracturas no Consolidadas/cirugía , Humanos , Fracturas del Húmero/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Valor Predictivo de las Pruebas , Curva ROC , Reoperación/métodos , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Medición de Riesgo , Factores Sexuales , Factores de Tiempo
14.
Braz Oral Res ; 33: e092, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31576904

RESUMEN

This study evaluated the effect of antimicrobial photodynamic therapy (aPDT) on the endodontic treatment of apical periodontitis (AP). AP was induced in 48 premolars of 6 dogs. After biomechanical preparation, the teeth were divided into 4 groups: Calcium-Hydroxide (CH)/120d and CH/180d: root canals filled with CH-based dressing for 15 days before obturation; aPDT/120d and aPDT/180d: conditioning with phenothiazine photosensitizer (10 mg/mL) for 1 minute and irradiation with diode laser in the same session as obturation. Root filling was performed with AH Plus sealer. After the experimental periods, animals were euthanized and teeth were submitted for histology. HE staining was performed for descriptive analysis of the periapical region, measurement of apical periodontitis and for inflammatory cells, and blood vessels count. Immunohistochemistry was performed for osteopontin (OPN) and alkaline phosphatase (ALP). Data were analyzed statistically by two-way ANOVA and chi-square test (α = 5%). Teeth in Group CH/120d presented only a slightly enlarged periodontal ligament (PL) with advanced repair. Group aPDT/120d presented the PL moderately enlarged, with moderate inflammatory infiltrate and few collagen fibers. The same pattern was observed at 180 days. AP lesions in CH-treated groups were smaller than those in aPDT-treated groups (p < 0.001) with more blood vessels (p < 0.0001), regardless of the evaluation period, without significant differences in the number of inflammatory cells (p > 0.05). CH-treated groups showed significantly more intense immunostaining for ALP and OPN (p < 0.001) in both periods. Although aPDT stimulated angiogenesis and expression of bone formation markers, the two-session endodontic treatment with CH-based dressing promoted better apical periodontitis repair.


Asunto(s)
Cementos para Huesos/uso terapéutico , Hidróxido de Calcio/uso terapéutico , Periodontitis Periapical/tratamiento farmacológico , Fotoquimioterapia/métodos , Tratamiento del Conducto Radicular/métodos , Animales , Vasos Sanguíneos/efectos de los fármacos , Regeneración Ósea/efectos de los fármacos , Inmunohistoquímica , Neovascularización Fisiológica/efectos de los fármacos , Periodontitis Periapical/patología , Reproducibilidad de los Resultados , Factores de Tiempo , Resultado del Tratamiento
15.
BMJ ; 367: l5515, 2019 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-31578196

RESUMEN

CLINICAL QUESTION: Recent 15-year updates of sigmoidoscopy screening trials provide new evidence on the effectiveness of colorectal cancer screening. Prompted by the new evidence, we asked: "Does colorectal cancer screening make an important difference to health outcomes in individuals initiating screening at age 50 to 79? And which screening option is best?" CURRENT PRACTICE: Numerous guidelines recommend screening, but vary on recommended test, age and screening frequency. This guideline looks at the evidence and makes recommendations on screening for four screening options: faecal immunochemical test (FIT) every year, FIT every two years, a single sigmoidoscopy, or a single colonoscopy. RECOMMENDATIONS: These recommendations apply to adults aged 50-79 years with no prior screening, no symptoms of colorectal cancer, and a life expectancy of at least 15 years. For individuals with an estimated 15-year colorectal cancer risk below 3%, we suggest no screening (weak recommendation). For individuals with an estimated 15-year risk above 3%, we suggest screening with one of the four screening options: FIT every year, FIT every two years, a single sigmoidoscopy, or a single colonoscopy (weak recommendation). With our guidance we publish the linked research, a graphic of the absolute harms and benefits, a clear description of how we reached our value judgments, and linked decision aids. HOW THIS GUIDELINE WAS CREATED: A guideline panel including patients, clinicians, content experts and methodologists produced these recommendations using GRADE and in adherence with standards for trustworthy guidelines. A linked systematic review of colorectal cancer screening trials and microsimulation modelling were performed to inform the panel of 15-year screening benefits and harms. The panel also reviewed each screening option's practical issues and burdens. Based on their own experience, the panel estimated the magnitude of benefit typical members of the population would value to opt for screening and used the benefit thresholds to inform their recommendations. THE EVIDENCE: Overall there was substantial uncertainty (low certainty evidence) regarding the 15-year benefits, burdens and harms of screening. Best estimates suggested that all four screening options resulted in similar colorectal cancer mortality reductions. FIT every two years may have little or no effect on cancer incidence over 15 years, while FIT every year, sigmoidoscopy, and colonoscopy may reduce cancer incidence, although for FIT the incidence reduction is small compared with sigmoidoscopy and colonoscopy. Screening related serious gastrointestinal and cardiovascular adverse events are rare. The magnitude of the benefits is dependent on the individual risk, while harms and burdens are less strongly associated with cancer risk. UNDERSTANDING THE RECOMMENDATION: Based on benefits, harms, and burdens of screening, the panel inferred that most informed individuals with a 15-year risk of colorectal cancer of 3% or higher are likely to choose screening, and most individuals with a risk of below 3% are likely to decline screening. Given varying values and preferences, optimal care will require shared decision making.


Asunto(s)
Colonoscopía/estadística & datos numéricos , Neoplasias Colorrectales/diagnóstico , Detección Precóz del Cáncer/normas , Tamizaje Masivo/normas , Sangre Oculta , Sigmoidoscopía/estadística & datos numéricos , Anciano , Colonoscopía/normas , Neoplasias Colorrectales/epidemiología , Detección Precóz del Cáncer/métodos , Detección Precóz del Cáncer/estadística & datos numéricos , Femenino , Humanos , Incidencia , Masculino , Tamizaje Masivo/métodos , Tamizaje Masivo/estadística & datos numéricos , Persona de Mediana Edad , Evaluación de Procesos y Resultados (Atención de Salud)/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Sigmoidoscopía/normas , Factores de Tiempo
16.
J Appl Oral Sci ; 27: e20180476, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31596364

RESUMEN

OBJECTIVES: Miniscrew has been frequently used, considering that anchorage control is a critical point in orthodontic treatment, and its failure, the main adverse problem. Using two groups of stable (successful) and unstable (failed) mini-implants, this in vivo study aimed to quantify proinflammatory cytokines IL-1 α, IL-6, IL-17, and TNF-α and osteoclastogenesis marker RANK, RANKL, and OPG in gingival tissue, using the real-time polymerase chain reaction technique. METHODOLOGY: Thirteen patients of both sexes (11-49 years old) under orthodontic treatment were selected, obtaining 11 successful and 7 failed mini-implants. The mini-implants were placed and removed by the same surgeon, in both jaws. The mean time of permanence in the mouth was 29.4 months for successful and 7.6 months for failed mini-implants. At removal time, peri-mini-implant gingival tissue samples were collected and processed for quantification of the proinflammatory cytokines and osteoclastogenesis markers. Nonparametric Wilcoxon rank-sum test considering the clusters and Kruskal-Wallis test were used for statistical analysis (α=0.05). RESULTS: No significant difference (p>0.05) was observed between the groups for either quantification of cytokines or osteoclastogenesis markers, except for IL-6 (p<0.05). CONCLUSIONS: It may be concluded that the expression of IL-1α, IL-17, TNF-α, RANK, RANKL, and OPG in peri-implant gingival tissue were not determinant for mini-implant stability loss, but the higher IL-6 expression could be associated with mini-implant failure.


Asunto(s)
Citocinas/análisis , Implantes Dentales/efectos adversos , Gingivitis/patología , Métodos de Anclaje en Ortodoncia/efectos adversos , Osteogénesis/fisiología , Periimplantitis/patología , Adolescente , Adulto , Pérdida de Hueso Alveolar , Biomarcadores/análisis , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteoprotegerina/análisis , Reacción en Cadena en Tiempo Real de la Polimerasa , Valores de Referencia , Estadísticas no Paramétricas , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
17.
J Appl Oral Sci ; 27: e20180574, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31596365

RESUMEN

OBJECTIVES: Hypertension is one of the main causes of premature death in the world; also, it is associated with several bone alterations. Preclinical studies have demonstrated delayed alveolar bone healing in hypertensive rats. However, losartan has been favorable for consolidation of bone grafts and reduction in active periodontitis. Therefore, losartan is suggested to be effective in bone formation stages, as well as in the synthesis of matrix proteins and mineralization. To evaluate the alveolar bone dynamics in hypertensive rats treated with losartan by laser confocal microscopy and histological analysis. METHODOLOGY: Thirty-two rats, 16 spontaneously hypertensive rats (SHR) and 16 Wistar albinus rats, treated or not with losartan (30 mg/kg/day) were used. Calcein fluorochrome at 21 days and alizarin red fluorochrome at 49 days were injected in rats (both 20 mg/kg). The animals were submitted to euthanasia 67 days after treatment, and then the right maxilla was removed for laser confocal microscopy analysis and the left maxilla for histological analysis. RESULTS: This study showed a greater calcium marking in normotensive animals treated with losartan in relation to the other groups. Laser confocal microscopy parameters showed higher values of bone volume formed, mineralized surface, active surface of mineralization and bone formation rate in normotensive animals treated with losartan. However, a smaller mineralized surface was observed in all hypertensive animals. CONCLUSION: Losartan can improve bone mineralization parameters under normal physiological conditions, but the same anabolic effect does not occur under hypertension.


Asunto(s)
Proceso Alveolar/efectos de los fármacos , Proceso Alveolar/fisiopatología , Antihipertensivos/farmacología , Hipertensión/fisiopatología , Losartán/farmacología , Proceso Alveolar/patología , Animales , Presión Sanguínea/efectos de los fármacos , Regeneración Ósea/efectos de los fármacos , Calcificación Fisiológica/efectos de los fármacos , Fluoresceínas/análisis , Masculino , Microscopía Confocal , Osteogénesis/efectos de los fármacos , Ratas Endogámicas SHR , Ratas Wistar , Reproducibilidad de los Resultados , Factores de Tiempo
18.
J Appl Oral Sci ; 27: e20180584, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31596366

RESUMEN

OBJECTIVES: This study aimed to compare two different soft tissue replacement grafts in their ability to treat gingival recession defects and successfully integrate with the surrounding tissues. METHODOLOGY: Nine beagle dogs were included and followed up to 10 weeks. Sites for intervention were allocated to one of the grafting materials investigated. Treatment consisted of coronally advanced flap combined with one of the two soft tissue substitutes on a previous surgically created defect. Materials employed were porcine-derived acellular dermal matrix (ADM) [Novomatrix™ (Test)] and collagen-based matrix (CBM) [Mucograft® (Control)]. Animals were sacrificed at 2, 6, and 10 weeks postoperatively and compared using descriptive histology and histomorphometric outcomes. RESULTS: Macroscopic findings were similar between test and control groups at all intervals. After 10 weeks, both groups demonstrated successful incorporation of the grafting materials without signs of rejection and with comparable tissue integration. The histomorphometric data were similar between groups at 2 weeks; however, the test group provided greater root coverage and increase in tissue thickness than the control at 6- and 10-weeks post surgically. CONCLUSIONS: Both porcine-derived ADM and CBM revealed similar histological outcomes with successful integration and absence of adverse events. Test group provided superior outcomes regarding root coverage and increase in tissue thickness.


Asunto(s)
Dermis Acelular , Colágeno/uso terapéutico , Recesión Gingival/cirugía , Animales , Vasos Sanguíneos/patología , Perros , Encía/patología , Encía/cirugía , Recesión Gingival/patología , Ensayo de Materiales , Valores de Referencia , Reproducibilidad de los Resultados , Colgajos Quirúrgicos , Porcinos , Factores de Tiempo , Resultado del Tratamiento
19.
J Appl Oral Sci ; 27: e20180663, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31596368

RESUMEN

OBJECTIVE: To investigate the use of polymethyl methacrylate (PMMA) electrospun fiber mats containing different amounts of polyethylene oxide (PEO) as a doxycycline delivery system and to test antibacterial activity against an oral pathogen. METHODOLOGY: PMMA powders or PEO (mol wt 200 Kd) (10,20,30% w/w/) were dissolved in N, N-dimethylformamide (DMF) to obtain a final polymer concentration of 15% in DMF (w/v). 2% Doxycycline monohydrate was added to the solutions and submitted to vortex mixing. The solution was transferred to a plastic syringe and fit into a nanofiber electrospinning unit. The parameters applied were: voltage at 17.2 kV; distance of 20 cm between the needle tip and the collector plate; target speed at 2 m/min; and transverse speed at 1cm/min. Syringe pump speed was 0.15 mm/min. The drug release analysis was performed by removing aliquots of the drug-containing solution (in PBS) at specific periods. Doxycycline release was quantified using RP-HPLC. Fiber mats from all groups had their antibacterial action tested against S. mutans based on inhibition halos formed around the specimens. The experiments were performed in triplicate. Gravimetric analysis at specific periods was performed to determine any polymer loss. Morphological characterization of the electrospun fibers was completed under an optical microscope followed by SEM analysis. RESULTS: The addition of PEO to the PMMA fibers did not affect the appearance and diameter of fibers. However, increasing the %PEO caused higher doxycycline release in the first 24 h. Fibers containing 30% PEO showed statistically significant higher release when compared with the other groups. Doxycycline released from the fibers containing 20% or 30% of PEO showed effective against S. mutans. CONCLUSION: The incorporation of PEO at 20% and 30% into PMMA fiber mat resulted in effective drug release systems, with detected antibacterial activity against S. mutans.


Asunto(s)
Antibacterianos/farmacocinética , Doxiciclina/farmacocinética , Nanofibras/química , Polietilenglicoles/farmacocinética , Polimetil Metacrilato/farmacocinética , Análisis de Varianza , Antibacterianos/química , Cromatografía Líquida de Alta Presión/métodos , Doxiciclina/química , Inmersión , Microscopía Electrónica de Rastreo , Peso Molecular , Polietilenglicoles/química , Polimetil Metacrilato/química , Reproducibilidad de los Resultados , Streptococcus mutans/efectos de los fármacos , Factores de Tiempo , Agua/química
20.
J Appl Oral Sci ; 27: e20180693, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31596370

RESUMEN

OBJECTIVES: To compare the sealing ability and biocompatibility of Biodentine with mineral trioxide aggregate (MTA) when used as root-end filling materials. METHODOLOGY: The Cell Counting Kit-8 (CCK-8) assay was used to compare the cytotoxicity of MTA and Biodentine. Twenty-one extracted teeth with a single canal were immersed in an acidic silver nitrate solution after root-end filling. Then, the volume and depth of silver nitrate that infiltrated the apical portion of the teeth were analyzed using micro-computed tomography (micro-CT). Seventy-two roots from 3 female beagle dogs were randomly distributed into 3 groups and apical surgery was performed. After six months, the volume of the bone defect surrounding these roots was analyzed using micro-CT. RESULTS: Based on the results of the CCK-8 assay, MTA and Biodentine did not show statistically significant differences in cytotoxicity (P>0.05). The volume and the depth of the infiltrated nitrate solution were greater in the MTA group than in the Biodentine group (P<0.05). The volume of the bone defect was larger in the MTA group than in the Biodentine group. However, the difference was not significant (P>0.05). The volumes of the bone defects in the MTA and Biodentine groups were smaller than the group without any filling materials (P<0.05). CONCLUSIONS: MTA and Biodentine exhibited comparable cellular biocompatibility. Biodentine showed a superior sealing ability to MTA in root-end filling. Both Biodentine and MTA promoted periradicular bone healing in beagle dog periradicular surgery models.


Asunto(s)
Compuestos de Aluminio/farmacología , Compuestos de Calcio/farmacología , Óxidos/farmacología , Tejido Periapical/efectos de los fármacos , Ligamento Periodontal/efectos de los fármacos , Materiales de Obturación del Conducto Radicular/farmacología , Tratamiento del Conducto Radicular/métodos , Silicatos/farmacología , Cicatrización de Heridas/efectos de los fármacos , Adolescente , Animales , Regeneración Ósea/efectos de los fármacos , Recuento de Células , Células Cultivadas , Perros , Combinación de Medicamentos , Humanos , Masculino , Ensayo de Materiales , Osteogénesis/efectos de los fármacos , Tejido Periapical/citología , Tejido Periapical/diagnóstico por imagen , Ligamento Periodontal/diagnóstico por imagen , Reproducibilidad de los Resultados , Factores de Tiempo , Raíz del Diente/diagnóstico por imagen , Raíz del Diente/efectos de los fármacos , Raíz del Diente/cirugía , Resultado del Tratamiento , Microtomografía por Rayos X , Adulto Joven
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA