Rutin ameliorates nitrergic and endothelial dysfunction on vessels and corpora cavernosa of diabetic animals.

Endothelial dysfunction is an early complication of diabetes and it is related to both micro- and macroangiopathies. In addition, >70% of diabetic patients develop autonomic neuropathies. Increased oxidative stress has a major role in the development of both nitrergic and endothelial dysfunction. The aim of this work is to evaluate whether rutin, a potent antioxidant, could ameliorate nitrergic and/or endothelial dysfunction in diabetic animals. Primary and secondary treatment protocols with rutin were investigated on rat aortic rings and the mesenteric arteriolar bed, and on rabbit aortic rings and corpora cavernosa (RbCC) from both euglycemic and alloxan-diabetic animals. Acetylcholine endothelium-dependent and sodium nitroprusside endothelium-independent relaxations were compared in tissues from euglycemic or diabetic animals. Electrical field stimulation (EFS)-induced relaxation was performed only in the RbCC. Endothelial-dependent relaxations were blunted by 40% in vessels and neuronal relaxation was blunted by 50% in RbCC taken from diabetic animals when compared to euglycemic animals. Pre-treatment with rutin restored both neuronal and endothelial dependent relaxations in diabetic animals towards the values achieved in control euglycemic tissues. Rutin was able to ameliorate both endothelial dysfunction and nitrergic neuropathy in animal experimental models. Rutin could be a lead compound in the primary or secondary preventive ancillary treatment of endothelial and nitrergic dysfunction in the course of diabetes.

Global conservation prioritization areas in three dimensions of crocodilian diversity.

Crocodilians are a taxonomic group of large predators with important ecological and evolutionary benefits for ecosystem functioning in the face of global change. Anthropogenic actions affect negatively crocodilians' survival and more than half of the species are threatened with extinction worldwide. Here, we map and explore three dimensions of crocodilian diversity on a global scale. To highlight the ecological importance of crocodilians, we correlate the spatial distribution of species with the ecosystem services of nutrient retention in the world. We calculate the effectiveness of global protected networks in safeguarding crocodilian species and provide three prioritization models for conservation planning. Our results show the main hotspots of ecological and evolutionary values are in southern North, Central and South America, west-central Africa, northeastern India, and southeastern Asia. African species have the highest correlation to nutrient retention patterns. Twenty-five percent of the world's crocodilian species are not significantly represented in the existing protected area networks. The most alarming cases are reported in northeastern India, eastern China, and west-central Africa, which include threatened species with low or non-significant representation in the protected area networks. Our highest conservation prioritization model targets southern North America, east-central Central America, northern South America, west-central Africa, northeastern India, eastern China, southern Laos, Cambodia, and some points in southeastern Asia. Our research provides a global prioritization scheme to protect multiple dimensions of crocodilian diversity for achieving effective conservation outcomes.

Statin Therapy Among Bariatric Patients: The Impact on Metabolic Outcomes and Diabetes Status.

INTRODUCTION: Statin therapy is associated with an increased risk of developing diabetes. Among bariatric patients, the influence of this therapy on various metabolic outcomes, such as diabetes status and its remission, is largely unknown. METHODS: This was a retrospective study of 1710 patients who underwent bariatric surgery at our hospital between January/2010 and June/2017. We compared patients with and without statin therapy at baseline, 12 and 24 months after surgery regarding statin use and its impact on several clinical and analytical parameters. Multiple linear regression was performed, adjusting differences for age, sex, surgery type, antidiabetic drugs at baseline, hypertension at baseline, LDL cholesterol ˃ 130 mg/dL, weight variation one year after surgery, and age of obesity onset. RESULTS: The overall prevalence of statin use was 20.2% before, 13.6% 12 months after surgery, and 15.0% 24 months after surgery. There was a larger reduction in fasting glucose and HbA1c at 12 and 24 months after surgery among statin-treated patients, with the opposite trend for weight reduction and BMI. Statin-treated patients with diabetes had lower diabetes remission rates (45.3 vs 68.5%) 12 months after surgery, with the highest reduction in HbA1c (1.3±1.3 vs -1.1±1.2%; p=0.042), fasting glucose (-40.8±48.8 vs -30.9±41.6 mg/dL; p=0.028), and insulin (-21.7±28.2 vs -13.4±14.2 mIU/L; p=0.039). The proportion of new-onset cases of diabetes was equal between statin-treated vs non-treated individuals at 12 months (1.9%) and 24 months (1.0%) after surgery. CONCLUSION: Bariatric surgery seems to lead to diabetes remission more frequently in patients not treated with statins. A larger reduction was observed in fasting glucose and HbA1c among statin-treated patients. Statin did not contribute to an increased proportion of new-onset diabetes after surgery.

Beta Cell Function as a Baseline Predictor of Weight Loss After Bariatric Surgery.

Background: Obesity is a multifactorial disease, which is strongly associated to other metabolic disorders. Bariatric surgery is the most effective treatment of morbid obesity. The role of beta cell function in weight loss after bariatric surgery is uncertain. Aim: To evaluate the association between beta cell function and percentage of total body weight loss (TBWL%) 1, 2, 3, and 4 years after bariatric surgery in patients with morbid obesity. Methods: Retrospective longitudinal study in patients with morbid obesity followed in our center between January 2010 and July 2018. Patients were excluded if they had diabetes at baseline or missing data on the needed parameters. We evaluated baseline Homeostatic Model Assessment of IR, Homeostatic Model Assessment of ß-cell function (HOMA-beta), Quantitative Insulin Sensitivity Check Index, and Matsuda and DeFronzo index, and TBWL% at years 1 to 4. Linear regression models were used to evaluate the association of indexes of insulin resistance with TBWL% (unadjusted and adjusted for age, sex, BMI, and type of surgery). Results: There were 1,561 patients included in this analysis. HOMA-beta was negatively associated with TBWL% at second, third, and fourth years post-surgery (ß = -1.04 [-1.82 to -0.26], p<0.01; ß = -1.16 [-2.13 to -0.19], p=0.02; ß = -1.29 [-2.64 to 0.06], p=0.061, respectively). This was not observed in the first year post-surgery nor for the other indexes. Glycemia at baseline was positively associated to EWL% at second and third years post-surgery. Conclusion: ß-cell function at baseline seems to be associated to long-term weight loss, explicitly after the first year post bariatric surgery. This might be a helpful predictor of weight loss in clinical practice.

Carbon sequestration scenarios in Portugal: which way to go forward?

Assessing carbon storage and sequestration is key for defining effective conservation actions to mitigate climate change. Forest species changes have direct impacts on carbon stocks and may lead to undesirable climate trade-offs. In this paper, we measure aboveground biomass (AGB) and the impact of forest changes on climate regulation through three land policy scenarios by 2030 in continental Portugal. We found that a High intervention scenario, supported by an important increase in "Other coniferous trees" class, will provide 29.5% more of carbon sequestration, whereas a Low intervention scenario, in which there is a moderate increase in all forest classes, will result in an increase of 5.7%. A business as usual (BAU) scenario, supported by an increase in eucalyptus forests and a decrease in autochthonous species, will decrease carbon sequestration (-2.7%), particularly Lisboa, Algarve and North regions. Economic valuation shows that the High intervention scenario will generate the highest economic outcome for climate regulation by 2030. This study provides a spatial-based methodology for monitoring carbon sequestration and new insights about the impact of policies for Green House Gas (GHG) mitigation, supporting the 2030 Sustainable Development Goals achievement.

Secondary Hyperparathyroidism Among Bariatric Patients: Unraveling the Prevalence of an Overlooked Foe.

INTRODUCTION: Bariatric surgery (BS) is the most effective therapeutic approach to obesity. It is associated with great gastrointestinal anatomic changes, predisposing the patients to altered nutrient absorption that impacts phosphocalcium metabolism. This study aimed to clarify the prevalence of secondary hyperparathyroidism (SHPT) and its predictors in patients submitted to BS. METHODS: Retrospective study of 1431 patients who underwent metabolic surgery between January 2010 and June 2017 and who were followed for at least 1 year. We compared the clinical and biochemical characteristics of patients with and without secondary hyperparathyroidism (considering SHPT a PTH ˃ 69 pg/mL). Two different analyses were performed: (1) paired analysis of participants before and 1 year after surgery (N = 441); (2) Cross sectional analysis of participants submitted to bariatric surgery before (N = 441), 1 year after (N = 1431) and 4 years after surgery (N = 333). Multiple logistic regression models were used to evaluate possible predictors of SHPT after BS. RESULTS: The overall prevalence of SHPT was 24.9% before surgery, 11.2% 1 year after surgery and 21.3% 4 years after surgery. Patients submitted to LAGB had the highest prevalence of SHPT 1 year after surgery (19.4%; vs RYGB, 12.8%, vs SG, 5.3%). Four years after surgery, RYGB had the highest prevalence of SHPT (27.0%), followed by LAGB (13.2%) and SG (6.9%). Higher body mass index and age, decreased levels of vitamin D and RYGB seem to be independent predictors of SHPT 1 year after surgery. The only independent predictor of SHPT 4 years after surgery was RYGB. CONCLUSION: The prevalence of SHPT is higher before and 4 years after BS than 1 year after surgery. This fact raises some questions about the efficacy of the implemented follow-up plans of vitamin D supplementation on the long term, mainly among patients submitted to RYGB.

Elaboration and psychometric analysis of a questionnaire to evaluate the knowledge of community health workers about breastfeeding / Elaboração e análise psicométrica de um questionário para avaliar o conhecimento de agentes comunitários de saúde sobre amamentação

Abstract Objectives: to develop and analyze the psychometric properties of a questionnaire to assess community health workers' knowledge on breastfeeding. Methods: this is a methodological study for the development of an instrument and analysis of validity and reliability. For the elaboration of items and identification of dimensions, a literature review was conducted. The items were submitted to the evaluation of a committee of judges, for apparent and content analysis. Construct validation was conducted through hypothesis test, with the participation of 282 community health workers and 19 pediatricians and obstetric nurses. For analysis and comparison of scores, the Mann-Whitney U test was used, assuming a significance level of 5%. Reliability was assessed using Cronbach's alpha coefficient and temporal consistency of the instrument was assessed using test-retest and Kappa analysis. Results: the final instrument presented a favorable opinion from the committee of judges. The hypothesis test showed that the questionnaire has discriminatory power to assess professionals with a higher level of knowledge (p<0.001). The Kappa test revealed that 63% of the items showed substantive to almost perfect agreement. The 32-item questionnaire showed a Cronbach's alpha of 0.794. Conclusion: the instrument developed was valid and reliable, allowing effective measurement of community health workers' knowledge on breastfeeding.

Resumo Objetivos: elaborar e analisar propriedades psicométricas de um questionário para avaliação do conhecimento de agentes comunitários de saúde sobre amamentação. Métodos: trata-se de estudo metodológico de elaboração de instrumento e análise de validade e confiabilidade. Para a elaboração dos itens e identificação das dimensões, realizou-se revisão da literatura. Os itens foram submetidos à apreciação de comitê de juízes, para análise aparente e de conteúdo. A validação de construto foi conduzida pelo teste de hipóteses, com participação de 282 agentes comunitários de saúde e 19 pediatras e enfermeiras obstetras. Para comparação dos escores, utilizou-se o teste U de Mann-Whitney, assumindo-se um nível de significância de 5%. A confiabilidade foi aferida por meio do coeficiente alfa de Cronbach e a consistência temporal do instrumento por meio do teste-reteste e análise de Kappa. Resultados: o instrumento final apresentou parecer favorável do comitê de juízes. O teste de hipóteses evidenciou que o instrumento tem poder discriminatório para aferir profissionais com maior nível de conhecimento (p<0,001). O teste Kappa revelou que 63% dos itens apresentaram concordância de substantiva a quase perfeita. O questionário, com 32 itens, apresentou um alfa de Cronbach de 0,794. Conclusão: o instrumento apresentou-se válido e confiável que permitirá mensurar de forma eficaz o conhecimento de agentes comunitários de saúde sobre amamentação.

The Impact of Vitamin D in Non-Alcoholic Fatty Liver Disease: A Cross-Sectional Study in Patients with Morbid Obesity.

PURPOSE: We aimed to evaluate the association between vitamin D status and hepatic function parameters and scores: Fatty Liver Index (FLI, predictor of hepatic steatosis) and BARD (BMI, AST/ALT ratio and DM, predictor of hepatic fibrosis) in patients with morbid obesity. PATIENTS AND METHODS: Cross-sectional study including patients with morbid obesity followed in our centre between January 2010 and July 2018. Patients with missing vitamin D levels or hepatic profile parameters were excluded. We divided the population according to two cut-offs of vitamin D levels (12ng/mL and 20ng/mL). RESULTS: The included population (n=1124) had an average age of 43.3±10.7 years and 84.3% were female. Seventy-point eight percent of the population had vitamin D levels lower than 20ng/mL and 34.8% lower than 12ng/dL. Patients with lower vitamin D levels (<12ng/mL) had higher BMI, hip and waist circumferences and higher prevalence of hypertension. Higher FLI scores [OR= 0.77 (0.07), p<0.01] and ALP levels [ß= -0.03 (-0.06, -0.01), p<0.01] associated to lower vitamin D levels. CONCLUSION: Vitamin D deficiency is associated with a higher risk of hepatic steatosis in individuals with morbid obesity. Correction of vitamin D deficiency may have a beneficial role in the management of NAFLD in patients with morbid obesity.

Thyroid Function and the Risk of Non-Alcoholic Fatty Liver Disease in Morbid Obesity.

Background: An association between hypothyroidism and the risk of Non-alcoholic Fatty Liver Disease (NAFLD) has been suggested. This association remains to be elucidated in patients with morbid obesity. Aim: To evaluate the association between thyroid function and parameters of liver function and hepatic scores in patients with morbid obesity. Methods: Patients with morbid obesity followed in our center between January 2010 and July 2018 were included. The ones without evaluation of liver and thyroid functions were excluded. Fatty Liver Index (FLI) and BARD scores were used as predictors of hepatic steatosis and fibrosis, respectively. Results: We observed a positive association between TSH and both BARD (OR 1.14; p = 0.035) and FLI (OR 1.19; p = 0.010) in the unadjusted analysis. We found a negative association between free triiodothyronine levels and BARD (OR 0.70; p<0.01) and a positive association between free triiodothyronine levels and FLI (OR 1.48; p = 0.022). Concerning liver function, we found a positive association between total bilirubin and free thyroxine levels (ß = 0.18 [0.02 to 0.35]; p = 0.033) and a negative association between total bilirubin and free triiodothyronine levels (ß = -0.07 [-0.14 to -0.002]; p = 0.042). Conclusion: Higher levels of TSH and free triiodothyronine may be associated with a higher risk of NAFLD, particularly steatosis, in patients with morbid obesity.

Remotely Sensed Data Fusion for Spatiotemporal Geostatistical Analysis of Forest Fire Hazard.

Forest fires are a natural phenomenon which might have severe implications on natural and anthropogenic ecosystems. Future projections predict that, under a climate change environment, the fire season would be lengthier with higher levels of droughts, leading to higher fire severity. The main aim of this paper is to perform a spatiotemporal analysis and explore the variability of fire hazard in a small Greek island, Skiathos (a prototype case of fragile environment) where the land uses mixture is very high. First, a comparative assessment of two robust modeling techniques was examined, namely, the Analytical Hierarchy Process (AHP) knowledge-based and the fuzzy logic AHP to estimate the fire hazard in a timeframe of 20 years (1996-2016). The former technique was proven more representative after the comparative assessment with the real fire perimeters recorded on the island (1984-2016). Next, we explored the spatiotemporal dynamics of fire hazard, highlighting the risk changes in space and time through the individual and collective contribution of the most significant factors (topography, vegetation features, anthropogenic influence). The fire hazard changes were not dramatic, however, some changes have been observed in the southwestern and northern part of the island. The geostatistical analysis revealed a significant clustering process of high-risk values in the southwestern and northern part of the study area, whereas some clusters of low-risk values have been located in the northern territory. The degree of spatial autocorrelation tends to be greater for 1996 rather than for 2016, indicating the potential higher transmission of fires at the most susceptible regions in the past. The knowledge of long-term fire hazard dynamics, based on multiple types of remotely sensed data, may provide the fire and land managers with valuable fire prevention and land use planning tools.

A divergent mode of activation of a nitrosyl iron complex with unusual antiangiogenic activity.

Nitric oxide (NO) and nitroxyl (HNO) have gained broad attention due to their roles in several physiological and pathophysiological processes. Remarkably, these sibling species can exhibit opposing effects including the promotion of angiogenic activity by NO compared to HNO, which blocks neovascularization. While many NO donors have been developed over the years, interest in HNO has led to the recent emergence of new donors. However, in both cases there is an expressive lack of iron-based compounds. Herein, we explored the novel chemical reactivity and stability of the trans-[Fe(cyclam)(NO)Cl]Cl2 (cyclam = 1,4,8,11-tetraazacyclotetradecane) complex. Interestingly, the half-life (t1/2) for NO release was 1.8 min upon light irradiation, vs 5.4 h upon thermal activation at 37 °C. Importantly, spectroscopic evidence supported the generation of HNO rather than NO induced by glutathione. Moreover, we observed significant inhibition of NO donor- or hypoxia-induced HIF-1α (hypoxia-inducible factor 1α) accumulation in breast cancer cells, as well as reduced vascular tube formation by endothelial cells pretreated with the trans-[Fe(cyclam)(NO)Cl]Cl2 complex. Together, these studies provide the first example of an iron-nitrosyl complex with anti-angiogenic activity as well as the potential dual activity of this compound as a NO/HNO releasing agent, which warrants further pharmacological investigation.

The Impact of Bariatric Surgery on Hepatic Function and Predictors of Liver Steatosis and Fibrosis.

PURPOSE: To evaluate the variation in parameters of hepatic function and in the scores Fatty Liver Index (FLI; predictor of hepatic steatosis) and BARD (BMI, AST/ALT ratio and DM, predictor of hepatic fibrosis), 1 year after bariatric surgery. MATERIAL AND METHODS: This is a observational retrospective cohort study in patients with morbid obesity that underwent bariatric surgery in our centre. We used two linear regression models: (1) unadjusted and (2) adjusted for surgery type, sex, age, body mass index, diabetes, and dyslipidaemia. RESULTS: The included population (n = 1955) had an average age of 43.1 ± 10 years and 85.8% were female. Diabetes was present in 32.4% of the patients, 45.1% had dyslipidaemia, and 62.2% had hypertension. Twelve percent were submitted to gastric band, 29.6% to sleeve gastrectomy, and 58.4% to gastric bypass. We observed a relevant decrease in transaminases and gamma-glutamyltransferase, and an increase in alkaline phosphatase and total bilirubin. Both FLI and BARD markedly decrease 1 year after surgery (p < 0.01). Comparing the surgical procedures, sleeve gastrectomy was associated with a greater reduction of hepatic enzymes and of both FLI and BARD compared with gastric band. Comparing with gastric bypass, sleeve was associated with a greater reduction of transaminases and alkaline phosphatase, but a smaller reduction of FLI and BARD. CONCLUSION: Bariatric surgery is associated with a reduction of the hepatic enzymes and an improvement of FLI and BARD. It may represent an effective therapeutic approach for NAFLD.

Antihypertensive potential of cis-[Ru(bpy)2(ImN)(NO)]3+, a ruthenium-based nitric oxide donor.

The aim of this study was to investigate the antihypertensive properties of cis-[Ru(bpy)2ImN(NO)]3+ (FOR0811) in normotensive and in Nω-nitro-L-arginine methyl ester (L-NAME)-induced hypertensive rats. Vasorelaxant effects were analyzed by performing concentration response curve to FOR0811 in rat aortic rings in the absence or presence of 1H-[1,2,4]-oxadiazolo-[4,3,-a]quinoxalin-1-one (ODQ), L-cysteine or hydroxocobalamin. Normotensive and L-NAME-hypertensive rats were treated with FOR0811 and the effects in blood pressure and heart rate variability in the frequency domain (HRV) were followed. FOR0811 induced relaxation in rat aortic rings. Neither endothelium removal nor L-cysteine altered the FOR0811 effects. However, the incubation with ODQ and hydroxocobalamin completely blunted FOR0811 effects. FOR0811 administered intravenously by bolus infusion (0.01-1 mg/bolus) or chronically by using subcutaneous implanted osmotic pumps significantly reduced the mean arterial blood pressure. The effect was long lasting and did not induce reflex tachycardia. FOR0811 prevented both LF and VLF increases in L-NAME hypertensive rats and has antihypertensive properties. This new ruthenium complex compound might be a promising nitric oxide donor to treat cardiovascular diseases.

Searching for Networks: Ecological Connectivity for Amphibians Under Climate Change.

Ecological connectivity depends on key elements within the landscape, which can support ecological fluxes, species richness and long-term viability of a biological community. Landscape planning requires clear aims and quantitative approaches to identify which key elements can reinforce the spatial coherence of protected areas design. We aim to explore the probability of the ecological connectivity of forest remnants and amphibian species distributions for current and future climate scenarios across the Central Corridor of the Brazilian Atlantic Forest. Integrating amphibian conservation, climate change and ecological corridors, we design a landscape ranking based on graph and circuit theories. To identify the sensitivity of connected areas to climate-dependent changes, we use the Model for Interdisciplinary Research on Climate by means of simulations for 2080-2100, representing a moderated emission scenario within an optimistic context. Our findings indicate that more than 70% of forest connectivity loss by climate change may drastically reduce amphibian dispersal in this region. We show that high amphibian turnover rates tend to be greater in the north-eastern edges of the corridor across ensembles of forecasts. Our spatial analysis reveals a general pattern of low-conductance areas in landscape surface, yet with some well-connected patches suggesting potential ecological corridors. Atlantic Forest reserves are expected to be less effective in a near future. For improved conservation outcomes, we recommend some landscape paths with low resistance values across space and time. We highlight the importance of maintaining forest remnants in the southern Bahia region by drafting a blueprint for functional biodiversity corridors.

Trends in pediatric epilepsy surgery in Europe between 2008 and 2015: Country-, center-, and age-specific variation.

OBJECTIVE: To profile European trends in pediatric epilepsy surgery (<16 years of age) between 2008 and 2015. METHODS: We collected information on volumes and types of surgery, pathology, and seizure outcome from 20 recognized epilepsy surgery reference centers in 10 European countries. RESULTS: We analyzed retrospective aggregate data on 1859 operations. The proportion of surgeries significantly increased over time (P < .0001). Engel class I outcome was achieved in 69.3% of children, with no significant improvement between 2008 and 2015. The proportion of histopathological findings consistent with glial scars significantly increased between the ages of 7 and 16 years (P for trend = .0033), whereas that of the remaining pathologies did not vary across ages. A significant increase in unilobar extratemporal surgeries (P for trend = .0047) and a significant decrease in unilobar temporal surgeries (P for trend = .0030) were observed between 2008 and 2015. Conversely, the proportion of multilobar surgeries and unrevealing magnetic resonance imaging cases remained unchanged. Invasive investigations significantly increased, especially stereo-electroencephalography. We found different trends comparing centers starting their activity in the 1990s to those whose programs were developed in the past decade. Multivariate analysis revealed a significant variability of the proportion of the different pathologies and surgical approaches across countries, centers, and age groups between 2008 and 2015. SIGNIFICANCE: Between 2008 and 2015, we observed a significant increase in the volume of pediatric epilepsy surgeries, stability in the proportion of Engel class I outcomes, and a modest increment in complexity of the procedures.

Arthroscopic assessment of meniscal injuries using an anatomical zone classification system

The present study aimed to evaluate the inter- and intra-observer reproducibility of the arthroscopic meniscus tear classification system in patients treated with meniscal suture, as well as to correlate these anatomical zones, according to the injury characteristics and the suture technique employed.Forty-six knee arthroscopies were analyzed for meniscal sutures. The evaluators recorded data of the zones described by Smigielski, types of injuries, meniscal vascularity, suture techniques, and types of suture knots applied to sutures. Data were analyzed with respect to inter and intra-observer agreement. All clinical and anatomical outcomes as well as the characterization of the injury and meniscal treatment were correlated.The intra- and inter-observer reproducibility (Kappa coefficient) for the arthroscopic classification system of meniscus injury proposed by Smigielski ranged from slight to moderate.The zone classification defines the menisci and their relationship with the surrounding anatomic landmarks of the knee; however, it has limited arthroscopic application. The practical knowledge of the classification system described in this study can help specifically guide treatment for various types of meniscal injury

El propósito del presente estudio es evaluar la reproducibilidad inter e intraobservador de la clasificación artroscópica de lesiones meniscales propuesta por Smigielski en pacientes tratados con suturas meniscales, así como correlacionar las zonas anatómicas con las características lesionales y el tipo de técnica de sutura empleada.Se analizaron cuarenta y seis artroscopías de rodilla con sutura meniscal de la lesión. Se examinó la zona descripta según Smigielski, el tipo de lesión meniscal, la vascularidad, la técnica de sutura meniscal y el tipo de nudo empleados. Los datos fueron evaluados para considerar la reproducibilidad intra e interobservador. Todos los resultados clínicos, anatómicos, características de la lesión, así como el tratamiento meniscal utilizado, se correlacionaron.La correlación intra e interobservador (coeficiente Kappa) para la clasificación artroscópica de lesiones meniscales propuesta por Smigielski fue leve o moderada. La clasificación por zonas que define la lesión meniscal y su relación con las estructuras anatómicas de la rodilla tiene aplicación limitada en la cirugía artroscópica. El conocimiento práctico de la clasificación podría servir como guía para la toma de conducta ante las lesiones meniscales reparables

Closing-Wedge Distal Femoral Osteotomies-Retrospective Study.

Objective To describe the surgical technique of distal closing-wedge femoral osteotomy and a cases series submitted to this technique. Methods A total of 26 patients submitted to medial closing-wedge distal femoral osteotomy from 2002 to 2013 were evaluated. All of the patients had their medical files and imaging exams reviewed to evaluate the degree of correction and their current state. Results Out of the 26 patients, 12 were male and 14 were female. Their mean age was 47.15 years old. In all of the cases, a neutral alignment related to the anatomical axis was achieved. Most of the patients presented bone healing at 6 weeks. There were no cases of bleeding during the surgery. One patient presented with delayed bone healing. One patient complained of plaque-related discomfort, requiring the removal of the device. One patient had a superficial infection, but no osteotomy revision was needed. There were no cases of deep venous thrombosis or of pulmonary thromboembolism. To date, there has been no conversion to total knee replacement. Conclusion Treatment with medial closing-wedge distal femoral osteotomy sustained the proposed correction in patients with up to 15 years of follow-up.

Modelling youth pregnancy in continental Portugal through geographically weighted regression.

Youth pregnancy, a global public health problem with important social, educational and economic impact, has mostly been studied in the least developed countries. However, this condition also affects the industrialized countries. This article presents a youth pregnancy study at the municipality level in continental Portugal based on geographically weighted regression. The results indicate that youth pregnancy rates can be explained by several variables: i) proportion (%) of social security beneficiaries; ii) number of households without amenities; iii) the rate of those prematurely leaving school; iv) the unemployment rates of youths and females, ceteris paribus. In addition, it was found that the beneficiaries of social security had a higher impact on youth pregnancy in the southern part of the country, and in the Centre too; that households without amenities had a higher impact along the central coast and in the South; that rates of those leaving school prematurely had a higher influence in the North and the Interior than in the rest of the country; and that youth and female unemployment rates were more widespread in the Centre, particularly along the coast. Overall, the model identified a strong association of explanatory variables with youth pregnancy rates in the country as a whole, except in the Porto metropolitan area. These findings may help health planners to define policies to mitigate this important social problem.