Os trigonum: a discussion of its role in posterior ankle impingement syndrome and a meta-analysis of its prevalence.

PURPOSE: the os trigonum is a supernumerary bone that may lead to posterior ankle impingement syndrome. The present study aims to assess the prevalence of this bone. METHODS: A meta-analysis regarding the presence of the os trigonum was performed. For this, the MEDLINE and SciElo databases were searched using "os trigonum" as the keyword. Only original articles, theses, books, dissertations, and monographs were included. Papers with a sample size of < 50 individuals were excluded. The data extracted from the articles were: the total sample size, the prevalence of the trigonum, the method of analysis, the region of the sample, and data regarding sex and side (left or right). Statistical analysis was performed using MedCalc Statistical Software version 14.8.1 (MedCalc Software bvba, Ostend, Belgium). The heterogeneity between the studies was assessed using the I² estimation and the Cochran Q test. For all analyses, a random effect was used and a value of p < 0.05 was considered significant. RESULTS: 249 papers were found, while 18 were included in the meta-analysis. A total of 17,626 ankles were included. The pooled prevalence of the os trigonum was 10.3% (95% CI 7-14.1%) in the present study. There was no significant difference regarding sex or side, while studies conducted in imaging exams showed a higher prevalence in comparison to cadaveric studies. CONCLUSION: Our results suggest that the os trigonum is relatively common. Knowledge of the prevalence of the os trigonum may help surgeons and clinicians diagnose posterior ankle impingement syndrome.

Retrospective case series of high-density silicone oil (Oxane HD) in severe proliferative vitreorretinal retinal detachment patients.

BACKGROUND: Describe complications and clinical outcomes of heavy silicone oil (HSO) Oxane HD® use as an alternative to overcome the challenges of performing vitrectomy to treat tractional and rhegmatogenous retinal detachments with proliferative vitreoretinopathy (PVR). METHODS: A retrospective, observational study was performed on patients from one center from August 2014 to Aug 2023. It was included patients who underwent surgery using HSO Oxane HD® to treat rhegmatogenous retinal detachment with PVR or mixed tractional and rhegmatogenous diabetic retinal detachment. Severely ill patients who could not attend to follow up were excluded. The primary outcome was successful retinal attachment at first postoperative month. A descriptive analysis was performed. RESULTS: Among the 31 patients, 29 (93.5%) underwent surgeries due to rhegmatogenous retinal detachment and two (6.5%) for diabetic retinal detachment. The primary anatomic success was achieved in 27 (87.1%) patients. At the final visit, 17 (56.6%) had vision better than 20/400 (range, 20/30 to light perception). The vision was stable or improved in 22 (76.8%) patients at the end of follow-up. Nineteen (61.3%) patients required hypotensive eye drops after HSO use and twelve (38.7%) still required hypotensive eye drops at the final follow-up; three (9.7%) patients required additional glaucoma surgeries. CONCLUSIONS: HSO is safe and useful for complex retinal detachments cases specially with inferior tears and PVR. Ocular hypertension is frequent and usually clinically controlled with hypotensive eyedrops. Close postoperatively follow-up is advised due to the ocular complications, particularly elevated intraocular pressure and emulsification.

An evaluation of treatment response and remission definitions in adult obsessive-compulsive disorder: A systematic review and individual-patient data meta-analysis.

INTRODUCTION: Expert consensus operationalized treatment response and remission in obsessive-compulsive disorder (OCD) as a Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) reduction ≥35% and score ≤12 with ≤2 on Clinical Global Impressions Improvement (CGI-I) and Severity (CGI-S) scales, respectively. However, there has been scant empirical evidence supporting these definitions. METHODS: We conducted a systematic review and an individual participant data meta-analysis of randomized-controlled trials (RCTs) in adults with OCD to determine optimal Y-BOCS thresholds for response and remission. We estimated pooled sensitivity/specificity for each percent reduction threshold (response) or posttreatment score (remission) to determine response and remission defined by a CGI-I and CGI-S ≤ 2, respectively. RESULTS: Individual participant data from 25 of 94 eligible RCTs (1235 participants) were included. The optimal threshold for response was ≥30% Y-BOCS reduction and for remission was ≤15 posttreatment Y-BOCS. However, differences in sensitivity and specificity between the optimal and nearby thresholds for response and remission were small with some uncertainty demonstrated by the confidence ellipses. CONCLUSION: While the empirically derived Y-BOCS thresholds in our meta-analysis differ from expert consensus, given the predominance of data from more recent trials of OCD, which involved more refractory participants and novel treatment modalities as opposed to first-line therapies, we recommend the continued use of the consensus definitions.

ASSESSMENT OF SIMULATED SURGICAL DEXTERITY AFTER MODIFIABLE EXTERNAL EXPOSURES AMONG NOVICE VERSUS EXPERIENCED VITREORETINAL SURGEONS.

PURPOSE: To evaluate novice and senior vitreoretinal surgeons after various exposures. Multiple comparisons ranked the importance of these exposures for surgical dexterity based on experience. METHODS: This prospective cohort study included 15 novice and 11 senior vitreoretinal surgeons (<2 and >10 years' practice, respectively). Eyesi-simulator tasks were performed after each exposure. Day 1, placebo, 2.5 mg/kg caffeine, and 5.0 mg/kg caffeine; day 2, placebo, 0.2 mg/kg propranolol, and 0.6 mg/kg propranolol; day 3, baseline simulation, breathalyzer readings of 0.06% to 0.10% and 0.11% to 0.15% blood alcohol concentrations; day 4, baseline simulation, push-up sets with 50% and 85% repetitions maximum; and day 5, 3-hour sleep deprivation. Eyesi-generated score (0-700, worst-best), out-of-tolerance tremor (0-100, best-worst), task completion time (minutes), and intraocular pathway (in millimeters) were measured. RESULTS: Novice surgeons performed worse after caffeine (-29.53, 95% confidence interval [CI]: -57.80 to -1.27, P = 0.041) and alcohol (-51.33, 95% CI: -80.49 to -22.16, P = 0.001) consumption. Alcohol caused longer intraocular instrument movement pathways (212.84 mm, 95% CI: 34.03-391.65 mm, P = 0.02) and greater tremor (7.72, 95% CI: 0.74-14.70, P = 0.003) among novices. Sleep deprivation negatively affected novice performance time (2.57 minutes, 95% CI: 1.09-4.05 minutes, P = 0.001) and tremor (8.62, 95% CI: 0.80-16.45, P = 0.03); however, their speed increased after propranolol (-1.43 minutes, 95% CI: -2.71 to -0.15 minutes, P = 0.029). Senior surgeons' scores deteriorated only following alcohol consumption (-47.36, 95% CI: -80.37 to -14.36, P = 0.005). CONCLUSION: Alcohol compromised all participants despite their expertise level. Experience negated the effects of caffeine, propranolol, exercise, and sleep deprivation on surgical skills.

Os Intermetatarseum: A Rare Variation of Great Relevance / Os Intermetatarseum: Una Rara Variación de Gran Relevancia

SUMMARY: The os intermetatarseum is an accessory bone located in the foot, usually between the first 2 metatarsals and the cuneiform bone. It can be presented as free, articulated or in a fused fashion. It is a very unusual variation found in less than 13 % of the population. A 27-year-old patient presented to the emergency service due to an ankle lesion. Physical exam showed pain and limited range of motion while supporting partial load. Radiographic imaging showed a bony trace near the base of the first and second metatarsals, diagnosed as the os intermetatarseum. Formation of this supernumerary bone begins as a separate ossification center. Most cases are asymptomatic; however, compression of the deep peroneal nerve branches by the os intermetatarseum can lead to pain. Some authors suggest that the presence of this bone may cause hallux valgus. The intermetatarseum can lead to diagnostic confusion, mainly related to Lisfranc fracture. Its origin is still little understood.

El os intermetatarseum es un hueso accesorio ubicado en el pie, generalmente entre los 2 primeros metatarsianos y el hueso cuneiforme. Puede presentarse de forma libre, articulada o fusionada. Es una variación muy inusual que se encuentra en menos del 13 % de la población. Paciente de 27 años que acude a urgencias por lesión en tobillo. El examen físico mostró dolor y rango de movimiento limitado mientras soportaba una carga parcial. Las imágenes radiológicas mostraron un rastro óseo cerca de la base del primer y segundo metatarsianos, diagnosticado como os intermetatarseum. La formación de este hueso supernumerario comienza como un centro de osificación separado. La mayoría de los casos son asintomáticos; sin embargo, la compresión de las ramas profundas del nervio fibular en el espacio intermetatarsiano puede provocar dolor. Algunos autores sugieren que la presencia de este hueso puede provocar hallux valgus. El hueso intermetatarsiano puede llevar a confusión diagnóstica, principalmente relacionada con la fractura de Lisfranc. Su origen aún es poco comprendido.

Surgical technique for removal of high-density silicone oil (Oxane HD).

The main drawback for the use of heavy silicone oil (HSO) Oxane HD is the difficulties it presents during removal. It differs from conventional silicone oil removal because it progressively concentrates in the posterior pole during the removal because of its heavier than water density. We describe a technique to facilitate proper HSO Oxane HD removal and minimize residual posterior bubbles and intraoperative complications. We describe our pearls for removing HSO to obtain the optimal results. A concern associated with HSO is the difficulty it presents when it is removed. However, this can be overcome by appropriate modification of surgical techniques during removal to limit intraoperative complications.

The impact of antibiotic prophylaxis with intracameral cefuroxime on postoperative infectious endophthalmitis rates in a high-volume cataract surgery center.

Our purpose was to compare postoperative infectious endophthalmitis rates before and after the introduction of antibiotic prophylaxis via intracameral with cefuroxime (ATB-P IC) in a high-volume cataract surgery service. Retrospective cohort study considering patients who underwent cataract surgery at Ophthal Hospital Especializado, São Paulo, Brazil, from January/2011 to December/2019. Patients operated from 2013 to 2019 comprised the ATB-P IC group while those operated from 2011 to 2013 formed the control group without the ATB-P IC protocol. A total of 23,184 cataract surgeries were included, with 6,207 in the Control Group and 16,977 in the ATB-P Group. A significantly higher rate of endophthalmitis was observed in the control group (0.0967%) when compared to the ATB-P group (0.0177%) (p = 0.014). Surgeries performed with ATB-P showed 80% less chance of reported endophthalmitis (OR = 0.20; 95% CI 0.05-0.72; p = 0.014) than those without ATB-P. Of the six cases confirmed by culture in the control group, all tested positive for Pseudomonas aeroginosa and the only case confirmed by culture in the ATB-P group was positive for Staphylococcus epidermidis. Our findings strongly support the use of intracameral antibiotic prophylaxis with cefuroxime to reduce postoperative infectious endophthalmitis rates, and we recommend its incorporation into cataract surgery protocols.

Paracentral Acute Middle Maculopathy Associated with Severe Anti-Mog (Myelin Oligodendrocyte Glycoprotein)-Positive Optic Neuritis.

Retinal complications in patients with inflammatory optic neuritis (ON) are generally related to post-infectious neuroretinitis and are considered uncommon in autoimmune/demyelinating ON, whether isolated or caused by multiple sclerosis (MS) or neuromyelitis optica spectrum disorder (NMOSD). More recently, however, cases with retinal complications have been reported in subjects positive for myelin oligodendrocyte glycoprotein (MOG) antibodies. We report a 53-year-old woman presenting with severe bilateral ON associated with a focal area of paracentral acute middle maculopathy (PAMM) in one eye. Visual loss recovered remarkably after high-dose intravenous corticosteroid treatment and plasmapheresis, but the PAMM lesion remained visible on both optical coherence tomography and angiography as an ischaemic lesion affecting the middle layers of the retina. The report emphasises the possible occurrence of retinal vascular complications in MOG-related optic neuritis, an important addition to the diagnosis of, and possible differentiation from, MS-related or NMOSD-related ON.

Mucinous Cystadenoma Arising in a Uterine Isthmocele: A Case Report.

Isthmocele is a discontinuation of the myometrium at the uterine scar site in a patient with a previous cesarian section (CS). The cause of isthmocele appears to be multifactorial. Poor surgical technique, low incision location, uterine retroflection, obesity, smoking, inadequate healing of scars, and maternal age are possible related factors. Most patients with this condition are asymptomatic. However, women can present with postmenstrual bleeding, pelvic pain, subfertility, dysmenorrhea, infertility, and scar abscess. Brazil has one of the world's highest cesarean section rates. One of the consequences of the rising rate of CS is the isthmocele, an emerging female health problem. Here we report a case of mucinous cystadenoma arising in a uterine isthmocele, a complication, as far as we could investigate, not yet described in the literature.

Istmocele é a descontinuidade do miométrio no local da cicatriz uterina em paciente com cesariana anterior. A causa da istmocele parece ser multifatorial. Má técnica cirúrgica, baixa localização da incisão, retroflexão uterina, obesidade, tabagismo, cicatrização inadequada de cicatrizes e idade materna são possíveis fatores relacionados. A maioria dos pacientes com esta condição é assintomática. No entanto, as mulheres podem apresentar sangramento pós-menstrual, dor pélvica, subfertilidade, dismenorreia, infertilidade e abscesso cicatricial. O Brasil tem uma das maiores taxas de cesariana do mundo. Uma das consequências da taxa crescente de cesarianas é a istmocele, um problema emergente de saúde feminina. Aqui relatamos um caso de cistoadenoma mucinoso originado em uma istmocele uterina, uma complicação ainda não descrita, até onde pudemos investigar.

Rheological and mechanical properties of hydroxypropyl methylcellulose-based hydrogels and cryogels controlled by AOT and SDS micelles.

HYPOTHESIS: The type and concentration of surfactants affect the rheological behavior of hydroxypropyl methylcellulose (HPMC) chains in hydrogels, influencing the microstructure and mechanical properties of HPMC cryogels. EXPERIMENTS: Hydrogels and cryogels containing HPMC, AOT (bis (2-ethylhexyl) sodium sulfosuccinate or dioctyl sulfosuccinate salt sodium, two C8 chains and sulfosuccinate head group), SDS (sodium dodecyl sulfate, one C12 chain and sulfate head group), and sodium sulfate (salt, no hydrophobic chain) at different concentrations were investigated using small-angle X-ray scattering (SAXS), scanning electron microscopy (SEM), rheological measurements, and compressive tests. FINDINGS: SDS micelles bound to the HPMC chains building "bead necklaces", increasing considerably the storage modulus G' values of the hydrogels and the compressive modulus E values of the corresponding cryogels. The dangling SDS micelles promoted multiple junction points among the HPMC chains. AOT micelles and HPMC chains did not form "bead necklaces". Although AOT increased the G' values of the hydrogels, the resulting cryogels were softer than pure HPMC cryogels. The AOT micelles are probably embedded between HPMC chains. The AOT short double chains rendered softness and low friction to the cryogel cell walls. Therefore, this work demonstrated that the structure of the surfactant tail can tune the rheological behavior of HPMC hydrogels and hence the microstructure of the resulting cryogels.

Mucinous Cystadenoma Arising in a Uterine Isthmocele: A Case Report / Cistadenoma mucinoso surgindo em istmocele uterina: relato de caso

Abstract Isthmocele is a discontinuation of the myometrium at the uterine scar site in a patient with a previous cesarian section (CS). The cause of isthmocele appears to be multifactorial. Poor surgical technique, low incision location, uterine retroflection, obesity, smoking, inadequate healing of scars, and maternal age are possible related factors. Most patients with this condition are asymptomatic. However, women can present with postmenstrual bleeding, pelvic pain, subfertility, dysmenorrhea, infertility, and scar abscess. Brazil has one of the world s highest cesarean section rates. One of the consequences of the rising rate of CS is the isthmocele, an emerging female health problem. Here we report a case of mucinous cystadenoma arising in a uterine isthmocele, a complication, as far as we could investigate, not yet described in the literature.

Resumo Istmocele é a descontinuidade do miométrio no local da cicatriz uterina em paciente com cesariana anterior. A causa da istmocele parece ser multifatorial. Má técnica cirúrgica, baixa localização da incisão, retroflexão uterina, obesidade, tabagismo, cicatrização inadequada de cicatrizes e idade materna são possíveis fatores relacionados. A maioria dos pacientes com esta condição é assintomática. No entanto, as mulheres podem apresentar sangramento pós-menstrual, dor pélvica, subfertilidade, dismenorreia, infertilidade e abscesso cicatricial. O Brasil tem uma das maiores taxas de cesariana do mundo. Uma das consequências da taxa crescente de cesarianas é a istmocele, um problema emergente de saúde feminina. Aqui relatamos um caso de cistoadenoma mucinoso originado em uma istmocele uterina, uma complicação ainda não descrita, até onde pudemos investigar.

A Polysomnographic Study of Effects of Sleep Deprivation on Novice and Senior Surgeons during Simulated Vitreoretinal Surgery.

PURPOSE: To assess the impact of a 3-hour polysomnography (PSG)-recorded night of sleep deprivation on next-morning simulated microsurgical skills among vitreoretinal (VR) surgeons with different levels of surgical experience and associate the sleep parameters obtained by PSG with Eyesi-generated performance. DESIGN: Self-controlled cohort study. PARTICIPANTS: Eleven junior VR surgery fellows with < 2 years of surgical experience and 11 senior surgeons with > 10 years of surgical practice. METHODS: Surgical performance was assessed at 7am after a 3-hour sleep-deprived night using the Eyesi simulator and compared with each subject's baseline performance. MAIN OUTCOME MEASURES: Changes in Eyesi-generated score (0-700, worst to best), time for task completion (minutes), tremor-specific score (0-100, worst to best), and out-of-tolerance tremor percentage. Polysomnography was recorded during sleep deprivation. RESULTS: Novice surgeons had worse simulated surgical performance after sleep deprivation compared with self-controlled baseline dexterity in the total score (559.1 ± 39.3 vs. 593.8 ± 31.7; P = 0.041), time for task completion (13.59 ± 3.87 minutes vs. 10.96 ± 1.95 minutes; P = 0.027), tremor-specific score (53.8 ± 19.7 vs. 70.0 ± 15.3; P = 0.031), and out-of-tolerance tremor (37.7% ± 11.9% vs. 28.0% ± 9.2%; P = 0.031), whereas no performance differences were detected in those parameters among the senior surgeons before and after sleep deprivation (P ≥ 0.05). Time for task completion increased by 26% (P = 0.048) in the post-sleep deprivation simulation sessions for all participants with a high apnea-hypopnea index (AHI) and by 37% (P = 0.008) among surgeons with fragmented sleep compared with those with normal AHI and < 10 arousals per hour, respectively. Fragmented sleep was the only polysomnographic parameter associated with a worse Eyesi-generated score, with a 10% (P = 0.005) decrease the following morning. CONCLUSIONS: This study detected impaired simulated surgical dexterity among novice surgeons after acute sleep deprivation, whereas senior surgeons maintained their surgical performance, suggesting that the impact of poor sleep quality on surgical skills is offset by increased experience. When considering the 2 study groups together, sleep fragmentation and AHI were associated with jeopardized surgical performance after sleep deprivation. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any materials discussed in this article.

Eye-related emergency visits during the early phase of the coronavirus disease pandemic in a reference hospital in Sao Paulo, Brazil / Atendimento no pronto-socorro de oftalmologia durante o início da pandemia do Covid-19 em um hospital de referência em São Paulo, Brasil

ABSTRACT Purpose: To evaluate the profile of emergency eye-related visits at a reference eye hospital in Sao Paulo during the first months of the quarantine due to the coronavirus disease (COVID-19) pandemic and to compare it with that in the same period of the previous year. Methods: Data were obtained from the emergency department of Ophthal Hospital Especializado, Sao Paulo, Brazil. All the cases registered between March 23 and May 19, 2020, were included in the study as Group 2020. The cases registered between March 23 and May 19, 2019, were included in the study as Group 2019. Frequency tables were used for the descriptive analyses. The chi-square and Fisher exact tests were applied to compare categorical variables between the groups. Results: We observe a decrease of 46.15% in the number of cases during the COVID-19 pandemic in 2020 compared with the same period in 2019. We observed a significant increase in the incidence rates of the following pathologies in 2020 compared with 2019: eyelid disorders (12.3%), corneal disorders (97.1%), retinal pathologies (173.1%), refraction (62.9%), glaucoma (acute and chronic; 43.9%), scleral alterations (68.8%), trauma (39.3%), herpes (54.7%), and cataracts (549.9%). On the other hand, the incidence rates of the following disorders decreased: conjunctivitis (-33.4%), disorders of lacrimal system (-81.0%), iridocyclitis (-39.9%), and postoperative visits (-80.1%). Conclusion: During the early phase of the COVID-19 pandemic, we observed a drastic decrease in the number of patients who visited the emergency eye service. The main reasons for visiting were also changed, with higher frequencies of high-severity cases such as retina disturbances, cornea disturbances, glaucoma, and trauma and lower frequencies of transmittable conditions such as conjunctivitis.

RESUMO Objetivos: Avaliar o perfil das consultas de emergência oftalmológicas durante os primeiros meses de quarentena por pandemia de covid-19 em um hospital oftalmológico de referência em São Paulo e compará-lo com o mesmo período do ano anterior. Métodos: Os dados foram extraídos do serviço de emergência do Hospital Ophthal Especializado, São Paulo, Brasil. Todos os casos registrados entre 23 de março e 19 de maio de 2020 foram incluídos no estudo como Grupo 2020. Os casos registrados entre 23 de março e 19 de maio de 2019 foram incluídos no estudo como Grupo de 2019. Tabelas de frequência foram utilizadas para análises descritivas. Os testes Qui-quadrado e Exato de Fisher foram aplicados para comparar variáveis categóricas entre os grupos. Resultados: Observamos uma diminuição de 46,15% no número de casos durante a pandemia Covid-19 em 2020 quando comparado ao mesmo período sem pandemia em 2019. Foi observado um aumento significativo nos achados de pálpebra (+12,3%), córnea (+97,1%), retina (+173,1%), refração (+62,9%), glaucoma (+43,9%), esclera (+68,8%), trauma (+39,3%), herpes (+54,7%) e catarata (+549,9%) em 2020 quando comparado para 2019. Por outro lado, houve redução nos casos de conjuntivite (-33,4%), transtornos do aparelho lacrimal (-81,0%), iridociclite (-39,9%) e consultas pós-operatórias (-80,1%). Conclusão: durante a fase inicial da pandemia Covid-19, foi observada uma redução drástica no número de pacientes que procuram o serviço de emergência ocular. Houve também uma mudança nos principais motivos para visitas com frequências mais altas de casos de alta gravidade como distúrbios da retina, distúrbios da córnea, glaucoma e trauma, e frequências mais baixas de condições transmissíveis como conjuntivite.

Resistance Training for Older Women: Do Adaptive Responses Support the ACSM and NSCA Position Stands?

PURPOSE: The optimal intensity of resistance training (RT) to improve muscular, physical performance, and metabolic adaptations still needs to be well established for older adults. Based on current position statements, we compared the effects of two different RT loads on muscular strength, functional performance, skeletal muscle mass, hydration status, and metabolic biomarkers in older women. METHODS: One hundred one older women were randomly allocated to perform a 12-wk whole-body RT program (eight exercises, three sets, three nonconsecutive days a week) into two groups: 8-12 repetitions maximum (RM) and 10-15RM. Muscular strength (1RM tests), physical performance (motor tests), skeletal muscle mass (dual-energy X-ray absorptiometry), hydration status (bioelectrical impedance), and metabolic biomarkers (glucose, total cholesterol, HDL-c, HDL-c, triglycerides, and C-reactive protein) were measured at baseline and posttraining. RESULTS: Regarding muscular strength, 8-12RM promoted higher 1RM increases in chest press (+23.2% vs +10.7%, P < 0.01) and preacher curl (+15.7% vs +7.4%, P < 0.01), but not in leg extension (+14.9% vs +12.3%, P > 0.05). Both groups improved functional performance ( P < 0.05) in gait speed (4.6%-5.6%), 30 s chair stand (4.6%-5.9%), and 6 min walking (6.7%-7.0%) tests, with no between-group differences ( P > 0.05). The 10-15RM group elicited superior improves in the hydration status (total body water, intracellular and extracellular water; P < 0.01), and higher gains of skeletal muscle mass (2.5% vs 6.3%, P < 0.01), upper (3.9% vs 9.0%, P < 0.01) and lower limbs lean soft tissue (2.1% vs 5.4%, P < 0.01). Both groups improved their metabolic profile. However, 10-15RM elicited greater glucose reductions (-0.2% vs -4.9%, P < 0.05) and greater HDL-c increases (-0.2% vs +4.7%, P < 0.01), with no between-group differences for the other metabolic biomarkers ( P > 0.05). CONCLUSIONS: Our results suggest that 8-2RM seems more effective than 10-15RM for increasing upper limbs' muscular strength, whereas the adaptative responses for lower limbs and functional performance appear similar in older women. In contrast, 10-15RM seems more effective for skeletal muscle mass gains, and increased intracellular hydration and improvements in metabolic profile may accompany this adaptation.

Osteochondrosis of the medial cuneiform bone as an incidental finding.

INTRODUCTION AND IMPORTANCE: Osteochondrosis is a disease described in several bones of the human body. It is a condition that can lead to pain and antalgic gait, although it can also be asymptomatic. The present work aims to report an incidental finding of osteochondrosis that afflicted the medial cuneiform bone. CASE PRESENTATION: A 6-year-old boy injured his leg in a road traffic accident and there was no evidence of a fracture line on the dorsal-plantar foot radiograph. However, the findings of marginal irregularity and sclerotic areas were considered to be indicative of osteochondrosis. CLINICAL DISCUSSION: Osteochondrosis is a self-limiting condition whose most accepted cause is stress injury. The main examination performed for diagnosis is radiography, in which morphological changes can be identified. The early ossification of the cuneiform bones may be related to the rare incidence of cuneiform osteochondrosis in children. Management of symptoms is the most indicated for this condition while surgical treatment is considered to be unnecessary and potentially harmful to the patient. CONCLUSION: Osteochondrosis of the cuneiforms is a rare entity that can be found accidentally during radiographic investigations. It is a disease that can spontaneously resolve. Anti-inflammatory drugs and activity reduction are commonly prescribed in symptomatic cases.

Comparison of Ahmed glaucoma drainage implant outcomes in the anterior chamber versus pars plana.

OBJECTIVE: To compare long-term outcomes of eyes undergoing Ahmed glaucoma drainage implants in the anterior chamber versus the pars plana.Retrospective cohort study. PARTICIPANTS: Operated patients were divided into anterior-chamber or pars plana groups. METHODS: Follow-up data included intraocular pressure (IOP), need for antiglaucoma medications (AGMs), and postoperative complications. Treatment success was evaluated based on the following criteria: IOP ≤21 mm Hg and no AGM use, IOP ≤21 mm Hg with or without AGM use, IOP ≤18 mm Hg and no AGM use, IOP ≤18 mm Hg with or without AGM use, IOP ≤15 mm Hg and no AGM use, and IOP ≤15 mm Hg with or without AGM use. RESULTS: A total of 170 eyes were selected and split into an anterior-chamber group (n = 57) and a pars plana group (n = 113). No differences between groups were found on the decrease in IOP (p = 0.612) or number of AGMs (p = 0.695) in the postoperative period. No differences regarding corneal decompensation (p = 0.554) or retinal detachment (p = 0.168) were observed between groups. The 1-year success rates for all the criteria were, respectively, 89%, 96%, 88%, 92%, 88% and 90%; the 3-year success rates for all the criteria were, respectively, 33%, 61%, 32%, 55%, 28%, and 45%; and the 5-year success rates for all the criteria were, respectively, 7%, 48%, 7%, 36%, 4% and 17%. CONCLUSIONS: No differences between the groups were observed for long-term outcomes of IOP, AGM use, or postoperative complications. Success rates were comparable between groups, decreased along the follow-up time, and were higher when associated with AGM use.

Weight-adjusted caffeine and ß-blocker use in novice versus senior retina surgeons: a self-controlled study of simulated performance.

BACKGROUND/OBJECTIVES: Tremor and expertise are potentially influenced variables in vitreoretinal surgery. We investigated whether surgeon experience impacts the association of microsurgical performance with caffeine and ß-blockers weight-adjusted intake. SUBJECTS/METHODS: Novice and senior surgeons (<2 and >10 practice years, respectively) were recruited in this self-controlled, cross-sectional study. A simulator's task sequence was repeated over 2 days, 30 min after the following exposures: day 1, placebo, 2.5 mg/kg caffeine, 5.0 mg/kg caffeine, and 0.6 mg/kg propranolol; and day 2, placebo, 0.2 mg/kg propranolol, 0.6 mg/kg propranolol, and 5.0 mg/kg caffeine. Outcomes were total score (0-700, worst-best), simulation time (minutes), intraocular trajectory (centimeters), and tremor-specific score (0-100, worst-best). RESULTS: We recruited 15 novices (9 men [60%], 1.33 ± 0.49 practice years) and 11 seniors (8 men [72.7%], 16.00 ± 4.24 practice years). Novices performed worse after 2.5 mg/kg caffeine and improved following 0.2 mg/kg propranolol in total score (557 vs. 617, p = 0.009), trajectory (229.86 vs. 208.07, p = 0.048), time (14.9 vs. 12.7, p = 0.048), and tremor-score (55 vs. 75, p = 0.009). Surgical performance improved with propranolol post-caffeine but remained worse than 0.2 mg/kg propranolol in total score (570 vs. 617, p = 0.014), trajectory (226.59 vs. 208.07, p = 0.033), and tremor-score (50 vs. 75, p = 0.029). Seniors' tremor-score was lower after 2.5 mg/kg caffeine compared to 0.2 mg/kg propranolol (8 vs. 37, p = 0.015). Tremor-score following propranolol post-caffeine remained inferior to 0.6 mg/kg propranolol alone (17 vs. 38, p = 0.012). CONCLUSION: While caffeine and propranolol were associated with performance changes among novices, only tremor was affected in seniors, without dexterity changes. The pharmacologic exposure impact on surgical dexterity seems to be offset by increased experience.