On the Nature of the Rotational Energy Barrier of Atropisomeric Hydrazides.

N-N atropisomers represent a useful class of compounds that has recently received important attention from many research groups. This article presents an in-depth analysis of the energy barrier needed for the racemization process of atropoisomeric hydrazides, combining an experimental and computational approach. The focus is on examining how electronic and steric factors impact the racemization process. The results obtained indicate that the barrier observed during the racemization process mainly arises from an increase in the p-orbital character of the nitrogen atoms.

Correction: Importance of TLR2 on Hepatic Immune and Non-Immune Cells to Attenuate the Strong Inflammatory Liver Response During Trypanosoma cruzi Acute Infection.

[This corrects the article DOI: 10.1371/journal.pntd.0000863.].

Single-Flask Enantioselective Synthesis of α-Amino Acid Esters by Organocatalysis.

An operationally simple Knoevenagel condensation/asymmetric epoxidation/domino ring-opening esterification (DROE) approach has been disclosed to successfully access a good variety of (R)- and (S)-α-arylglycine esters from commercially available aldehydes, phenylsulfonyl acetonitrile, cumyl hydroperoxide, anilines, and readily available Cinchona alkaloid-based catalysts using a single solvent and reaction vessel. DFT calculations performed on the key asymmetric epoxidation showed the importance of cooperative H-bonding interactions in affecting the stereocontrol.

Tradução e adaptação cultural da COVID-19 Anxiety Scale no Brasil / Translation and cultural adaptation of the COVID-19 Anxiety Scale in Brazil

Objetivo Este estudo objetivou traduzir e adaptar culturalmente a COVID-19 Anxiety Scale para o contexto brasileiro. Método Trata-se de um estudo transversal e metodológico, que seguiu as seguintes etapas: tradução inicial, síntese das traduções, retrotradução, revisão por um comitê de especialistas e pré-teste. Resultados Inicialmente dois tradutores fizeram uma primeira tradução da COVID-19 Anxiety Scale para o português. Depois, estabeleceu-se a versão consensual, que foi retrotraduzida para o idioma inglês por outro tradutor. Posteriormente, as versões da COVID-19 Anxiety Scale foram revistas por oito especialistas. Após a análise, dois dos sete itens da escala foram modificados, obtendo--se a versão pré-final da COVID-19 Anxiety Scale. Por fim, essa última versão do instrumento foi pré-testada com 47 pessoas, que consideraram a escala clara e compreensível. Conclusão Conclui-se, portanto, que a COVID-19 Anxiety Scale foi adequadamente traduzida e adaptada para o contexto brasileiro e almeja-se dar seguimento à pesquisa para verificar evidências de validade da escala.

Objective This study aimed to translate and culturally adapt the COVID-19 Anxiety Scale for the Brazilian context. Method Cross-sectional and methodological study that encompassed the following stages: initial translation, synthesis of translations, back-translation, expert committee review, and pre-testing. Results The COVID-19 Anxiety Scale was initially translated into Portuguese by two translators. A consensus version was established and then back-translated into English by a different translator. Eight experts reviewed these versions, resulting in modifications to two of the seven scale items. This led to the creation of the pre-final version of the COVID-19 Anxiety Scale. Finally, the pre-testing of this version was conducted with 47 individuals, who found the scale to be clear and understandable. Conclusion In conclusion, the COVID-19 Anxiety Scale was adequately translated and culturally adapted for the Brazilian context, and further research is intended to verify evidence of the scale's validity.

Synthesis of Atropisomeric Hydrazides by One-Pot Sequential Enantio- and Diastereoselective Catalysis.

The first catalytic enantioselective and diastereoselective synthesis of atropisomeric hydrazides was achieved using a sequential catalysis protocol. This strategy is based on a one-pot sequence of two organocatalytic cycles featuring the enamine amination of branched aldehydes followed by nitrogen alkylation under phase-transfer conditions. The resulting axially chiral hydrazides were obtained directly from commercially available reagents in high yields and with good stereocontrol. The permutation of organocatalysts allowed easy access to all stereoisomers, enabling a stereodivergent approach to enantioenriched atropisomeric hydrazides.

Early caloric deficit is associated with a higher risk of death in invasive ventilated COVID-19 patients.

BACKGROUND & AIMS: The aim of this study was to evaluate the nutritional support management in mechanically ventilated coronavirus disease 2019 (COVID-19) patients and explore the association between early caloric deficit and mortality, taking possible confounders (i.e. obesity) into consideration. METHODS: This was a prospective study carried out during the first pandemic wave in the intensive care units (ICUs) of two referral University Hospitals in Lombardy, Italy. Two hundred twenty-two consecutive mechanically ventilated COVID-19 patients were evaluated during the ICU stay. In addition to major demographic and clinical data, we recorded information on the route and amount of nutritional support provided on a daily basis. RESULTS: Among patients still in the ICUs and alive on day 4 (N = 198), 129 (65.2%) and 72 (36.4%) reached a satisfactory caloric and protein intake, respectively, mainly by enteral route. In multivariable analysis, a satisfactory caloric intake on day 4 was associated with lower mortality (HR = 0.46 [95%CI, 0.42-0.50], P < 0.001). Mild obesity (body mass index [BMI] ≥30 and < 35 kg/m2) was associated with higher mortality (HR = 1.99 [95%CI, 1.07-3.68], P = 0.029), while patients with moderate-severe obesity (BMI≥35 kg/m2) were less likely to be weaned from invasive mechanical ventilation (HR = 0.71 [95%CI, 0.62-0.82], P < 0.001). CONCLUSIONS: This study confirmed the negative prognostic and clinical role of obesity in mechanically ventilated COVID-19 patients and suggested that early caloric deficit may independently contribute to worsen survival in this patients' population. Therefore, any effort should be made to implement an adequate timely nutritional support in all COVID-19 patients during the ICU stay.

Injury analysis of a professional female soccer team in first division Italian season.

BACKGROUND: Soccer, the most popular sport worldwide, has seen an exponential increase in women's participation at the elite level in the last few years. The main purpose of the current epidemiological study was to analyze the injury incidence, characteristics, and burden among elite female soccer players during a regular season. METHODS: We recorded all injuries that occurred throughout the 2018-2019 competitive soccer season (August-April). The studied group consisted of 22 elite players, who were militant in the first national leagues from the first team of the same soccer club in the north of Italy. The 2006 FIFA consensus statement was used to design the injury registration form. RESULTS: Throughout the 2018-2019 season, medical staff treated 35 injuries in 22 females. Of the total number of injuries reported in 9 months (5.8 injuries per 1000 hours of exposure), 7 (20%) occurred during matches and 28 (80%) during training sessions. The most common injury was represented by muscular disorders (18; 51.43%) which affected the thigh in 16 cases, and the lower leg and trunk in one case each. According to an anatomic site, most injuries occurred in the lower limbs (94,28%), with the majority affecting thighs (16; 45%), ankles (8; 23%), and knees (5; 14%). CONCLUSIONS: Non-contact injuries are shown to be more frequent than contact injuries, which may be connected to the increasing athletic burden among athletes. Further prospective investigations are needed with a focus on prevention protocols.

Preferences for a COVID-19 vaccine in Australia.

In absence of a COVID-19 vaccine, testing, contact tracing and social restrictions are among the most powerful strategies adopted around the world to slow down the spread of the pandemic. Citizens of most countries are suffering major physical, psychological and economic distress. At this stage, a safe and effective COVID-19 vaccine is the most sustainable option to manage the current pandemic. However, vaccine hesitancy by even a small subset of the population can undermine the success of this strategy. The objective of this research is to investigate the vaccine characteristics that matter the most to Australian citizens and to explore the potential uptake of a COVID-19 vaccine in Australia. Through a stated preference experiment, preferences towards a COVID-19 vaccine of 2136 residents of the Australian states and territories were collected and analysed via a latent class model. Results show that preferences for mild adverse cases, mode of administration, location of administration, price and effectiveness are heterogeneous. Conversely, preferences for immediacy and severe reactions are homogeneous, with respondents preferring a shorter period until vaccine is available and lower instances of severe side effects. The expected uptake of the vaccine is estimated under three different scenarios, with the value of 86% obtained for an average scenario. By calculating individual preferences, the willingness to pay is estimated for immediacy, effectiveness, mild and severe side effects.

Two rotator cuff tear repair techniques for sovraspinatus tendon tear: transosseous sharc-ft vs single row repair.

BACKGROUND: Despite rotator cuff repair techniques have developed significantly in last decade, pushed by the progress in technology and materials, the treatment of rotator cuff tears and re-tears is still a big challenge for shoulder surgeons. The aim of this study is to perform clinical and radiological evaluation (ultrasound and MRI) of patients treated with transosseous sharc-ft, and single row techniques for sovraspinatus rotator cuff tear at 6, 12 and 24 months follow up. METHODS: Twenty-eight consecutive patients who underwent arthroscopic repair for rotator cuff tear were enrolled in the study and divided in two different groups: group A (14 patients) underwent a single row technique repair; group B (14 patients) underwent a transosseous sharc-ft technique repair. All participants had MRI or ultrasound examination confirmed fullthickness tears of sovraspinatus tendon before surgery. All the patients underwent clinical evaluation at 45 days, 3 months, 6 months, 12 and 24 months post-operatively with VAS, Dash, Constant and ASES score. Diagnostic ultrasound examination was performed at 6 months follow up while the MRI examination at 1 and 2 year follow up. RESULTS: The whole primary variables didn't show any significant difference and the groups were homogenous (age, Goutallier fatty infiltration, VAS, DASH, Constant, ASES). Some statistically significant differences are visible at discrete variables in a specific time: Dash at 12 months and Constant at 24 months show a significant improvement versus single-row technique. CONCLUSION: The arthroscopic transosseous repair technique with sharc-ft showed excellent results with little significant statically difference between this technique and the single row for this kind of lesion after 1 year of follow-up. Clinical data from this study confirmed, with the help of ultrasound examination and MRI, the excellent clinical outcome obtained by the patients. Further studies are needed to find differences between these techniques in the repair of large and massive rotator cuff lesions. (www.actabiomedica.it).

Isolated displaced type II partial articular radial head fracture: correlation of preoperative imaging with intraoperative findings of lateral ulnar collateral ligament tear.

BACKGROUND: The aim of this study was to determine the lateral ulnar collateral ligament (LUCL) injury associated with isolated radial head fracture (RHF) and the relationship of the ligament injury with the displacement of the fragment-loss of contact-in unstable displaced partial articular RHF in individuals without any history of ulnohumeral dislocation. METHODS: We retrospectively identified 131 consecutive patients who underwent open reduction and internal fixation of isolated closed Mason type II RHF performed at our institution. We identified 3 subsets by the pattern of RHF and the position of the unstable fragment (anterior or posterior) relative to the capitulum humeri: displaced stable (group I), displaced anterior unstable (group II), and displaced posterior unstable (group III). Standard radiographs were obtained preoperatively and postoperatively. The pattern of lateral collateral ligament avulsion and its distribution were inferred from intraoperative records. RESULTS: Preoperative radiographs of the 131 patients showed 101 nonseparated fractures (77%, group I) and 30 unstable fractures (23%). Anterior displacement of the fragment was found in 18 elbows (14%, group II) and posterior displacement in 12 (9%, group III). LUCL avulsion was found in 18 of 30 unstable RHFs (60%) and in 1 of 60 stable RHFs (1.6%). CONCLUSION: RHF is a complex fracture often associated with soft tissue lesions. It is important to determine which structures need to be repaired to avoid complications that could lead to elbow instability. The RHF pattern and classification as stable or unstable can help the surgeon in the identification and treatment of LUCL lesions.

Hallux valgus correction with a new percutaneous distal osteotomy: Surgical technique and medium term outcomes.

BACKGROUND: Many procedures and different osteotomies have been described for percutaneous hallux valgus correction. Percutaneous techniques may lead to reduced morbidity, surgery, and recovery time. The aim of this study is to evaluate the clinical and radiographic outcome of a new percutaneous procedure (PBS-Percutaneous Bianchi System). METHODS: Fifty-eight cases were treated with Percutaneous Bianchi System procedure for correction of mild, moderate or severe hallux valgus deformity. All patients were clinically assessed preoperatively and then followed up by weight-bearing x-rays, AOFAS (American Orthopedic Foot and Ankle Score), VAS (Visual Analog Scale) pain score, and patient satisfaction. RESULTS: AOFAS scores improved from 28.6 at the preoperative assessment to 91.7 at the latest follow-up. The VAS pain score improved from 6.7 before surgery to 0.6 at the latest follow-up. The mean Hallux valgus angle (HVA), Intermetatarsal angle (IMA) and Distal metatarsal articular angle (DMAA) significatively decreased from the preoperative assessment to the latest follow-up. CONCLUSIONS: The PBS technique is a safe, reliable, and effective procedure for the correction of symptomatic mild-to-severe hallux valgus.

Comparison of Scapular Mechanics After Activity With and Without a Targeted Compression Garment.

Muscle fatigue can result in scapular dyskinesis, which has been implicated in impingement, labral injury, and rotator cuff injury. This study evaluated the ability of a compression shirt to maintain scapular alignment after fatiguing of periscapular musculature. Subjects' scapular movements were monitored before and after a periscapular muscle- fatiguing exercise program. In the anterior and posterior tilt and medial and lateral rotation dimensions, control and shirt subjects both exhibited differences between the prefatigue and postfatigue measurements throughout humeral elevation. In the retraction and protraction dimension, control subjects exhibited differences between prefatigue and postfatigue measurements for a large portion of elevation, while shirt subjects only had different measurements toward the extreme of shoulder flexion. Thus the shirt does not stabilize the scapula in the anterior and posterior tilt and medial and lateral rotation dimensions. In the retraction and protraction dimension, the shirt provides stability to the scapula and maintains prefatigue position. It is currently unclear if preserving one plane of scapular motion has clinical significance. (Journal of Surgical Orthopaedic Advances 28(1):18-23, 2019).

Injuries of the trochanteric region: can analysis of radiographic indices help in prediction of recurrent osteoporotic hip fractures?

OBJECTIVE: In a context of bone fragility, primitive and subsequent fractures are a growing problem in the industrialized countries where the mean age of the population is constantly increasing. Among the various factors that favor a fragility fracture, the most important is osteoporosis, a pathology that can be prevented through diagnostic screenings and treated by pharmacological and rehabilitative therapies. The aim of this study is to identify the subjects who are likely to have a higher risk of subsequent fractures of the trochanteric region through a retrospective radiographic evaluation of patients affected by low-energy trochanteric fractures and operated by intramedullary fixation between June 2013 and June 2015, so they can be targeted for prevention interventions. MATERIALS AND METHODS: Three hundred and sixty-one patients yet alive were analyzed 2 years after surgery. Fifty-one (group 1), characterized by another contralateral trochanteric femoral fracture, were included. All subjects were retrospectively examined with the analysis of contralateral femur X-ray performed at the time of initial trauma in order to detect a condition of bone fragility and a predisposition to fractures by evaluating three radiographic indices (Singh index, Dorr's classification and Cortical Thickness Index). Patients of group 1 were compared to the other 310 patients (group 2) affected by isolated trochanteric fracture. RESULTS: Group 1 had all radiographic indices worse than group 2. CONCLUSIONS: The results observed suggest that orthopedists can use radiographic indices, in particular Cortical Thickness Index, as a valuable, simple and inexpensive screening tool for prevention of recurrent osteoporotic fractures.

Behavioural But Not Cognitive Impairment Is a Determinant of Caregiver Burden in Amyotrophic Lateral Sclerosis.

BACKGROUND: Caregivers of patients affected by amyotrophic lateral sclerosis (ALS) are involved with great determination in the treatment process since the earliest stages of the disease with an increasing burden to be of help to the ailing persons. AIM: To test separately the impact of ALS patients' cognitive and behavioural impairments on caregiver burden and mood status in 84 outpatient/main caregiver couples. DESIGN: Patients were tested with the ALS-Cognitive Behavioural Screen (ALSCBS-ci and -bi), Frontal Assessment Battery, Weigl's Sorting Test, Mini-Mental State Examination, Beck's Depression Inventory (BDI). Analogously, caregivers completed the BDI and Caregiver Burden Inventory (CBI). RESULTS: CBI correlated with ALSCBS-bi, besides ALSFRS-R, disease progression index and caregiver BDI. Caregiver BDI also correlated with ALSCBS-bi scores. No correlations were found with cognitive tests. The correlation between CBI and the ALSCBS-bi score was specifically sustained by the social burden sub-domain of CBI. CONCLUSIONS: As previously reported using other tools, behavioural impairment is a determinant of burden and mood in ALS caregivers. Conversely, cognitive impairment fails to emerge as a major target when aiming at easing the increasing burden or improving mood in ALS caregivers.

Does scapula stabilizing t-shirt help over-head athletes in shoulder discomfort? A randomized control study.

Scapular dyskinesis in pitchers can potentially lead to impairments in the optimal performance of muscles of the shoulder complex. The purpose of this prospective study was to evaluate whether the use of a scapula stabilizing t-shirt can decrease stress and discomfort in over-head baseball pitchers. Thirty-two semi-professional baseball pitchers were divided into 2 groups. Group A dressed the scapula stabilizing t-shirt during the weekly practice while group B (control group) continued to follow their training program without the t-shirt. All pitchers underwent a clinical examination at the beginning of the study (T0), 4 weeks (T1) and 8 weeks after (T2). Data collected showed a better clinical outcome at T1 which increased in T2 for pitchers in Group A, while in Group B athletes these positive results were not observed. This study underlines that scapula-stabilizing t-shirt can have positive effects on shoulder discomfort in over-head athletes.

BDNF Serum Levels with Respect to Multidimensional Assessment in Amyotrophic Lateral Sclerosis.

BACKGROUND: The clinical presentation of amyotrophic lateral sclerosis (ALS) is characterized by high heterogeneity, the greatest part of which still remains unexplained. OBJECTIVE: To assess serum levels of brain-derived neurotrophic factor (BDNF) in ALS patients, implementing a multidimensional characterization focused on four a priori chosen elements of phenotypic variability: ALS bulbar/spinal subtype, cognitive impairment, mood dysfunction and disease progression speed. METHODS: Serum samples were obtained from 45 ALS outpatients (16% bulbar onset) and 22 healthy controls. Each patient underwent the Montreal Cognitive Assessment (MoCA) and the Beck Depression Inventory (BDI), and disease progression speed was estimated by calculating the decay of the ALSFRS-R score over time. RESULTS: BDNF serum levels did not differ between patients and controls, although ∼25% lower levels characterized those patients carrying a depressive trait. Finally, BDNF serum levels were significantly lower in ALS patients expressing lower ALSFRS-R scores (r = 0.39, p < 0.01). No differences were found when considering cognitive impairment, disease progression speed and site of onset. CONCLUSION: BDNF serum levels might mark and possibly contribute in part to ALS phenotypic variability.

Risks of subsequent contralateral fractures of the trochanteric region in elderly.

BACKGROUND: Fractures in elderly are always a dramatic event and the healing is often not complete. In a context of bone fragility, repeated fractures are a growing problem in the industrialized world, in which the mean age of population is increasing. The aim of this study was to identify those general factors which may increase the risk of subsequent trochanteric fractures after an initial lesion. MATERIALS AND METHODS: Three-hundred and thirty-one patients who underwent intramedullary fixation for trochanteric fractures between January 2012 and December 2013 were studied. Forty subjects yet alive (group 1), affected by a subsequent contralateral hip fracture, were compared with 202 patients (group 2) affected by isolated trochanteric fracture. Days of hospitalization before surgery, hospitalization, period of rehabilitation, type of discharge and comorbidities, that are reported in literature as possible risk factors for hip refracture, were analyzed. In addition, all patients were interviewed in order to assess if a therapy for osteoporosis was prescribed after the initial fracture and how their gait had been modified by fractures. RESULTS: Days of hospitalization before surgery, hospitalization, period of rehabilitation and type of discharge were not predictive factors for subsequent fractures, as well as diabetes mellitus, hypertension and cardiac diseases. The presence of neurologic and respiratory diseases were associated to a higher risk of refractures, as well as the absence of specific medical treatment for osteoporosis. CONCLUSIONS: Neurologic and respiratory comorbidities and the absence of osteoporosis medical treatment are the variables associated to a higher risk of contralateral fractures. Physicians can do more in terms of prevention and strategies must consider these risk factors.

The Constant score and the assessment of scapula dyskinesis: Proposal and assessment of an integrated outcome measure.

The Constant-Murley score (CMS) is a popular measure of shoulder function. However, its ability to monitor the evolution of patients during rehabilitation after rotator-cuff repair is controversial. Moreover, CMS does not account for possible alterations in the scapulo-humeral coordination (SHC, scapula dyskinesis), which are apparent in variety of shoulder pathologies. To address these issues, a new formulation of CMS was firstly proposed, which rates the "affected-to-controlateral side difference in SHC" of a patient with respect to reference values of asymptomatic controls (Scapula-Weighted CMS). Then, 32 patients (53±9year-old) were evaluated with CMS and SW-CMS at 45, 70, 90-day and >6-month after rotator-cuff repair, to test three hypotheses: (1) CMS and SW-CMS are largely responsive to change; (2) accounting (SW-CMS) or not (CMS) for scapula dyskinesis leads to statistically different scores and SW-CMS cannot be predicted from CMS without clinically relevant differences; (3) 90% of patients recover a side-to-side SHC similar to asymptomatic controls at 90days. Results supported hypotheses 1 and 2. On the contrary (hypothesis 3), only 10% of patients recovered for SHC alterations at 90days, and 50% at follow-up. These findings support the use of SW-CMS and the importance of treating scapula dyskinesis after rotator-cuff repair.

A 3D finite element model for geometrical and mechanical comparison of different supraspinatus repair techniques.

BACKGROUND: Contact pressure and contact area are among the most important mechanical factors studied to predict the effectiveness of a rotator cuff repair. The suture configurations can strongly affect these factors but are rarely correlated with each other. For example, there is a significant difference between the single-row technique and the transosseous or transosseous-like approaches in terms of footprint contact area coverage. A finite element model-based approach is presented and applied to account for various parameters (eg, suture pretension, geometry of the repair, effect of the sutures, geometry of the lesion) and to compare the efficacy of different repair techniques in covering the original footprint. METHODS: The model allows us to evaluate the effect of parameters such as suture configuration and position and suture pretension. The validity of such an approach was assessed in comparing 3 different repair techniques: single row, transosseous equivalent, and double row. RESULTS: Results from the application of the models show that the double-row and transosseous-equivalent techniques lead to progressive increase of the contact area compared with the single-row approach, supporting the conclusion that transosseous-equivalent fixation leads to an increase of the contact area and a better distribution of the pressure coverage. CONCLUSION: The 3-dimensional finite element model approach allows multiple variables to be assessed singularly, weighing the specific influence. Moreover, the approach presented in this study could be a valid tool to predict and to reproduce different configurations, identifying how to reduce the stress over the tendon and when a repair could be effective or not.

Semitendinosus Tendon Transfer Associated With Distal Alignment for Patella Alta in a Patient With Recurrent Dislocations.

Patellofemoral instability is characterized by pain during normal daily activities and frequent dislocation events. In the reported case, an adolescent girl, aged 15 years, affected by left patellofemoral instability, underwent surgery with a double technique comprising tibial tubercle distalization and medial patellofemoral ligament reconstruction. In case of patella alta associated with patellofemoral instability, surgical treatment should focus on medial patellofemoral ligament repair and on recurrent instability prevention.