COVID-19 vaccine confidence in the post-vaccination era: Perceptions among adults with immune-mediated inflammatory diseases.

Objective: Assess the perceived protection afforded by a range of COVID-19 vaccines in immune-mediated inflammatory diseases patients previously vaccinated against SARS-CoV-2. Study design: Survey. Methods: On-line cross-sectional survey aimed at evaluating the perceived protection (and its determinants) afforded by a range of COVID-19 vaccines among immune-mediated inflammatory diseases previously vaccinated for COVID-19. Results: Out of 493 eligible respondents who lived in Brazil, 397 (80.5%) were confident that their primary vaccination series would protect them against severe COVID-19. In multivariate analysis, only overlapping immune-mediated inflammatory diseases remained (negatively) associated with the perception of protection. Conclusions: No influence was found between COVID-19 vaccine types and the perception of protection after initial vaccinations.

Impact of surrogate outcomes in randomized controlled trials for shoulder rotator cuff tears.

PURPOSE: Surrogate outcomes are clinical endpoints that are used as substitutes for direct measures of how a patient feels, functions, or survives. The present study aims to analyze the impact of surrogate outcomes on the results of randomized controlled trials on shoulder rotator cuff tears disorders. METHODS: Randomized controlled trials (RCTs) related to rotator cuff tear conditions published up until 2021 were retrieved from the PubMed and ACCESSSS databases. The primary outcome of the article was considered a surrogate outcome when the authors used radiological, physiologic, or functional variables. The result of the article was considered positive when results supported the intervention based on the trial's primary outcome. We recorded the sample size, the mean follow-up, and the type of funding. Statistical significance was set at p < 0.05. RESULTS: A total of 112 papers were included in the analysis. The mean sample size was 87.6 patients; mean follow-up period was 25.97 months. Thirty-six out of 112 RCTs used a surrogate outcome as a primary endpoint. More than half of papers using surrogate outcomes reported a positive finding (20 out of 36), while 10 out of 71 RCTs using patient-centered outcomes favored the intervention (14.08%, p < 0.001) [RR = 3.94 (95% CI 2.07-7.51)]. The mean sample size was smaller in trials using surrogate endpoints (75.11 vs 92.35 patients, respectively, p = 0.049), while the follow-up was shorter (14.12 m vs. 31.9 m, p < 0.001). Approximately 25% of the papers that reported surrogate endpoints (22.58%) were industry-funded projects. CONCLUSIONS: The substitution of surrogate endpoints for patient-important outcomes in shoulder rotator cuff trials quadruplicates the chances of obtaining a favorable result that favors the analyzed intervention.

HLA-G expression in Merkel cell carcinoma and the correlation with Merkel cell polyomavirus infection.

Merkel cell carcinoma (MCC) is a rare aggressive neuroendocrine cutaneous carcinoma with a high mortality rate. The MCC etiology is not fully understood. Merkel cell-associated polyomavirus (MCPyV) was found in MCC patients, indicating a risk factor for the tumor. Caucasian, elderly, and immunocompromised individuals are more likely to develop this tumor. HLA-G consists of a non-classical class I (Ib) HLA molecule with an immunoregulatory function and was associated with tumor escape in different types of tumors, nonetheless, never been studied in MCC. The purpose of this study was to evaluate the HLA-G expression and also to detect the MCPyV in MCC patients and correlate it with the clinical course of the disease. Forty-five MCC patients were included in a retrospective study. Formalin-fixed paraffin-embedded cutaneous skin biopsies were used by immunohistochemistry and RT-PCR to verify the HLA-G expression and MCPyV infection. HLA-G expression was found in 7 (15.6%), while the presence of MCPyV was detected in 28 (62.2%) of the studied patients. No significant association was found between HLA-G expression and MCPyV infection (p = 0.250). The presence of MCPyV was associated with areas of low sunlight exposure (p = 0.042) and the HLA-G expression with progression to death (p = 0.038). HLA-G expression was detected in MCC patients, as well as the MCPyV presence was confirmed. These markers could represent factors with a possible impact on patient survival; however, further studies with a greater number of patients are needed, to better elucidate the possible role in disease progression.

HLA-G expression in Merkel cell carcinoma and the correlation with Merkel cell polyomavirus infection

Merkel cell carcinoma (MCC) is a rare aggressive neuroendocrine cutaneous carcinoma with a high mortality rate. The MCC etiology is not fully understood. Merkel cell-associated polyomavirus (MCPyV) was found in MCC patients, indicating a risk factor for the tumor. Caucasian, elderly, and immunocompromised individuals are more likely to develop this tumor. HLA-G consists of a non-classical class I (Ib) HLA molecule with an immunoregulatory function and was associated with tumor escape in different types of tumors, nonetheless, never been studied in MCC. The purpose of this study was to evaluate the HLA-G expression and also to detect the MCPyV in MCC patients and correlate it with the clinical course of the disease. Forty-five MCC patients were included in a retrospective study. Formalin-fixed paraffin-embedded cutaneous skin biopsies were used by immunohistochemistry and RT-PCR to verify the HLA-G expression and MCPyV infection. HLA-G expression was found in 7 (15.6%), while the presence of MCPyV was detected in 28 (62.2%) of the studied patients. No significant association was found between HLA-G expression and MCPyV infection (p = 0.250). The presence of MCPyV was associated with areas of low sunlight exposure (p = 0.042) and the HLA-G expression with progression to death (p = 0.038). HLA-G expression was detected in MCC patients, as well as the MCPyV presence was confirmed. These markers could represent factors with a possible impact on patient survival; however, further studies with a greater number of patients are needed, to better elucidate the possible role in disease progression.

Surgical treatment of proximal humeral fractures with the transosseous suture fixation.

BACKGROUND: The surgical treatment of displaced proximal humeral fractures is commonly affected by implant-related complications. We evaluated the functional and radiographic results of transosseous suture fixation in a series of displaced proximal humeral fractures (PHF). METHODS: Sixty-four patients were retrospectively classified by age, sex, and the Neer fracture classification. Two-part greater tuberosity (2pGT) displaced fractures and 3-part (varus and valgus) and 4-part valgus impacted fractures were managed with fragment reduction and transosseous suture fixation. Patients with minimum follow-up of 24 months and assessed with the Constant-Murley score (CMS) were included. Radiological and medical complications, as well as reinterventions were also recorded. RESULTS: Forty-six patients with a mean follow-up of 58 (24-132) and a mean age of 58 years old were analyzed. Patients with 2pGT (n = 10) fractures had a CMS of 76 points (59-89); patients with 3-part fractures (n = 22) had a score of 67 points (13-91); and those with 4-part fractures (n = 14) had a score of 64 (24-76) points. The overall complication rate was 6 out of 46, and 4 patients required reintervention for different reasons. Patients presenting with 3-part varus fractures had significantly lower functional outcomes scores (p = 0.007). Humeral head osteonecrosis was present in 9 patients and significantly affected the functional outcomes (p < 0.05). However, only three out of nine patients with osteonecrosis required subsequent surgery at the indicated follow-up. CONCLUSIONS: The fracture reduction and transosseous fixation technique represents a safe technique with low complication and reintervention rates. The presence of humeral head necrosis did not lead to subsequent surgical intervention because no hardware had protruded. LEVEL OF EVIDENCE: Level IV, retrospective study.

Reverse shoulder arthroplasty for acute proximal humeral fractures: Postoperative complications at 7 days, 90 days and 1 year.

BACKGROUND: In the last decade, the biomechanics of reverse shoulder arthroplasty (RSA) for proximal humeral fractures in the elderly have led to more functional outcomes and greater pain relief. However, its use has also introduced a significant rate of complications. The purpose of this study is to assess the complication rate of RSA in these cases as well as the relationship to ASA score and basic disease history. METHODS: We evaluate patients who underwent RSA due to acute proximal humeral fractures at three hospitals from 2010 to 2016. We analyze previous disease and anticoagulant treatment, American Society of Anesthesiologists (ASA) Physical Status Classification, and the transfusion rate to correlate these factors with major and minor postoperative complications at 7, 90, and 365 days. RESULTS: We include 103 patients (104 shoulders) over 65 years of age. Mean age is 77.31 years (62-91), 20 of which are male. The overall rate of complications is 25%, with 17.4% minor and 7.6% major complications. We observe a statistically significant relationship between a higher ASA score (3,4) and major complication at 90 days (p = 0.024) and a trend (p = 0.072) towards a higher ASA score with minor complication during the first week. Rheumatoid disease significantly increases major complications at 90 days (p = 0.037). The transfusion rate is 11.5%. CONCLUSIONS: The overall major complication rate of RSA for acute fractures is low in the elderly population. Although, the patient's history (e.g. previous rheumatoid pathology, neurological diseases, or anticoagulant treatment) as well as their ASA score should be considered before RSA surgery. The higher the ASA score and the presence of rheumatoid disease, leads to a higher rate of major complications during the first 90 days after surgery. LEVEL OF EVIDENCE: Level IV; Case series; Treatment study.

Retaining or excising the supraspinatus tendon in complex proximal humeral fractures treated with reverse prosthesis: a biomechanical analysis in two different designs.

PURPOSE: We aimed to biomechanically evaluate the effect of the supraspinatus tendon on tuberosity stability using two different reverse shoulder arthroplasty (RSA) models for complex proximal humeral fractures (PHFs). METHODS: Four-part proximal humeral fractures were simulated in 20 cadaveric shoulders. Two different RSA designs were implemented: a glenosphere-medialized model and a glenosphere-lateralized model. Tuberosities were reconstructed, and displacement of bony fragments was measured (mm) by placing three sensors: in the humeral diaphysis (D), in the greater tuberosity (GT), and in the lesser tuberosity (LT). Axial forces were induced and measured in Newton (N). The test was performed twice in each specimen, with and without the supraspinatus tendon. The regression line (RL) was measured in mm/N. RESULTS: In the medialized model, the GT-D displacement was greater in the supraspinatus preserving model than that in the tendon excision model (p < 0.001), as well as for the LT-D displacement (p < 0.001). In the lateralized model, GT-D displacement and GT-LT distance were greater in the preserving model than that in the excision model (p < 0.001, p = 0.04). CONCLUSION: The supraspinatus tendon resection leads to a more biomechanically stable tuberosity construct when performing RSA for PHFs, while the rest of the rotator cuff tendons (infraspinatus and teres minor) are retained in the greater tuberosity. LEVEL OF EVIDENCE: Basic science study. Cadaveric study.

Age and growth of the endemic Xingu River stingray Potamotrygon leopoldi validated using fluorescent dyes.

Between 2003 and 2005, vertebrae of 151 Xingu River Potamotrygon leopoldi (Potamotrygonidae) (75 males and 76 females) were analysed to derive a growth curve for this species. The disc width (WD ) was significantly different between sexes, with females measuring 149-700 mm WD and males 109-500 mm WD . The average percentage error for vertebrae readings of the whole sample was 2·7%. The marginal increment ratio (RMI ) showed an increasing trend with the highest value in November, decreasing from December on. The majority of vertebrae displaying RMI zero, occurred in September, but the annual periodicity of ring deposition throughout the year was not conclusive. Tetracycline (TCN) injected specimens were held in captivity for 13 months and displayed a fluorescent mark in vertebrae confirming a yearly periodicity of band pair formation with the translucent ring deposited in September-October. The Akaike information criterion (AIC) showed that, among the seven models considered, the best fit was obtained for the von Bertalanffy modified with W0 (where W0 = WD at birth) for both sexes. Growth parameters for females were: W0 = 149 mm; W∞ = 763·06 mm; k = 0·12 year- 1 , whereas for males: W0 = 109 mm; W∞ = 536·4 and k = 0·22 year-1 . Maximal ages were 7·2 years in males and 14·3 years in females. The species shows sexual dimorphism expressed in the growth pattern, size at maturity, longevity and asymptotic sizes. Concern for sustainability is raised due to the construction of the Belo Monte Hydroelectric Power Plant (2015 and 2016) in the State of Pará causing changes to the habitat of this species, which is endemic to the Xingu River and two of its tributaries.

Do we publish what we preach? Analysis of the European Society for Surgery of the Shoulder and Elbow Congress publication rates.

BACKGROUND: Scientific congresses have become the most expedient method to communicate novel findings on any research topic. However, an important question is whether this information will be published in peer-reviewed journals. Our aim was to determine the publication rate of the abstracts presented at the European Society for Surgery of the Shoulder and Elbow Congress and analyze factors that may influence this rate. METHODS: A total of 398 abstracts reported in the Abstract Book from the 2008 European Society for Surgery of the Shoulder and Elbow Congress were examined and categorized by oral and poster presentations, topic, and the number of authors listed. A search in PubMed and Google Scholar for subsequent peer-reviewed publications was performed in September 2015. The time to publication after the meeting had been held; the type of journal and its impact factor at the time to publication were recorded for those abstracts that reached peer-reviewed journal publication. RESULTS: The overall publication rate for the 2008 European Society for Surgery of the Shoulder and Elbow oral and poster presentations was 45.20% after 7 years. The mean time to publication was 18.53 months, and the mean impact factor value was 2.32. Oral presentations were significantly better represented in journals than posters (64.40 vs. 35.40%, p < 0.001). Abstracts with a greater number of authors listed had better publication rates (p < 0.001). CONCLUSION: Less than half of the oral presentations and posters at the 21st European Society for Surgery of the Shoulder and Elbow Congress were published in peer-reviewed journals. Oral presentations with a higher number of authors had an increased likelihood of being published.

Bioactive materials improve some physical properties of a MTA-like cement.

One of the main disadvantages of MTA is its long setting time which could result in higher solubility and microleakage, producing a failed treatment. Studies have shown that the addition of bioactive glass may decrease the setting time. The aim of this study is to evaluate the compressive strength, setting time, solubility and radiopacity of a MTAlike experimental cement to which different percentage of wollastonite and bioactive glass are added. White MTA Angelus® was used as control; an experimental MTA-like cement (ExpC) was prepared using white Portland cement with 20wt% of Bi2O3; three wollastonite cement composites were prepared adding 10, 20 and 30wt% of wollastonite to ExpC, and three more adding the same proportions of bioactive glass. Compressive strength was tested according to ADA 30; radiopacity, setting time and solubility were tested according to ISO 6876. SEM observations of the surface were made after the solubility test. Compressive strength, setting time, solubility and radiopacity were reduced as the wollastonite increased; solubility increased with the addition of bioactive glass. The surfaces of MTA Angelus® and ExpC were smoother than Wollastonite and Bioactive glass groups. Addition of wollastonite and bioactive glass improved the physical properties of a MTA-like experimental cement, reducing the setting time with good solubility percentages, which would be an advantage in its clinical use.

Growth of the dolphinfish Coryphaena hippurus from north-eastern Brazil with an appraisal of the efficacy of scales and otoliths for ageing.

Age and growth of the dolphinfish Coryphaena hippurus caught off north-eastern Brazil were studied by counting growth increments on scales and otoliths. A sample (n = 2338) measuring 7·7-195 cm fork length (LF ) was collected from September 2001 to February 2003. The scales (n = 69) removed from six different regions of the body were examined and those from the caudal region exhibited greater morphological regularity, symmetry and a smaller rate of regeneration. The regression between caudal scale radius (RS ) and LF displayed was linear (LF = 28·334 RS + 9·186; r(2) = 0·754). Otolith micro-increments were counted assuming daily periodicity. Ages estimated from otoliths ranged from 64 to 659 days. The von Bertalanffy growth model was fitted based on the otolith readings generating L∞ = 194·1 cm LF , k = 0·912 year(-1) and t0 = 0·081 years. Species longevity was estimated to be c. 4 years. Ninety-eight per cent of the overall sample was adult specimens well above the age of first maturity in the study area. The large variability between scale length and LF and the failure to ascertain increment deposition periodicity suggest that scales are not appropriate for ageing C. hippurus and analysis of otolith micro-increments is deemed the best structure for ageing this species in the study area.

Body adiposity and bone parameters of male rats from mothers fed diet containing flaxseed flour during lactation.

Obesity and osteoporosis may have their origins in early postnatal life. This study was designed to evaluate whether flaxseed flour use during lactation period bears effect on body adiposity and skeletal structure of male rat pups at weaning. At birth, male Wistar rats were randomly assigned to control and experimental (FF) groups, whose dams were treated with control or flaxseed flour diet, respectively, during lactation. At 21 days of age, pups were weaned to assess body mass, length and composition by dual-energy X-ray absorptiometry. The animals were then sacrificed to carry out analysis of serum profile, intra-abdominal adipocyte morphology and femur characteristics. Differences were considered significant when P<0.05. The FF group displayed the following characteristics (P<0.05): higher body mass, length, bone mineral content, bone area and concentrations of osteoprotegerin, osteocalcin and high-density lipoprotein cholesterol; higher levels of stearic, α-linolenic, eicosapentaenoic and docosapentaenoic acids and lower levels of arachidonic acid and cholesterol; smaller adipocyte area; and higher mass, epiphysis distance, diaphysis width, maximal load, break load, resilience and stiffness of femur. Flaxseed flour intake during lactation period promoted adipocyte hypertrophy down-regulation and contributed to pup bone quality at weaning.

Age and growth of the midwater crocodile shark Pseudocarcharias kamoharai.

Age and growth were analysed on the basis of 372 vertebrae from specimens of the crocodile shark Pseudocarcharias kamoharai (66·0-122·0 cm, total length, LT ) collected in the south-western Atlantic Ocean. Centrum edge analysis suggested the first four months of the year as the period of band completion, leading to acceptance of free-living bands as annual. A pre-birth ring is formed in embryos >31·0 cm LT , whereas the birthmark is deposited in newborns of 46·1 ± 1·1 cm LT (mean ± s.d.). Growth was parameterized using seven models and the AIC was used for selection of the most plausible model. The von Bertalanffy growth model received the greatest support from the data, providing the following growth parameters for combined sexes: L∞ = 129·2 cm, k = 0·137 year(-1) and t0 = -3·9 years. No significant differences were detected in growth by sex, but significant differences in age composition by sex were found in the sample. Overall age ranged from 2 to >13 years in females and from 1 to 8 years in males. Males achieved first maturity at 3·1 years and females at 5·1 years, with pregnancy appearing at 4·8 years. Similar to other lamnoid species, P. kamoharai is relatively fast growing.

Genetic parameters and prediction of genotypic values for root quality traits in cassava using REML/BLUP.

The aim of this study was to estimate the genetic parameters and predict the genotypic values of root quality traits in cassava (Manihot esculenta Crantz) using restricted maximum likelihood (REML) and best linear unbiased prediction (BLUP). A total of 471 cassava accessions were evaluated over two years of cultivation. The evaluated traits included amylose content (AML), root dry matter (DMC), cyanogenic compounds (CyC), and starch yield (StYi). Estimates of the individual broad-sense heritability of AML were low (hg(2) = 0.07 ± 0.02), medium for StYi and DMC, and high for CyC. The heritability of AML was substantially improved based on mean of accessions (hm(2) = 0.28), indicating that some strategies such as increasing the number of repetitions can be used to increase the selective efficiency. In general, the observed genotypic values were very close to the predicted average of the improved population, most likely due to the high accuracy (>0.90), especially for DMC, CyC, and StYi. Gains via selection of the 30 best genotypes for each trait were 4.8 and 3.2% for an increase and decrease for AML, respectively, an increase of 10.75 and 74.62% for DMC for StYi, respectively, and a decrease of 89.60% for CyC in relation to the overall mean of the genotypic values. Genotypic correlations between the quality traits of the cassava roots collected were generally favorable, although they were low in magnitude. The REML/BLUP method was adequate for estimating genetic parameters and predicting the genotypic values, making it useful for cassava breeding.

The influence of the CIVIQ dimensions on quality of life of patients with primary superficial venous incompetence.

OBJECTIVES: To get to know the influence of the four domains of the Chronic Lower Limb Venous Insufficiency Questionnaire (CIVIQ) on the quality of life (QoL) of patients with primary superficial venous incompetence, and their behaviour in relation to age, gender, occupation, body mass index (BMI), and also with respect to the clinical and anatomical classes of the CEAP. MATERIAL AND METHODS: The sample was composed of 468 patients with primary superficial venous reflux (135 male and 333 female) who answered 100% of the questions in the Short Form-12 (SF12) and CIVIQ questionnaires. After a clinical and duplex examination, the patients were categorized as C0-6, Ep, As, Ap or As,p and Pr according to the CEAP classification. The relationships between CIVIQ domains and gender, age, occupation, BMI, and the clinical and anatomical classes of the CEAP classification were analyzed. RESULTS: Men reported better QoL than women (33.2 vs. 46.3) and this was also true for each of the CIVIQ's domains (p < .00). Pain (50.6) and physical restriction (45.3) were the dimensions with a greater influence on QoL, whereas social (41.7) and psychological (38.1) dimensions had a lesser influence. Patients aged between 45 and 64, household activities, and patients with C2-3 clinical classes were the patient groups with the worst scores in all the CIVIQ dimensions and those where significant differences were found. The BMI and anatomical distribution of the reflux had no influence on the QoL. CONCLUSIONS: Pain and physical restriction were the CIVIQ domains with greater influence on the QoL of patients with primary superficial venous reflux. Age increase (up to 64 years), female gender, household activities, and C2-3 CEAP clinical class were the main factors associated with the worst QoL perception.

Morbimortalidad en fracturas de húmero proximal tratadas quirúrgicamente / Morbidity and mortality of surgically treated proximal humerus fractures

Introducción. El objetivo de este estudio es analizar los factores que se correlacionan con la mortalidad y la capacidad para realizar actividades de la vida diaria (AVD) en las fracturas de húmero proximal tratadas quirúrgicamente. Métodos. Se estudiaron retrospectivamente a 94 pacientes con fractura de húmero proximal intervenidas quirúrgicamente con un seguimiento medio de 8 años (2-12 años). De la muestra, se estudió el tipo de fractura, el tratamiento aplicado y sus comorbilidades. Se correlacionan los parámetros con la mortalidad y el nivel de las actividades de la vida diaria. Resultados. Se localizaron a 72 pacientes, de los cuales el 18,6% habían fallecido. Un 85,4% de los pacientes presentan comorbilidades. El 79,5% de los pacientes eran totalmente independientes para las actividades de la vida diaria. No encontramos correlación entre la mortalidad, el tipo de fractura y el tratamiento aplicado. No se encontró relación significativa entre las AVD y las comorbilidades con el tipo de fractura, pero sí que se encontró una reducción significativa de la función de las actividades de la vida diaria en pacientes tratados con hemiartroplastia y en pacientes con trastornos neurológicos. Conclusiones. Encontramos una mortalidad del 18,6% en los pacientes con fractura de húmero proximal tratada quirúrgicamente. La mayoría de los pacientes intervenidos son totalmente independientes para las actividades de la vida diaria, con un seguimiento a largo plazo (AU)

Background. The aim of the present study is to analyse the factors associated with mortality and the capacity to perform daily life activities (DLA) in patients with surgically treated proximal humeral fractures. Methods. A retrospective study was conducted on 94 patients with a surgically treated proximal humeral fracture, with a mean follow-up of 8 years (2 - 12 years). A correlation analysis was performed to determine the relationship between the type of fracture, surgical technique, comorbidities and mortality and DLA. The Student t test was used for statistical analysis. Results. A total of 72 patients were identified, 18.6% of them died during follow-up, all diagnosed with some comorbidity. There was no correlation between mortality, type of fracture or the technique used. Most of the patients (85.4%) had comorbidities, and 79.5% were completely independent for DLA. Although there was no relationship with the type of fracture, there was a significant reduction in the performing of DLA in patients treated with hemiarthroplasty, and in patients with neurological disorders. Conclusions. There was a mortality of 18.6% among patients with surgically treated proximal humerus fractures. The majority of surgically treated patients were fully independent for DLA at long-term follow-up (AU)