The longitudinal behavioral effects of acute exposure to galactic cosmic radiation in female C57BL/6J mice: implications for deep space missions, female crews, and potential antioxidant countermeasures.

Galactic cosmic radiation (GCR) is an unavoidable risk to astronauts that may affect mission success. Male rodents exposed to 33-beam-GCR (33-GCR) show short-term cognitive deficits but reports on female rodents and long-term assessment is lacking. Here we asked: What are the longitudinal behavioral effects of 33-GCR on female mice? Also, can an antioxidant/anti-inflammatory compound mitigate the impact of 33-GCR? Mature (6-month-old) C57BL/6J female mice received the antioxidant CDDO-EA (400 µg/g of food) or a control diet (vehicle, Veh) for 5 days and either Sham-irradiation (IRR) or whole-body 33-GCR (0.75Gy) on the 4th day. Three-months post-IRR, mice underwent two touchscreen-platform tests: 1) location discrimination reversal (which tests behavior pattern separation and cognitive flexibility, two abilities reliant on the dentate gyrus) and 2) stimulus-response learning/extinction. Mice then underwent arena-based behavior tests (e.g. open field, 3-chamber social interaction). At the experiment end (14.25-month post-IRR), neurogenesis was assessed (doublecortin-immunoreactive [DCX+] dentate gyrus neurons). Female mice exposed to Veh/Sham vs. Veh/33-GCR had similar pattern separation (% correct to 1st reversal). There were two effects of diet: CDDO-EA/Sham and CDDO-EA/33-GCR mice had better pattern separation vs. their respective control groups (Veh/Sham, Veh/33-GCR), and CDDO-EA/33-GCR mice had better cognitive flexibility (reversal number) vs. Veh/33-GCR mice. Notably, one radiation effect/CDDO-EA countereffect also emerged: Veh/33-GCR mice had worse stimulus-response learning (days to completion) vs. all other groups, including CDDO-EA/33-GCR mice. In general, all mice show normal anxiety-like behavior, exploration, and habituation to novel environments. There was also a change in neurogenesis: Veh/33-GCR mice had fewer DCX+ dentate gyrus immature neurons vs. Veh/Sham mice. Our study implies space radiation is a risk to a female crew's longitudinal mission-relevant cognitive processes and CDDO-EA is a potential dietary countermeasure for space-radiation CNS risks.

Vision-Related Quality of Life after Cataract Surgery in West Africa.

PURPOSE: To study vision related quality of life (VRQoL) before and after a massive cataract campaign in West Africa and the relationship with visual indicators. METHODS: All the patients who received cataract surgery in Burkina Faso during a blindness prevention campaign were examined. VRQoL was assessed using a modified version of the WHO/PBD VF20. The questionnaire was changed to reflect the socioeconomic and local culture. Patients were interviewed by local interviewers before and three months after surgery. A quality of life related to vision index (QoL-RVI) was calculated. RESULTS: A total of 305 patients underwent cataract extraction in at least one eye, of these, a total of 196 (64%) completed the study. Mean age was 61.97 ± 14.39 years. The majority of eyes had poor visual acuity (VA<20/200, log MAR: 1.0) preoperatively (88.70%) with a mean VA of logMAR 2.17 ± 0.70 (20/2000) which improved to 0.86 ± 0.64 LogMAR (20/150) 3 months after cataract surgery. QoL-RVI improved postoperatively in 90.2% of patients, did not change in 3.1% and was worse in 6.7%. Statistically significant differences were detected (Wilcoxon test p <0.05) for all items tested before and after surgeries. Correlations for the patients after operations showed that there was a statistically significant relation between a global estimated QoL-RVI and the VA previous to the surgery (-0.196 p=0.014), regarding the same index and the VA after the procedures (-0,35 p=0,00018). CONCLUSION: Cataract surgery increases the quality of life of patients living in a developing country such as Burkina Faso and the improvement correlates with the recovery of the visual acuity.

OBJECTIF: Étudier la qualité de vie liée à la vision (VRQoL) avant et après une campagne massive contre la cataracte en Afrique de l'Ouest et la relation avec les indicateurs visuels. MÉTHODES: Tous les patients qui ont été opérés de la cataracte au Burkina Faso pendant une campagne de prévention de la cécité ont été examinés. La VRQoL a été évaluée en utilisant une version modifiée du VF20 de l'OMS/PBD. Le questionnaire a été modifié pour refléter la culture socio-économique et locale. Les patients ont été interrogés par des enquêteurs locaux avant et trois mois après la chirurgie. Un indice de qualité de vie liée à la vision (QoL-RVI) a été calculé. RÉSULTATS: Un total de 305 patients ont subi une extraction de la cataracte dans au moins un œil, parmi ceux-ci, un total de 196 (64%) ont terminé l'étude. L'âge moyen était de 61,97 ± 14,39 ans. La majorité des yeux avaient une mauvaise acuité visuelle (AV<20/200, logMAR : 1,0) en préopératoire (88,70%) avec une VA moyenne de logMAR 2,17 ± 0,70 (20/2000) qui s'est améliorée à 0,86±0,64 LogMAR (20/150) 3 mois après la chirurgie de la cataracte. La QoL-RVI s'est améliorée après l'opération chez 90,2% des patients, n'a pas changé chez 3,1% et s'est aggravée chez 6,7%. Des différences statistiquement significatives ont été détectées (test de Wilcoxon p <0,05) pour tous les éléments testés avant et après les opérations. Les corrélations pour les patients après les opérations ont montré qu'il y avait une relation statistiquement significative entre une estimation globale de la QoL-RVI et l'AV avant l'opération (-0,196 p=0,014), concernant le même indice et l'AV après les procédures (-0,35 p=0,00018). CONCLUSION: La chirurgie de la cataracte augmente la qualité de vie des patients vivant dans un pays en voie de développement comme le Burkina Faso et cette amélioration est corrélée avec la récupération de l'acuité visuelle. Mots clés: Qualité de Vie, Cataracte, Cécité, Afrique de l'Ouest.

Spinal fractures and thoracoabdominal injuries in polytraumatized patients: epidemiological evaluation / Fraturas da coluna vertebral e lesões toracoabdominais em pacientes politraumatizados: avaliação epidemiológica / Fracturas vertebrales y lesiones toracoabdominales en pacientes politraumatizados: evaluación epidemiológica

ABSTRACT Objective: Establish the frequency of incidences, management, and description of the relationship between thoracic and abdominal trauma and spinal injury. Methods: Observational, retrospective study of quantitative analysis carried out through the analysis of medical records of patients who presented spinal fractures and associated thoracoabdominal injuries. The participants were treated at a reference hospital in trauma care in Curitiba-PR from 2019 to 2021. The data were from patients with spine fractures referring to gender, age, trauma mechanism, fracture classification, associated injuries, Frankel neurological scale, and proposed treatment. Results: There was a predominance of male patients (84.5%) and young, with a mean age of 37.3 years, victims of car accidents. The main vertebrae affected were the lumbar spine (36.8%) and thoracic spine (36.2%). The most prevalent associated injuries were extra vertebral and cervical spine fractures. The most observed thoracic injuries were hemothorax, chest contusion, and fracture of multiple costal arches, while the most observed abdominal injuries were kidney injury, hemoperitoneum/abdominal hematoma, and liver injury. Of the total patients analyzed, 68% had fractures with associated thoracoabdominal injuries. Conclusion: Abdominal and thoracic injuries are frequently associated with spine fractures, with an association of 14.6% and 53.4%, respectively. The production of knowledge on the subject contributes to creating action plans to optimize the management and reduce the morbidity and mortality of these cases. Levels of evidence III; Systematic Review.

Resumo: Objetivos: Estabelecer a frequência de incidências, manejo e descrição da relação entre traumas torácicos e abdominais com a lesão da coluna vertebral. Métodos: Estudo observacional, retrospectivo de análise quantitativa realizado através da análise de prontuários de pacientes que apresentaram fraturas da coluna vertebral e lesões toracoabdominais associadas. Os participantes incluídos foram atendidos em um hospital referência no atendimento ao trauma em Curitiba-PR no período de 2019 a 2021. Os dados foram de pacientes com fratura de coluna referente a sexo, idade, mecanismo de trauma, classificação da fratura, lesões associadas, escala neurológica de Frankel e tratamento proposto. Resultados: Houve predomínio de pacientes masculinos (84,5%) e jovens, sendo a média de idade de 37,3 anos, vítimas de acidentes automobilísticos. As principais vértebras acometidas foram de coluna lombar (36,8%) e torácica (36,2%). As lesões associadas mais prevalentes foram as fraturas extravertebrais e de coluna cervical. As lesões torácicas mais observadas foram o hemotórax, contusão torácica e fratura de múltiplos arcos costais, enquanto as lesões abdominais mais observadas foram lesão renal, hemoperitônio/ hematoma abdominal e lesão hepática. Sendo do total de pacientes analisados 68% apresentavam fraturas com lesões toracoabdominais associadas. Conclusão: Lesões abdominais e torácicas frequentemente estão associadas a fraturas de coluna, com associação de 14,6% e de 53,4% respectivamente. A produção de conhecimento sobre o assunto, contribui para criação de planos de ação para a otimização do manejo e redução da morbimortalidade desses casos. Nível de evidência III; Revisão sistemática.

Resumen: Objetivos: Establecer la frecuencia de incidencias, manejo y descripción de la relación entre trauma torácico y abdominal y lesión medular. Métodos: Estudio observacional, retrospectivo de análisis cuantitativo realizado a través del análisis de historias clínicas de pacientes que presentaron fracturas de columna y lesiones toracoabdominales asociadas. Los participantes incluidos fueron atendidos en un hospital de referencia en atención de trauma en Curitiba-PR de 2019 a 2021. Los datos fueron de pacientes con fracturas de columna con referencia a sexo, edad, mecanismo de trauma, clasificación de fractura, lesiones asociadas, escala neurológica de Frankel y tratamiento propuesto. Resultados: Predominaron los pacientes del sexo masculino (84,5%) y jóvenes, con una edad media de 37,3 años, víctimas de accidentes automovilísticos. Las principales vértebras afectadas fueron la columna lumbar (36,8%) y la columna torácica (36,2%). Las lesiones asociadas más prevalentes fueron las fracturas extra vertebrales y de columna cervical. Las lesiones torácicas más observadas fueron hemotórax, contusión torácica y fractura de múltiples arcos costales, mientras que las lesiones abdominales más observadas fueron lesión renal, hemoperitoneo/ hematoma abdominal y lesión hepática. Del total de pacientes analizados, el 68% presentaba fracturas con lesiones toracoabdominales asociadas. Conclusión: Las lesiones abdominales y torácicas se asocian con frecuencia a las fracturas de columna, con una asociación del 14,6% y 53,4% respectivamente. La producción de conocimiento sobre el tema contribuye a la creación de planes de acción para optimizar el manejo y disminuir la morbimortalidad de estos casos. Nivel de evidencia; Revisión sistemática.

Interlaminar endoscopic lumbar discectomy - clinical outcome / Discectomia lombar endoscópica interlaminar - desfecho clínico / Discectomía lumbar endoscópica interlaminar - resultado clínico

ABSTRACT Objective: Evaluate the clinical outcome of patients with lumbar disc herniation (HDL) operated by endoscopic interlaminar microdiscectomy. We evaluated epidemiology, time to return to work, and technique-related complications as secondary outcomes. Method: Prospective longitudinal study, where patients with HDL with surgical indications were evaluated. They underwent endoscopic discectomy exclusively using the interlaminar technique. Clinical results were evaluated using the Oswestry 2.0 questionnaire (ODI) and the visual analog scale (VAS). In this study, we inserted the Macnab postoperative satisfaction index. In parallel with these indices, we analyzed the results regarding epidemiology variables, time to return to work, and complications. Such questionnaires were applied preoperatively, postoperatively the day after surgery, and one year after. Results: In 132 patients selected for the study, we obtained significant clinical improvement in the ODI and VAS questionnaires, and 81.3% of the patients had excellent and good Macnab index. The hospital stay was 22.7 hours, and the return to work was 30 days. The rate of complications with the method was 12.8%, with recurrence of disc herniation being the most common complication with 9.8% of cases. Conclusion: The endoscopic technique proved effective in treating lumbar spinal disc herniation with significant clinical improvement in the analyzed period, low incidence of complications, early postoperative rehabilitation, and results close to or superior to the gold standard technique. Level of Evidence III; Prospective cohort study

Resumo: Objetivo: Avaliar o desfecho clínico dos pacientes com hérnia discal lombar (HDL) operados por microdiscectomia endoscópica interlaminar. Como desfechos secundários, avaliamos a epidemiologia, tempo de retorno ao trabalho e as complicações relacionadas a técnica. Método: Estudo longitudinal prospectivo, onde foram avaliados os pacientes portadores de HDL com indicação cirúrgica. Foram submetidos a discectomia endoscópica exclusivamente pela técnica interlaminar. Avaliou-se também os resultados clínicos por meio do questionário Oswestry 2.0 (ODI) e da escala visual analógica (EVA). Inserimos nesse estudo índice de satisfação pós-operatória de Macnab. Em paralelo a esses índices analisamos os resultados quanto as variáveis de epidemiologia, tempo de retorno ao trabalho e as complicações. Tais questionários foram aplicados no pré-operatório, no pós-operatório no dia seguinte a cirurgia e após 1 ano da cirurgia. Resultados: Em 132 pacientes selecionados para o estudo obtivemos significante melhora clínica nos questionários ODI e EVA, assim como 81,3% dos pacientes tiveram excelentes e bons no índice de Macnab. O tempo de internação hospitalar foi de 22,7 horas o retorno laboral de 30 dias. Já a taxa de complicações com o método foi de 12,8%, sendo a recidiva da hérnia discal a complicação mais comum com 9,8% dos casos. Conclusão: A técnica endoscópica se mostrou eficaz no tratamento da hérnia discal da coluna lombar com melhora clínica significante no período analisado, baixa incidência de complicações, precoce reabilitação pós-operatória e resultados próximos ou superiores à técnica padrão-ouro. Nível de Evidencia III; Estudo de coorte prospectivo.

Resumen: Objetivo: Evaluar el desenlace clínico de pacientes con hernia de disco lumbar (HDL) operados mediante microdiscectomía interlaminar endoscópica. Como resultados secundarios, evaluamos la epidemiología, el tiempo de regreso al trabajo y las complicaciones relacionadas con la técnica. Método: Estudio longitudinal prospectivo, donde se evaluaron pacientes con HDL con indicación quirúrgica. Se les realizó discectomía endoscópica interlaminar. Los resultados clínicos también se evaluaron mediante el cuestionario Oswestry 2.0 (ODI) y la escala analógica visual (VAS). En este estudio, insertamos el índice de satisfacción postoperatoria de Macnab. Analizamos los resultados cuanto a variables epidemiológicas, tiempo de reincorporación al trabajo y complicaciones. Dichos cuestionarios se aplicaron en el preoperatorio, en el postoperatorio al día siguiente de la cirugía y al año de la cirugía. Resultados: En 132 pacientes seleccionados para el estudio se obtuvo una mejoría clínica significativa en los cuestionarios ODI y EVA, así como el 81,3% de los pacientes tuvieron excelente y bueno en el índice de Macnab. La estancia hospitalaria fue de 22,7 horas y la reincorporación al trabajo de 30 días. Entre las complicaciones, la recurrencia de la hernia discal fue la más frecuente con el 9,8% de los casos. Conclusión: La técnica endoscópica demostró ser efectiva en el tratamiento de la hernia de disco espinal lumbar con mejoría clínica significativa en el período analizado, baja incidencia de complicaciones, rehabilitación posoperatoria y resultados cercanos a la técnica estándar de oro. Nivel de Evidencia III; Estudio de cohorte prospectivo.

Conservative treatment and vitamin d levels in patients with spinal fractures / Tratamento conservador e níveis de vitamina d em pacientes com fraturas toracolombares / Tratamiento conservador y niveles de vitamina d en pacientes con fracturas toracolumbares

ABSTRACT Objectives: Evaluate the evolution of pain, functional capacity, and vitamin D levels in conservatively treated patients with low-energy spinal fractures. Methods: Between January 2017 and March 2021, patients older than 40 years old affected by these fractures were selected and treated conservatively for six months. Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores and Cobb angle were evaluated pre- and post-treatment. Serum vitamin D levels were also measured at the first outpatient visit, and it was investigated whether the patient had a previous diagnosis of osteoporosis or previous fractures. Results: A total of 105 patients were analyzed, 70.5% of whom were women, with a mean age of 73.1 years. The average vitamin D level was 25.3 ng/mL, and hypovitaminosis was found in 75% of patients. Eight patients (7.62%) had a previous diagnosis of osteoporosis, and ten (9.52%) reported the occurrence of previous fractures. Regarding the VAS score, there was a mean reduction of 5.5 points of pain; for ODI, there was an average increase of 1 percentage point and an average increase of 4.3º of kyphosis in the fractured segment between pre- and post-treatment. Conclusion: The treatment improved pain, and patients maintained their functional capacity. Low levels of vitamin D were associated with more complex fractures. Level of evidence III; Retrospective Study.

Resumo: Objetivos: Avaliar a evolução da dor, capacidade funcional e níveis de vitamina D em pacientes com fraturas toracolombares por trauma de baixa energia tratados conservadoramente. Métodos: No período de janeiro de 2017 a março de 2021, pacientes com mais de 40 anos acometidos por estas fraturas foram selecionados e tratados conservadoramente durante 6 meses. As pontuações da Escala Visual Analógica (VAS), do Índice de Incapacidade de Oswestry (ODI) e o ângulo de Cobb foram avaliados no pré e pós tratamento. Dosagem sérica de vitamina D no primeiro retorno ambulatorial também foi realizada e o paciente foi questionado se tinha diagnóstico prévio de osteoporose ou fraturas prévias. Resultados: Foram avaliados 105 pacientes, sendo 70,5% mulheres, cuja idade média foi de 73,1 anos. O nível sérico médio de vitamina D foi de 25,3 ng/mL, sendo que uma hipovitaminose foi encontrada em 75% dos pacientes. Oito pacientes (7,62%) tinham diagnóstico prévio de osteoporose e dez (9,52%) relataram a ocorrência de fraturas prévias. Em relação à pontuação de VAS, observou-se uma redução média de 5,5 pontos da dor, para ODI houve um aumento médio de 1 ponto percentual e um aumento médio de 4,3º de cifose no segmento fraturado entre o pré e pós tratamento. Conclusão: O tratamento se mostrou eficaz na melhora da dor e os pacientes mantiveram sua capacidade funcional. Baixos níveis de vitamina D estavam associados a fraturas mais complexas. Nível de evidência III; Estudo Retrospectivo.

Resumen: Objetivos: Evaluar la evolución del dolor, capacidad funcional y los niveles de vitamina D en los pacientes con fracturas toracolumbares por trauma de baja energía tratados conservadoramente. Métodos: Entre enero de 2017 y marzo de 2021, los pacientes con más de 40 años afectados por estas fracturas fueran seleccionados y tratados de forma conservadora por 6 meses. Las puntuaciones de la escala analógica visual (VAS), el índice de discapacidad de Oswestry (ODI) y el ángulo de Cobb antes y después del tratamiento fueron evaluados. También se realizó la determinación del nivel sérico de vitamina D en la primera consulta y se preguntó al paciente si tenía diagnóstico previo para la osteoporosis o fracturas previas. Resultados: 105 pacientes fueran evaluados, de los cuales 70,5% eran mujeres, con edad promedio de 73,1 años. La media del nivel sérico de vitamina D fue de 25,3 ng/mL y la hipovitaminosis fue encontrada en 75% de los pacientes. Ocho pacientes (7,62%) tenían diagnóstico previo de osteoporosis y diez (9.52%) reportaron la ocurrencia de fracturas previas. Cuanto a la puntuación VAS, hubo una reducción promedio de 5,5 puntos en el dolor, para ODI hubo un aumento promedio de 1 punto porcentual y un aumento promedio de 4,3º de cifosis en el segmento fracturado entre pre y post tratamiento. Conclusión: El tratamiento demostró ser efectivo para mejorar el dolor y los pacientes mantuvieron su capacidad funcional. Los niveles bajos de vitamina D se asociaron con fracturas más complejas. Nivel de evidencia III; Estudio Retrospectivo.

MicroBooNE and the ν_{e} Interpretation of the MiniBooNE Low-Energy Excess.

A new generation of neutrino experiments is testing the 4.7σ anomalous excess of electronlike events observed in MiniBooNE. This is of huge importance for particle physics, astrophysics, and cosmology, not only because of the potential discovery of physics beyond the standard model, but also because the lessons we will learn about neutrino-nucleus interactions will be crucial for the worldwide neutrino program. MicroBooNE has recently released results that appear to disfavor several explanations of the MiniBooNE anomaly. Here, we show quantitatively that MicroBooNE results, while a promising start, unquestionably do not probe the full parameter space of sterile neutrino models hinted at by MiniBooNE and other data, nor do they probe the ν_{e} interpretation of the MiniBooNE excess in a model-independent way.

Severe cervical myelopathy: approaches and postoperative evaluation / Mielopatia cervical grave: vias de acesso e avaliação pós-operatória / Mielopatía cervical grave: vías de acceso y evaluación postoperatoria

ABSTRACT Objectives: To evaluate and compare the clinical evolution of surgical approaches used in patients with severe cervical myelopathy. Methods: Retrospective observational study in which 19 patients with myelopathy who underwent surgery were evaluated. Neurological assessments using the Frankel scale were conducted both preoperatively and one year following surgery, and the modified Japanese Orthopedic Association (JOA), Nurick, and Visual Analog Scale for pain (VAS) questionnaires were applied 1 year after the surgical procedure. Results: 89% of the participants were male and the average age was 63.9 years. No patient had postoperative neurological worsening, 12 patients (63.16%) had mild pain, and seven (36.84%) had moderate pain. The group with degenerative disease showed neurological improvement after surgery and the exclusively anterior approach was used in 84% of the cases, the exclusively posterior approach in 10% of the cases, and the dual approach in 6% of the cases. Conclusion: Surgical treatment has good results for inhibiting the unfavorable natural evolution of myelopathy within 1 year following surgery and promotes neurological improvement in degenerative cases, making it possible to use the anterior access route in most cases. Level of evidence III; Retrospective Study.

RESUMO Objetivos: Avaliar a evolução clínica em comparação com as vias de acesso cirúrgico em pacientes com mielopatia cervical grave. Métodos: Estudo observacional retrospectivo no qual foram avaliados 19 pacientes com mielopatia submetidos à cirurgia. Foram aplicados o questionário da Japanese Orthopedic Association (JOA) modificado, a Escala de Nurick e a Escala Visual Analógica (EVA) da dor um ano depois do procedimento cirúrgico e realizada avaliação neurológica pré-operatória e após um ano da cirurgia com a Escala de Frankel. Resultados: Os participantes eram 89% do sexo masculino e a média de idade foi de 63,9 anos. Nenhum paciente apresentou piora neurológica pós-operatória, 12 pacientes (63,16%) apresentaram dor leve e sete (36,84%) dor moderada. O grupo com doença degenerativa apresentou melhora neurológica depois da cirurgia e a via de acesso anterior exclusiva foi utilizada em 84% dos casos, 10% tiveram acesso exclusivamente por via posterior e 6% tiveram acesso com dupla via. Conclusões: O tratamento cirúrgico apresenta bons resultados para inibir a evolução natural desfavorável da mielopatia no período de um ano depois da cirurgia e promove melhora neurológica nos casos degenerativos, sendo possível a utilização da via de acesso anterior na maior parte dos casos. Nível de evidencia III; Estudo Retrospectivo.

RESUMEN Objetivos: Evaluar la evolución clínica en comparación con las vías de acceso quirúrgico en pacientes con mielopatía cervical severa. Métodos: Estudio observacional retrospectivo en el que se evaluaron 19 pacientes con mielopatía intervenidos quirúrgicamente. Se aplicó el cuestionario modificado de la Japanese Orthopedic Association (JOA), la escala de Nurick y la Escala Visual Analógica (EVA) del dolor 1 año después de la intervención quirúrgica y se realizó la evaluación neurológica preoperatoria y un año después de la cirugía utilizando la Escala de Frankel. Resultados: El 89% de los participantes eran hombres y la edad promedio era de 63,9 años. Ningún paciente presentó empeoramiento neurológico postoperatorio, 12 pacientes (63,16%) presentaron dolor leve y siete (36,84%) dolor moderado. El grupo con enfermedad degenerativa presentó mejoría neurológica tras la cirugía y en el 84% de los casos se utilizó la vía de acceso anterior exclusiva, el 10% la vía posterior exclusiva y el 6% la vía doble. Conclusión: El tratamiento quirúrgico presenta buenos resultados al inhibir la evolución natural desfavorable de la mielopatía en el período de un año después de la cirugía y promueve la mejoría neurológica en los casos degenerativos, posibilitando el uso de la vía de acceso anterior en la mayoría de los casos. Nivel de evidencia III; Estudio Retrospectivo.

Management of spinal gunshot wound injuries / Manejo das lesões por arma de fogo na coluna vertebral / Manejo de lesiones por arma de fuego en la columna

ABSTRACT Objectives Elaborate a care protocol for spinal gunshot wounds (GSWs), based on the experience of more than fifteen years of treating this type of injury. Methods A retrospective cross-sectional analysis of the electronic medical record data of a tertiary hospital related to the treatment of spinal GSWs between January 2002 and January 2018. Results The management proposed was applied to 700 patients. Epidemiological data collected describes the population served. Conclusions An easy-to-use treatment flowchart was developed that, according to factors related to the neurological condition, projectile location, lesion stability and additional criteria, allows the objective determination of the best treatment option for each case. Level of evidence II; Retrospective Study.

RESUMO Objetivos Elaborar um protocolo de atendimento para ferimentos por arma de fogo (FAF) na coluna vertebral, com base na experiência de mais de quinze anos de atendimento desse tipo de lesão. Métodos Realizou-se uma análise transversal retrospectiva dos dados do prontuário eletrônico de um hospital terciário referentes ao atendimento de FAF na coluna vertebral entre janeiro de 2002 e janeiro de 2018. Resultados O manejo proposto foi aplicado a 700 pacientes. Os dados epidemiológicos coletados mostram a população atendida. Conclusões Foi elaborado um fluxograma de tratamento de uso fácil que, de acordo com fatores relacionados com o quadro neurológico, a localização do projétil, a estabilidade da lesão e critérios adicionais, permite determinar objetivamente a melhor opção de tratamento para cada caso. Nível de evidência II; Estudo Retrospectivo.

RESUMEN Objetivos Desarrollar un protocolo de atención a las heridas por arma de fuego (HAF) en la columna vertebral, basado en la experiencia de más de quince años en la atención a este tipo de lesiones. Métodos Se realizó un análisis transversal retrospectivo de los datos de la historia clínica electrónica de un hospital terciario sobre la atención en casos de HAF en la columna vertebral entre enero de 2002 y enero de 2018. Resultados Se aplicó el tratamiento propuesto a 700 pacientes. Los datos epidemiológicos recopilados muestran la población atendida. Conclusiones Se desarrolló un diagrama de flujo de tratamiento de fácil de usar que, de acuerdo a factores relacionados con la condición neurológica, ubicación del proyectil, estabilidad de la lesión y criterios adicionales, permite determinar objetivamente la mejor opción de tratamiento para cada caso. Nivel de evidencia II; Estudio Retrospectivo.

Comparison of two endoscopic spine surgical techniques.

OBJECTIVE: The objective of this study is to compare the clinical outcome among patients who are surgically treated for lumbar disc herniation by transforaminal and interlaminar endoscopy techniques. METHODS: For the treatment of lumbar disc herniation, 31 patients were assigned to undergo the interlaminar technique and 24 patients the transforaminal technique. They were evaluated using visual analog scale and Oswestry disability index in the preoperative period, in the first postoperative period, and in the 12th month after the procedure. The clinical results between the two techniques were then compared. RESULTS: Overall, 89.1% of the patients obtained good results, with 12.5% complications in the transforaminal technique and 9.6% in the interlaminar technique. CONCLUSION: Although both the endoscopic techniques, compared in this study, are safe and effective for the surgical treatment of lumbar herniated disc, the interlaminar technique presented significantly better results and lower rates of complications than the transforaminal technique.

Desde la periferia: la noción de espacio social en la movilización sociopolítica de la juventud / From the periphery: The notion of social space in the socio-political mobilization of youth / Da partir da periferia: A noção de espaço social na mobilização sócio-política da juventude

Resumen (analítico) Este artículo pone de manifiesto la existencia de un elemento transversal en la relación de la juventud con la esfera pública, que contribuye a comprender mejor la naturaleza de sus expresiones políticas: la asimilación de una cierta posición periférica impuesta dentro del espacio social. La idea de espacio social, y en particular la de periferia, contribuyen a dar coherencia a determinados fenómenos y tendencias de la movilización sociopolítica de la juventud en su conjunto. Para ello, se analizan tres movimientos juveniles surgidos en Barcelona durante el año 2019, en los que la juventud tuvo especial protagonismo. Las diferencias y similitudes entre los tres movimientos muestran la versatilidad de la noción de periferia, que sirve para visualizar la precariedad vital que identifica a toda una generación, más allá de sus diferencias.

Abstract (analytical) This article highlights the existence of a transversal element in the relationship of youth with the public sphere, which contributes to a better understanding of the nature of their political expressions: the internalization of a certain imposed peripheral position within the social space. The idea of social space, and in particular the idea of periphery, contributes to give coherence to some phenomena and trends on the sociopolitical mobilization of youth as a whole. To do this, three youth movements emerged in Barcelona during 2019 are analyzed, in which the youth played a special role. The differences and similarities between the three movements show the versatility of the notion of periphery, which serves to visualize the vital precariousness that identifies an entire generation, beyond their internal differences.

Resumo (analítico) Este artigo tem como objetivo destacar a existência de um elemento transversal na relação dos jovens com a esfera pública, o que contribui para a melhor compreensão da natureza de suas expressões políticas: a assimilação de uma determinada posição periférica imposta dentro do espaço social. A ideia de espaço social e, em particular, de periferia, contribui para dar coerência a certos fenômenos e tendências na mobilização sócio-política da juventude como um todo. Para isso, são analisados três movimentos juvenis surgidos em Barcelona em 2019, nos quais os jovens tiveram protagonismo especial. As diferenças e semelhanças entre os três movimentos mostram a versatilidade da noção de periferia, que serve para visualizar a precariedade vital que identifica uma geração inteira, além de suas diferenças internas.

Comparison of two endoscopic spine surgical techniques

SUMMARY OBJECTIVE: The objective of this study is to compare the clinical outcome among patients who are surgically treated for lumbar disc herniation by transforaminal and interlaminar endoscopy techniques. METHODS: For the treatment of lumbar disc herniation, 31 patients were assigned to undergo the interlaminar technique and 24 patients the transforaminal technique. They were evaluated using visual analog scale and Oswestry disability index in the preoperative period, in the first postoperative period, and in the 12th month after the procedure. The clinical results between the two techniques were then compared. RESULTS: Overall, 89.1% of the patients obtained good results, with 12.5% complications in the transforaminal technique and 9.6% in the interlaminar technique. CONCLUSION: Although both the endoscopic techniques, compared in this study, are safe and effective for the surgical treatment of lumbar herniated disc, the interlaminar technique presented significantly better results and lower rates of complications than the transforaminal technique.

Polygenic Markers in Patients Diagnosed of Autosomal Dominant Hypercholesterolemia in Catalonia: Distribution of Weighted LDL-c-Raising SNP Scores and Refinement of Variant Selection.

Familial hypercholesterolemia (FH) is associated with mutations in the low-density lipoprotein (LDL) receptor (LDLR), apolipoprotein B (APOB), and proprotein convertase subtilisin/kexin 9 (PCSK9) genes. A pathological variant has not been identified in 30-70% of clinically diagnosed FH patients, and a burden of LDL cholesterol (LDL-c)-raising alleles has been hypothesized as a potential cause of hypercholesterolemia in these patients. Our aim was to study the distribution of weighted LDL-c-raising single-nucleotide polymorphism (SNP) scores (weighted gene scores or wGS) in a population recruited in a clinical setting in Catalonia. The study included 670 consecutive patients with a clinical diagnosis of FH and a prior genetic study involving 250 mutation-positive (FH/M+) and 420 mutation-negative (FH/M-) patients. Three wGSs based on LDL-c-raising variants were calculated to evaluate their distribution among FH patients and compared with 503 European samples from the 1000 Genomes Project. The FH/M- patients had significantly higher wGSs than the FH/M+ and control populations, with sensitivities ranging from 42% to 47%. A wGS based only on the SNPs significantly associated with FH (wGS8) showed a higher area under the receiver operating characteristic curve, and higher diagnostic specificity and sensitivity, with 46.4% of the subjects in the top quartile. wGS8 would allow for the assignment of a genetic cause to 66.4% of the patients if those with polygenic FH are added to the 37.3% of patients with monogenic FH. Our data indicate that a score based on 8 SNPs and the75th percentile cutoff point may identify patients with polygenic FH in Catalonia, although with limited diagnostic sensitivity and specificity.

Complex Fractures of the Sacrum with Spinopelvic Dissociation Treated Surgically with Iliolumbar Fixation.

Objective To analyze a series of cases of complex fractures of the sacrum with spinopelvic dissociation surgically treated with iliolumbar fixation, and to review the existing medical literature. Methods For the analysis, the medical records of the cases operated using the Schildhauer et al technique for fixation were retrospectively evaluated, and followed up for at least 12 months. The functional results were assessed using the visual analog scale (VAS) for pain and the Oswestry disability index, version 2.0. The data were compared with those of the existing medical literature. Results Six cases were analyzed, four of which evolved with moderate disability, one, with minimal disability, and one, with severe disability. Three cases that presented neurological deficits obtained significant improvement. Only one case evolved with pulmonary thromboembolic complications. Conclusion The Schildhauer et al technique is an efficient technique for the fixation of complex sacral fractures with spinopelvic dissociation. The patients evolved with good functional results. Early weight-bearing has been shown to be safe with the use of this treatment.

Complex Fractures of the Sacrum with Spinopelvic Dissociation Treated Surgically with Iliolumbar Fixation / Fraturas complexas do sacro com dissociação espinopélvica tratadas cirurgicamente com fixação iliolombar

Abstract Objective To analyze a series of cases of complex fractures of the sacrum with spinopelvic dissociation surgically treated with iliolumbar fixation, and to review the existing medical literature. Methods For the analysis, the medical records of the cases operated using the Schildhauer et al technique for fixation were retrospectively evaluated, and followed up for at least 12 months. The functional results were assessed using the visual analog scale (VAS) for pain and the Oswestry disability index, version 2.0. The data were compared with those of the existing medical literature. Results Six cases were analyzed, four of which evolved with moderate disability, one, with minimal disability, and one, with severe disability. Three cases that presented neurological deficits obtained significant improvement. Only one case evolved with pulmonary thromboembolic complications. Conclusion The Schildhauer et al technique is an efficient technique for the fixation of complex sacral fractures with spinopelvic dissociation. The patients evolved with good functional results. Early weight-bearing has been shown to be safe with the use of this treatment.

Resumo Objetivo Analisar uma série de casos de fraturas complexas do sacro com dissociação espinopélvica tratados cirurgicamente com fixação iliolombar, e revisar a literatura médica existente. Métodos Para a análise, foram avaliados retrospectivamente os prontuários médicos de casos operados utilizando a técnica de Schildhauer et al para fixação. O período de acompanhamento foi de pelo menos 12 meses. Os resultados funcionais foram avaliados por meio da escala visual analógica (EVA) de dor e do índice de incapacidade de Oswestry, versão 2.0. Os dados foram comparados com os da literatura médica existente. Resultados Seis casos foram analisados, sendo que quatro evoluíram com incapacidade moderada, um, com incapacidade mínima, e um, com incapacidade grave. Três casos que apresentavam déficit neurológico obtiveram melhora significativa. Apenas um caso evoluiu com complicação tromboembólica pulmonar. Conclusão A técnica de Schildhauer et al é eficiente para a fixação de fraturas complexas de sacro com dissociação espinopélvica. Os pacientes evoluíram com bons resultados funcionais. A liberação precoce de sustentação de carga demonstrou-se segura com o uso deste tratamento.

Stroke treatment outcomes in hospitals with and without Stroke Units. / Resultados en el tratamiento del ictus en hospitales con y sin Unidad de Ictus.

INTRODUCTION: Organisational capacity in terms of resources and care circuits to shorten response times in new stroke cases is key to obtaining positive outcomes. This study compares therapeutic approaches and treatment outcomes between traditional care centres (with stroke teams and no stroke unit) and centres with stroke units. METHODS: We conducted a prospective, quasi-experimental study (without randomisation of the units analysed) to draw comparisons between 2 centres with stroke units and 4 centres providing traditional care through the neurology department, analysing a selection of agreed indicators for monitoring quality of stroke care. A total of 225 patients participated in the study. In addition, self-administered questionnaires were used to collect patients' evaluations of the service and healthcare received. RESULTS: Centres with stroke units showed shorter response times after symptom onset, both in the time taken to arrive at the centre and in the time elapsed from patient's arrival at the hospital to diagnostic imaging. Hospitals with stroke units had greater capacity to respond through the application of intravenous thrombolysis than centres delivering traditional neurological care. CONCLUSION: Centres with stroke units showed a better fit to the reference standards for stroke response time, as calculated in the Quick study, than centres providing traditional care through the neurology department.

Effect of a chronotype-adjusted diet on weight loss effectiveness: A randomized clinical trial.

BACKGROUND & AIMS: The alteration of normal biological rhythms, also known as chronodisruption, may be associated with obesity development. For instance, those subject with preference for vespertinity seem to be prone to develop obesity. However, the current hypocaloric dietary treatment of obesity does not take into account these aspects. Therefore, the objective of this trial was to evaluate whether a diet adjusted to patient's chronotype is more effective that the current dietary recommendations. METHODS: 209 subjects take part on a 3 month randomized, double-blind trial. 104 subjects followed a typical hypocaloric dietary treatment and the other 105 subjects undergone a diet with a daily caloric distribution adjusted to their chronotype. There were no sex or age differences between groups. RESULTS: Baseline characteristics were similar in both groups. Dropout rate was also similar in both interventions (p = 0.683). Although both groups improved their anthropometrical parameters, the chronotype-adjusted diet group achieved a statistically significant greater reduction in percentage of total body weight loss (%TWL), BMI and waist circumference than the control group (p < 0.010 in all contrasts). The effect on clinical parameters was less pronounced. CONCLUSIONS: This randomized trial has demonstrated for the first time that in overweight/obese subjects, a chronotype-adjusted diet is more effective than the traditional hypocaloric dietary treatment, at least regarding the anthropometrical parameters. Further research will confirm if this intervention is also more effective in the long term. TRIAL REGISTRATION: NCT-ID: #NCT03755674, (available at: http://www.clinicaltrials.gov).

Evaluation of lumbar endoscopic discectomy in obese patients / Avaliação da discectomia lombar endoscópica em pacientes obesos / Evaluación de la discectomía lumbar endoscópica en pacientes obesos

ABSTRACT Objectives: Obesity is a public health problem with high morbidity and mortality rates and perioperative complications in the general population. Minimally invasive procedures are promising alternatives to perioperative complications in individuals with a high body mass index (BMI). Endoscopic lumbar discectomy has been gaining popularity in this regard. However, there are few descriptions in the literature about the endoscopic approach to improve pain and quality of life in obese individuals. Likewise, it is not determined whether individuals with a high BMI have more complications in this type of surgical approach. Methods: A longitudinal retrospective case-control study was performed with 63 subjects submitted to endoscopic discectomy, divided into 2 groups according to BMI (Group A, BMI ≥ 30kg/m2 and Group B, BMI <30kg/m2), in order to compare improvement in quality of life through the Oswestry Disability Index (ODI) and pain improvement by the Visual Analogue Scale (VAS), as well as to observe the incidence of postoperative complications in both groups. Results: There was no difference in postoperative ODI (p=0.36) and VAS (p=0.54) between groups, nor was there a statistical difference in the incidence of complications between groups (p=0.56). Conclusions: Endoscopic discectomy brings similar results in pain and quality of life in obese and non-obese patients without causing higher rates of complications. Level of Evidence III; Case-Control Study.

RESUMO Objetivos: A obesidade é um problema de saúde pública com taxas elevadas de morbimortalidade e complicações perioperatórias em relação à população em geral. Procedimentos minimamente invasivos são alternativas promissoras em relação às complicações perioperatórios nos indivíduos com Índice de Massa Corporal (IMC) elevado. A discectomia lombar endoscópica vem ganhando popularidade neste sentido. Todavia, há poucas descrições na literatura acerca da abordagem endoscópica na melhora da dor e qualidade de vida em indivíduos obesos. Da mesma forma, não está estabelecido se os indivíduos com IMC elevado apresentam mais complicações neste tipo de abordagem cirúrgica. Métodos: Estudo longitudinal retrospectivo tipo caso-controle com 63 indivíduos submetidos à discectomia endoscópica subdivididos em dois grupos de acordo com o IMC (Grupo A, IMC≥30Kg/m2 e Grupo B<30Kg/m2), afim de comparar a melhora na qualidade de vida pelo escore Oswestry Disability Index (ODI) e a melhora da dor pela Escala Visual Analógica (EVA), assim como observar a incidência de complicações pós-operatórias em ambos os grupos. Resultados: Não houve diferença nos escores ODI (p=0.36) e EVA (p=0.54) pós-operatórios entre os grupos, assim como não houve diferença estatística na incidência de complicações entre os grupos (p=0.56). Conclusões: A discectomia via endoscópica traz resultados semelhantes na dor e qualidade de vida em pacientes obesos e não obesos sem apresentar maiores taxas de complicações. Nível de Evidência III; Estudo de Caso-Controle.

RESUMEN Objetivos: La obesidad es un problema de salud pública con tasas elevadas de morbimortalidad y complicaciones perioperatorias en la población en general. Los procedimientos mínimamente invasivos son alternativas prometedoras en relación a las complicaciones perioperatorias en los individuos con índice de masa corporal (IMC) elevado. La discectomía lumbar endoscópica viene ganando popularidad en este sentido. Sin embargo, hay pocas descripciones en la literatura acerca del acceso endoscópico en la mejora del dolor y calidad de vida en individuos obesos. Del mismo modo, no está establecido si los individuos con IMC elevado tienen más complicaciones en este tipo de abordaje quirúrgico. Métodos: Estudio longitudinal retrospectivo tipo caso-control con 63 individuos sometidos a discectomía endoscópica, subdivididos en 2 grupos de acuerdo con el IMC (Grupo A, IMC ≥ 30 kg/m2 y Grupo B, IMC < 30 kg/m2), a fin de comparar la mejora en la calidad de vida por el score Oswestry Disability Index (ODI) y la mejora del dolor por la Escala Visual Analógica (EVA), así como observar la incidencia de complicaciones postoperatorias en ambos grupos. Resultados: No hubo diferencia en las puntuaciones ODI (p = 0,36) y EVA (p = 0,54) postoperatorios entre los grupos, así como no hubo diferencia estadística en la incidencia de complicaciones entre los grupos (p = 0,56). Conclusiones: La discectomía por vía endoscópica brinda resultados similares en el dolor y calidad de vida de pacientes obesos y no obesos sin causar tasas de complicaciones más altas. Nivel de Evidencia III; Estudio de Caso-Control.

Use of intraoperatory vancomycin in spinal surgeries / O uso da vancomicina intraoperatória em cirurgias de coluna / Uso de la vancomicina intraoperatoria en cirugías de columna

ABSTRACT Objectives: Despite the use of systemic antibiotic prophylaxis, infection is still a challenge for spine surgeons, with high morbidity and mortality, long hospitalization, delayed rehabilitation, and a greater number of interventions. The purpose of this cross-sectional retrospective case-control study was to compare the incidence of postoperative infection in individuals who received a systemic antibiotic as the sole prophylactic method with those who received vancomycin in the operative wound in association with systemic antibiotic prophylaxis in spinal surgery. Methods: We evaluated 2694 medical records of individuals submitted to posterior spinal surgery in the thoracolumbar segment in the period from January 2012 to June 2017, 1360 in the treatment group and 1334 in the control group. Results: Nineteen (1.39%) of the treatment group progressed with surgical site infection, compared to 42 (3.14%) of the control group. Conclusions: There was a significant reduction in the postoperative infection rate with the use of vancomycin (p=0.0379). Level of Evidence III; Case-Control Study.

RESUMO Objetivos: Apesar do uso de antibioticoprofilaxia sistêmica, a infecção ainda constitui um desafio para os cirurgiões de coluna, com alta morbimortalidade, longo período de internação, retardo na reabilitação e maior número de intervenções. O propósito deste estudo transversal retrospectivo tipo caso-controle foi comparar a incidência de infecção pós-operatória nos indivíduos que receberam antibiótico sistêmico como único método profilático aos que receberam Vancomicina na ferida operatória em associação com antibiótico sistêmico em cirurgias na coluna vertebral. Métodos: Foram avaliados 2694 prontuários de indivíduos submetidos à cirurgia de coluna por via posterior no segmento toracolombar no período de janeiro de 2012 a Junho de 2017, sendo 1360 no grupo tratamento e 1334 no grupo controle. Resultados: Dezenove (1,39%) do grupo tratamento evoluíram com infecção do sítio cirúrgico, em comparação com 42 (3.14%) do grupo controle. Conclusão: Houve redução significativa na taxa de infecção pós-operatória com o uso da Vancomicina (p=0,0379). Nível de Evidência III; Estudo de Caso-Controle.

RESUMEN Objetivos: A pesar del uso de profilaxis con antibióticos sistémicos, la infección todavía constituye un desafío para los cirujanos de columna, con alta morbimortalidad, largo período de internación, retraso en la rehabilitación y mayor número de intervenciones. El propósito de este estudio transversal retrospectivo tipo caso-control fue comparar la incidencia de infección postoperatoria en los individuos que recibieron antibiótico sistémico como único método profiláctico a los que recibieron vancomicina en la herida operatoria en asociación con antibiótico sistémico en cirugías de la columna vertebral. Métodos: Se evaluaron 2694 prontuarios de individuos sometidos a cirugía de columna por vía posterior en el segmento toracolumbar en el período de enero de 2012 a junio de 2017, siendo 1360 en el grupo tratamiento y 1334 en el grupo control. Resultados: Diecinueve (1,39%) del grupo de tratamiento evolucionó con infección del sitio quirúrgico, en comparación con 42 (3,14%) del grupo control. Conclusiones: Hubo reducción significativa en la tasa de infección postoperatoria con el uso de la vancomicina (p = 0,0379). Nivel de Evidencia III; Estudio de Caso-Control.