Bailey-Bloch Congenital Myopathy in Brazilian Patients: A Very Rare Myopathy with Malignant Hyperthermia Susceptibility.

BACKGROUND: Congenital myopathy-13 (CMYP13), also known as Bailey-Bloch congenital myopathy and Native American myopathy (NAM), is a condition caused by biallelic missense pathogenic variants in STAC3, which encodes an important protein necessary for the excitation-relaxation coupling machinery in the muscle. Patients with biallelic pathogenic variants in STAC3 often present with congenital weakness and arthrogryposis, cleft palate, ptosis, myopathic facies, short stature, kyphoscoliosis, and susceptibility to malignant hyperthermia provoked by anesthesia. We present two unrelated cases of Bailey-Bloch congenital myopathy descendants of non-consanguineous parents, which were investigated for delayed psychomotor development and generalized weakness. To the best of our knowledge, these are the first descriptions of CMYP13 in Brazil. In both patients, we found the previously described pathogenic missense variant p.Trp284Ser in homozygosity. CONCLUSION: We seek to highlight the need for screening for CMYP13 in patients expressing the typical phenotype of the disease even in the absence of Lumbee Native American ancestry, and to raise awareness to possible complications like malignant hyperthermia in Bailey-Bloch congenital myopathy.

A regulação do acesso à atenção especializada pela Atenção Primária à Saúde da cidade do Rio de Janeiro: coordenação ou competição? / Regulation of access to specialized care in primary health care of Rio de Janeiro city: coordination or competition?

Resumo Há estudos que sugerem necessidade de maior participação da atenção primária à saúde (APS) na regulação assistencial. Na última década, o município do Rio de Janeiro descentralizou a regulação ambulatorial, conferindo maior protagonismo a médicos da APS no processo regulatório. Este estudo, realizado entre 2019 e 2020, analisou o processo local de regulação do acesso à atenção especializada na APS desta cidade, a partir de entrevistas com profissionais e gestores e análise documental. Os resultados foram organizados nas categorias "atores da APS na regulação: papéis, interações e ferramentas", "a regulação na APS ampliando a capacidade de coordenação do cuidado" e "a prática da regulação ambulatorial sob domínio da urgência". Identificaram-se vantagens comparativas do arranjo descentralizado para a interação entre solicitante e regulador, ampliação parcial da capacidade de coordenação do cuidado, competição por vagas e iniquidades de acesso, além de frágil interface entre APS e atenção especializada. A descentralização da regulação é promissora, porém requer atenção ao processo de trabalho na APS e sinergia com os processos regulatórios centralizados, tendo a rede regionalizada como pano de fundo.

Abstract There are studies that suggest the need for greater participation of primary health care (PHC) in care regulation. In the last decade, the city of Rio de Janeiro has decentralized outpatient regulation, giving PHC physicians a greater role in the regulatory process. This study, carried out between 2019 and 2020, analyzed the local process of regulating access to specialized care in PHC in this city, based on interviews with professionals and managers, document analysis and visits to services. The results were organized in the categories "PHC actors in regulation: roles, interactions and tools", "PHC regulation expanding the coordination capacity of care" and "the practice of outpatient regulation under the urgency domain". Comparative advantages of the decentralized arrangement for the interaction between requester and regulator were identified, partial expansion of the ability to coordinate care, competition for vacancies and inequities in access, in addition to the fragile interface between PHC and specialized care. Decentralization of regulation is promising, but requires attention to the work process in PHC and synergy with centralized regulatory processes, with the regionalized network as a backdrop.

ANTEGRADE NAILING VERSUS LOCKING PLATE OF 2-AND 3-PART PROXIMAL HUMERUS FRACTURES.

Objective: To evaluate and compare the proportions of complications and radiographic findings of osteosynthesis of 2- and 3-part proximal humerus fractures with two methods of treatment: third-generation antegrade nailing and locking plate. Methods: 46 patients with a mean age of 58.9 ± 16.6 years between January 2020 and January 2021 were evaluated. In sixteen cases (34.8%), antegrade nailing was used, and in thirty cases (65, 2%), a locking proximal humerus plate. The method used included the rate of complications with a minimum follow-up of 6 months after surgery and radiographic evaluation. Results: There was no difference between the groups regarding the proportion of complications (nail group 18.8%, plate group 13.3%; p = 0.681). The nail group had less residual varus loss (cervicodiaphyseal angle nail group with 132.1º ± 2.3º, plate group 123.8º ± 10.1º; p < 0.001). In the plate group, women had the lowest value (1.43 ± 0.22) of the deltoid tuberosity index (DTI) compared to men (1.58 ± 0.11) (p = 0.022). Conclusion: Osteosynthesis, with a locking plate and antegrade nailing, did not show differences in the proportion of complications. The nail group had less change in the postoperative cervicodiaphyseal angle, however, there were two serious complications with screw cut-out and varus deviation, requiring surgical reapproach. Level of Evidence II, Retrospective Observational Study.

Objetivo: Avaliar retrospectivamente e comparar proporções de complicações e achados radiográficos da osteossíntese da fratura do úmero proximal em duas e três partes com dois métodos de tratamento: haste intramedular bloqueada de terceira geração e placa bloqueada. Métodos: Foram avaliados 46 pacientes com idade média de 58,9 ± 16,6 entre janeiro de 2020 a janeiro de 2021. Em 16 casos (34,8%), utilizou-se a haste intramedular e, em 30 casos (65,2%), a placa bloqueada de úmero proximal. A avaliação incluiu a taxa de complicações com seguimento mínimo de seis meses de pós-operatório e avaliação radiográfica. Resultados: Não houve diferença significativa entre os grupos quanto à proporção de complicações (grupo haste: 18,8%; grupo placa: 13,3%; p = 0,681). O grupo haste apresentou menor perda residual em varo (ângulo cervicodiafisário: grupo haste com 132,1º ± 2,3º; grupo placa com 123,8º ± 10,1º; p < 0,001). No grupo placa, as mulheres apresentaram menor índice de tuberosidade-deltoide (DTI) (1,43 ± 0,22) em relação aos homens (1,58 ± 0,11) (p = 0,022). Conclusão: No seguimento de curto prazo, a osteossíntese, com placa bloqueada ou haste intramedular, não apresentou diferenças nas proporções de complicações. O grupo haste apresentou menor alteração do ângulo cervicodiafisário no pós-operatório; entretanto, ocorreram duas complicações graves com cut out e desvio em varo com necessidade de reabordagem cirúrgica no grupo haste. Nível de Evidência II, Estudo Retrospectivo Observacional.

Translation and Transcultural Adaptation of the Milestones Instrument to Assess Teaching in Medical Residency Services on Orthopedics and Traumatology.

Objective Orthopedics is not very common in many Brazilian medical schools, and there is no questionnaire to assess the teaching of musculoskeletal disorders during medical training. The Orthopedic Surgery Milestone Project is an assessment tool for orthopedic residents in programs or fellowships recognized by the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Orthopedic Surgery (ABOS). This study aims to translate the Orthopedic Surgery Milestone Project into Portuguese and to perform its transcultural adaptation. Methods The translation and transcultural adaptation consisted of the initial translation into Portuguese, back-translation into English, preparation of a pretest consensual text, and the subsequent elaboration of a final text. Results The final text was deemed adequate and equivalent to the original one for the evaluation of orthopedics residents throughout their program. Conclusions Given the lack of instruments for the assessment of orthopedic residents, the translation and transcultural adaptation of the Orthopedic Surgery Milestone Project were compatible; this can be an instrument for improved medical education.

Translation and Transcultural Adaptation of the Milestones Instrument to Assess Teaching in Medical Residency Services on Orthopedics and Traumatology / Tradução e adaptação transcultural do instrumento Milestones de avaliação do ensino dos serviços de residência médica em ortopedia e traumatologia

Abstract Objective Orthopedics is not very common in many Brazilian medical schools, and there is no questionnaire to assess the teaching of musculoskeletal disorders during medical training. The Orthopedic Surgery Milestone Project is an assessment tool for orthopedic residents in programs or fellowships recognized by the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Orthopedic Surgery (ABOS). This study aims to translate the Orthopedic Surgery Milestone Project into Portuguese and to perform its transcultural adaptation. Methods The translation and transcultural adaptation consisted of the initial translation into Portuguese, back-translation into English, preparation of a pretest consensual text, and the subsequent elaboration of a final text. Results The final text was deemed adequate and equivalent to the original one for the evaluation of orthopedics residents throughout their program. Conclusions Given the lack of instruments for the assessment of orthopedic residents, the translation and transcultural adaptation of the Orthopedic Surgery Milestone Project were compatible; this can be an instrument for improved medical education.

Resumo Objetivo A ortopedia é uma especialidade pouco presente na formação de muitas escolas médicas brasileiras, sendo que não foi identificado nenhum questionário que avalie o ensino das desordens musculoesqueléticas durante a formação médica. O Orthopedic Surgery Milestone Project constitui um instrumento de avaliação de residentes de ortopedia nos programas de residência ou bolsas credenciados pela ACGME (The Accreditation Council for Graduate Medical Education) e pelo ABOS (The American Board of Orthopedic Surgery). O objetivo é realizar a tradução para a língua portuguesa e adaptação transcultural do Orthopedic Surgery Milestone Project. Métodos A tradução e adaptação transcultural consistiram na tradução inicial para o português, retro tradução para o inglês, análise para a obtenção de uma versão consensual pré-teste e posterior versão final. Resultados A versão final foi considerada adequada e equivalente à original para a avaliação dos residentes de ortopedia ao longo do programa de residência médica. Conclusões Diante da falta de instrumentos para a avaliação dos residentes em Ortopedia, a tradução e a adaptação transcultural do Orthopedic Surgery Milestone Project foi compatível, podendo ser um instrumento para uma formação médica mais adequada.

Outpatient regulation in Primary Care in the municipality of Rio de Janeiro, Brazil, based on the local regulatory doctors. / A regulação ambulatorial na Atenção Primária do Município do Rio de Janeiro, Brasil, a partir dos médicos reguladores locais.

The scope of the article was to characterize the process of regulation of care in Primary Health Care units in the city of Rio de Janeiro, with an emphasis on the outpatient dimension. A cross-sectional study was carried out in 2019, by means of a survey, with the participation of 114 local regulatory physicians. With respect to the profile of local regulators, there is a high percentage with training in Family and Community Medicine and the length of service of these professionals in the units is relatively satisfactory. For 52.6%, the infrastructure for regulation is adequate, but connectivity frequently presents problems. In the regulation system, the mechanisms and schedules for making vacancies available and accessing them elicit competition between the regulators of the units, with work overload and associated access inequities. There was major involvement of local regulators in activities of evaluation and management of waiting times. The majority reported that there was little or no interaction with specialized care. Although the decentralized regulation process still has some shortcomings, the study points to the feasibility and contribution of more intense participation of Primary Care in the regulation of access.

O artigo teve por objetivo caracterizar o processo de regulação assistencial realizado nas unidades de Atenção Primária à Saúde do município do Rio de Janeiro, com ênfase na dimensão ambulatorial. Foi realizado estudo transversal, por meio de um survey, com participação de 114 médicos reguladores locais, no ano de 2019. Quanto ao perfil dos reguladores locais, destacou-se o alto percentual com formação em Medicina de Família e Comunidade e o tempo de atuação relativamente adequado destes profissionais nas unidades. Para 52,6%, a infraestrutura para regulação é adequada, mas a conectividade apresenta problemas com frequência. No sistema de regulação, os mecanismos e horários de disponibilização de vagas produzem competição entre os reguladores das unidades, com sobrecarga de trabalho e iniquidades de acesso associadas. Observou-se importante envolvimento dos reguladores locais em atividades de avaliação e gestão de filas de espera. A maioria informou haver pouca ou nenhuma interação com a atenção especializada. Apesar do processo de regulação descentralizada ainda apresentar importantes limites, o estudo aponta a factibilidade e contribuição da entrada mais intensa da Atenção Primária na regulação do acesso.

A regulação ambulatorial na Atenção Primária do Município do Rio de Janeiro, Brasil, a partir dos médicos reguladores locais / Outpatient regulation in Primary Care in the municipality of Rio de Janeiro, Brazil, based on the local regulatory doctors

Resumo O artigo teve por objetivo caracterizar o processo de regulação assistencial realizado nas unidades de Atenção Primária à Saúde do município do Rio de Janeiro, com ênfase na dimensão ambulatorial. Foi realizado estudo transversal, por meio de um survey, com participação de 114 médicos reguladores locais, no ano de 2019. Quanto ao perfil dos reguladores locais, destacou-se o alto percentual com formação em Medicina de Família e Comunidade e o tempo de atuação relativamente adequado destes profissionais nas unidades. Para 52,6%, a infraestrutura para regulação é adequada, mas a conectividade apresenta problemas com frequência. No sistema de regulação, os mecanismos e horários de disponibilização de vagas produzem competição entre os reguladores das unidades, com sobrecarga de trabalho e iniquidades de acesso associadas. Observou-se importante envolvimento dos reguladores locais em atividades de avaliação e gestão de filas de espera. A maioria informou haver pouca ou nenhuma interação com a atenção especializada. Apesar do processo de regulação descentralizada ainda apresentar importantes limites, o estudo aponta a factibilidade e contribuição da entrada mais intensa da Atenção Primária na regulação do acesso.

Abstract The scope of the article was to characterize the process of regulation of care in Primary Health Care units in the city of Rio de Janeiro, with an emphasis on the outpatient dimension. A cross-sectional study was carried out in 2019, by means of a survey, with the participation of 114 local regulatory physicians. With respect to the profile of local regulators, there is a high percentage with training in Family and Community Medicine and the length of service of these professionals in the units is relatively satisfactory. For 52.6%, the infrastructure for regulation is adequate, but connectivity frequently presents problems. In the regulation system, the mechanisms and schedules for making vacancies available and accessing them elicit competition between the regulators of the units, with work overload and associated access inequities. There was major involvement of local regulators in activities of evaluation and management of waiting times. The majority reported that there was little or no interaction with specialized care. Although the decentralized regulation process still has some shortcomings, the study points to the feasibility and contribution of more intense participation of Primary Care in the regulation of access.

Plant height and spatial context influence individual connectivity and specialization on seed dispersers in a tree population.

While network analyses have stimulated a renewed interest in understanding patterns and drivers of specialization within communities, few studies have explored specialization within populations. Thus, in plant populations, causes and consequences of individual variation in their interactions with mutualistic animals remain poorly understood. Studying a Brazilian pepper (Schinus terebinthifolia) population, we measured the extent of individual variation in interactions with seed dispersers and tested whether connectivity (number of seed dispersers) and specialization (exclusiveness of partners) are associated with phenotypic and phenological traits of individuals and their spatial context. We found that: (i) individuals varied broadly in their connectivity and specialization on seed dispersers; (ii) phenotypic traits and spatial context matter more than fruiting duration in determining how many and how exclusive are seed dispersers of an individual; (iii) the individual-based network was nested and indicated that the less connected individuals were shorter, occurred in neighborhoods with fewer fruits, and tended to interact with a subset of the partners of more generalist individuals which, in turn, were taller and inserted in higher fruit density neighborhoods; (iv) modularity indicated the existence of subsets of individuals that interacted disproportionately with distinct groups of partners, which may occur due to differences in bird habitat use across the landscape. Our study underlines a remarkable interindividual variation that is overlooked when interactions are compiled to describe species-level interactions. Traits and spatial contexts that define variation among individuals may have important implications not only for fitness but also for sampling and description of interactions at species level.

Oportunidades, percalços e justificativas: a descentralização da regulação ambulatorial no município do Rio de Janeiro / Opportunities, drawbacks and justifications: outpatient care regulation's decentralization in the city of Rio de Janeiro

RESUMO Desde 2012, o município do Rio de Janeiro possui a inovação no cenário nacional de ter a regulação do acesso à atenção especializada feita por médicos na Atenção Primária à Saúde (APS). Este artigo analisa o processo técnico-político que produziu a descentralização da regulação ambulatorial para APS: suas motivações e contexto, atores, apostas, decisões e desdobramentos. Produzido através de entrevistas com gestores, analisou-se o material tendo como referência principal o ciclo de políticas públicas de Howlett e Ramesh, de modo que suas etapas inspiraram a categorização adotada no artigo. O movimento de descentralização da regulação ambulatorial apoiou-se em insatisfações com o acesso ambulatorial. Em contexto de fortalecimento da APS, disputa pelo controle de recursos assistenciais e utilizando a coordenação do cuidado como elemento discursivo, o modelo viabilizou maior protagonismo de APS na regulação do acesso. Em contrapartida, alguns 'sucessos' não são reflexos exclusivos da descentralização para a APS, e surgem consequências negativas. A partir da adoção de processos avaliativos, pode-se viabilizar a criação de outros arranjos regulatórios num modelo que permanece promissor.

ABSTRACT Since 2012, the city of Rio de Janeiro has the innovation on the national scene of having the regulation of access to specialized care made by physicians in Primary Health Care (PHC). This article analyses the technical-political process that produced outpatient regulation decentralization to PHC: its motivations and context, actors, stakes, decisions and ramifications. Produced from interviews with managers, the material was analyzed having as main reference the public policies' cycle of Howllet and Ramesh, so that its steps inspired the categories adopted in the article. The movement to decentralize outpatient regulation was based on dissatisfaction with outpatient access. In a context of strengthening the PHC, disputes for the control of care resources and using the care coordination as a discursive element, the model enabled greater role for PHC in access' regulation. Nonetheless, some 'successes' are not exclusive reflections of decentralization for PHC, and negative consequences arise. From the adoption of evaluation processes, it is possible to create other regulatory arrangements in a model that remains promising.

Spectral Doppler ultrasound in the placental development of Mangalarga Marchador mares.

The aim of the study was to correlate the spectral index of the right and left uterine arteries with equine placental development in mares with advanced pregnancies. We examined 32 multiparous Mangalarga Marchador mares with gestation of 150-240 days. During pregnancy, the pulsatility index (PI) and resistance index (RI) of the uterine arteries were obtained using spectral Doppler ultrasonography, and the combined uteroplacental thickness was obtained monthly using B-mode ultrasonography. The combined uteroplacental thickness correlated with gestational time of up to 13 years of age, and the significant difference was observed from the sixth month onwards. The CUPT stayed within the ideal measurements for this breed and for this gestational period. There was no correlation of CUPT with PI, however a negative and significant correlation of the RI was observed. The resistance index differed significantly among age groups, and the RI of the left uterine artery tended to decrease in all age groups. Furthermore, only RI differed significantly between the medians of gestatinal age. The left PI dropped in older mares. Thus, there an increased blood perfusion in the uterine arteries of mares with advanced pregnancies and among different age categories during placental and fetal physiological development.

Antegrade nailing versus locking plate of 2-and 3-part proximal humerus fractures / Haste intramedular versus placa bloqueada no tratamento da fratura do úmero proximal em duas e três partes

ABSTRACT Objective: To evaluate and compare the proportions of complications and radiographic findings of osteosynthesis of 2- and 3-part proximal humerus fractures with two methods of treatment: third-generation antegrade nailing and locking plate. Methods: 46 patients with a mean age of 58.9 ± 16.6 years between January 2020 and January 2021 were evaluated. In sixteen cases (34.8%), antegrade nailing was used, and in thirty cases (65, 2%), a locking proximal humerus plate. The method used included the rate of complications with a minimum follow-up of 6 months after surgery and radiographic evaluation. Results: There was no difference between the groups regarding the proportion of complications (nail group 18.8%, plate group 13.3%; p = 0.681). The nail group had less residual varus loss (cervicodiaphyseal angle nail group with 132.1º ± 2.3º, plate group 123.8º ± 10.1º; p < 0.001). In the plate group, women had the lowest value (1.43 ± 0.22) of the deltoid tuberosity index (DTI) compared to men (1.58 ± 0.11) (p = 0.022). Conclusion: Osteosynthesis, with a locking plate and antegrade nailing, did not show differences in the proportion of complications. The nail group had less change in the postoperative cervicodiaphyseal angle, however, there were two serious complications with screw cut-out and varus deviation, requiring surgical reapproach. Level of Evidence II, Retrospective Observational Study.

RESUMO Objetivo: Avaliar retrospectivamente e comparar proporções de complicações e achados radiográficos da osteossíntese da fratura do úmero proximal em duas e três partes com dois métodos de tratamento: haste intramedular bloqueada de terceira geração e placa bloqueada. Métodos: Foram avaliados 46 pacientes com idade média de 58,9 ± 16,6 entre janeiro de 2020 a janeiro de 2021. Em 16 casos (34,8%), utilizou-se a haste intramedular e, em 30 casos (65,2%), a placa bloqueada de úmero proximal. A avaliação incluiu a taxa de complicações com seguimento mínimo de seis meses de pós-operatório e avaliação radiográfica. Resultados: Não houve diferença significativa entre os grupos quanto à proporção de complicações (grupo haste: 18,8%; grupo placa: 13,3%; p = 0,681). O grupo haste apresentou menor perda residual em varo (ângulo cervicodiafisário: grupo haste com 132,1º ± 2,3º; grupo placa com 123,8º ± 10,1º; p < 0,001). No grupo placa, as mulheres apresentaram menor índice de tuberosidade-deltoide (DTI) (1,43 ± 0,22) em relação aos homens (1,58 ± 0,11) (p = 0,022). Conclusão: No seguimento de curto prazo, a osteossíntese, com placa bloqueada ou haste intramedular, não apresentou diferenças nas proporções de complicações. O grupo haste apresentou menor alteração do ângulo cervicodiafisário no pós-operatório; entretanto, ocorreram duas complicações graves com cut out e desvio em varo com necessidade de reabordagem cirúrgica no grupo haste. Nível de Evidência II, Estudo Retrospectivo Observacional.

Surgical multicenter collaborative studies: ¿What happen in Latin America?

BACKGROUND: GlobalSurg is an international group of researchers whose purpose is to conduct and disseminate robust collaborative, international and multicenter studies. OBJECTIVE: To expose the necessary strategies and the barriers crossed in conducting massive multicenter studies in surgery. METHOD: During the second semester of 2020, the study Surg-Week Prospective International Cohort Study was carried out. Surg-Week has been the largest international study in the field of surgery to date, with 141,582 patients included. A total of 4975 mini-teams, of between 1 and 5 members, collected data from 116 countries on all continents. RESULTS: The creation of an official website for the study, reports with relevant information via email or groups via WhatsApp, formation of a Dissemination Committee of the protocol, delivery of webinars on recent team publications, appointment of leaders at the national and international level, and outreach through partnerships, were the strategies used for the development of the research. However, the barriers turned out to involve different aspects. CONCLUSIONS: Collaborative work allows establishing networks between different professionals with the goal of improving the quality of management, health policies and care of our patients in a timely manner of constant change.

ANTECEDENTES: GlobalSurg es un grupo internacional de investigadores que tiene como propósito la conducción y la diseminación de robustos estudios colaborativos, internacionales y multicéntricos. OBJETIVO: Exponer las estrategias necesarias y las barreras encontradas en la conducción de estudios multicéntricos masivos en cirugía. MÉTODO: Durante el segundo semestre del año 2020 se llevó a cabo el estudio Surg-Week Prospective International Cohort Study, hasta la fecha el estudio internacional más grande en el campo de la cirugía, con 141,582 pacientes incluidos. Un total de 4975 miniequipos, de uno a cinco integrantes, recopilaron datos de 116 países de todos los continentes. RESULTADOS: La creación de un sitio web oficial del estudio, reportes con información relevante vía e-mail o grupos vía WhatsApp, conformación de un comité de diseminación del protocolo, dictado de webinars sobre publicaciones recientes del equipo, designación de líderes nacionales e internacionales, y la divulgación por medio de sociedades, fueron las estrategias utilizadas para el desarrollo de la investigación. Sin embargo, las barreras detectadas para llevar a cabo el estudio multicéntrico fueron variadas. CONCLUSIONES: Los trabajos colaborativos permiten establecer redes entre diferentes profesionales con el fin de mejorar la calidad de la gestión, las políticas sanitarias y la atención a los pacientes en tiempos de constante cambio.

A POST-TREATMENT RETROSPECTIVE EVALUATION OF SLIPPED CAPITAL FEMORAL EPIPHYSIS.

OBJECTIVE: To analyze the cases of slipped capital femoral epiphysis (SCFE) submitted to surgery at the Pediatric Orthopedics Surgery service of the Hospital Risoleta Tolentino Neves (HRTN), Belo Horizonte/MG, between 2016 and 2019. METHODS: Patients treated for SCFE at the HRTN between January/2016 and January/2019 participated in this study. The following data were collected: gender, age, affected side, procedure performed, and postoperative complications. RESULTS: Twenty-one patients were treated at HRTN during the specified period. Among these, most were female (57%) with mean age of 12 years. At the initial diagnosis, about 80% of the patients presented with chronic/acute-on-chronic epiphysis. The left hip was slightly more affected than the right (6:5), with a bilateral rate of 47%, and avascular necrosis was the most frequent complication, occurring in 33% of cases. CONCLUSION: Slipped femoral capital epiphysis is associated with high morbidity; thus, early diagnosis, endocrine disorder investigation, and appropriate surgical treatment are key for improving these patients' clinical and functional outcome. Level of Evidence II, Retrospective study.

OBJETIVO: Analisar os casos de epifisiólise do fêmur proximal operados pelo serviço de Ortopedia Pediátrica do Hospital Risoleta Tolentino Neves (HRTN), Belo Horizonte/MG, entre os anos de 2016 e 2019. MÉTODOS: Foram analisados retrospectivamente os pacientes submetidos a tratamento cirúrgico de epifisiólise no Hospital Risoleta Tolentino Neves entre janeiro/2016 a janeiro/2019. Os dados coletados para análise foram: sexo, idade, lado acometido, cirurgia realizada, complicações pós-operatórias. RESULTADOS: De janeiro de 2016 a janeiro de 2019, foram tratados 21 pacientes no HRTN. Houve predomínio do sexo feminino (57%), com média de idade de 12 anos. Cerca de 80% dos pacientes apresentaram quadro de epifisiólise crônica/ crônica-agudizada no primodiagnóstico. O lado esquerdo foi ligeiramente mais acometido em relação ao direito (6:5), com bilateralidade de 47%. A necrose avascular foi a complicação mais frequente, em 33% dos casos. CONCLUSÃO: Trata-se de quadro de alta morbidade associada, devendo haver um diagnóstico precoce, investigação de distúrbios endócrinos e tratamento cirúrgico adequado, visando uma melhora do prognóstico clínico e funcional do paciente. Nível de Evidência II, Estudo retrospectivo.

A post-treatment retrospective evaluation of slipped capital femoral epiphysis / Avaliação pós-tratamento de epifisiólise proximal do fêmur: estudo retrospectivo

ABSTRACT Objective: To analyze the cases of slipped capital femoral epiphysis (SCFE) submitted to surgery at the Pediatric Orthopedics Surgery service of the Hospital Risoleta Tolentino Neves (HRTN), Belo Horizonte/MG, between 2016 and 2019. Methods: Patients treated for SCFE at the HRTN between January/2016 and January/2019 participated in this study. The following data were collected: gender, age, affected side, procedure performed, and postoperative complications. Results: Twenty-one patients were treated at HRTN during the specified period. Among these, most were female (57%) with mean age of 12 years. At the initial diagnosis, about 80% of the patients presented with chronic/acute-on-chronic epiphysis. The left hip was slightly more affected than the right (6:5), with a bilateral rate of 47%, and avascular necrosis was the most frequent complication, occurring in 33% of cases. Conclusion: Slipped femoral capital epiphysis is associated with high morbidity; thus, early diagnosis, endocrine disorder investigation, and appropriate surgical treatment are key for improving these patients' clinical and functional outcome. Level of Evidence II, Retrospective study.

RESUMO Objetivo: Analisar os casos de epifisiólise do fêmur proximal operados pelo serviço de Ortopedia Pediátrica do Hospital Risoleta Tolentino Neves (HRTN), Belo Horizonte/MG, entre os anos de 2016 e 2019. Métodos: Foram analisados retrospectivamente os pacientes submetidos a tratamento cirúrgico de epifisiólise no Hospital Risoleta Tolentino Neves entre janeiro/2016 a janeiro/2019. Os dados coletados para análise foram: sexo, idade, lado acometido, cirurgia realizada, complicações pós-operatórias. Resultados: De janeiro de 2016 a janeiro de 2019, foram tratados 21 pacientes no HRTN. Houve predomínio do sexo feminino (57%), com média de idade de 12 anos. Cerca de 80% dos pacientes apresentaram quadro de epifisiólise crônica/ crônica-agudizada no primodiagnóstico. O lado esquerdo foi ligeiramente mais acometido em relação ao direito (6:5), com bilateralidade de 47%. A necrose avascular foi a complicação mais frequente, em 33% dos casos. Conclusão: Trata-se de quadro de alta morbidade associada, devendo haver um diagnóstico precoce, investigação de distúrbios endócrinos e tratamento cirúrgico adequado, visando uma melhora do prognóstico clínico e funcional do paciente. Nível de Evidência II, Estudo retrospectivo.

68Ga-Prostate-specific membrane antigen (PSMA) positron emission tomography (pet) in prostate cancer: a systematic review and meta-analysis

ABSTRACT Introduction: Prostate cancer (PC) is the second most commonly diagnosed cancer in males. 68Ga-PSMA PET/CT, a non-invasive diagnostic tool to evaluate PC with prostate-specific membrane antigen (PSMA) expression, has emerged as a more accurate alternative to assess disease staging. We aimed to identify predictors of positive 68Ga-PSMA PET and the accuracy of this technique. Materials and methods: Diagnostic accuracy cross-sectional study with prospective and retrospective approaches. We performed a comprehensive literature search on PubMed, Cochrane Library, and Embase database in search of studies including PC patients submitted to radical prostatectomy or radiotherapy with curative intent and presented biochemical recurrence following ASTRO 1996 criteria. A total of 35 studies involving 3910 patients submitted to 68-Ga-PSMA PET were included and independently assessed by two authors: 8 studies on diagnosis, four on staging, and 23 studies on restaging purposes. The significance level was α=0.05. Results: pooled sensitivity and specificity were 0.90 (0.86-0.93) and 0.90 (0.82-0.96), respectively, for diagnostic purposes; as for staging, pooled sensitivity and specificity were 0.93 (0.86-0.98) and 0.96 (0.92-0.99), respectively. In the restaging scenario, pooled sensitivity and specificity were 0.76 (0.74-0.78) and 0.45 (0.27-0.58), respectively, considering the identification of prostate cancer in each described situation. We also obtained specificity and sensitivity results for PSA subdivisions. Conclusion: 68Ga-PSMA PET provides higher sensitivity and specificity than traditional imaging for prostate cancer.

Investigation of phase transition employing strain mapping in TT- and T-Nb2O5 obtained by HRTEM micrographs.

This work aimed to study the crystalline structure of TT-,T-phases of Nb2O5 nanoparticles through XRD, Rietveld refinement, and HRTEM, using geometric phase analysis (GPA). The results show the presence of distorted NbO6 and NbO7 polyhedral, producing strain effects, mainly in the plane boundaries and along the b-c plane. XRD and HRTEM analyses show the TT→T transition at 700 °C, with increased particle size and increased strain in the boundaries between nanoparticles. The sample calcinated at 700 °C presents segregation of the TT-(001), (100), and T-(130) planes, where the strain effect is more relevant along the [100] zone axis and between phases.

The role of 68Gallium-prostate-specific membrane antigen positron emission tomography on staging of high-risk localized prostate cancer: for all high-risk patients or would it be better to select them?

BACKGROUND: According to pathologico-clinical features, patients diagnosed with localized prostate cancer (PCa) are stratified into distinct risk groups (low-risk, intermediate-risk or high-risk). Data have demonstrated that 68Gallium-prostate-specific membrane antigen positron emission tomography (68Ga-PSMA PET/CT) is superior to conventional radiological exams (CT or MRI and bone scintigraphy) in the primary staging of high-risk localized PCa. However, it is still unknown if in a population of high-risk PCa, there would be a subgroup of patients with a higher probability of identifying metastatic disease by the 68Ga-PSMA PET/CT. MATERIALS AND METHODS: Data from patients with localized PCa who underwent 68GA-PSMA PET/CT for primary staging from four institutions were retrospectively collected. We selected patients with at least one D'Amico classification risk factor (International Society of Urological Pathology ≥ IV and/or prostate-specific antigen > 20 ng/ml). To detect an association between extent of disease and number of risk factors as well as International Society of Urological Pathology prostate cancer grade, contingency tables were used, and Fisher Exact Test was performed. RESULTS: Between 2016 and 2020, 60 patients underwent a 68GA-PSMA PET/CT for primary staging of high-risk localized PCa. Regarding the number of risk factors, 37 patients (62%) had one risk factor, and 23 (38%) had two risk factors. In the subgroup of patients with metastatic disease (n = 22), those with two risk factors had higher incidence of metastatic disease, and it was statistically significant (p = 0.011). CONCLUSION: This retrospective analysis demonstrated that 68GA-PSMA PET/CT was able to identify advanced disease in more than one-third of patients with high-risk disease especially those with two adverse risk factors.

68Ga-Prostate-specific membrane antigen (psma) positron emission tomography (pet) in prostate cancer: a systematic review and meta-analysis.

INTRODUCTION: Prostate cancer (PC) is the second most commonly diagnosed cancer in males. 68Ga-PSMA PET/CT, a non-invasive diagnostic tool to evaluate PC with prostate-specific membrane antigen (PSMA) expression, has emerged as a more accurate alternative to assess disease staging. We aimed to identify predictors of positive 68Ga-PSMA PET and the accuracy of this technique. MATERIALS AND METHODS: Diagnostic accuracy cross-sectional study with prospective and retrospective approaches. We performed a comprehensive literature search on PubMed, Cochrane Library, and Embase database in search of studies including PC patients submitted to radical prostatectomy or radiotherapy with curative intent and presented biochemical recurrence following ASTRO 1996 criteria. A total of 35 studies involving 3910 patients submitted to 68-Ga-PSMA PET were included and independently assessed by two authors: 8 studies on diagnosis, four on staging, and 23 studies on restaging purposes. The significance level was α=0.05. RESULTS: pooled sensitivity and specificity were 0.90 (0.86-0.93) and 0.90 (0.82-0.96), respectively, for diagnostic purposes; as for staging, pooled sensitivity and specificity were 0.93 (0.86-0.98) and 0.96 (0.92-0.99), respectively. In the restaging scenario, pooled sensitivity and specificity were 0.76 (0.74-0.78) and 0.45 (0.27-0.58), respectively, considering the identification of prostate cancer in each described situation. We also obtained specificity and sensitivity results for PSA subdivisions. CONCLUSION: 68Ga-PSMA PET provides higher sensitivity and specificity than traditional imaging for prostate cancer.