Hepatic and skeletal muscle tissue immunometabolism in trained rats / Inmunometabolismo del tejido hepático y muscular esquelético de ratas entrenadas / Imunometabolismo tecidual hepático e muscular esquelético de ratos treinados

ABSTRACT Introduction: Physical exercise can be an alternative for preventing and treating the harmful effects of obesity, mainly inflammatory effects on skeletal muscle and liver tissues. However, no consensus exists regarding this purpose's best physical training model. Objective: Evaluate morphological, metabolic, and inflammatory alterations in rats' skeletal and hepatic muscle tissues caused by aerobic and resistance training. Methods: 24 Wistar rats were divided into sedentary (S), aerobic (AE), and resistance training (R) groups. Blood glucose, total cholesterol, and serum triglycerides were measured periodically. After euthanasia, body mass was measured to calculate the total mass gain during the experiment. High-density lipoprotein (HDL) was measured. Adipose tissue was extracted to calculate its percentage relative to body mass and the liver, soleus, and gastrocnemius muscles for morphological analyses and concentrations of glycogen, lipids, and Tumor Necrosis Factor α (TNF-α). The Kruskall-Wallis test and Dunn's post-test were performed for statistical analysis, adopting p<0.05. Results: Both training models reduced the percentage of adipose tissue, body mass gain, and hepatic TNF-α concentration (p<0.05). AE increased serum HDL, gastrocnemius fiber diameter and reduced the fractal dimension in the soleus (p<0.05). R reduced blood glucose and serum and liver lipids, increased liver and soleus glycogen concentrations, increased gastrocnemius fiber diameter, and decreased TNF-α (p<0.05). Conclusion: Both training models reduced body mass, relative visceral adipose tissue, serum total cholesterol concentration, and liver inflammation. However, resistance training was more effective in promoting metabolic effects in the liver and skeletal muscle and reducing muscle inflammation in rats. Level of Evidence V; Expert Opinion.

RESUMEN Introducción: El ejercicio físico puede ser una alternativa para prevenir y tratar los efectos nocivos de la obesidad, principalmente los efectos inflamatorios sobre los tejidos del músculo esquelético y del hígado. Sin embargo, no existe consenso sobre cuál es el mejor modelo de entrenamiento físico para este fin. Objetivo: Evaluar las alteraciones morfológicas, metabólicas e inflamatorias del entrenamiento aeróbico y de resistencia en sobre los tejidos músculo esqueléticos y hepáticos de ratas. Métodos: 24 ratas Wistar se dividieron en grupos sedentarios (S), aeróbicos (AE) y de entrenamiento de resistencia (R). Se midieron periódicamente glucosa en sangre, colesterol total y triglicéridos. Después de la eutanasia, se midió la masa corporal para calcular la ganancia de masa total durante el experimento. Se midió la lipoproteína de alta densidad (HDL). Se extrajo tejido adiposo para calcular su porcentaje relativo a la masa corporal, así como hígado, músculos sóleo y gastrocnemio para análisis morfológicos y concentraciones de glucógeno, lípidos y Factor de Necrosis Tumoral α (TNF-α). Para el análisis estadístico fueron utilizados Kruskall-Wallis y el post-test de Dunn, adoptando p<0,05. Resultados: Ambos entrenamientos redujeron el porcentaje de tejido adiposo, masa corporal y la concentración de TNF-α hepático (p<0,05). AE aumentó el HDL sérico, el diámetro de la fibra del gastrocnemio y redujo la dimensión fractal en el sóleo (p<0,05). R redujo la glucosa en sangre y los lípidos séricos y hepáticos, aumentó las concentraciones de glucógeno hepático y sóleo, aumentó el diámetro de la fibra del gastrocnemio y disminuyó el TNF-α (p<0,05). Conclusión: Ambos modelos de entrenamiento redujeron la masa corporal, el tejido adiposo visceral relativo, la concentración sérica de colesterol total y la inflamación hepática. El entrenamiento de resistencia demostró ser más eficaz para promover los efectos metabólicos en el hígado y el músculo esquelético, además de reducir la inflamación muscular en ratas. Nivel de Evidencia V; Opinión del Especialista.

RESUMO Introdução: O exercício físico pode se apresentar como uma alternativa para prevenção e tratamento de efeitos deletérios da obesidade, principalmente efeitos inflamatórios sobre os tecidos muscular esquelético e hepático. No entanto, não há consenso quanto ao melhor modelo de treinamento físico para tal finalidade. Objetivos: Avaliar alterações morfológicas, metabólicas e inflamatórias dos treinamentos aeróbico e resistido sobre os tecidos muscular esquelético e hepático de ratos. Métodos: 24 ratos Wistar foram divididos nos grupos sedentário (S), treinamento aeróbico (AE) e resistido (R). Glicemia, colesterol total e triglicerídeos séricos foram mensurados periodicamente. Após a eutanásia, a massa corporal foi mensurada para calcular o ganho total de massa durante o experimento. A lipoproteína de alta densidade (HDL) foi dosada. O tecido adiposo foi extraído para cálculo de sua porcentagem relativa à massa corporal assim como o fígado e os músculos sóleo e gastrocnêmio para as análises morfológicas e das concentrações de glicogênio, lipídios e Fator de Necrose Tumoral α (TNF-α). Para análise estatística, foram utilizados o teste de Kruskall-Wallis e o pós-teste de Dunn, adotando-se p<0,05. Resultados: Ambos os modelos de treinamento reduziram o percentual de tecido adiposo, ganho de massa corporal e concentração hepática de TNF-α (p<0,05). AE aumentou o HDL sérico, o diâmetro das fibras do gastrocnêmio e reduziu a dimensão fractal no sóleo (p<0,05). R reduziu a glicemia e os lipídios séricos e hepáticos, aumentou a concentração de glicogênio hepático e sóleo, aumentou o diâmetro das fibras gastrocnêmicas e diminuiu o TNF-α (p<0,05). Conclusão: Ambos os modelos de treinamento reduziram a massa corporal, o tecido adiposo visceral relativo, a concentração sérica de colesterol total e a inflamação hepática. No entanto, o treinamento resistido mostrou-se mais eficaz em promover efeitos metabólicos no fígado e no músculo esquelético, além de reduzir a inflamação muscular em ratos. Nível de Evidência V; Opinião do Especialista.

Isolated open tibial shaft fracture: a seven-hospital, prospective observational study in two Latin America countries.

INTRODUCTION: open tibial fractures are challenging due to the frequent severe bone injury associated with poor soft tissue conditions. This is relevant in low- and middle-income countries, mainly related to delayed definitive fixation and lack of adequate training in soft tissue coverage procedures. Due to these factors, open tibial fracture is an important source of disability for Latin American countries. Herein we sought to provide an epidemiological overview of isolated open tibial shaft fracture across seven hospitals in southern cone of Latin America. The secondary goal was to assess the impact on quality of life based on return-to-work rate (RWR). METHODS: patients with an isolated open tibial shaft fracture treated in seven different hospitals from Brazil and Argentina from November 2017 to March 2020 were included in the study. Clinical and radiographic results were evaluated throughout the 120-day follow-up period. Final evaluation compared RWR with the SF-12 questionnaire, bone healing, and gait status. RESULTS: Seventy-two patients were treated, 57 followed for 120 days and 48 completed the SF-12 questionnaire. After 120 days, 70.6% had returned to work, 61.4% had experienced bone healing. Age, antibiotic therapy, type of definitive treatment, and infection significantly influenced the RWR. Gait status exhibited strong correlations with RWR and SF-12 physical component score. CONCLUSIONS: Isolated open tibial shaft fractures are potentially harmful to the patient's quality of life after 120 days of the initial management. RWR is significantly higher for younger patients, no history of infection, and those who could run in the gait status assessment.

Isolated open tibial shaft fracture: a seven-hospital, prospective observational study in two Latin America countries / Fraturas expostas isoladas da diáfise da tíbia: estudo prospectivo observacional em sete hospitais de dois países da América Latina

ABSTRACT Introduction: open tibial fractures are challenging due to the frequent severe bone injury associated with poor soft tissue conditions. This is relevant in low- and middle-income countries, mainly related to delayed definitive fixation and lack of adequate training in soft tissue coverage procedures. Due to these factors, open tibial fracture is an important source of disability for Latin American countries. Herein we sought to provide an epidemiological overview of isolated open tibial shaft fracture across seven hospitals in southern cone of Latin America. The secondary goal was to assess the impact on quality of life based on return-to-work rate (RWR). Methods: patients with an isolated open tibial shaft fracture treated in seven different hospitals from Brazil and Argentina from November 2017 to March 2020 were included in the study. Clinical and radiographic results were evaluated throughout the 120-day follow-up period. Final evaluation compared RWR with the SF-12 questionnaire, bone healing, and gait status. Results: Seventy-two patients were treated, 57 followed for 120 days and 48 completed the SF-12 questionnaire. After 120 days, 70.6% had returned to work, 61.4% had experienced bone healing. Age, antibiotic therapy, type of definitive treatment, and infection significantly influenced the RWR. Gait status exhibited strong correlations with RWR and SF-12 physical component score. Conclusions: Isolated open tibial shaft fractures are potentially harmful to the patient's quality of life after 120 days of the initial management. RWR is significantly higher for younger patients, no history of infection, and those who could run in the gait status assessment.

RESUMO Introdução: o tratamento de fraturas expostas isoladas da diáfise da tíbia (FEIDT) apresenta desafios por frequentemente associar severa lesão óssea com condições ruins de tecido mole, fatores relevantes em países de média e baixa renda, especialmente devido a atrasos na implementação da fixação definitiva e falta de treinamento adequado no manejo de tecidos moles. Consequentemente, FEIDTs representam importante fonte de incapacitação na América Latina. Este estudo objetivou apresentar uma visão geral das FEIDTs em sete hospitais do cone sul da América Latina. O objetivo secundário foi avaliar o seu impacto na qualidade de vida baseado na taxa de retorno ao trabalho (TRT). Métodos: foram incluídos no estudo pacientes com FEIDT tratados em sete hospitais de Brasil e Argentina entre novembro de 2017 e março de 2020. Resultados clínicos e radiográficos foram analisados num período de 120 dias. Avaliação final comparou TRT com o questionário SF-12, consolidação óssea e condições de marcha. Resultados: setenta e dois pacientes foram tratados, 57 seguidos por 120 dias e 48 completaram o questionário SF-12. Após 120 dias, 70,6% havia retornado ao trabalho, 61,4% tinha fratura consolidada. Idade, antibioticoterapia, tipo de tratamento definitivo e infecção influenciaram significativamente na TRT. A condição de marcha apresentou forte correlação com TRT e o componente físico do SF-12. Conclusão: FEIDTs são potencialmente deletérias à qualidade de vida dos pacientes 120 dias após o tratamento inicial. TRT é significativamente maior para pacientes mais jovens, sem história de infecção e que conseguem correr na avaliação da condição de marcha..

Punch shear test for quantitative evaluation of bone defect repair in Wistar rat tibia.

INTRODUCTION: Bone healing is a complex process influenced by biological and mechanical factors that restores the injured bone's load bearing function. Qualitative methods are usually employed to assess this repair process. This study presents a method of quantitative evaluation of bone repair in circular defects produced in the medial proximal metaphysis of the tibia of rats by means of punch shear tests (PST). OBJECTIVE: To describe and test a mechanical punch shear test designed to quantify over time the regeneration of bone defects produced in Wistar rats' tibiae. MATERIAL AND METHODS: In seven experimental groups, 3.2 mm in diameter and 1.5 mm deep defects were drilled on the medial surface of both proximal tibial metaphyses of the animals, just below the joint surfaces. The animals of an additional group were maintained with intact tibiae. After one, two, three, four, six, eight and 12 weeks of follow-up, the animals were sacrificed and the tibiae removed. After removing the soft tissue, the tibial proximal metaphyses were embedded in epoxy resin and cut with a diamond cutting blade, in order to obtain bone slices with equal thickness. The PST were carried out in a universal testing machine and the maximum shear forces were measured. RESULTS: The forces increased as a function of the follow-up time in the period of one to three weeks (p <0.001); from this follow-up time on, there were no statistical significant differences between the groups, including the intact tibiae. CONCLUSION: The test method proved to be suitable to quantitatively assess bone regeneration in monocortical defects produced in the proximal metaphysis of rat tibia within one and three weeks after defect production.

Quick-DASH as a main early outcome of humeral shaft fractures: A Latin American multicenter prospective study.

PURPOSE: The main objective of this study was to evaluate the Quick-Disabilities of the Arm, Shoulder and Hand Score (DASH) score as the main early (90 days) outcome in a prospective multicenter observational Latin American study on isolated humeral shaft fractures. METHODS: From December 2015 to April 2017, in six Latin American countries, patients 18 years or older with a closed, isolated nonpathological 12A, 12B, or 12C AO/OTA (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association) fractures were included. The 90 (±10)-day Quick-DASH score was used to compare the results of the different treatments. The secondary outcomes were patient treatment satisfaction, shoulder and elbow range of motion, and radiographic evaluation. RESULTS: A total of 92 patients successfully completed the Quick-DASH questionnaire. Surgical treatments resulted in better outcomes than nonsurgical treatment, but only minimally invasive plate osteosynthesis produced significantly lower Quick-DASH scores than nonsurgical treatment (p < 0.05). There were strong correlations between patient self-evaluation and the Quick-DASH score (p < 0.0005) but not between the Quick-DASH score and radiographic fracture healing. No significant difference was found between the treatments regarding the rate of return to work, but the medical center had a significant influence on treatment choice (p < 0.0005). CONCLUSION: The high correlation between Quick-DASH score and patient satisfaction and functional outcome indicates that the Quick-DASH questionnaire is a suitable tool for evaluating adult humeral shaft fracture outcomes. Patients with a Quick-DASH score below 15 could be considered recovered, and patients with a Quick-DASH score above 40 could be considered not yet recovered. Quick-DASH scores were not significantly associated with radiographic fracture healing.

Demographics and clinical features of humeral shaft fractures: The Latin American multicentre prospective study (HSF-LAMPS).

PURPOSE: To present transversal data (demographic and clinical) on isolated humeral shaft fractures (HSFs) in Latin American countries. METHODS: Patients were enrolled between December 2015 and April 2017 at 11 medical institutions from six Latin America countries. INCLUSION CRITERIA: Age ≥18 years and a closed, isolated 12A, 12B, or 12C fracture (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) classification). The patients' demographic, comorbidity, and other baseline data were recorded. The outcome measures included the basal results of the research and the associations among the demographic factors, fracture features, and type of treatment applied. RESULTS: A total of 123 patients were included. There was a preponderance of men (61.8%), whose mean age was significantly lower than that of the women (31.48 vs. 60.55). Overweight or obesity was present in 61.0% of women; 56.1% of patients were sedentary, 75.6% were nonsmokers, and 74.0% had no chronic disease. The type or treatment (operative/nonoperative) was not significantly associated with the patient's or fracture's characteristics. Falls and traffic accidents were the main causes of HSFs. Intramedullary nailing treatment was performed significantly more often in women, elderly patients, patients who did not participate in sports, and patients participating in only home activities. Minimally invasive plate osteosynthesis was performed significantly more frequently in men and in those who were self-employed. Open reduction internal fixation was performed significantly more often when the cause of the fracture was a traffic accident and when radial nerve palsy was present. CONCLUSION: The demographics and etiological differences observed in comparison to the current literature show the importance of regional studies for both preventive measures and educational guidance.

QUANTITATIVE EVALUATION OF EXPERIMENTAL BONE REGENERATION USING INDENTATION TESTS.

OBJECTIVES: To determine whether the macroindentation test can be applied to quantitatively assess bone regeneration. METHODS: A 3.2 mm diameter transverse monocortical defect was created on the medial aspect of both proximal metaphyses of the tibia of male Unib-WH rats. For the macroindentation tests, we used 5.00 mm diameter indenters with a 3.2 mm tip. Defect testing was performed 1 to 12 weeks following the surgical procedures to compare the hardness of the newly developed tissue over the 12-week study period. Additional histological, morphological and physical/chemical data were obtained by optical and electronic microscopy, Raman, and energy dispersive x-ray spectrometry (EDS). RESULTS: The mean indentation forces increased in a time-dependent manner from 4 to 12 weeks (p<0.001). Tests performed with the 5.0 mm diameter tip were not able to measure the indentation forces in the first week after the procedure. Moreover, in the second postoperative week indentation forces and the newly formed tissue within the spinal canal were greater than those measured in the fourth and eighth weeks. CONCLUSIONS: The macroindentation test can be used to quantitatively assess bone regeneration in experimental studies. The choice of indenter tip diameter should consider the study design. Level of Evidence II, Diagnostic Studies.

OBJETIVOS: Determinar se o teste de macroendentação pode ser aplicado para avaliar quantitativamente a regeneração óssea. MÉTODOS: Foi criado um defeito monocortical transversal com 3,2 mm de diâmetro na face medial de ambas as metáfises proximais da tíbia de ratos Wistar machos. Para os testes de macroendentação, empregou-se endentador com ponta de 3,2 mm e 5,0 mm de diâmetro. O teste dos defeitos foi realizado em 1 a 12 semanas depois dos procedimentos cirúrgicos, de modo que a dureza do tecido recém-formado foi comparada no período de 12 semanas do estudo. Os dados histológicos, morfológicos e físico-químicos adicionais foram obtidos por microscopia óptica e eletrônica, espectrometria Raman e EDS (espectrometria com dispersão de energia). RESULTADOS: As forças médias de endentação aumentaram de modo dependente do tempo de 4 a 12 semanas (p < 0,001). Os testes realizados com a ponta de 5 mm de diâmetro não foram capazes de medir as forças de endentação na primeira semana depois do procedimento. Além disso, na segunda semana, as forças de endentação e o tecido recém-formado no interior do canal medular foram superiores aos da quarta e oitava semanas. CONCLUSÕES: O teste de macroendentação pode ser utilizado em estudos experimentais para avaliar quantitativamente a regeneração óssea. A escolha do diâmetro da ponta do endentador deve considerar o desenho do estudo. Nível de Evidência II, Estudos Diagnósticos.

QUANTITATIVE EVALUATION OF EXPERIMENTAL BONE REGENERATION USING INDENTATION TESTS / AVALIAÇÃO QUANTITATIVA DE REGENERAÇÃO ÓSSEA EXPERIMENTAL USANDO TESTES DE INDENTAÇÃO

ABSTRACT Objectives: To determine whether the macroindentation test can be applied to quantitatively assess bone regeneration. Methods: A 3.2 mm diameter transverse monocortical defect was created on the medial aspect of both proximal metaphyses of the tibia of male Unib-WH rats. For the macroindentation tests, we used 5.00 mm diameter indenters with a 3.2 mm tip. Defect testing was performed 1 to 12 weeks following the surgical procedures to compare the hardness of the newly developed tissue over the 12-week study period. Additional histological, morphological and physical/chemical data were obtained by optical and electronic microscopy, Raman, and energy dispersive x-ray spectrometry (EDS). Results: The mean indentation forces increased in a time-dependent manner from 4 to 12 weeks (p<0.001). Tests performed with the 5.0 mm diameter tip were not able to measure the indentation forces in the first week after the procedure. Moreover, in the second postoperative week indentation forces and the newly formed tissue within the spinal canal were greater than those measured in the fourth and eighth weeks. Conclusions: The macroindentation test can be used to quantitatively assess bone regeneration in experimental studies. The choice of indenter tip diameter should consider the study design. Level of Evidence II, Diagnostic Studies.

RESUMO Objetivos: Determinar se o teste de macroendentação pode ser aplicado para avaliar quantitativamente a regeneração óssea. Métodos: Foi criado um defeito monocortical transversal com 3,2 mm de diâmetro na face medial de ambas as metáfises proximais da tíbia de ratos Wistar machos. Para os testes de macroendentação, empregou-se endentador com ponta de 3,2 mm e 5,0 mm de diâmetro. O teste dos defeitos foi realizado em 1 a 12 semanas depois dos procedimentos cirúrgicos, de modo que a dureza do tecido recém-formado foi comparada no período de 12 semanas do estudo. Os dados histológicos, morfológicos e físico-químicos adicionais foram obtidos por microscopia óptica e eletrônica, espectrometria Raman e EDS (espectrometria com dispersão de energia). Resultados: As forças médias de endentação aumentaram de modo dependente do tempo de 4 a 12 semanas (p < 0,001). Os testes realizados com a ponta de 5 mm de diâmetro não foram capazes de medir as forças de endentação na primeira semana depois do procedimento. Além disso, na segunda semana, as forças de endentação e o tecido recém-formado no interior do canal medular foram superiores aos da quarta e oitava semanas. Conclusões: O teste de macroendentação pode ser utilizado em estudos experimentais para avaliar quantitativamente a regeneração óssea. A escolha do diâmetro da ponta do endentador deve considerar o desenho do estudo. Nível de Evidência II, Estudos Diagnósticos.

Comparing the In Vitro Stiffness of Straight-DCP, Wave-DCP, and LCP Bone Plates for Femoral Osteosynthesis.

The objective of this study was to compare the Locking Compression Plate (LCP) with the more cost-effective straight-dynamic compression plate (DCP) and wave-DCPs by testing in vitro the effects of plate stiffness on different types of diaphyseal femur fractures (A, B, and C, according to AO classification). The bending structural stiffness of each plate was obtained from four-point bending tests according to ASTM F382-99(2008). The plate systems were tested by applying compression/bending in different osteosynthesis simulation models using wooden rods to simulate the fractured bone fragments. Kruskal-Wallis test showed no significant difference in the bending structural stiffness between the three plate models. Rank-transformed two-way ANOVA showed significant influence of plate type, fracture type, and interaction plate versus fracture on the stiffness of the montages. The straight-DCP produced the most stable model for types B and C fractures, which makes its use advantageous for complex nonosteoporotic fractures that require minimizing focal mobility, whereas no difference was found for type A fracture. Our results indicated that DCPs, in straight or wave form, can provide adequate biomechanical properties for fixing diaphyseal femoral fractures in cases where more modern osteosynthesis systems are cost restrictive.

Análise fotoelástica da distribuiçäo de tensöes produzida na mandíbula pela simulaçäo do esforço mastigatório em sobredentaduras muco-dento-suportadas e prótese total / Photoelastic analysis of stress distribution in jaws under masticatory efforts simulation in overdentures and conventional complete denture

O objetivo deste estudo foi verificar a distribuiçäo dos esforços mastigatórios em mandíbulas sob próteses do tipo sobredentaduras e prótese total. Foram confeccionadas três mandíbulas em material fotoelástico, obtidas pela moldagem de uma mandíbula humana desdentada. Os moldes foram preenchidos com resina fotoelástica PLM-4 (Photolastic Inc., Raleigh, USA). Variou-se a disposiçäo dos pilares radiculares nas réplicas, dividindo-as em três grupos: Grupo I, a mandíbula näo apresentava raízes suportes (grupo controle); Grupo II, raízes dispostas bilateralmente na arcada dentária correspondendo às raízes dos dois caninos; e Grupo III, raiz de um canino e de um molar dispostos no mesmo hemiarco, de maneira unilateral. Sobre estas, foram confeccionadas prótese total convencional e sobredentaduras, respectivamente, as quais ocluíam em um modelo padräo de resina acrílica termopolimerizável montado num articulador semi-ajustável para a aplicaçäo do carregamento (20 N), simulando a carga mastigatória...

Influência da geometria de parafusos corticais AO quanto ao arrancamento in vitro / Influence of the geometry of AO cortical screws on in vitro pull-out

O desempenho de parafusos do tipo cortical AO/ASIF**, comd,5mm de diâmetro (com dimensöes dentro e fora de norma), foi avaliado através de testes de arrancamento in vitro. Utilizaram-se no ensaio 30 corpos de prova, provenientes de dez fêmures de cäes. As forças de arrancamento obtidas durante oteste foram maiores para o parafuso com ângulo ß mais elevado. Para explicar essa aparente contradiçäo, os autores discutem a importância de outros fatores, como o diâmetro externo do parafuso e o perfil do cortador de rosca