Temporal exposure to malathion: Biochemical changes in the Amazonian fish tambaqui, Colossoma macropomum.

The main toxicity mechanism of organophosphate insecticides such as malathion is the acetylcholinesterase enzyme inhibition. However, fish responses to organophosphates may vary depending on the activation of different defense mechanisms as well as the length of exposure. As such, the evaluation of acetylcholinesterase activity, in combination with the evaluation of biotransformation and antioxidants enzymes levels, is useful for indicating damage in fish exposed to this insecticide. Moreover, evaluating mitochondrial activity might evidence how the hierarchic responses occur in relation to the length of time that the fish is exposed. Therefore, the aim of our study is to evaluate whether the length of exposure to malathion differentially affects the biochemical responses of tambaqui. Our hypothesis is that the physiological alterations due to exposure are time dependent. Fish were exposed to sublethal concentrations of the insecticide during 6, 12, 24, 36, and 48 h. Contrary to expectations, there was no acetylcholinesterase activity inhibition during the experiment, which indicates an absence of neurotoxicity. Phase II biotransformation mechanism was activated early, especially in the liver. Oxidative damage was evident in the first hours of exposure and was concurrent with the activation of antioxidant enzymes. Mitochondrial bioenergetics were differentially affected by the length of exposure. The data suggest that the tambaqui regulates mitochondrial respiration differently over time, seeking to maintain homeostasis and ATP demand, and ensures the activation of response mechanisms, thus minimizing oxidative damage and avoiding the neurotoxicity of malathion.

Risk factors for colonization and infection by resistant microorganisms in kidney transplant recipients.

OBJECTIVES: to assess the prevalence of colonization and infection by multidrug-resistant bacteria in patients undergoing kidney transplantation and identify the rate of infection, morbidity and mortality and associated risk factors. METHODS: a prospective cohort of 200 randomly included kidney transplant recipients. Epidemiological surveillance of the studied microorganisms was carried out in the first 24 hours and 7 days after transplantation. RESULTS: ninety (45%) patients were considered colonized. Female sex, hypertension and diabetes (p<0.005), dialysis time (p<0.004), length of stay after transplantation, delayed renal function, and length of stay were identified as risk factors. The microorganisms were isolated from surgical site, bloodstream and urinary tract infections. CONCLUSIONS: colonization by resistant microorganisms in kidney transplant patients was frequent and risk factors associated with infection were identified. The results should guide the care team in order to minimize morbidity and mortality related to infectious causes in this population.

Development of a medical device compatible with MRI/CT to measure ankle joint laxity: the Porto Ankle Testing Device.

Ankle sprains are common and often develop into chronic ankle instability. Ankle laxity is usually assessed by manual testing followed by magnetic resonance imaging to confirm the diagnosis. Manual testing however provides a subjective measure and is limited to the assessor sensibility. Current available technologies incorporate arthrometers to objectively measuring ankle laxity, but are not capable to assess the structural integrity of the capsuloligamentous structures. To overcome these limitations, we developed a novel medical device to assist in the diagnosis of ankle ligament injuries-the Porto Ankle Testing Device. With this device, it is possible to combine and correlate the assessment of the capsuloligamentous' structural integrity with the joint functional competence (ie, joint multiplanar laxity). The main purpose of this work is to present the fundamental aspects and step-by-step development of the Porto Ankle Testing Device. We discuss the design specifications and technical requirements with the purpose to design and develop this medical device, described the features of the different components and explained the mechanical systems that are incorporated emulate manual testing and to measure the multiplanar ankle laxity. The preliminary findings are presented with the purpose to display the assessment protocol, the method of laxity measurement and the obtained results. We propose a unique and reliable medical device to safety and effectively assess ankle ligament injuries and contribute to enhance diagnosis, refine treatment indications and allow objective measurement of ligament laxity before and/or after stabilization surgery.

Risk factors for colonization and infection by resistant microorganisms in kidney transplant recipients / Factores de riesgo de colonización e infección por microorganismos resistentes en receptores de trasplante renal / Fatores de risco para colonização e infecção por microrganismos resistentes em transplantados renais

ABSTRACT Objectives: to assess the prevalence of colonization and infection by multidrug-resistant bacteria in patients undergoing kidney transplantation and identify the rate of infection, morbidity and mortality and associated risk factors. Methods: a prospective cohort of 200 randomly included kidney transplant recipients. Epidemiological surveillance of the studied microorganisms was carried out in the first 24 hours and 7 days after transplantation. Results: ninety (45%) patients were considered colonized. Female sex, hypertension and diabetes (p<0.005), dialysis time (p<0.004), length of stay after transplantation, delayed renal function, and length of stay were identified as risk factors. The microorganisms were isolated from surgical site, bloodstream and urinary tract infections. Conclusions: colonization by resistant microorganisms in kidney transplant patients was frequent and risk factors associated with infection were identified. The results should guide the care team in order to minimize morbidity and mortality related to infectious causes in this population.

RESUMEN Objetivos: evaluar la prevalencia de colonización e infección por bacterias multirresistentes en pacientes sometidos a trasplante renal, identificar la tasa de infección, morbimortalidad y factores de riesgo asociados. Métodos: cohorte prospectiva de 200 receptores de trasplante renal incluidos aleatoriamente. La vigilancia epidemiológica de los microorganismos estudiados se realizó en las primeras 24 horas y 7 días posteriores al trasplante. Resultados: noventa (45%) pacientes fueron considerados colonizados. Se identificaron como factores de riesgo: sexo femenino, hipertensión y diabetes (p<0,005), tiempo en diálisis (p<0,004), tiempo de estancia después del trasplante, función renal retrasada, tiempo de estancia. Los microorganismos se aislaron de infecciones del sitio quirúrgico, del torrente sanguíneo y del tracto urinario. Conclusiones: la colonización por microorganismos resistentes en pacientes con trasplante renal fue frecuente y se identificaron factores de riesgo asociados a infección. Los resultados deben orientar al equipo asistencial para minimizar la morbimortalidad relacionada con causas infecciosas en esta población.

RESUMO Objetivos: avaliar a prevalência de colonização e infecção por bactéria multirresistente em pacientes em transplante renal, identificar a taxa de infecção, morbimortalidade e os fatores de risco associados. Métodos: coorte prospectivo de 200 transplantados renais incluídos aleatoriamente. Realizou-se vigilância epidemiológica dos microrganismos em estudo nas primeiras 24 horas e 7 dias pós-transplante. Resultados: noventa (45%) pacientes foram considerados colonizados. Identificaram-se como fatores de risco: sexo feminino, hipertensão arterial e diabetes (p<0,005), tempo de diálise (p<0,004), tempo de internação pós-transplante, função renal retardada, tempo de internação. Os microrganismos foram isolados das infecções em sítio cirúrgico, corrente sanguínea e trato urinário. Conclusões: a colonização por microrganismos resistentes nos pacientes transplantados renais foi frequente e os fatores de riscos associados à infecção foram identificados. Os resultados devem direcionar a equipe assistencial, a fim de minimizar a morbimortalidade relacionada às causas infecciosas nesta população.

Consequences of oxidative damage on the fatty acid profile in muscle of Cichlasoma amazonarum acutely exposed to copper.

Rapid industrialization results in the production of large quantities of waste that are commonly discharged into water bodies, leading to the damage of the aquatic ecosystem and freshwater organisms. Copper (Cu) can induce oxidative damage in fish muscle, the main fish portion that is consumed by humans. However, the responses of the Amazon fish Cichlasoma amazonarum and its capacity to withstand acute Cu concentrations found in Amazon water around mines remain unknown. Thus, the aim of this study was to evaluate whether exposure to Cu causes muscle oxidative stress and/or oxidative damage and impairs the fillet fatty acid profile of C. amazonarum acutely exposed to Cu found in Amazon waters around mines. Muscle reactive oxygen species and protein carbonylation levels were significantly higher in fish exposed to 1500 µg/L Cu compared with the control group, while muscle lipid peroxidation levels were significantly higher in fish exposed to 500, 750, and 1500 µg/L Cu compared with control group. Muscle antioxidant capacity against peroxyl radical's levels and glutathione peroxidase activity were significantly lower in fish exposed to 1500 µg/L Cu compared with the control group, while muscle superoxide dismutase activity was significantly lower in fish exposed to 750 and 1500 µg/L Cu compared with control group. The total content of saturated fatty acids was significantly higher in fish exposed to 1500 µg/L Cu compared with the control group, while the total content of monounsaturated fatty acids and sum of n3 fatty acids were significantly lower in fish exposed to 1500 µg/L Cu compared with control group. No significant difference was observed regarding muscle catalase, glutathione S-transferase, and glutathione reductase activities. Based on these lines of evidence, the results of this comprehensive study agree with the initial hypothesis that the exposure to Cu found in Amazon water around mines induces oxidative damage and inhibits enzymatic and non-enzymatic antioxidant response in the muscle of C. amazonarum exposed to high Cu levels. Moreover, the impairment of the fillet fatty acid profile appears to be mediated by oxidative damage, representing a negative impact on fish health.

Acute exposure to environmentally relevant concentrations of copper affects branchial and hepatic phosphoryl transfer network of Cichlasoma amazonarum: Impacts on bioenergetics homeostasis.

The toxic effects of copper (Cu) are linked to dysfunction of metabolism and depletion of adenosine triphosphate (ATP). Nevertheless, the effects related to phosphoryl transfer network, a network of enzymes to precise coupling of the ATP-production and ATP-consuming process for maintenance of bioenergetic, remain unknown. Therefore, the aim of this study was to determine whether the phosphoryl transfer network could be one pathway involved in the bioenergetic imbalance of Cichlasoma amazonarum exposed for 96 h to environmentally relevant concentrations of Cu found in Amazonia water around mines. Branchial mitochondrial creatine kinase (CK) activity was significantly lower in fish exposed to 1500 µg/L Cu than in the control group, while branchial cytosolic CK activity was significantly greater. Branchial (exposed to 750 and 1500 µg/L Cu) and hepatic (exposed to 1500 µg/L Cu) pyruvate kinase (PK) activity was significantly lower in fish exposed to Cu than in the control group. Branchial and hepatic ATP levels were significantly lower in fish exposed to 1500 µg/L than in the control group. Branchial reactive oxygen species (ROS) and lipid peroxidation (LPO) levels were significantly higher in fish exposed to 750 and 1500 µg/L Cu compared to control. Hepatic ROS and LPO levels were significantly higher in fish exposed to 1500 µg/L than in the control group. Branchial and hepatic Cu levels were significantly higher in fish exposed to 1500 µg/L compared to other groups. Exposure to 750 and 1500 µg/L Cu impairs bioenergetics homeostasis, which appears to be mediated by ROS overproduction and lipid peroxidation.

Bolsonaro e a COVID-19: e daí? "o Brazil tá matando o Brasil", "do Brasil, SOS ao Brasil", "chora a nossa pátria, mãe gentil... "

Editorial crítico-analítico da situação político-social do país, denunciando os movimentos autoritários que o (des)governo bolsonaro vem implementando em plena pandemia de coronavirus, na direção de uma tentantiva de quebra do estado de direito. Trás reflexões sobre a educação e a educação física em tempos de Covid-19, bem como aponta questões sobre temas a serem considerados na realidade pós-pandemia.

Sprint versus isolated eccentric training: Comparative effects on hamstring architecture and performance in soccer players.

AIMS: The purpose of this study was to compare the effects of hamstring eccentric (NHE) strength training versus sprint training programmed as complements to regular soccer practice, on sprint performance and its mechanical underpinnings, as well as biceps femoris long head (BFlh) architecture. METHODS: In this prospective interventional control study, sprint performance, sprint mechanics and BFlh architecture variables were compared before versus after six weeks of training during the first six preseason weeks, and between three different random match-pair groups of soccer players: "Soccer group" (n = 10), "Nordic group" (n = 12) and "Sprint group" (n = 10). RESULTS: For sprint performance and mechanics, small to large pre-post improvements were reported in "Sprint group" (except maximal running velocity), whereas only trivial to small negative changes were reported in "Soccer group" and "Nordic group". For BFlh architecture variables, "Sprint" group showed moderate increase in fascicle length compared to smaller augment for the "Nordic" group with trivial changes for "Soccer group". Only "Nordic" group presented small increases at pennation angle. CONCLUSIONS: The results suggest that sprint training was superior to NHE in order to increase BFlh fascicle length although only the sprint training was able to both provide a preventive stimulus (increase fascicle length) and at the same time improve both sprint performance and mechanics. Further studies with advanced imaging techniques are needed to confirm the validity of the findings.

How should clinicians rehabilitate patients after ACL reconstruction? A systematic review of clinical practice guidelines (CPGs) with a focus on quality appraisal (AGREE II).

OBJECTIVES: To summarise recommendations and appraise the quality of international clinical practice guidelines (CPGs) for rehabilitation after ACL reconstruction. DESIGN: Systematic review of CPGs (PROSPERO number: CRD42017020407). DATA SOURCES: Pubmed, EMBASE, Cochrane, SPORTDiscus, PEDro and grey literature databases were searched up to 30 September 2018. ELIGIBILITY CRITERIA: English-language CPGs on rehabilitation following ACL reconstruction that used systematic search of evidence to formulate recommendations. METHODS: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to report the systematic review. Two appraisers used the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument to report comprehensiveness, consistency and quality of CPGs. We summarised recommendations for rehabilitation after ACL reconstruction. RESULTS: Six CPGs with an overall median AGREE II total score of 130 points (out of 168) and median overall quality of 63% were included. One CPG had an overall score below the 50% (poor quality score) and two CPGs scored above 80% (higher quality score). The lowest domain score was 'applicability' (can clinicians implement this in practice?) (29%) and the highest 'scope and purpose' (78%) and 'clarity of presentation' (75%). CPGs recommended immediate knee mobilisation and strength/neuromuscular training. Early full weight-bearing exercises, early open and closed kinetic-chain exercises, cryotherapy and neuromuscular electrostimulation may be used according individual circumstances. The CPGs recommend against continuous passive motion and functional bracing. CONCLUSION: The quality of the CPGs in ACL postoperative rehabilitation was good, but all CPGs showed poor applicability. Immediate knee mobilisation and strength/neuromuscular training should be used. Continuous passive motion and functional bracing should be eschewed.

Infection related to Klebsiella pneumoniae producing carbapenemase in renal transplant patients.

OBJECTIVE: To evaluate the risk factors related to Klebsiella pneumoniae carbapenemase infection after renal transplantation. METHODS: This was a retrospective epidemiological (case-control) study, conducted from October 2011 to march 2016. Transplanted patients with infection by this bacteria during hospitalization were selected as cases. The controls were paired by age, sex, type of donor and transplant time. The proportion of cases and controls was 1:2. RESULTS: Thirty hundred and five patients were included in the study (45 cases and 90 controls). The risk factors found for infection by KPC were: time of hospitalization after the transplant (OR: 4.82; CI95% 2.46-9.44), delayed kidney function (OR: 5.60; CI95% 1.91-11.01) and previous infectious for another microorganism ( OR: 34.13 CI95% 3.52-132.00). CONCLUSION: The risk of acquisition of this bacterium was directly related to invasive procedures and exposure to the hospital environment. The findings reinforce the importance of prevention measures and control of infection by this microorganism.

lilacs search strategy for systematic reviews of diagnostic test accuracy studies.

BACKGROUND: There are few publications on search strategies to identify diagnostic test accuracy (DTA) studies in lilacs. OBJECTIVE: To translate and customise medline search strategies for use in lilacs and assess their retrieval of studies in Cochrane DTA systematic reviews. METHOD: We developed a six-step process to translate and customise medline search strategies for use in lilacs (iAHx interface). We identified medline search strategies of published Cochrane DTA reviews, translated/customised them for use in lilacs, ran searches in lilacs and compared the retrieval results of our translated search strategy versus the one used in the published reviews. RESULTS: Our lilacs search strategies translated/customised from the medline strategies retrieved studies in 70 Cochrane DTA reviews. Only 29 of these reviews stated that they had searched the lilacs database and 21 published their lilacs search strategies. Few had used the lilacs database search tools, none exploded the subject headings, and 86% used only English terms. CONCLUSION: Translating and tailoring a medline search strategy for the lilacs database resulted in the retrieval of DTA studies that would have been missed otherwise.

Infection related to Klebsiella pneumoniae producing carbapenemase in renal transplant patients / Infección relacionada con Klebsiella pneumoniae productora de carbapenemasa en pacientes trasplantados renales

ABSTRACT Objective: To evaluate the risk factors related to Klebsiella pneumoniae carbapenemase infection after renal transplantation. Methods: This was a retrospective epidemiological (case-control) study, conducted from October 2011 to march 2016. Transplanted patients with infection by this bacteria during hospitalization were selected as cases. The controls were paired by age, sex, type of donor and transplant time. The proportion of cases and controls was 1:2. Results: Thirty hundred and five patients were included in the study (45 cases and 90 controls). The risk factors found for infection by KPC were: time of hospitalization after the transplant (OR: 4.82; CI95% 2.46-9.44), delayed kidney function (OR: 5.60; CI95% 1.91-11.01) and previous infectious for another microorganism ( OR: 34.13 CI95% 3.52-132.00). Conclusion: The risk of acquisition of this bacterium was directly related to invasive procedures and exposure to the hospital environment. The findings reinforce the importance of prevention measures and control of infection by this microorganism.

RESUMEN Objetivo: Evaluar los factores de riesgo relacionados con la infección por Klebsiella pneumoniae carbapenemasa después del trasplante renal. Método: Estudio retrospectivo epidemiológico (caso-control), realizado de octubre de 2011 a marzo de 2016. Pacientes transplantados con infección por esa bacteria durante la internación fueron seleccionados como casos. Los controles se parearon por edad, sexo, tipo de donante y tiempo de trasplante. La proporción de casos y controles fue de 1: 2. Resultados: Treinta y cinco pacientes fueron incluidos en el estudio (45 casos y 90 controles). Los factores de riesgo para la infección encontrados por KPC fueron: tiempo de hospitalización después del trasplante (OR: 4,82, IC95% 2,46-9,44), función renal retardada (OR: 5,60, IC95% 1, 91-11,01) y anterior infecciosa para otro microorganismo (OR: 34,13 IC95% 3,52-132,00). Conclusión: El riesgo de adquisición de esta bacteria estuvo directamente relacionado a procedimientos invasivos y exposición al ambiente hospitalario. Los hallazgos refuerzan la importancia de medidas de prevención y control de la infección por ese microorganismo.

Return to play after conservative and surgical treatment in athletes with spondylolysis: A systematic review.

PURPOSE: Analyze the return to sports rate and timing after conservative and surgical treatment in athletes with spondylolysis. METHODS: Comprehensive search using Pubmed, Cochrane Library and SPORTDiscus databases to identify English language studies that assessed the return to sports after conservative or surgical treatment of symptomatic spondylolysis in athletes. The main outcome of interest was the return to sports rate and timing, as well as, the follow-up clinical and functional outcomes. RESULTS: A total of 14 trials (592 participants) were included. Eight and seven studies reported the outcomes of conservative and surgical approach, respectively. A total of 92% (n = 492) and 88% (n = 100) of athletes return to sports at any level, and 89% (n = 185) and 81% (n = 103) returned to their pre-injury level of sports for conservative and surgical approaches, respectively. The time to return to sports was 4.6 and 6.8 months for conservative and surgical approaches, respectively. CONCLUSIONS: Conservative management (bracing, sports modification and physiotherapy) of athletes with spondylolysis show excellent return to sports rates at any level and at the pre-injury level at a mean of 4.6 months. Those who fail the conservative treatment can be successfully managed with surgical treatment with a high rate of return to sports at 6.8 months. LEVEL OF EVIDENCE: Level IV, Systematic review of level IV studies.

Tibiofemoral bone bruise volume is not associated with meniscal injury and knee laxity in patients with anterior cruciate ligament rupture.

PURPOSE: This study aimed at evaluating the association between the volume of the bone bruises and the magnitude of knee sagittal laxity and presence of meniscal injury in patients with anterior cruciate ligament (ACL) rupture. It was hypothesized that higher volumes of bone bruises will be associated with increased knee laxity and the presence of meniscal injury. METHODS: Patients with clinical diagnosis of ACL injury were referred for magnetic resonance imaging (MRI) and knee sagittal laxity measurement with a mechanical instrumented device (Porto-Knee Testing Device). The femoral and tibial bone bruises were assessed by MRI and the volume measured by manually contouring the bone bruise using a computerized software and computed by a mathematical algorithm combining all measured areas. The ACL rupture type (partial or total), meniscal tear (medial or lateral), and the localization of bone bruise were also analyzed. RESULTS: Seventy-six ACL-ruptured participants were included and 34 patients displayed bone bruises. Tibiofemoral sagittal laxity was higher in participants with complete ACL rupture (p < 0.05), but not influenced by the volume of bone bruises and meniscal status (n.s.). The volume of bone bruises was not significantly associated with the meniscal lesion or with the tibiofemoral sagittal laxity, independently of the meniscal injury status (n.s.). CONCLUSIONS: The volume of femoral and/or tibial bone bruises was not associated with the type of ACL injury, tibiofemoral sagittal laxity or the status of meniscal injury. Bone bruises must be considered as a radiographic sign of injury and should not be suggestive of injury severity and not overvalued. LEVEL OF EVIDENCE: Retrospective cohort study, Level III. IRB NUMBER: 0011/0014.

Spatial distribution of beetle attack and its association with mango sudden decline: an investigation using geostatistical tools.

BACKGROUND: Ceratocystis fimbriata recognized among the species that induce mango sudden decline (MSD), causes plant death within a short period. The beetles Hypocryphalus mangiferae and Xyleborus affinis (Curculionidae: Scolytinae) are the vectors of MSD. Thorough understanding of the spatial distribution of the pest is crucial to designing control techniques and drawing up sampling plans. This study aimed to identify the beetles and their dispersal pattern in mango trees in MSD-infected commercial orchards, and the association with the severity of the C. fimbriata infestation. RESULTS: Beetle attacks were observed to be maximal on mango tree trunks revealing severe infestation. From the geostatistical analysis, an aggregated pattern was evident as galleries in the trunks and branches of mango trees. CONCLUSION: This is the first study to employ geostatic tools on a plant scale in MSD-infested mango orchards and to study the incidence of beetle attack. The results may prove a highly effective tool for mango growers, with respect to the management of beetles and MSD, as this will facilitate the monitoring of specific sites where the frequency of beetles and MSD is high. © 2018 Society of Chemical Industry.

Quality of life in children with kidney transplant: Systematic review.

OBJECTIVE: To identify in the literature studies that evaluate the quality of life in pediatric patients with kidney transplant through use of specific, validated instruments in Pediatrics. METHOD: Systematic review of the literature with searches conducted in the following databases: Medline, PubMed, LILACS, CINAHL, SciELO and Cochrane Library. Main keywords: Quality of life, Kidney transplantation and Pediatrics. RESULTS: A total of 366 studies were selected and eight observational studies were included that evaluated the quality of life of children with kidney transplant by means of evaluation instruments of quality of life. CONCLUSION: The quality of life of children with kidney transplant is inferior compared to healthy children. The post-transplant period presents better results compared to pre-transplant children. The identification of mental, physical and social conditions related to the quality of life of this population allows for better planning the assistance provided to them.

Clinical Management in Early OA.

Knee osteoarthritis affects an important percentage of the population throughout their life. Several factors seem to be related to the development of knee osteoarthritis including genetic predisposition, gender, age, meniscal deficiency, lower limb malalignments, joint instability, cartilage defects, and increasing sports participation. The latter has contributed to a higher prevalence of early onset of knee osteoarthritis at younger ages with this active population demanding more consistent and durable outcomes. The diagnosis is complex and the common signs and symptoms are often cloaked at these early stages. Classification systems have been developed and are based on the presence of knee pain and radiographic findings coupled with magnetic resonance or arthroscopic evidence of early joint degeneration. Nonsurgical treatment is often the first-line option and is mainly based on daily life adaptations, weight loss, and exercise, with pharmacological agents having only a symptomatic role. Surgical treatment shows positive results in relieving the joint symptomatology, increasing the knee function and delaying the development to further degenerative stages. Biologic therapies are an emerging field showing early promising results; however, further high-level research is required.

Bone morphology and morphometry of the lateral femoral condyle is a risk factor for ACL injury.

PURPOSE: The purpose of this study was to investigate the influence of the knee lateral compartment bony morphology and morphometry on risk of sustaining an anterior cruciate ligament (ACL) injury. METHODS: A total of 400 age and sex-matched patients (200 ACL-ruptured and 200 ACL-intact) were included. The lateral femoral and tibial bone morphology and morphometric parameters were measured on knee lateral radiographs, taken at 30° of knee flexion with overlapping of the femoral condyles. Radiographic measurements included: anteroposterior-flattened surface of the femur's lateral condyle (XY); femur's diaphysis anteroposterior distance (A); anteroposterior distance of the femur's lateral condyle (B); height of the femur's lateral condyle (C); anteroposterior distance of the tibial plateaus (AB); tibial slope. In addition, three morphological ratios were calculated: B/AB; B/XY; XY/AB (Porto ratio). RESULTS: Most of bone morphological parameters were different between genders (P < 0.05). ACL-ruptured female subjects showed statistical significant smaller condyle heights (C), smaller distances of the flattened surface of the distal femoral condyle (XY), smaller tibial plateau anteroposterior distances (AB), and higher XY/AB ratio (P < 0.05). ACL-ruptured male subjects had statistical significant smaller condyle height (C), anteroposterior distance of the femur's lateral condyle (B), tibial plateau anteroposterior distances (AB), and tibial slope (P < 0.05). Multivariate logistic regression model showed that five morphological parameters (A, XW, XY, XZ, and AB) were significantly associated with ACL rupture (AUC = 0.967, P < 0.001). Calculated ratios (XY/AB; B/AB; B/XY) showed a significant accuracy in identifying individuals with ACL injury (P < 0.001). CONCLUSIONS: The most important finding of this study was that the calculated ratios (XY/AB; B/AB; B/XY) showed a significant accuracy in identifying the individuals with and without an ACL injury. Within this line, a longer flat surface of the lateral femoral condyle or higher Porto ratio (XY/AB) is associated with a lower the risk of ACL injury. Moreover, when considering the combination of five primary bone morphology and morphometric parameters (A, XW, XY, XZ, and AB), the accuracy in identifying these individuals was excellent (AUC = 0.967). These findings may contribute to injury risk assessment, sports participation, and injury prevention counseling and surgical planning refining by identifying high-risk patients who would benefit from the addition of associated procedures to the anatomic ACL reconstruction aiming the improvement of knee stability and decrease the risk of further injuries. LEVEL OF EVIDENCE: III, case-control study.

Quality of life in children with kidney transplant: Systematic review / La Calidad de vida en niños trasplantados renales: Revisión sistemática / Qualidade de vida em crianças transplantadas renais: Revisão sistemática

ABSTRACT Objective: To identify in the literature studies that evaluate the quality of life in pediatric patients with kidney transplant through use of specific, validated instruments in Pediatrics. Method: Systematic review of the literature with searches conducted in the following databases: Medline, PubMed, LILACS, CINAHL, SciELO and Cochrane Library. Main keywords: Quality of life, Kidney transplantation and Pediatrics. Results: A total of 366 studies were selected and eight observational studies were included that evaluated the quality of life of children with kidney transplant by means of evaluation instruments of quality of life. Conclusion: The quality of life of children with kidney transplant is inferior compared to healthy children. The post-transplant period presents better results compared to pre-transplant children. The identification of mental, physical and social conditions related to the quality of life of this population allows for better planning the assistance provided to them.

RESUMEN Objetivo: Identificar en la literatura estudios que evalúan la calidad de vida de pacientes pediátricos trasplantados renales a través de instrumentos específicos y validados en pediatría. Método: Revisión Sistemática de la Literatura con investigaciones realizadas en los bancos de datos: Medline, PubMed, LILACS, CINAHL, SciELO e Biblioteca Cochrane. Principales descriptores: Quality of life, Kidney transplantation and Pediatrics. Resultados: Se seleccionaron 366 estudios e incluyó ocho estudios observacionales que evaluaron la calidad de vida de los niños trasplantados renales por medio de instrumentos de evaluación de la Calidad de Vida. Conclusión: La calidad de vida de los niños trasplantados renales es inferior en comparación con los niños sanos. El período post trasplante presenta resultados mejores comparados a los niños pretrasplante. La identificación de las condiciones mentales, físicas y sociales relacionadas a la Calidad de Vida de esa población abre posibilidades para la mejor planificación de la asistencia prestada.

RESUMO Objetivo: Identificar na literatura estudos que avaliam a qualidade de vida de pacientes pediátricos transplantados renais através de instrumentos específicos e validados em pediatria. Método: Revisão Sistemática da Literatura com pesquisas realizadas nos bancos de dados: Medline, PubMed, LILACS, CINAHL, SciELO e Biblioteca Cochrane. Principais descritores: Quality of life, Kidney transplantation and Pediatrics. Resultados: Foram selecionados 366 estudos e incluído oito estudos observacionais que avaliaram a qualidade de vida das crianças transplantadas renais por meio de instrumentos de avaliação da Qualidade de Vida. Conclusão: A qualidade de vida de crianças transplantadas renais é inferior quando comparadas as crianças saudáveis. O período pós transplante apresentam resultados melhores comparadas às crianças pré-transplante. A identificação das condições mentais, físicas e sociais relacionadas à Qualidade de Vida dessa população abre possibilidades para o melhor planejamento da assistência prestada.