Genomic full-length sequence of the HLA-B*13:64 allele was identified in a Chinese bone marrow donor.

Genomic full-length sequence of HLA-B*13:64 was identified in a Chinese individual by sequence-based typing.

Injerto de tejido conectivo en combinación con la técnica de colgajo lateralmente cerrado para el tratamiento de recesiones gingivales anteroinferiores: resultado clínico y revisión sistemática comparativa / Connective tissue grafting in combination with the laterally closed flap technique for the treatment of anteroinferior gingival recessions: Clinical outcome and comparative systematic review

Objetivo: evaluar la eficacia clínica de latécnica del túnel lateralmente cerrado coninjerto de tejido conectivo en recesiones gingivales unitarias en el área antero inferior, mediante una serie de seis casos. Otro de los objetivos fue realizar una revisión de la literatura para comparar la eficacia de la técnica de técnica del túnel lateralmente cerrado frente a la técnica de colgajo de avance coronal con injerto de tejido conectivo. Material y métodos: seis pacientes con recesiones gingivales antero inferiores fueron tratados mediante la técnica del túnel lateralmente cerrado. Se recogieron distintas variables clínicas periodontales, especialmente la profundidad de la recesión para calcular el porcentaje de cobertura radicular de dicha técnica. Por otra parte, se realizó una revisión bibliográfica basada en la siguiente pregunta PICO:P (pacientes con recesiones gingivales unitarias en dientes anteriores mandibulares), I (técnica del túnel lateralmente cerrado con injerto de tejido conectivo),C (técnica de colgajo avance coronal),O (analizando profundidad de sondaje, profundad de recesión, nivel de inserción clínica, ancho de tejido queratinizado, grosor gingival, cobertura radicular mediay cobertura radicular completa). Resultados: en la serie de casos se obtuvo una cobertura radicular media del 96. 67% ± 8.17 %, siendo este resultado estadísticamente significativo. Al igual que en la reducción de la profundidad de recesión (p=0,001), del nivel de inserción clínica (p=0,003) y en la ganancia de anchura de tejido queratinizado (p=0,001) y grosor gingival (p<0,001). No siendo significativo la reducción de la profundidad de sondaje. En cuanto a la revisión sistemática, se comprobó que la profundidad de sondaje fue mayor en la técnica de colgajo de avance coronal,mientras que se obtuvieron mejores ganancias de anchura de tejido queratinizado con la técnica de túnel lateralmente cerrado...(AU)

Objective: To evaluate the clinical efficacy of the laterally closed tunnel technique with connective tissue grafting in single gingival recessions in the antero inferior area, using a series of six cases. Another objective was to carry out a review to compare the efficacy of the laterally closed tunnel technique versus the coronal advancement flap technique with connective tissue graft. Material and methods: Six patients with antero inferior gingival recessions were treated using the laterally closed tunnel technique. Different periodontal clinical variables were collected, especially the depth of recession to calculate the percentage of root coverage of this technique. On the other hand, a literature review was carried out based on the following PICO question: P (patients with single gingival recessions in mandibular anterior teeth), I (laterally closed tunnel technique with connective tissue graft),C (coronal advancement flap technique),O (analysing probing depth, recession depth, clinical attachment level, width of keratinised tissue, gingival thickness,average root coverage and complete root coverage). Results: In the case series a mean root coverage of 96.67% ± 8.17 % was obtained, this result being statistically significant. The same was true for the reduction in recession depth (p=0.001), clinical attachment level (p=0.003) and the gain in keratinised tissue width (p=0.001) and gingival thickness (p<0.001). The reduction in probing depth was not significant. In terms of the systematic review, it was found that probing depth was greater in the coronal advancement flap technique, while better gains in keratinised tissue width were obtained with the laterally closed tunnel technique. Conclusions: The laterally closed tunnel technique...(AU)

Morte na doação de órgãos e tecidos: discursos dos profissionais de saúde / Death in organs and tissues donation: speeches of health professionals / Muerte en la donación de órganos y tejidos: discursos de profesionales de la salud

Objetivou-se identificaros discursos que atravessam os profissionais de saúde ao significar a morte no contexto de doação de órgãos e tecidos para transplante. Estudo qualitativo desenvolvido com 24 profissionais de saúde de dois hospitais de ensino do Rio Grande do Sul, Brasil. Os dados foram coletados por meio de entrevista semi estruturada, sendo realizada análise de conteúdo convencional, operacionalizando com a noção de discurso de Michel Foucault. Obteve-se aprovação por um comitê de ética. Foram produzidas onze categorias, sendo elas: discurso da morte como tabu; da finitude; da aceitação e resignação; da centralidade do coração; do sujeito cerebral; do utilitarismo, político, da tecnologia; da religião; da empatia; da dádiva, da caridade e do amor ao próximo. Diante disso,evidenciaram-se, a partir dos discursos que os atravessam os profissionais, que eles buscam dar novo significado à morte por meio da doação de órgãos e tecidos.

The objective was to identify health professional's statements when talking about death in the context of organ and tissue donation for transplantation. It is a qualitative study developed with 24 health professionals from two teaching hospitals in Rio Grande do Sul, Brazil. The data was collected through semi-structured interviews, and conventional content analysis was carried out, operating with the notion of speech by Michel Foucault. The study was approved by an ethics committee. Eleven categories were produced, namely: discourse of death as a taboo; finitude speech; discourse of acceptance and resignation; discourse of the centrality of the heart; the cerebral subject; utilitarianism, politics, technology; religion; empathy; gift, charity and love for the other. In view of this, it was evident from their discourses that they seek to give new meaning to death through the donation of organs and tissues.

El objetivo era identificar los discursos por los que pasan los profesionales de la salud cuando esto significa la muerte en el contexto de la donación de órganos y tejidos para el trasplante. Estudio cualitativo desarrollado con 24 profesionales de la salud de dos hospitales docentes en Rio Grande do Sul, Brasil. Los datos se recopilaron a través de entrevistas semiestructuradas, y se realizó un análisis de contenido convencional, operando con la noción de discurso de Michel Foucault. La aprobación fue obtenida por un comité de ética. Se produjeron once categorías, a saber: el discurso de la muerte como un tabú; finitud; aceptación y resignación; la centralidad del corazón; el sujeto cerebral utilitarismo, política, tecnología; de religión; empatía; de don, caridad y amor al prójimo. Por lo tanto, era evidente, a partir de los discursos que pasan los profesionales, que buscan dar un nuevo significado a la muerte mediante la donación de órganos y tejidos.

Colgajo adipofascial de flujo reverso del dorso del antebrazo para reconstrucción de la mano y muñeca: nuestra experiencia clínica / Back Forearm Reverse Flow Adipofascial Flap for hand and wrist reconstruction: our clinical experience

Los defectos cutáneos de la mano pueden ser difíciles de resolver. La cobertura cutánea es esencial para proveer una protección adecuada y permitir el funcionamiento correcto de las estructuras subyacentes. El objetivo de este estudio es reportar nuestra experiencia con el uso del colgajo adipofascial de flujo reverso del dorso del antebrazo para cobertura del dorso de la mano, dedos y muñeca en pacientes tratados en la ciudad de San Cristóbal, Estado Táchira, desde mayo de 2015 hasta enero de 2018. Se realizó un estudio longitudinal, descriptivo y prospectivo en pacientes con pérdidas cutáneas extensas de la mano, que fueron cubiertas con el colgajo adipofascial reverso del dorso del antebrazo. Se incluyeron 10 pacientes. 90% de sexo masculino. La edad promedio fue 41±12,32(13-69). La etiología de los defectos fue: 40% traumatismos de alta energía, 30% mano diabética tropical, 10% secuela de quemadura de segundo grado, 10% herida por arma de fuego artesanal, 10% carcinoma primario de piel. 100% de los colgajos sobrevivieron, logrando buena cobertura y cicatrización sin necesidad de otros procedimientos quirúrgicos y con mínimas complicaciones de la zona dadora. La función de la mano y muñeca se recuperó en todos los pacientes. En conclusión, el colgajo adipofascial de flujo reverso del antebrazo es un procedimiento útil, versátil y sencillo para la reconstrucción del dorso de la mano, dedos y cara volar de muñeca en pacientes de distintas edades(AU)

Hand skin defects can be difficult to resolve. Skin coverage is essential to provide adequate protection and allow proper function of the underlying structures. The objective of this study is to report our experience with the use of the Back Forearm Reverse Flow Adipofascial Flap to cover the back of the hand, fingers and wrist in patients treated in the city of San Cristóbal, Táchira State, since may 2015 to january 2018. A longitudinal, descriptive and prospective study was made in patients with extensive skin losses of the hand, which were covered with the Back Forearm Reverse Flow Adipofascial Flap. 10 patients were included. 90,0% male. Mean age 41±12.32(13-69) years. The etiology of the defects was: 40,0% high-energy trauma, 30,0% tropical diabetic hand, 10,0% second degree burn sequel, 10,0% handcrafted firearm wound, 10,0% primary skin carcinoma. 100,0% of the flaps survived, achieving good coverage and healing without the need for other surgical procedures and with minimal complications in the donor area. Hand and wrist function recovered in all patients. In conclusion, the reverse flow adipoascial flap of the forearm is a useful, versatile and simple procedure for the reconstruction of the back of the hand, fingers and volar face of the wrist in patients of different ages(AU)

Comparação de duas técnicas cirúrgicas para recobrimento radicular de recessões unitárias: ensaio clínico paralelo, randomizado e duplo cego / Comparison of two surgical techniques for root coverage of single-unit recessions: parallel, randomized, double-blind clinical trial

As crescentes demandas dos pacientes pelo tratamento das recessões gengivais trazem à tona questões terapêuticas clinicamente significativas, exigindo dos profissionais constante aperfeiçoamento em técnicas cirúrgicas cada vez menos invasivas e mais previsíveis. OBJETIVO: Comparar duas técnicas para recobrimento radicular em recessões gengivais unitárias, unilaterais, do tipo 1. METODOLOGIA: Este estudo clínico, paralelo, randomizado e duplo cego avaliou indivíduos com recessões gengivais unitárias, unilaterais, do tipo 1 (RT1), submetidos à cirurgia para recobrimento radicular, através da associação do enxerto de tecido conjuntivo subepitelial ao retalho posicionado coronalmente (grupo controle) e técnica de túnel (grupo teste). Os principais parâmetros avaliados foram profundidade de sondagem (PS), sangramento à sondagem (SS), nível clínico de inserção (NCI), recessão gengival (RG), faixa e espessura da mucosa ceratinizada (MC e EG), percentual de recobrimento radicular (RR) e fenótipo gengival (FG), além de fatores centrados no paciente (FCP), como dor pós-operatória, hipersensibilidade dentinária cervical (HSDC), estética, grau de satisfação e a qualidade de vida, intra e intergrupo, ao longo de 06 meses de acompanhamento. Os dados foram analisados estatisticamente através dos testes t emparelhado de Student, teste t para amostras independentes, Qui-quadrado, McNemar, Análise de Variância Split-Plot com pós-teste t de Student (α = 5%). RESULTADOS: 46 indivíduos finalizaram este estudo (controle: 23; teste: 23). O tempo de cirurgia foi maior para o grupo teste (controle: 40min ± 5,6; teste: 51min ± 5,9; p = 0,041). Foram observadas reduções estatisticamente significativas para a RG e ganho significativo do NCI, de MC e de EG na análise intragrupo, em ambos os grupos de tratamento, porém, sem diferenças entre as técnicas. O RR aumentou significativamente nos períodos avaliados, mas não foram observadas diferenças intergrupo (controle: 89,2%; teste: 86,5%; p = 0,069). A análise intragrupo revelou mudança de FG (controle: 95,65%; teste: 91,3%; p < 0,001). Ambos os protocolos de tratamento reduziram dor pós-operatória e HSDC, e proporcionaram melhora na estética, satisfação e na qualidade de vida (p < 0,001), sem diferenças entre as técnicas ao longo do tempo. CONCLUSÃO: Ambos os tratamentos apresentaram eficácia clínica semelhante em termos de recobrimento radicular e melhora dos FCP (AU).

The increasing demands of patients for the treatment of gingival recessions bring up clinically significant therapeutic issues, requiring professionals to constantly improve in less invasive and more predictable surgical techniques. AIM: To compare two root coverage techniques to treat single, unilateral, type 1 gingival recessions. METHOD: This parallel, randomized, doubleblind clinical trial evaluated individuals with single, unilateral, type 1 gingival recessions 1 (RT1), who underwent root coverage procedure with subepithelial connective tissue graft associated to a coronally advanced flap (control group) or a tunnel technique (test group). The main parameters evaluated were probing depth (PD), bleeding on probing (BoP), clinical attachment level (CAL), gingival recession (GR), heigth of keratinized tissue (KTH), gingival thickness (GT), percentage of root coverage (RC) and gingival phenotype (GP), in addition to patient-reported outcome measures (PROMs), such as postoperative pain, cervical dentin hypersensitivity (CDH), esthetics, degree of satisfaction and quality of life, intra and intergroup, throughout 06 months follow-up. Data were statistically analyzed using paired Student t-test, t-test for independent samples, Chi-square, McNemar, Split-Plot Analysis of Variance with post hoc t-test (α = 5%). RESULTS: 46 subjects completed this study (control: 23; test: 23). Surgery time was longer for the test group (control: 40min ± 5.6; test: 51min ± 5.9; p = 0.041). Statistically significant reductions for GR and significant gain for CAL, KTH and GT were observed in the intragroup analysis, in both treatment groups, however, without differences between techniques. The CR increased significantly, but no intergroup differences were observed (control: 89.2%; test: 86.5%; p = 0.069). Intragroup analysis revealed a change in GP (control: 95.65%; test: 91.3%; p < 0.001). Both treatment protocols reduced postoperative pain and CDH and improved esthetics, satisfaction and quality of life (p < 0.001), with no differences between the techniques over time. CONCLUSION: Both treatments showed similar clinical efficacy in terms of root coverage and improvement in PROMs (AU).

Microsurgical Reconstruction in an Orthopedic Hospital: Indications and Outcomes in Adults / Reconstrução microcirúrgica em um hospital ortopédico: Indicações e desfechos em adultos

Abstract Objective Advances in reconstructive microsurgery in orthopedic surgery provided better functional and aesthetic results and avoided many indications for amputation. In high-volume trauma and orthopedic hospitals, microsurgical reconstruction is essential to reduce costs and complications for these complex orthopedic defects. We describe a microsurgical approach to traumatic wounds, tumor resection, bone defects, and free muscle transfer, performed by an orthopedic microsurgery unit. The objective of the present study was to evaluate predictor factors for outcomes of microsurgical flaps for limb reconstruction, and to provide a descriptive analysis of microsurgical flaps for orthopedic indications. Methods Cross-sectional prospective study that included all consecutive cases of microsurgical flaps for orthopedic indications from 2014 to 2020. Data were collected from personal medical history, intraoperative microsurgical procedure, and laboratory blood tests. Complications and free-flap outcomes were studied in a descriptive and statistical analysis. Results We evaluated 171 flaps in 168 patients; the indications were traumatic in 66% of the patients. Type III complications of the Clavien-Dindo Classification were observed in 51 flaps. The overall success rate of the microsurgical flaps was 88.3%. In the multivariate analysis, the risk factors for complications were ischemia time ≥ 2 hours (p= 0.032) and obesity (p= 0.007). Partial flap loss was more common in patients with thrombocytosis in the preoperative platelet count (p= 0.001). Conclusion The independent risk factors for complications of microsurgical flaps for limb reconstruction are obesity and flap ischemia time ≥ 2 hours, and presence of thrombocytosis is a risk factor for partial flap loss.

Resumo Objetivo Os avanços da microcirurgia reconstrutiva na cirurgia ortopédica proporcionaram melhores resultados funcionais e estéticos, evitando as muitas indicações de amputação. Nos hospitais de ortopedia e traumatologia com um grande volume de atendimento, a reconstrução microcirúrgica é essencial, a fim de reduzir os custos e as complicações destes complexos defeitos ortopédicos. Descrevemos uma abordagem microcirúrgica para feridas traumáticas, ressecção tumoral, defeitos ósseos e transferência muscular livre realizada por uma unidade ortopédica especializada em microcirurgia. O objetivo do presente estudo é avaliar os fatores preditivos de resultados dos retalhos microcirúrgicos na reconstrução dos membros, fornecendo uma análise descritiva dos retalhos microcirúrgicos para as indicações ortopédicas. Métodos Estudo prospectivo transversal, que incluiu todos os casos consecutivos de retalhos microcirúrgicos com indicação ortopédica de 2014 a 2020. Foram coletados os dados do histórico clínico pessoal, procedimentos microcirúrgicos intraoperatórios e exames laboratoriais. As complicações e os desfechos de retalho livre foram estudados mediante uma análise descritiva e estatística. Resultados Avaliamos 171 retalhos em 168 pacientes. A indicação mais frequente para a realização de um retalho microcirúrgico foi a traumática, em 66% dos pacientes. Foram observadas complicações cirúrgicas em 51 retalhos, conforme a classificação de Clavien-Dindo do tipo III. A taxa de êxito global dos retalhos microcirúrgicos foi de 88,3%. Na análise multivariada, foram identificados como fatores de risco para complicações tempo de isquemia ≥ 2 horas (p= 0,032) e obesidade (p= 0,007). A perda parcial do retalho foi mais comum em pacientes com trombocitose, com contagem de plaquetas pré-operatória (p= 0,001). Conclusão Os fatores de risco independentes para complicações de retalhos microcirúrgicos para a reconstrução de membro são obesidade e tempo de isquemia do retalho ≥ 2 horas, e a presença de trombocitose como fator de risco para perda parcial do retalho.

Colgajo submentoniano en la reconstrucción decabeza y cuello / Submental flap in head and neck reconstruction

Introducción. Los colgajos del territorio de la arteria submentoniana pueden ser utilizados como un colgajo cutáneo, musculofacial y osteocutáneo, realizando cierres primarios del defecto del sitio donante, sin generar defectos funcionales ni estéticos mayores. Métodos. Describir la experiencia de nuestro equipo quirúrgico, las complicaciones relacionadas con el uso del colgajo y los resultados oncológicos, así como los desenlaces tardíos durante el seguimiento de los pacientes incluidos en el estudio. Resultados. Se incluyeron veintiún pacientes, con una edad media de 66 años (rango 52 - 86), con patología oncológica de lengua, labio inferior, paladar blando, nariz, órbita y orofaringe. Todos los pacientes fueron sometidos a disección selectiva ipsilateral del cuello, tras la extracción del colgajo y en todos los casos se preservó el nervio mandibular marginal. Se registraron complicaciones como la necrosis parcial. La estancia hospitalaria media fue de 8 días.Conclusiones. El colgajo de la arteria submentoniana ha mostrado resultados favorables debido a su uso versátil, amplio arco de rotación, color y baja morbilidad del sitio donante. Se recomienda realizar estudios más robustos, que incluyan la experiencia de diversos especialistas en países que compartan las mismas limitaciones técnicas y características sociodemográficas.

Introduction. Flaps from the territory of the submental artery can be used as a cutaneous, musculofacial and osteocutaneous flap, performing primary closure of the donor site defect, without generating major functional or aesthetic defects. Methods. To describe the experience of the same surgical team, the complications related to the use of the flap and the oncological results, as well as the late outcomes during the follow-up of the patients included in the study. Results. Twenty-one patients with a mean age of 66 years (range: 52-86), with oncological pathology of the tongue, lower lip, soft palate, nose, orbit, and oropharynx were included. All patients underwent ipsilateral selective neck dissection after flap removal, and in all cases the marginal mandibular nerve was preserved. Complications such as partial necrosis were recorded. The mean hospital stay was 8 days. Conclusions. The submental artery flap has shown favorable results due to its versatile use, wide arc of rotation, color, and low donor site morbidity. More robust studies are recommended, including the experience of various specialists in countries sharing the same technical limitations and sociodemographic characteristics.

Colgajo de reposición coronal, con y sin injerto de tejido conectivo, para tratar recesiones gingivales / Coronally repositioned flap with and without connective tissue graft to treat gingival recession

Introducción: Las recesiones gingivales son afecciones de las encías, que son muy frecuentes y podrían provocar repercusiones estéticas, hipersensibilidad dentinaria y tener más tendencia a la formación de lesiones cervicales. Es necesario recubrir la superficie radicular mediante técnicas regenerativas periodontales. Objetivo: Comparar la cantidad de recubrimiento radicular, la profundidad al sondaje y el nivel de inserción clínica, empleando las técnicas de colgajo de reposición coronal, con y sin injerto de tejido conectivo, en pacientes con recesiones gingivales Miller I y II. Métodos: Se incluyeron un total de 16 pacientes con recesiones gingivales Miller clase I y II, de los cuales se seleccionaron 50 piezas dentarias tratadas quirúrgicamente para cubrir las recesiones. Se utilizaron las técnicas de colgajo de reposición coronal, con y sin injerto de tejido conectivo. Las mediciones clínicas fueron comparadas al inicio y a los tres meses posoperatorios. Resultados: Al tercer mes poscirugía los resultados del recubrimiento radicular, profundidad al sondaje y el nivel de inserción clínica para la técnica colgajo de reposición coronal con injerto de tejido conectivo, fueron 0,96 ± 1,33; 0,87 ± 0,63; 1,83 ± 1,7 y para la técnica colgajo de reposición coronal fueron 1,44 ± 1,19; 1,04 ± 0,52; 2,48 ± 1,48, respectivamente. Al comparar el recubrimiento radicular intergrupo no se encontraron diferencias significativas (p = 0,11). Sin embargo, al comparar la profundidad al sondaje intergrupo (p = 0,04), el nivel de inserción clínica intergrupo (p = 0,001) y todas las mediciones clínicas intragrupo (p = 0,001), se encontraron diferencias significativas. Conclusiones: La técnica de colgajo de reposición coronal, con y sin injerto de tejido conectivo, demostró diferencias significativas en la profundidad al sondaje y el nivel de inserción clínica en recesiones gingivales Miller I y II. No se alcanzaron diferencias significativas para el recubrimiento radicular en ambas técnicas a los 3 meses de seguimiento(AU)

Introduction: Gingival recession is a very common gum condition which may result in aesthetic alterations and dentin hypersensitivity, and increase the probability of cervical lesions. It is necessary to cover the root surface using periodontal regeneration techniques. Objective: Compare the amount of root coverage, probing depth and clinical insertion level, using coronally repositioned flap techniques with and without connective tissue graft in patients with Miller I and II gingival recessions. Methods: A total 16 patients with Miller class I and II gingival recessions were included in the study, from whom 50 teeth were selected which had been treated surgically to cover the recessions. The techniques used were coronally repositioned flap with and without connective tissue graft. Clinical measurements were compared at the start of the postoperative period and three months later. Results: Three months after surgery, root coverage, probing depth and clinical insertion level were 0.96 ± 1.33; 0.87 ± 0.63; 1.83 ± 1.7, respectively, for coronally repositioned flap with connective tissue graft, and 1.44 ± 1.19; 1.04 ± 0.52; 2.48 ± 1.48, respectively, for coronally repositioned flap. Root coverage intergroup comparison did not find any significant differences (p = 0.11). However, intergroup comparison of probing depth (p = 0.04) and clinical insertion level (p = 0.001), and all the intragroup clinical measurements (p = 0.001) did find significant differences. Conclusions: Coronally repositioned flap technique with and without connective tissue graft showed significant differences in terms of probing depth and clinical insertion level in Miller I and II gingival recessions. At three months' follow-up, no root coverage significant differences were observed for either technique(AU)

Recomendaciones para reactivar y mantener los servicios de donación y trasplante en el contexto de la COVID-19 en América Latina

La pandemia de COVID-19 ha tenido unos efectos sin precedentes en la población, las economías y los servicios de salud de todo el mundo. Pese a las medidas adoptadas para mitigar su impacto, las consecuencias para los sistemas de salud se han hecho evidentes; por ejemplo, en América Latina y el Caribe, donde la actividad de donación y trasplante se ha reducido de manera considerable y, en algunos países, se ha interrumpido por completo. Las presentes recomendaciones de la Organización Panamericana de la Salud tratan de promover el mantenimiento de los servicios de donación y trasplante aun en el curso de la pandemia de COVID-19. Además, plantean sugerencias que puedan tenerse en cuenta en otras situaciones de emergencia de salud o pandemias en las que se requieran medidas de gestión y prevención del riesgo de infecciones. Esta publicación está dirigida a ministerios de salud, organizaciones, organismos o programas nacionales de donación y trasplantes, así como a responsables de la toma de decisiones en este ámbito, profesionales de la salud y otros interesados en la donación y trasplante. Cada país puede adaptar estas recomendaciones a su contexto y ajustarlas periódicamente de acuerdo con la mejor evidencia científica disponible y la experiencia adquirida desde el inicio de la pandemia.

La fijación con tornillo de interferencia tibial cuadrante específico permite un constante desplazamiento de los injertos de tejido dentro de tuneles tibiales mal poscionados: análisis cuantitativo de ligamento cruzado anterior en porcinos / Quadrant specific tibial interference screw fixation allows constant displacement of soft tissue grafts inside misplaced tibial tunnels: a porcine anterior cruciate ligament quantitative assessment study

INTRODUCCIÓN El error técnico más común durante la reconstrucción del ligamento cruzado anterior (LCA) es la ubicación incorrecta del túnel. Es incierto si un túnel tibial mal ubicado puede corregirse en el intraoperatorio. OBJETIVO Medir el desplazamiento del injerto de tejido blando con tornillos de interferencia tibial.MATERIALES Y MÉTODOS Estudio experimental ex vivo en 28 rodillas porcinas. Se cosechó el tendón flexor de la extremidad posterior, que fue duplicado y dimensionado para que pasara a través de un túnel tibial mal posicionado. Las muestras se dividieron en 4 grupos según el cuadrante de entrada (anterior [A], posterior [P], medial [M], o lateral [L]) de un tornillo de interferencia tibial de 9 mm con relación al injerto. Se ubicó una regla milimétrica en la meseta tibial, la cual fue fotografiada con una cámara EOS T6 (Canon Inc., Ota, Tokio, Japón), y la imagen fue digitalizada, y puesta en escala a tamaño. La distancia y dirección de los desplazamientos del injerto se midieron con Adobe Photoshop CC 2019 (San José, CA, EEUU). Se analizaron las diferencias medias entre los grupos por análisis de la varianza (analysis of variance, ANOVA, en inglés) unidireccional. El análisis estadístico se realizó con el programa Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Armonk, NY, EEUU), versión 25.0 (p ≤ 0,05)).RESULTADOS La distancias medias de los desplazamientos del injerto fueron similares en todos los grupos: A ­ 4,4 mm; P ­ 4,6 mm; M ­ 4,5 mm; y L ­ 4,3 mm, sin diferencias estadísticamente significativas (p = 0,894). Las direcciones medias de los desplazamientos del injerto también fueron similares entre los 4 grupos: A ­ 176° (desviación estándar [DE]: ± 15,4°); P ­ 165° (DE: ± 16,6°); M ­ 166° (DE: ± 12,1°); y L ­ 169° (DE: ± 10,6°). No se encontraron diferencias estadísticamente significativas (p = 0.42).CONCLUSIONES Independientemente del cuadrante de entrada, se observó un desplazamiento constante del injerto hacia el lado opuesto cuando el tornillo tibial alcanzaba la superficie articular. Relevancia clínica: el tornillo tibial mal posicionado puede corregirse en el intraoperatorio con fijación proximal en cuadrante específico, y debe alcanzar la superficie articular para generar un desplazamiento efectivo del injerto. Sin embargo, no podemos predecir la magnitud de error en todos los túneles mal brocados, que debe ser evaluada caso a caso.

BACKGROUND The most common technical error during anterior cruciate ligament (ACL) reconstruction is incorrect tunnel placement. It remains unclear if a misplaced tibial tunnel may be corrected intraoperatively. AIM To measure the displacement of soft-tissue grafts with tibial interference screws. MATERIALS AND METHODS Ex-vivo experimental study in 28 porcine knees. The flexor tendon of the posterior limb was harvested, doubled and sized to fit through a 9-mm misplaced tibial tunnel. The specimens were divided into 4 groups according to the quadrant of entry (anterior [A], posterior [P], medial [M], or lateral [L]) of a 9-mm tibial interference screw in relation to the graft. A millimetric ruler was placed at the tibial plateau, which was photographed with a an EOS T6 (Canon Inc., Ota, Tokio, Japan) camera, and the image was digitalized and scaled to size. The length and direction of the graft displacements were measured with Adobe Photoshop CC 2019 (San José, CA, US). The mean differences among the groups were analyzed through one-way analysis of variance (ANOVA). The statistical analysis was performed using the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Armonk, NY, US) software, version 25.0 (p 0.05) RESULTS The mean lengths of the graft displacements were similar among the groups: A ­ 4.4 mm; P ­4.6 mm; M ­ 4.5 mm; and L ­ 4.3 mm, without statistically significant differences (p » 0.894). The mean directions of the graft displacements were also similar among the groups: A ­ 176° (standard deviation [SD]: 15.4°); P ­ 165° (SD: 16.6°); M ­ 166° (SD: 12.1°); and L ­ 169° (SD: 10.6°). No statistically significant differences were found (p » 0.42). CONCLUSIONS Regardless of the entry quadrant, constant graft displacement to the opposite side was observed when the tibial screw reached the articular surface. Clinical relevance: a misplaced tibial tunnel may be corrected intraoperatively with a quadrantspecific screw, which must reach the articular surface to produce an effective graft displacement. Nevertheless, we cannot predict the magnitude of this error in every poorly-drilled tibial tunnel; it should be assessed case by case.

Tissue selecting technique for adult women with low rectovaginal fistula.

BACKGROUND: This study aimed to assess the effect of tissue selecting technique (TST) on low rectovaginal fistula (RVF) repair. METHODS: Patients with low RVF were included in the prospective study from August 2009 and January 2013 in xx hospital. Patients assigned to the TST or control groups based on the different surgical methods. Surgical success, complications, and quality of life were evaluated. Patients were followed up for 1-3 years. RESULTS: A total of 81 patients were included in the study. Foutry-one were in the TST group, and 40 were in the control group. Surgery was successful in 100% of patients who underwent TST, and in 95% of patients who underwent the classical perineal approach. Less patients experienced pain (72% vs 90%, p = 0.04) and edema (6% vs 25%, p < 0.001) in the TST group compared with the control group. In addition, the QOL score was significantly higher in the TST group (122 ± 21 vs 111 ± 12, p = 0.02). CONCLUSION: The TST stapler approach appears to be appropriate for the treatment of low RVF in adults.

Functional outcome after single-stage laryngotracheal reconstruction with rib cartilage grafting.

OBJECTIVE: Single-stage laryngotracheal reconstruction (SSLTR) provides a definite surgical treatment for patients with complex glotto-subglottic stenosis. To date, the influence of SSLTR on the functional outcome after surgery has not been analyzed. METHODS: A retrospective analysis of all patients receiving a SSLTR between November 2012 and October 2019 was performed. Preoperatively and 3 months postoperatively, patients received a full functional evaluation, including spirometry; voice measurements (eg, fundamental frequency; dynamic range, singing voice range, and perceptual voice evaluation using the Roughness-Breathiness-Hoarseness [RBH] score, and fiberoptic endoscopic evaluation of swallowing [FEES]). RESULTS: A total of 15 patients with a mean age of 45 ± 17 years underwent SSTLR. Two (13%) patients were men and 13 (87%) were women. The majority of patients (67%) had undergone previous surgical or endoscopic treatment attempts that had failed. At the 3-month follow-up visit, none of the patients had signs of penetration or aspiration in their swallowing examination. Voice measurements revealed a significantly lower fundamental voice frequency (201.0 Hz vs 155.5 Hz; P = .006), whereas voice range (19.1 semitones vs 14.9 semitones; P = .200) and dynamic range (52.5 dB vs 53.0 dB; P = .777) was hardly affected. The median RBH score changed from R1 B0 H1 to R2 B1 H2. In spirometry, breathing capacity increased significantly (peak expiratory flow, 44% vs 87% [P < .001] and mean expiratory flow at 75% of vital capacity, 48% vs 90% [P < .001]). During a median follow-up of 32.5 months (range, 7-88 months), none of the patients developed re-stenosis. CONCLUSIONS: For complex glotto-subglottic stenoses, durable long-term airway patency together with reasonable voice quality and normal deglutition can be achieved by SSLTR.

Tratado de regulação para avaliação especializada em transplante, via SUS, em Goiás / Regulatory treaty for specialized evaluation in transplantation, through SUS, in Goiás

Aborda sobre o atendimento por modalidade de transplantes via SUS, em Goiás. Apresenta as unidades de saúde e profissionais responsáveis. Discorre sobre o fluxo de regulação de transplantes no estado, o fluxo de exames para a inscrição, manutenção e acompanhamento do potencial receptor, os direito dos usuários dos serviços de transplantes e o tratamento fora do domicílio. Orienta sobre o Fluxo Geral de Regulação para Consulta de Avaliação em Transplantes

It addresses the care by type of transplant via SUS in the state of Goiás. It presents the health units and responsible professionals. It discusses the flow of regulation of transplants in the state, the flow of exams for the registration, maintenance and monitoring of the potential recipient, the rights of users of transplant services and treatment outside the home. Guidance on the General Regulation Flow for Evaluation Consultation in Transplants

Aborda la atención por tipo de trasplante vía SUS en el estado de Goiás. Presenta las unidades de salud y los profesionales responsables. Discute el flujo de regulación de trasplantes en el estado, el flujo de exámenes para el registro, mantenimiento y seguimiento del potencial receptor, los derechos de los usuarios de los servicios de trasplante y el tratamiento fuera del hogar. Guías sobre el Reglamento General de Flujo para la Consulta de Evaluación en Trasplantes

Posterior rehabilitation using 3D-printed dental implants and synthetic regenerative biomaterials / Reabilitação posterior com implantes impressos e biomateriais sintéticos

Aim: To describe through a clinical case report the surgical sequence of rehabilitation with 3D-printed implants associated with maxillary sinus floor lift with synthetic regenerative materials, including biphasic bioceramic. Case Report: Patient had an agenesis of the upper left premolars (#12 and #13), a vertical bone deficiency caused by maxillary sinus' pneumatization, and a horizontal alveolar resorption around the missing teeth area. During the surgical procedures, incisions, detachment, and osteotomy were performed in the lateral region of the maxillary sinus. The sinus membrane was detached and lifted 10 mm. Then, a thick poly(dioxanone)-based synthetic resorbable membrane (Plenum) was inserted and adapted inside the sinus to protect the sinus membrane. After the osteotomies with sub-instrumentation, 3D-printed implants (Plenum) were installed in the #12 area (3.5mm x 11.5 mm; 30N) and #13 area (4.0mm x 10mm; 20N). The maxillary sinus was entirely filled with a biphasic bioceramic, HA/ß-TCP (70:30) 500-1000 µm (Plenum) and covered by the same synthetic resorbable membrane. Connective tissue graft from the palatal area was positioned internally to the flap and stabilized with sutures to improve the vestibular tissue architecture. The entire surgical wound was sutured, and the tissues stabilized. No complications occurred in the postoperative period. Conclusion: The use of synthetic regenerative memberane and 3D-printed implants seems to be a promising option in areas of deficient bone remnants (AU)

Objetivo: Descrever por meio de um relato de caso clínico a sequência cirúrgica de reabilitação com implantes obtidos por impressão 3D associados à elevação do assoalho do seio maxilar com materiais regenerativos sintéticos, incluindo uma biocerâmica bifásica. Relato de Caso: Paciente apresentava agenesia dos pré-molares superiores esquerdos (24 e 25), deficiência óssea vertical causada pela pneumatização do seio maxilar e reabsorção alveolar horizontal ao redor da área dos dentes ausentes. Durante os procedimentos cirúrgicos foram realizados incisões, descolamento e osteotomia na região lateral do seio maxilar. A membrana sinusal foi descolada e elevada 10 mm. Em seguida, uma membrana reabsorvível sintética à base de poli(dioxanona) espessa (Plenum) foi inserida e adaptada dentro do seio para proteger a membrana do seio. Após as osteotomias com subinstrumentação, implantes impressos em 3D (Plenum) foram instalados na área do 24 (3,5mm x 11,5mm; 30N) e na área do 25 (4,0mm x 10mm; 20N). O seio maxilar foi inteiramente preenchido com biocerâmica bifásica, HA/ß-TCP (70:30)500-1000 µm (Plenum) e recoberto pela mesma membrana sintética reabsorvível. O tecido conjuntivo da região palatina foi posicionado internamente ao retalho e estabilizado com suturas para melhorar a arquitetura do tecido vestibular. Toda a ferida cirúrgica foi suturada e os tecidos estabilizados. Não ocorreram complicações no pós-operatório. Conclusão:A utilização de biomateriais regenerativos sintéticos e implantes impressos parece ser uma opção promissora em áreas de remanescentes ósseos deficientes.(AU)

Comparação de enxerto de tecido conjuntivo e membrana de fibrina rica em plaquetas (PRF) no aumento de espessura de tecido mole peri-implantar: reanálise de dados de ensaios clínicos randomizados / Comparison of conjunctive tissue graft and platelet-rich fibrine membrane (PRF) in the increase in peri-implant soft tissue thickness. Reanalysis of data from randomized controlled trials

O implante dentário é uma importante ferramenta para se obter resultados estéticos e funcionais em pacientes com ausências dentárias, porém é observado que a falta de tecido mole peri-implantar é frequente e pode levar a diversos problemas, como maior reabsorção de crista óssea e maior risco de recessão peri-implantar. Estudos anteriores demonstraram a eficácia de técnica como enxerto de tecido conjuntivo (CTG) que é considerado padrão ouro no aumento de tecido mole peri-implantar em região anterior de maxila. No entanto, a utilização de enxerto de tecido conjuntivo apresenta algumas limitações descrita na literatura, como maior desconforto pósoperatório e quantidade limitada de enxerto. Portanto, outras formas de enxerto de tecido mole para aumento de espessura do tecido periimplantar devem ser investigadas. Bons resultados foram obtidos quando utilizamos fibrina rica em plaquetas (PRF) para o tratamento de diversas condições periodontais e periimplantares. Sendo assim, o objetivo desse estudo é comparar a utilização de PRF com o CTG para aumento da espessura de tecido mole peri-implantar quando colocados simultaneamente a implantes unitários em área estética de maxila. Trinta pacientes advindos de dois estudos clínicos randomizados prévios do presente grupo de pesquisa foram reanalisados. Parâmetros clínicos foram mensurados por um avaliador cego e calibrado em baseline e 4 meses. As seguintes medidas foram avaliadas: espessura do tecido mole periimplantar em vestibular (ETQv) e na oclusal (ETQo) do implante instalado, defeito do rebordo (DR) e altura do tecido queratinizado (ATQ). Além disso, medidas transoperatórias foram reanalisadas. Frente aos resultados observados, o uso do CTG favoreceu melhores resultados em ETQv (3,09mm) e DR (0,27mm) após 4 meses, quando comparado ao PRF, ETQv (2,55mm) e DR (1,26mm). Em adição, avaliações frente à parâmetros centrados no paciente evidenciaram similaridade no desconforto pós-operatório e número de analgésicos utilizados. Conclui-se que os dois grupos apresentaram aumento de espessura do tecido periimplantar, porém o CTG demonstrou maior ganho relativo, até o período de acompanhamento preconizado (AU)

The dental implant is an important tool to obtain aesthetic and functional results in patients with missing teeth, however, it is observed that the lack of peri-implant soft tissue is frequent and can lead to several problems, such as greater bone crest resorption and greater risk peri-implant recession. Previous studies have demonstrated the effectiveness of a technique such as connective tissue grafting (CTG), which is considered the gold standard in the increase of peri-implant soft tissue in the anterior region of the maxilla. However, the use of connective tissue graft has some limitations described in the literature, such as greater postoperative discomfort and limited amount of graft. Therefore, other forms of soft tissue grafting to increase peri-implant tissue thickness should be investigated. Good results were obtained when using platelet-rich fibrin (PRF) for the treatment of various periodontal and peri-implant conditions. Therefore, the aim of this study is to compare the use of PRF with CTG to increase peri-implant soft tissue thickness when placed simultaneously with single implants in the esthetic area of the maxilla. Thirty patients from two previous randomized clinical trials of the present research group were reanalyzed. Clinical parameters were measured by a blinded evaluator and calibrated at baseline and 4 months. The following measurements were evaluated: peri-implant soft tissue thickness in the labial (ETQv) and occlusal (ETQo) of the installed implant, ridge defect (RD) and height of the keratinized tissue (ATQ). In addition, intraoperative measurements were reanalyzed. In view of the observed results, the use of CTG favored better results in ETQv (3.09mm) and RD (0.27mm) after 4 months, when compared to PRF, ETQv (2.55mm) and RD (1.26mm). In addition, evaluations against patient-centered parameters showed similarity in postoperative discomfort and number of analgesics used. It was concluded that both groups showed an increase in periimplant tissue thickness, but the CTG showed a greater relative gain, until the recommended follow-up period (AU)

Selamento de perfuração radicular associado a enxerto de tecido conjuntivo em área estética: relato de caso / Sealing of root perforation associated with connective tissue graft in aesthetic area: Case report

Introdução: Perfuração radicular é a comunicação entre as paredes do canal radicular e o espaço periodontal. O tempo, a localização e a dimensão da perfuração são fatores que afetam no prognóstico do dente. Objetivo: Relatar um caso clínico de tratamento de perfuração radicular supraóssea associado a enxertia de tecido conjuntivo em área estética. Relato do caso: Paciente relatou ter sido submetido, há 3 meses, ao tratamento endodôntico do dente #22; porém, esse não foi finalizado. Ao exame clínico, o dente apresentava ausência de dor e presença de fístula na região da gengiva inserida. As imagens radiográficas e tomográficas revelaram imagem sugestiva de perfuração radicular na região vestibular do dente #22, além de área hipodensa/radiolúcida circunscrita ao ápice radicular, conduzindo ao diagnóstico de periodontite apical assintomática associada a perfuração radicular supraóssea. Inicialmente, foi realizado preparo do canal radicular e utilizada medicação intracanal por 21 dias. Posteriormente, foi realizada a obturação do canal radicular e restauração definitiva em resina composta na face palatal. Na mesma sessão, foi realizado o acesso cirúrgico para selamento da perfuração com resina composta, associado a enxertia de tecido conjuntivo no dente #22, para evitar recessão tecidual marginal. Foi observada, após 12 meses, neoformação óssea na região periapical do dente #22, com ausência de dor e preservação da estética na região periodontal. Conclusão: O diagnóstico e o planejamento multidisciplinar são fatores importantes no tratamento de perfurações radiculares, assim como a correta escolha do material selador (AU).

Introduction: Root perforation is the communication between the walls of the root canal and the periodontal space. The time, location and size of the perforation are factors that affect the prognosis of the tooth. Objective: To report a clinical case of treatment of supraosseous root perforation associated with grafting of connective tissue in aesthetic area. Case report: Patient reported that 3 months had started root canal treatment of tooth 22, but was not finalized. At the clinical examination, the tooth presented absence of pain and presence of sinus tract in the region of attached gingiva. Radiographic and tomographic images revealed an image suggestive of root perforation in the buccal region of tooth 22, as well as a hypodense / radiolucent area circumscribed to the root apex, leading to the diagnosis of asymptomatic apical periodontitis associated with supraosseous root perforation. Initially, it were performed root canal preparation and intracanal medication. After 21 days, root canal obturation and composite restoration were performed on the palatal face. In the same session, the surgical access was made to sealing the perforation with composite resin, associated to the grafting of connective tissue in tooth 22, to avoid marginal tissue recession. It was observed after 12 months new bone formation in the periapical region of tooth 22, with absence of pain and preservation of aesthetics in the periodontal region. Conclusion: Multidisciplinary diagnosis and planning are important factors in the treatment of root perforations, as well as the correct selection of materials used to seal root perforations (AU).

3D Printed Multiphasic Scaffolds for Osteochondral Repair: Challenges and Opportunities.

Osteochondral (OC) defects are debilitating joint injuries characterized by the loss of full thickness articular cartilage along with the underlying calcified cartilage through to the subchondral bone. While current surgical treatments can provide some relief from pain, none can fully repair all the components of the OC unit and restore its native function. Engineering OC tissue is challenging due to the presence of the three distinct tissue regions. Recent advances in additive manufacturing provide unprecedented control over the internal microstructure of bioscaffolds, the patterning of growth factors and the encapsulation of potentially regenerative cells. These developments are ushering in a new paradigm of 'multiphasic' scaffold designs in which the optimal micro-environment for each tissue region is individually crafted. Although the adoption of these techniques provides new opportunities in OC research, it also introduces challenges, such as creating tissue interfaces, integrating multiple fabrication techniques and co-culturing different cells within the same construct. This review captures the considerations and capabilities in developing 3D printed OC scaffolds, including materials, fabrication techniques, mechanical function, biological components and design.

Retinal Organoid Technology: Where Are We Now?

It is difficult to regenerate mammalian retinal cells once the adult retina is damaged, and current clinical approaches to retinal damages are very limited. The introduction of the retinal organoid technique empowers researchers to study the molecular mechanisms controlling retinal development, explore the pathogenesis of retinal diseases, develop novel treatment options, and pursue cell/tissue transplantation under a certain genetic background. Here, we revisit the historical background of retinal organoid technology, categorize current methods of organoid induction, and outline the obstacles and potential solutions to next-generation retinal organoids. Meanwhile, we recapitulate recent research progress in cell/tissue transplantation to treat retinal diseases, and discuss the pros and cons of transplanting single-cell suspension versus retinal organoid sheet for cell therapies.