Multimodality imaging in connective tissue disease-related interstitial lung disease.

Interstitial lung disease is a well-recognised manifestation and a major cause of morbidity and mortality in patients with connective tissue diseases. Interstitial lung disease may arise in the context of an established connective tissue disease or be the initial manifestation of an otherwise occult autoimmune disorder. Early detection and characterisation are paramount for adequate patient management and require a multidisciplinary approach, in which imaging plays a vital role. Computed tomography is currently the imaging method of choice; however, other imaging techniques have recently been investigated, namely ultrasound, magnetic resonance imaging, and positron-emission tomography, with promising results. The aim of this review is to describe the imaging findings of connective tissue disease-related interstitial lung disease and explain the role of each imaging technique in diagnosis and disease characterisation.

Ocular involvement in systemic lupus erythematosus patients: a paradigm shift based on the experience of a tertiary referral center.

OBJECTIVE: To evaluate ocular involvement in a cohort of systemic lupus erythematosus (SLE) patients of a tertiary referral center and to compare the results with the existing literature. METHODS: Patients underwent a complete ophthalmological evaluation, including visual acuity, slit-lamp examination, fluorescein staining, Schirmer-I test, Goldmann applanation tonometry, fundoscopy, 10-2 automated threshold visual fields, fundus autofluorescence and spectral-domain optical coherence tomography to screen for hydroxychloroquine (HCQ) macular toxicity. RESULTS: A total of 161 patients (16 men and 145 women) were enrolled in this study. The mean age was 47.6 years and the mean disease duration was 11.5 years. Fifty patients (31.1%) had at least one ocular manifestation of SLE. The most frequent manifestation was dry eye syndrome (12.4%), immediately followed by cataracts (11.2%) and HCQ macular toxicity (11.2%). Among patients with HCQ maculopathy, two presented with an atypical spectral-domain optical coherence tomography pattern. Five patients (3.1%) presented with glaucoma, two patients (1.2%) presented with SLE retinopathy while only one presented with lupus choroidopathy (0.6%). CONCLUSIONS: Compared with previous studies, we conclude there has been a significant reduction in disease-related ocular complications, particularly those associated with poor systemic disease control. On the other hand, drug and age-related complications are assuming a prominent role in the ophthalmic care of these patients.

Diarrhoeagenic Escherichia coli and Escherichia albertii in Brazil: pathotypes and serotypes over a 6-year period of surveillance.

Diarrhoeagenic Escherichia coli (DEC) is a leading cause of infectious diarrhoea worldwide. In recent years, Escherichia albertii has also been implicated as a cause of human enteric diseases. This study describes the occurrence of E. coli pathotypes and serotypes associated with enteric illness and haemolytic uremic syndrome (HUS) isolated in Brazil from 2011 to 2016. Pathotypes isolated included enteropathogenic E. coli (EPEC), enteroaggregative E. coli (EAEC), enterotoxigenic E. coli (ETEC), enteroinvasive E. coli (EIEC) and Shiga toxin-producing E. coli (STEC). PCR of stool enrichments for DEC pathotypes was employed, and E. albertii was also sought. O:H serotyping was performed on all DEC isolates. A total of 683 DEC and 10 E. albertii strains were isolated from 5047 clinical samples. The frequencies of DEC pathotypes were 52.6% (359/683) for EPEC, 32.5% for EAEC, 6.3% for ETEC, 4.4% for EIEC and 4.2% for STEC. DEC strains occurred in patients from 3 months to 96 years old, but EPEC, EAEC and STEC were most prevalent among children. Both typical and atypical isolates of EPEC and EAEC were recovered and presented great serotype heterogeneity. HUS cases were only associated with STEC serotype O157:H7. Two E. albertii isolates belonged to serogroup O113 and one had the stx2f gene. The higher prevalence of atypical EPEC in relation to EAEC in community-acquired diarrhoea in Brazil suggests a shift in the trend of DEC pathotypes circulation as previously EAEC predominated. This is the first report of E. albertii isolation from active surveillance. These results highlight the need of continuing DEC and E. albertii surveillance, as a mean to detect changes in the pattern of pathotypes and serotypes circulation and provide useful information for intervention and control strategies.

Evaluation of apical transportation and centring ability of five thermally treated NiTi rotary systems.

AIM: To evaluate apical transportation and centring ability during root canal preparation in mesial root canals of mandibular molars associated with ProTaper Gold (PTG), ProDesign S (PDS), Hyflex CM (HCM), Hyflex EDM and ProDesign Logic (PDL). METHODOLOGY: Sixty mandibular first molars with two separate canals in the mesial root were selected after root anatomy pairing by microcomputed tomography (microCT). The teeth were randomly divided into five groups (n = 24); the root canal volume was calculated to ensure sample homogeneity. All the root canals were prepared up to size 25 in accordance with the instructions of each rotary system manufacturer. After root canal preparation, the teeth were scanned by microCT to analyse apical transportation, root canal centralization and the pre- and post-preparation root canal volume at the apical and cervical levels. Kruskal-Wallis and Dunn tests were used for comparisons amongst groups for transportation values. For volume changes, the parametric ANOVA and Tukey's tests were used RESULTS: There were no significant differences in apical transportation amongst the rotary systems (P > 0.05). All the systems created apical transportation; values ranging from 0.031 mm (PDL) to 0.072 mm (PTG), and enlargements between 39% (HCM) and 91.1% (PDS) were observed. In relative to cervical transportation, significant differences were observed amongst the systems (P < 0.05). Mean transportation values between 0.07 mm (HCM) and 0.172 mm (PTG) were found, with enlargements between 35.4% (HCM) and 51.5% (PDS). CONCLUSION: All the thermally treated systems resulted in similar apical transportation. In the cervical region, the Hyflex CM and Prodesign Logic systems were associated with more centred preparations.

Successful treatment of systemic lupus erythematosus with subcutaneous immunoglobulin.

The therapeutic efficacy of high-dose intravenous immunoglobulin in systemic lupus erythematosus (SLE) patients is well established. However, side effects might limit its use and lead to the consideration of therapeutic alternatives, such as the subcutaneous formulation of immunoglobulin, which has been used in some patients with other autoimmune diseases. We report a case of SLE refractory to classical therapies. High-dose intravenous immunoglobulin was effective, but gave rise to significant side effects. The patient was successfully treated with subcutaneous human immunoglobulin, achieving and maintaining clinical and laboratory remission. A lower immunoglobulin dose was needed and no side effects were observed, compared to the intravenous administration. Subcutaneous immunoglobulin could be a better-tolerated and cost-saving therapeutic option for select SLE patients.

A combined variation of Palmaris longus and Flexor digitorum superficialis: Case report and review of literature.

The muscles of the anterior compartment of the forearm often exhibit anatomic variations. During dissection of the upper right limb of a preserved cadaver, morphological variations in the Palmaris longus and Flexor digitorum superficialis muscles were found. The Palmaris longus muscular fibers converged to a tendon that passed beneath the Flexor retinaculum, and inserted at the base of the middle phalanx of the fourth digit, replacing the tendon of Flexor digitorum superficialis. The Flexor digitorum superficialis was divided into two muscular heads: a digastric medial head giving tendons to the second and fifth digits, and a lateral head giving one tendon to the third digit. All these tendons were inserted in the respective digits by two bundles between which were located the tendon of the Flexor digitorum profundus muscle. Variations of flexor muscles must be documented because of their clinical significance and their potential use of these muscles in orthopaedic and reconstructive surgery.

Egg laying and egg quality in meat type quails in diallel crosses.

This study aimed to assess egg laying and egg quality in quail lines in diallel crosses. We evaluated 16 genetic groups obtained from crosses of four strains of meat quails (L1, L2, L3, and L4) in a complete diallel. We assessed weekly egg number (WEN), egg yield (EY), egg weight (EW), and Haugh unit (HU) for: 51-80, 81-110, 111-140, and 51-140 days (whole period) old. The general combining capacity (GCC) showed significance for WEN and EY, with the exception of the period of 111-140 days. In general, L3 had the highest positive GCC estimates. The additive genetic variability was significant for EW in all periods, as was HU, with the exception of the first period. The specific combining capacity was significant for HU, except in the second period. The largest estimates for GCC were submitted by L1 for EW, followed by L4, considering the whole period. For HU, L2 had the highest estimates for GCC. The more favorable cross for HU was L2xL3, in the whole period. In the third period, there was a significant reciprocal effect, where there was a positive estimate for the cross L2xL3.

Preparation and extraction of chorion proteins from Salmo salar embryos at the pigmented eye stage for electrophoresis with SDS-polyacrylamide gel.

The chorion fulfills important functions in fish embryos, including protecting the embryo during development. The characterization of the protein profile of this envelope could be used as a bioindicator in the evaluation of the quality of embryonic development. The object of this work was to validate a standardized protocol for protein extraction from chorion of Salmo salar embryos at 280 accumulated thermal units (ATU) by comparing and combining existing methods. The protocol consists of consecutive washing of the chorion samples followed by protein extraction with the solution that was named SDS solution (Tris-HCl 100 mM (pH 8), Urea 8 M, 1% SDS, ß-mercaptoethanol 300 mM and EGTA 10 Mm, and 1% protease inhibitor cocktail) and mechanical methods. Protein extraction is enhanced by a working temperature of 75 °C and use of a disperser. The protein concentration was quantified by Bradford Assay. After extraction, the samples were diluted (dilution factor 10) before reading against the calibration curve. After gel electrophoresis with a load of 3 µg of protein, staining showed more than 4 bands, with molecular weights between 25 kDa and 180 kDa.•The protein profile of fish chorion was between 25 kDa and 180 kDa.•Solution containing 1% SDS allows a higher extraction of proteins from the chorion of Atlantic salmon embryos with 280 ATU.•Chorion protein identification is a valuable tool in determining gamete and embryo quality in fish.

The REWRITE Study - REal-WoRld effectIveness of TrifluridinE/tipiracil in Patients with Previously Treated Metastatic Colorectal Cancer.

AIMS: In the pivotal RECOURSE trial, trifluridine/tipiracil improved survival outcomes in refractory metastatic colorectal cancer (mCRC), while demonstrating an acceptable toxicity profile. Routine clinical practice evidence is important to support the ongoing value of recently approved medicines. Our objective was to assess the utilisation patterns and real-world effectiveness of trifluridine/tipiracil in previously treated mCRC patients. MATERIALS AND METHODS: This was a retrospective observational study including consecutive patients who started trifluridine/tipiracil between 1 April 2018 and 30 September 2019 in the medical oncology departments of three major public hospitals in Portugal. The primary outcome measure was overall survival. Associations between overall survival and patient and tumour characteristics were assessed using multivariate Cox regression analyses. RESULTS: In total, 111 patients were included in the study, with a mean age of 64 years. From these, 45.9% received two prior lines of treatment, 47.8% had three or more previous lines of treatment and 83.6% had Eastern Cooperative Oncology Group (ECOG) performance status 0-1 at baseline. The median duration of trifluridine/tipiracil treatment was 3.7 cycles (95% confidence interval 3.4-4.1). Most patients (80.4%) remained on their planned dose throughout the trifluridine/tipiracil treatment period, fulfilling 100% relative dose intensity. The median overall survival in the total study cohort was 7.9 months (95% confidence interval 6.4-9.8) and the median progression-free survival was 3.4 months (95% confidence interval 3.2-3.9). The median overall survival was significantly higher in patients with a normal serum lactate dehydrogenase (LDH) level (median overall survival 11.2 months for [135, 205] IU/l LDH [95% confidence interval 8.2-NR] and 13.6 months for [205, 251] IU/l LDH [95% confidence interval 8.2-NR]) and in better fitted (ECOG = 0-1) patients (median overall survival 8.0 months; 95% confidence interval 6.7-10.0). The median time to worsening performance status was 6.2 months (95% confidence interval 5.0-8.0). Treatment discontinuation due to adverse events was low (3.1%). CONCLUSION: Our study confirms the effectiveness of trifluridine/tipiracil in real-life mCRC patients. Overall survival and progression-free survival outcomes are consistent with the efficacy profile reported in the earlier randomised RECOURSE clinical trial. Like other real-world studies, we found no additional safety concerns in the use of trifluridine/tipiracil.

Concomitant multipotent and unipotent dental pulp progenitors and their respective contribution to mineralised tissue formation.

Upon in vitro induction or in vivo implantation, the stem cells of the dental pulp display hallmarks of odontoblastic, osteogenic, adipogenic or neuronal cells. However, whether these phenotypes result from genuine multipotent cells or from coexistence of distinct progenitors is still an open question. Furthermore, determining whether a single cell-derived progenitor is capable of undergoing a differentiation cascade leading to tissue repair in situ is important for the development of cell therapy strategies. Three clonal pulp precursor cell lines (A4, C5, H8), established from embryonic ED18 first molars of mouse transgenic for a recombinant plasmid adeno-SV40, were induced to differentiate towards the odonto/osteogenic, chondrogenic or adipogenic programme. Expression of phenotypic markers of each lineage was evaluated by RT-PCR, histochemistry or immunocytochemistry. The clones were implanted into mandibular incisors or calvaria of adult mice. The A4 clone was capable of being recruited towards at least 3 mesodermal lineages in vitro and of contributing to dentin-like or bone formation, in vivo, thus behaving as a multipotent cell. In contrast, the C5 and H8 clones displayed a more restricted potential. Flow cytometric analysis revealed that isolated monopotent and multipotent clones could be distinguished by a differential expression of CD90. Altogether, isolation of these clonal lines allowed demonstrating the coexistence of multipotential and restricted-lineage progenitors in the mouse pulp. These cells may further permit unravelling specificities of the different types of pulp progenitors, hence facilitating the development of cell-based therapies of the dental pulp or other cranio-facial tissues.

Evaluation of cleaning capacity and instrumentation time of manual, hybrid and rotary instrumentation techniques in primary molars.

AIM: To compare the cleaning effectiveness of manual, hybrid and rotary instrumentation techniques in primary molar teeth. METHODOLOGY: Fifteen primary molars were selected. After endodontic access, the teeth were immersed in a medium containing Enterococcus faecalis and divided into three groups, according to the root canal instrumentation technique: group 1 - manual, group 2 - hybrid and group 3 - nickel-titanium (NiTi) rotary files. For microbiological evaluation, comparisons before and after instrumentation were performed using the paired Student's t-test. One-way anova complemented with the Student's t-test was used to compare the percentage of microbial reduction. Instrumentation time was evaluated by Kruskal-Wallis and Student-Newman-Keuls tests. Images obtained under scanning electron microscopy were analysed by three blinded examiners, and kappa statistics was used to evaluate calibration among examiners. The most frequent results among examiners were analysed using Kruskal-Wallis and Student-Newman-Keuls tests. RESULTS: The hybrid technique required a significantly longer instrumentation time than the manual and rotary techniques (P < 0.05). All techniques tested were able to significantly reduce the number of E. faecalis (P < 0.05). The hybrid technique was associated with the highest intracanal bacterial reduction, with a statistically significant difference compared with manual instrumentation (P = 0.01). Manual instrumentation resulted in the lowest amount of debris and the highest amount of smear layer when compared with the rotary and hybrid techniques (P < 0.05). There was no difference between rotary and hybrid instrumentation in the removal of debris and smear layer. CONCLUSION: The use of NiTi rotary files is an option for root canal instrumentation in primary teeth.

Sodium levels for Japanese quail at initial phases.

The aim of this research was to determine the nutritional requirements of sodium for Japanese quail (Coturnix coturnix Japonica) during the periods of 1 to 21 d and 22 to 40 d of age, as well as to evaluate the residual effect on egg production and densitometry bone traits from 41 to 63 d. Two experiments were developed. Experiment 1: 360 Japanese quail were used, from 1 to 21 d of age. Treatments consisted of 5 sodium levels (0.06, 0.12, 0.18, 0.24, and 0.30%). Experiment 2: 240 Japanese quail were used, from 22 to 40 d. Treatments consisted of 5 sodium levels (0.04, 0.12, 0.20, 0.28, and 0.36%). In both experiments, weight gain, final weight, and feed conversion presented a quadratic trend, whereas water intake presented a linear trend. Treatments did not affect the densitometry of bone traits, although they presented a quadratic influence on tibia ash, calcium, and calcium:phosphorus ratio. Therefore, the nutritional requirement of sodium for Japanese quail from 1 to 21 d and from 22 to 40 d is 0.222% and 0.253%, respectively.

Assessment of microbial contamination of radiographic equipment and materials during intraoral imaging procedures.

AIM: Aim of the present study was to assess microbial contamination of radiology procedures. METHODS: Patients who needed radiographic exams were selected and the bisecting technique was used: G1 - (control): absence of plastic barrier and overgloving or disinfectant solutions; G2 - alcohol spraying; G3 - protection of the film with a plastic barrier and alcohol spray; G4 - protection of film with plastic barrier, use of overgloving and alcohol spray. The following regions were assessed: trigger switch, X-ray tube, sleeve of the portable dark chamber, water, developer and fixer. The areas for microbiological sample collection were standardized with a label cut internally so that the hollow area was 5 cm long and 2 cm wide. One mL of the developer, water and fixer were also collected before and after developing the films. The samples were incubated under anaerobiosis and aerobiosis. The results were submitted to the Cochran's Q and Mann-Whitney tests. RESULTS: The sleeve of the developing chamber showed greater anaerobic contamination followed by the X-ray tube and only the use of alcohol associated with mechanical barriers was efficient to control this microbiota. The trigger showed higher aerobic microbial contamination and the use of alcohol or alcohol associated with mechanical barriers was efficient to control this microbiota. The developing solutions presented no significant growth of anaerobic and aerobic bacteria. CONCLUSION: The characteristic of an aerobic or anaerobic microbial strain influences microbial contamination while radiographic projections are being taken and the use of alcohol associated with a plastic barrier and overgloving is indicated to reduce this microbiota.

Prediction of significant liver fibrosis in kidney transplant patients with chronic hepatitis C virus infection: the TX-3 index.

HCV infection is highly prevalent among kidney transplant (KT) recipients. The natural history and management of these patients are controversial. We sought to assess the diagnostic value of noninvasive markers of liver fibrosis in KT HCV-infected patients. This cross-sectional study included 102 KT individuals with positive HCV-RNA. Bivariate and multivariate analyses were used to identify variables associated with significant fibrosis (METAVIR > or = F2). Significant fibrosis was observed in 20 patients (20%). Time after transplantation, AST level, and platelet count were identified as independent predictors of significant fibrosis. Based on the regression model, a simplified index was devised. The AUROC for the TX-3 model was 0.867 +/- 0.081 (0.909, when adjusted by DANA). Values < or =4.0 of TX-3 showed a NPV of 97% and scores >9.6 exhibited a PPV of 71%. If biopsy indication was restricted to scores in the intermediate range of TX-3, this could have been correctly avoided in 68% of cases. The APRI score provided a correct diagnosis in only 47 individuals (46%) and exhibited lower diagnostic indices for both cutoffs, as compared to the TX-3 index. Comparison of AUROCs showed a trend towards superior diagnostic accuracy for TX-3 over APRI, although the difference between AUROCs did not reach statistical significance (0.867 +/- 0.053 vs 0.762 +/- 0.066, respectively, P = 0.064). In conclusion, significant liver fibrosis can be reliably predicted in KT HCV-infected subjects by simple and widely available parameters. If additional studies confirm our results, this model might obviate the requirement for a liver biopsy in a significant proportion of those patients.

Absence of DOMR, a new antigen in the Dombrock blood group system that weakens expression of Do(b) , Gy(a) , Hy, Jo(a) , and DOYA antigens.

BACKGROUND: The Dombrock (Do) blood group system consists of six distinct antigens: Do(a) , Do(b) , Gy(a) , Hy, Jo(a) , and DOYA. Our finding of a pregnant patient whose red blood cells (RBCs) were Hy+ but whose serum contained an apparent alloanti-Hy suggested the presence of a seventh antigen and prompted this study. STUDY DESIGN AND METHODS: Standard hemagglutination and polymerase chain reaction-based methods were used throughout. RESULTS: The patient's RBCs typed as Do(a-b+(w) ), Gy(a+(w) ), Hy+(w) , Jo(a+(w) ), and DOYA+(w) . Her serum agglutinated RBCs with common Dombrock phenotypes. Hy- RBC samples were very weakly reactive or nonreactive, Jo(a-) and DOYA- RBC samples were reactive, and Gy(a-) RBC samples were nonreactive. Reactivity was obtained with RBCs treated with papain or α-chymotrypsin, but not with RBCs treated with trypsin or dithiothreitol. DNA analysis showed the patient to be DO*793G (DO*B/DO*B), DO*323G, DO*350C, DO*547T, and DO*898G and revealed two homozygous nucleotide changes of DO*431C>A and DO*432C>A in Exon 2, which predicts a change of Ala (GCC) at Amino Acid 144 to Glu (GAA). This indicates that she is homozygous DO*B-WL with Nucleotide 431 and 432 changes, which without knowing the effect of the two novel changes, is predicted to encode the Do(a-b+), Gy(a+), Hy+, Jo(a+), DOYA+ phenotype. CONCLUSIONS: The antibody in the patient's plasma recognizes the high-prevalence antigen absent from her RBCs. The Ala144Glu change caused an absence of a high-prevalence Do antigen that we have named DOMR [provisional ISBT number 014007 (DO7)]. The absence of DOMR is associated with weakening of Do(b) , Gy(a) , Hy, Jo(a) , and DOYA antigens.

Autoimmunity and periodontal disease: Arguing a possible correlation.

Currently, there is a growing interest in studying systemic conditions associated with periodontal disease such as autoimmune disorders. Periodontal disease is a destructive inflammatory disease of the dental supporting tissues. The microorganisms associated with periodontal disease constitute diverse species that can colonize the oral cavity and influence the emergence or evolution of autoimmunity, characterized by a breakdown in the mechanisms of tolerance to self-antigens. Here, we reviewed and discussed a possible correlation between periodontal disease and autoimmunity, placing periodontal-pathogenic microorganisms as orchestrators of these pathological conditions.

Antimicrobial Capacity of a Hydroxyapatite-Lysozyme-Lactoferrin-Lactoperoxidase Combination Against Streptococcus mutans for the Treatment of Dentinal Caries.

CONTEXT: Hydroxyapatite has shown to regenerate the mineralized layer of dentin, whereas the combination of the enzymes lysozyme, lactoferrin, and lactoperoxidase may exhibit antimicrobial properties against oral pathogens. AIMS: To evaluate a combination of hydroxyapatite and lysozyme, lactoferrin, and lactoperoxidase for the treatment of dentinal caries by measuring viable Streptococcus mutans. SETTINGS AND DESIGN: Laboratory study with experimental groups. METHODS AND MATERIAL: Carious lesions in 20 permanent third molars were treated with a combination of hydroxyapatite and the enzymes lysozyme, lactoferrin, and lactoperoxidase. Carious dentin was collected and homogenized in a vortex shaker. After homogenization, five decimal dilutions were performed. Three aliquots of 25 µL of each dilution were seeded onto the surface of mitis salivarius bacitracin (MSB) medium. All plates were incubated in anaerobic jars. After incubation, the viable bacterial count was determined. S. mutans counts were obtained before and 24 h, 1 month, and 6 months after treatment. STATISTICAL ANALYSIS USED: Descriptive statistical analysis and the Kruskal-Wallis test, supplemented by the Student-Newman-Keuls test. RESULTS: A significant reduction in S. mutans counts was observed 24 h after sealing with a combination of hydroxyapatite, lysozyme, lactoferrin, and lactoperoxidase as compared to counts after 1 month and after 6 months (P < 0.05). CONCLUSIONS: The combination of hydroxyapatite with lysozyme, lactoferrin, and lactoperoxidase may be an alternative for S. mutans control in dentinal caries.

Posterior urethral valves: comparison of clinical outcomes between postnatal and antenatal cohorts.

BACKGROUND: Posterior urethral valves (PUVs) constitute the most common infravesical urinary obstruction in boys and are often accompanied by severe consequences to the lower and upper urinary tract. Currently, about two-thirds of diagnosis of PUVs has been suspected by prenatal ultrasonography findings. The aim of this study was to compare long-term clinical outcomes in two groups of patients with PUVs, with antenatal vs. postnatal diagnosis. STUDY DESIGN: This was a retrospective cohort study of 173 patients with PUVs systematically followed up in a tertiary center. Median follow-up time was 66.5 months (interquartile range [IQ], 11.4-147.9 months) for those patients who survived neonatal period. Seventy-nine (45.6%) patients were followed up for more than 5 years and 55 (32%) for more than 10 years. For analysis, the cohort was stratified into two groups according to the clinical presentation (prenatal vs. postnatal). The events of interest were urinary tract infection (UTI), surgical interventions, proteinuria, hypertension, chronic kidney disease (CKD), and death. Survival analyses were performed to evaluate time until occurrence of the events. RESULTS: Sixty-two patients (35.8%) were diagnosed by fetal sonography. Patients of postnatal group presented a higher incidence rate of UTI episodes (6.5, 95% confidence interval [CI], 4.9-8.3) than antenatal group (1.2, 95% CI, 0.4-2.7) (P < 0.001). Thirty-six patients (21%) presented hypertension, and 77 (44.5%) had persistent mild proteinuria. There was no significant difference in the estimated incidence of hypertension (P = 0.28) and proteinuria (P = 0.78) between antenatal and postnatal groups. The cumulative incidence of CKD stage ≥3 was estimated to be about 37% at 10 years of age, and 56% at 18 years of age. By survival analysis, there was no significant difference in the estimated incidence of CKD stage ≥3 (log-rank = 0.32, P = 0.57) and CKD stage 5 (log-rank = 1.08, P = 0.28, Figure) between antenatal and postnatal groups. Of 173 patients included in the analysis, 13 (7.5%) died during follow-up with a median age of 2.6 months (IQ, 15 days-62 months). Survival analyses have not shown any significant difference in the estimated incidence of death between antenatal and postnatal groups (log-rank = 1.38, P = 0.24). CONCLUSION: The study findings did not corroborate the initial hypothesis that the rates of renal function declining in patients with PUVs would be attenuated by an early diagnosis and intervention after antenatal diagnosis.

Anxiolytic and panicolytic effects of escitalopram in the elevated T-maze.

Escitalopram is a highly selective inhibitor of serotonin re-uptake that is used to treat anxiety disorders. In the present study, we investigated the effects of acute, sub-chronic (14 days) and chronic (21 days) administration of escitalopram (2, 4 and 8 mg/kg, PO) on the performance of rats in the elevated T-maze. For comparison, imipramine (15 mg/kg, PO) was also studied. The apparatus is made of three elevated arms of equal dimension, one enclosed transversal to the two open arms. Inhibitory avoidance of the open arms, trained in the enclosed arm, has been related to generalised anxiety disorder, while one-way escape from one open arm, to panic disorder. After acute administration, the three doses of escitalopram impaired avoidance (anxiolytic effect), while imipramine was ineffective. Escape was unaffected by either drug. With subchronic administration, both drugs were ineffective on either avoidance or escape. After chronic treatment, avoidance was impaired by imipramine and by the two highest doses of escitalopram. In addition, escape was impaired (panicolytic effect) by imipramine and by the highest dose of escitalopram. Locomotion measured in a square arena was increased by the three doses of escitalopram, given chronically. Therefore, both imipramine and escitalopram had anxiolytic and panicolytic-like effects after chronic administration, but acutely only escitalopram decreased anxiety. Since no such effect was observed following subchronic administration, it is likely that the mechanisms of the early and late anxiolytic actions of escitalopram are different.

The role of microsurgical flaps in primary burn reconstruction.

Despite the wide and growing use of microsurgery, its application in primary burn reconstruction is not very frequent as it faces a number of additional challenges in this setting. A retrospective analysis of the clinical records of all patients submitted to microvascular free tissue transfer for primary burn reconstruction over an 8-year period (from January 2009 to December 2016) was performed. An evaluation of the indications, timing, principles of flap selection, complications and outcomes of free tissue transfer in primary burn reconstruction was made. Fourteen patients required 18 microsurgical flaps for acute soft tissue reconstruction (1.1% of all patients admitted). 64.3% of the patients were male. The mean age was 59.64 years, and mean TBSA was 10.5%. The majority of the injuries were caused by flames (71.4%), followed by electrical contact (21.4%). The primary indication for microsurgical reconstruction was tissue deficit with exposure of tendons, nerves, vessels, bone and/or joints after debridement. The procedure was more often performed in the early period after injury (between the 5th and 22nd day). The most frequently used flaps were the Latissimus dorsi and the anterolateral thigh flap. Major complications included 2 total flap failures (11.1%) and a partial flap failure that required reconstruction with another free flap. Microsurgical free flaps have a valuable role in primary burn reconstruction. Despite the reported higher complication rate in this specific clinical scenario, their use may reduce the total number of surgeries needed to achieve wound closure.

Bien que de plus en plus utilisée, la microchirurgie est rarement utilisée dans la prise en charge initiale des brûlés, et doit faire face à plusieurs difficultés supplémentaires dans cette indication. Nous avons effectué une analyse rétrospective des dossiers de tous les patients brûlés entre janvier 2009 et décembre 2016 ayant bénéficié au stade d'un lambeau libre (LL). Nous avons évalué l'indication, le délai, la sélection du site donneur, les complications et l'évolution du lambeau. Quatorze patients (1,1% du total) dont 64,5% d'hommes ont bénéficié de 18 LL. L'âge moyen était de 59,64 ans, la surface brûlée de 10,5%. La majorité des brûlures (71,4%) étaient dues à une flamme, 21,4% à l'électricité. L'indication principale était l'exposition ostéo-articulaire ou d'éléments nobles (tendons, nerfs, vaisseaux) après excision. La réalisation du LL était précoce (J5-J22). Les sites donneurs étaient Latissimus dorsi et la région antéro-latérale de cuisse. Deux lambeaux ont totalement nécrosé, un partiellement, ce qui a nécessité la réalisation d'un second LL. Les LL ont une place dans la prise en charge initiale des brûlés. Bien de grevés d'un taux de complications plus élevé dans cette indication, ils peuvent permettre de diminuer le nombre d'interventions nécessaires à la cicatrisation.