RTN2 deficiency results in an autosomal recessive distal motor neuropathy with lower limb spasticity.

Heterozygous RTN2 variants have been previously identified in a limited cohort of families affected by autosomal dominant spastic paraplegia (SPG12-OMIM:604805) with a variable age of onset. Nevertheless, the definitive validity of SPG12 remains to be confidently confirmed due to the scarcity of supporting evidence. In this study, we identified and validated seven novel or ultra-rare homozygous loss-of-function RTN2 variants in 14 individuals from seven consanguineous families with distal hereditary motor neuropathy (dHMN) using exome, genome and Sanger sequencing coupled with deep-phenotyping. All affected individuals (seven males and seven females, aged 9-50 years) exhibited weakness in the distal upper and lower limbs, lower limb spasticity and hyperreflexia, with onset in the first decade of life. Nerve conduction studies revealed axonal motor neuropathy with neurogenic changes in the electromyography. Despite a slowly progressive disease course, all patients remained ambulatory over a mean disease duration of 19.71 ± 13.70 years. Characterization of Caenorhabditis elegans RTN2 homologous loss-of-function variants demonstrated morphological and behavioural differences compared with the parental strain. Treatment of the mutant with an endoplasmic/sarcoplasmic reticulum Ca2+ reuptake inhibitor (2,5-di-tert-butylhydroquinone) rescued key phenotypic differences, suggesting a potential therapeutic benefit for RTN2-disorder. Despite RTN2 being an endoplasmic reticulum (ER)-resident membrane shaping protein, our analysis of patient fibroblast cells did not find significant alterations in ER structure or the response to ER stress. Our findings delineate a distinct form of autosomal recessive dHMN with pyramidal features associated with RTN2 deficiency. This phenotype shares similarities with SIGMAR1-related dHMN and Silver-like syndromes, providing valuable insights into the clinical spectrum and potential therapeutic strategies for RTN2-related dHMN.

Genetic risk impacts the association of menopausal hormone therapy with colorectal cancer risk.

BACKGROUND: Menopausal hormone therapy (MHT), a common treatment to relieve symptoms of menopause, is associated with a lower risk of colorectal cancer (CRC). To inform CRC risk prediction and MHT risk-benefit assessment, we aimed to evaluate the joint association of a polygenic risk score (PRS) for CRC and MHT on CRC risk. METHODS: We used data from 28,486 postmenopausal women (11,519 cases and 16,967 controls) of European descent. A PRS based on 141 CRC-associated genetic variants was modeled as a categorical variable in quartiles. Multiplicative interaction between PRS and MHT use was evaluated using logistic regression. Additive interaction was measured using the relative excess risk due to interaction (RERI). 30-year cumulative risks of CRC for 50-year-old women according to MHT use and PRS were calculated. RESULTS: The reduction in odds ratios by MHT use was larger in women within the highest quartile of PRS compared to that in women within the lowest quartile of PRS (p-value = 2.7 × 10-8). At the highest quartile of PRS, the 30-year CRC risk was statistically significantly lower for women taking any MHT than for women not taking any MHT, 3.7% (3.3%-4.0%) vs 6.1% (5.7%-6.5%) (difference 2.4%, P-value = 1.83 × 10-14); these differences were also statistically significant but smaller in magnitude in the lowest PRS quartile, 1.6% (1.4%-1.8%) vs 2.2% (1.9%-2.4%) (difference 0.6%, P-value = 1.01 × 10-3), indicating 4 times greater reduction in absolute risk associated with any MHT use in the highest compared to the lowest quartile of genetic CRC risk. CONCLUSIONS: MHT use has a greater impact on the reduction of CRC risk for women at higher genetic risk. These findings have implications for the development of risk prediction models for CRC and potentially for the consideration of genetic information in the risk-benefit assessment of MHT use.

Pituitary Apoplexy: a re-appraisal of risk factors and best management strategies in the COVID-19 era.

Pituitary apoplexy (PA) is a clinical syndrome caused by acute hemorrhage and/or infarction of the pituitary gland, most commonly in the setting of a pituitary macroadenoma. PA generally presents with severe headache, nausea, vomiting, visual disturbance, and, in more severe cases, altered mental status. Many factors have been attributed to the risk of developing PA, including most recently, numerous reports showcasing an association with COVID-19 infection or vaccination. Initial management of PA includes evaluation and correction of deficient hormones and electrolytes and an assessment if surgical decompression to relieve pressure on optic nerves and other brain structures is needed. While prompt recognition and treatment are crucial to avoid morbidity and mortality, in the modern era, PA is less commonly considered a true neurosurgical emergency requiring immediate (< 24 h) surgical decompression. Traditionally, surgical decompression has been the standard of care for significant mass effects. However, several studies have shown similar outcomes in visual and hormonal recovery with either surgical decompression or conservative medical management. Unfortunately, most evidence on optimal management strategies is limited to retrospective case series, small prospective studies, and one multi-center observational study. This review aims to provide the most up-to-date evidence on the role of COVID-19 in PA and best management strategies.

Exploring the use of exhaled breath as a diagnostic tool for pulmonary TB.

Despite its historical decline, TB remains a significant cause of infectious disease-related global deaths. The lack of reliable diagnostic tests for vulnerable groups, such as children and immunocompromised patients, remains a challenge for TB control. For decades, it has been recognised that exhaled breath has great potential as a non-invasive and universally accessible clinical alternative to sputum and invasive sampling methods. Although translation into clinical practice has not yet occurred, there has been significant progress with promising results in various applications, including diagnosis, estimation of infectiousness, and monitoring of treatment response. More recently, the COVID-19 pandemic reignited global interest in this field and technological advances have further accelerated its development. In the coming decade, breath sampling will enhance our understanding of respiratory infectious diseases and host-immune responses, which may lead to clinical applications. Here we discuss the diagnostic landscape of TB and the current state of the art of breath sampling.

XFEM for Composites, Biological, and Bioinspired Materials: A Review.

The eXtended finite element method (XFEM) is a powerful tool for structural mechanics, assisting engineers and designers in understanding how a material architecture responds to stresses and consequently assisting the creation of mechanically improved structures. The XFEM method has unraveled the extraordinary relationships between material topology and fracture behavior in biological and engineered materials, enhancing peculiar fracture toughening mechanisms, such as crack deflection and arrest. Despite its extensive use, a detailed revision of case studies involving XFEM with a focus on the applications rather than the method of numerical modeling is in great need. In this review, XFEM is introduced and briefly compared to other computational fracture models such as the contour integral method, virtual crack closing technique, cohesive zone model, and phase-field model, highlighting the pros and cons of the methods (e.g., numerical convergence, commercial software implementation, pre-set of crack parameters, and calculation speed). The use of XFEM in material design is demonstrated and discussed, focusing on presenting the current research on composites and biological and bioinspired materials, but also briefly introducing its application to other fields. This review concludes with a discussion of the XFEM drawbacks and provides an overview of the future perspectives of this method in applied material science research, such as the merging of XFEM and artificial intelligence techniques.

A proposed paradigm shift in the management of distal radius fractures.

Background and objective: Distal radius fractures represent a remarkable orthopaedic entity. Most distal radius fractures can be treated conservatively with closed reduction and immobilisation with satisfactory results, while open reduction and internal fixation is reserved for displaced fractures. Our objective was to propose a paradigm shift in the management of distal radius fractures. Methods: A literature search of management of distal radius fractures was conducted. PubMed and Cochrane databases were used for the search. English articles with open access or institutional subscription availability were included. Key content and finding: Current literature supports operative management for younger active patients with defined radiographic inclusion parameters, but among the elderly there is little evidence of benefit. Most orthopaedic literature defines "elderly" as patients above 65 years of age. Non-surgical treatment for fractures of the distal radius tends to yield satisfactory functional results, and these favourable outcomes do not necessarily align with normal radiological parameters. For the minority of patients that have symptomatic malunion, corrective osteotomy is a good option to improve the function provided the symptoms can be clearly attributed to the malalignment. Conclusion: The vast majority of distal radius fractures can be managed conservatively. Further studies are recommended to explore the feasibility of advocating for universal conservative treatment for patients with less functional demands while still having the option of staged surgery in the form of corrective osteotomy where there is symptomatic malunion amenable to anatomical correction. Future research should also aim to identify patients who would benefit most from surgical intervention by considering the type of functional recovery needed, rather than relying predominantly on the patient's chronological age as the determining factor in the decision-making process.

The dehydration mechanism of Na and K birnessites: a comprehensive multitechnique study.

The structural, spectroscopic and electronic properties of Na and K birnessites were investigated from ambient conditions (birA) to complete dehydration, and the involved mechanisms were scrutinized. Density Functional Theory (DFT) simulations were employed to derive structural models for lamellar A0.33MnO2·xH2O (A = Na+ or K+, x = 0 or 0.66), subsequently compared with the experimental results obtained for Na0.30MnO2·0.75H2O and K0.22MnO2·0.77H2O materials. Thermal analysis (TGA-DSC), X-ray diffraction (XRD), Fourier Transform Infrared (FTIR) spectroscopy, and Near Ambient Pressure X-ray Photoemission Spectroscopy (NAP-XPS) measurements were conducted for both birnessites. Dehydration under vacuum, annealing, or controlled relative humidity were considered. Results indicated that complete birnessite dehydration was a two-stage process. In the first stage, water removal from the interlayer of fully hydrated birnessite (birA) down to a molar H2O/A ratio of ∼2 (birB) led to the progressive shrinkage of the interlayer distance (3% for Na birnessite, 1% for K birnessite). In the second stage, water-free (birC) domains with a shorter interlayer distance (20% for Na birnessite, 10% for K birnessite) appeared and coexisted with birB domains. Then, birB was essentially transformed into birC when complete dehydration was achieved. The vibrational properties of birA were consistent with strong intermolecular interactions among water molecules, whereas partially dehydrated birnessite (birB) showed a distinct feature, with 3 (for Na-bir) and 2 (for K-bir) vibrations that were reproduced by DFT calculations for organized water into the interlayer (x = 0.66). The study also demonstrated that the electronic structure of Na birnessite depends on the interlayer water content. The external Na+ electronic level (Na 2p) was slightly destabilized (+0.3 eV binding energy) under near ambient conditions (birA) compared to drier conditions (birB and birC).

The Discrepancy Between Hemoglobin A1c and Glucose Management Indicators in 26 Patients Treated With Continuous Glucose Monitoring in an Internal Medicine Residency Clinic.

We conducted a retrospective observational cohort study between 2020 and 2023 in 26 patients with type 1 and type 2 diabetes mellitus (DM) who were using 3-4 injections per day of insulin and were monitored by continuous glucose monitoring (CGM). The goal of this retrospective observational cohort study is to compare these two metrics in an internal medicine community primary care residency clinic. We used CGM devices, Dexcom G6 and G7, and Freestyle Libre 3. The goal was to compare the patient's hemoglobin A1c (HbA1c) taken during their clinic visit by phlebotomy as a marker for diabetic control with an estimated HbA1c glucose management indicator (GMI) derived from the 30-day CGM readings. HbA1c is derived from the blood, while the GMI value is derived from the interstitial fluid. Both parameters were taken within 30 days of each other. GMI was taken in the last 30 days. We excluded patients with known anemia, chronic kidney disease, polycythemia, cirrhosis of the liver, or metabolic dysfunction associated with steatohepatitis (MASH) because disease states can affect the measured HbA1c. Also, pregnant and African American patients were excluded. We concluded the measured HbA1c was 0.34% (4 mmol/mol) higher than the CGM-derived GMI. The relationship between factors that affect glycemic control was discussed in the article, as well as the future utilization of them in improving diabetic control and management. As the use of CGM continues to grow, addressing differences between laboratory-measured HbA1c and CGM-derived GMI is critical.

Reprogramming the pancreatic cancer stroma and immune landscape by a silicasome nanocarrier delivering nintedanib, a protein tyrosine kinase inhibitor.

The prevailing desmoplastic stroma and immunosuppressive microenvironment within pancreatic ductal adenocarcinoma (PDAC) pose substantial challenges to therapeutic intervention. Despite the potential of protein tyrosine kinase (PTK) inhibitors in mitigating the desmoplastic stromal response and enhancing the immune milieu, their efficacy is curtailed by suboptimal pharmacokinetics (PK) and insufficient tumor penetration. To surmount these hurdles, we have pioneered a novel strategy, employing lipid bilayer-coated mesoporous silica nanoparticles (termed "silicasomes") as a carrier for the delivery of Nintedanib. Nintedanib, a triple PTK inhibitor that targets vascular endothelial growth factor, platelet-derived growth factor and fibroblast growth factor receptors, was encapsulated in the pores of silicasomes via a remote loading mechanism for weak bases. This innovative approach not only enhanced pharmacokinetics and intratumor drug concentrations but also orchestrated a transformative shift in the desmoplastic and immune landscape in a robust orthotopic KRAS-mediated pancreatic carcinoma (KPC) model. Our results demonstrate attenuation of vascular density and collagen content through encapsulated Nintedanib treatment, concomitant with significant augmentation of the CD8+/FoxP3+ T-cell ratio. This remodeling was notably correlated with tumor regression in the KPC model. Strikingly, the synergy between encapsulated Nintedanib and anti-PD-1 immunotherapy further potentiated the antitumor effect. Both free and encapsulated Nintedanib induced a transcriptional upregulation of PD-L1 via the extracellular signal-regulated kinase (ERK) pathway. In summary, our pioneering approach involving the silicasome carrier not only improved antitumor angiogenesis but also profoundly reshaped the desmoplastic stromal and immune landscape within PDAC. These insights hold excellent promise for the development of innovative combinatorial strategies in PDAC therapy.

Spontaneous sphenoid sinus meningocele with associated amenorrhea and headache: illustrative case.

BACKGROUND: Developmental meningoceles of the sphenoid sinus are uncommon. When encountered, they are often associated with cerebrospinal fluid (CSF) rhinorrhea. OBSERVATIONS: The authors present the case of a 27-year-old female with a large meningocele eroding through the sella turcica and sphenoid sinus into the nasopharynx. The patient presented with intractable headaches and amenorrhea without CSF rhinorrhea. LESSONS: The patient underwent an endoscopic endonasal transsphenoidal reduction of the meningocele with reelevation of the pituitary gland and skull base reconstruction with abdominal fat graft and nasoseptal flap.

Rebalancing the motor circuit restores movement in a Caenorhabditis elegans model for TDP-43 toxicity.

Amyotrophic lateral sclerosis can be caused by abnormal accumulation of TAR DNA-binding protein 43 (TDP-43) in the cytoplasm of neurons. Here, we use a C. elegans model for TDP-43-induced toxicity to identify the biological mechanisms that lead to disease-related phenotypes. By applying deep behavioral phenotyping and subsequent dissection of the neuromuscular circuit, we show that TDP-43 worms have profound defects in GABA neurons. Moreover, acetylcholine neurons appear functionally silenced. Enhancing functional output of repressed acetylcholine neurons at the level of, among others, G-protein-coupled receptors restores neurotransmission, but inefficiently rescues locomotion. Rebalancing the excitatory-to-inhibitory ratio in the neuromuscular system by simultaneous stimulation of the affected GABA- and acetylcholine neurons, however, not only synergizes the effects of boosting individual neurotransmitter systems, but instantaneously improves movement. Our results suggest that interventions accounting for the altered connectome may be more efficient in restoring motor function than those solely focusing on diseased neuron populations.

Two genome-wide interaction loci modify the association of nonsteroidal anti-inflammatory drugs with colorectal cancer.

Regular, long-term aspirin use may act synergistically with genetic variants, particularly those in mechanistically relevant pathways, to confer a protective effect on colorectal cancer (CRC) risk. We leveraged pooled data from 52 clinical trial, cohort, and case-control studies that included 30,806 CRC cases and 41,861 controls of European ancestry to conduct a genome-wide interaction scan between regular aspirin/nonsteroidal anti-inflammatory drug (NSAID) use and imputed genetic variants. After adjusting for multiple comparisons, we identified statistically significant interactions between regular aspirin/NSAID use and variants in 6q24.1 (top hit rs72833769), which has evidence of influencing expression of TBC1D7 (a subunit of the TSC1-TSC2 complex, a key regulator of MTOR activity), and variants in 5p13.1 (top hit rs350047), which is associated with expression of PTGER4 (codes a cell surface receptor directly involved in the mode of action of aspirin). Genetic variants with functional impact may modulate the chemopreventive effect of regular aspirin use, and our study identifies putative previously unidentified targets for additional mechanistic interrogation.

Genome-Wide Gene-Environment Interaction Analyses to Understand the Relationship between Red Meat and Processed Meat Intake and Colorectal Cancer Risk.

BACKGROUND: High red meat and/or processed meat consumption are established colorectal cancer risk factors. We conducted a genome-wide gene-environment (GxE) interaction analysis to identify genetic variants that may modify these associations. METHODS: A pooled sample of 29,842 colorectal cancer cases and 39,635 controls of European ancestry from 27 studies were included. Quantiles for red meat and processed meat intake were constructed from harmonized questionnaire data. Genotyping arrays were imputed to the Haplotype Reference Consortium. Two-step EDGE and joint tests of GxE interaction were utilized in our genome-wide scan. RESULTS: Meta-analyses confirmed positive associations between increased consumption of red meat and processed meat with colorectal cancer risk [per quartile red meat OR = 1.30; 95% confidence interval (CI) = 1.21-1.41; processed meat OR = 1.40; 95% CI = 1.20-1.63]. Two significant genome-wide GxE interactions for red meat consumption were found. Joint GxE tests revealed the rs4871179 SNP in chromosome 8 (downstream of HAS2); greater than median of consumption ORs = 1.38 (95% CI = 1.29-1.46), 1.20 (95% CI = 1.12-1.27), and 1.07 (95% CI = 0.95-1.19) for CC, CG, and GG, respectively. The two-step EDGE method identified the rs35352860 SNP in chromosome 18 (SMAD7 intron); greater than median of consumption ORs = 1.18 (95% CI = 1.11-1.24), 1.35 (95% CI = 1.26-1.44), and 1.46 (95% CI = 1.26-1.69) for CC, CT, and TT, respectively. CONCLUSIONS: We propose two novel biomarkers that support the role of meat consumption with an increased risk of colorectal cancer. IMPACT: The reported GxE interactions may explain the increased risk of colorectal cancer in certain population subgroups.

Quantitative ctDNA Detection in Hepatoblastoma: Implications for Precision Medicine.

Hepatoblastoma is characterized by driver mutations in CTNNB1, making it an attractive biomarker for a liquid biopsy approach utilizing circulating tumor DNA (ctDNA). This prospective observational study sought to ascertain the feasibility of ctDNA detection in patients with hepatoblastoma and explore its associations with established clinical indicators and biomarkers, including serum Alpha-fetoprotein (AFP). We obtained 38 plasma samples and 17 tumor samples from 20 patients with hepatoblastoma. These samples were collected at various stages: 10 at initial diagnosis, 17 during neoadjuvant chemotherapy, 6 post-operatively, and 5 at disease recurrence. Utilizing a bespoke sequencing assay we developed called QUENCH, we identified single nucleotide variants and deletions in CTNNB1 ctDNA. Our study demonstrated the capability to quantitate ctDNA down to a variant allele frequency of 0.3%, achieving a sensitivity of 90% for patients at initial diagnosis, and a specificity of 100% at the patient level. Notably, ctDNA positivity correlated with tumor burden, and ctDNA levels exhibited associations with macroscopic residual disease and treatment response. Our findings provide evidence for the utility of quantitative ctDNA detection in hepatoblastoma management. Given the distinct detection targets, ctDNA and AFP-based stratification and monitoring approaches could synergize to enhance clinical decision-making. Further research is needed to elucidate the interplay between ctDNA and AFP and determine the optimal clinical applications for both methods in risk stratification and residual disease detection.

Effects of zinc during lactation on the junctional epithelium and inserted gum in rats / Efectos del zinc durante la lactancia sobre el epitelio de unión y la encía insertada en ratas

The purpose of this study was to evaluate the effects of zinc, during lactation, on the junctional epithelium and inserted gum of the first upper molar of rats. The study used one-day old male rats, divided into two groups: those whose mother had been treated with 300 mg zinc chloride (ZnCl2) in the drinker water (treated group), and those whose mothers did not receive ZnCl2 (control group). After 21 days, the rat pups were sacrificed. Using karyometrical techniques, the greater (D) and smaller (d) nuclear diameters of the different layers of the junctional and inserted gum epithelia were determined, and the mean geometric diameter, D/d ratio, perimeter, area, volume, volume/area ratio, eccentricity, shape coefficient, and the contour index were estimated. The 100-point Merz grid was used with the purpose of evaluating the citoplasmatic and celular volume, the nucleus/citoplasm relationship, number density, outer surface/basal layer ratio, the thickness of epithelial layers, and the surface density. The results were submitted to statistical analysis using the Wilcoxon-Mann-Whitney test. The nuclei of the studied structures were significantly smaller, and the stereological results demonstrated that there were smaller cells, hence meaning a greater number of cells per mm3 of tissue, in the treated group. Zinc caused changes on the studied epitheliums, according to morphometric and stereological evaluations.

El objetivo de este estudio fue evaluar los efectos del zinc durante la lactancia, sobre el epitelio de unión y la encía insertada del primer molar superior de ratas. Fueron utilizadas ratas macho de un día de edad, divididas en dos grupos: aquellas cuyas madres habían sido tratadas con 300 mg de cloruro de zinc (ZnCl2) con agua del bebedero (grupo tratado) y aquellas cuyas madres no recibieron ZnCl2 (grupo control). Las crías fueron sacrificadas después de 21 días. Utilizando técnicas cariométricas fueron medidos los diámetros mayor (D) y menor (d) de los núcleos de las células de los diferentes estratos del epitelio de unión y de la encía insertada, estimándose el diámetro geométrico medio, la relación D/d, perímetro, área, volumen, relación volumen/área, excentricidad, coeficiente de forma e índice de contorno. Fue usada la rejilla de Merz, de 100 puntos, con la finalidad de evaluar el volumen celular y citoplasmático, la relación núcleo/citoplasma, densidad numérica, relación superficie externa/superficie basal, espesor de las capas epiteliales y densidad de superficie. Los resultados fueron sometidos a análisis estadístico mediante el test de Wilcoxon-Mann-Whitney. En el grupo tratado los núcleos celulares de las estructuras estudiadas fueron significativamente menores y los resultados estereológicos demostraron que las células eran menores, por lo tanto, con mayor número por mm3 de tejido. De acuerdo a los resultados morfométricos y estereológicos, el zinc provocó cambios en los epitelios estudiados.

Patients in treatment for chronic low back pain have higher externalised beliefs: a cross-sectional study / Pacientes em tratamento da dor lombar crônica têm crenças mais externalizadas: um estudo transversal

BACKGROUND: People with low back pain (LBP) with higher levels of external locus of control have a poorer prognosis and require greater improvements from active interventions in order to consider these interventions worthwhile. Whether locus of control levels differ between participants with LBP in a patient-health provider relationship and those waiting for treatment is unclear. OBJECTIVE: The aim was to investigate if differences in locus of control exist between participants with non-specific chronic LBP being treated (treatment group) and those waiting treatment (control group). METHODS: 100 participants (50 per group) with low back symptoms for at least three months for the current episode of LBP and aged between 18 and 60 years were recruited. Multidimensional health locus of control questionnaire (MHLC) was used to collect their beliefs. Multiple linear regression adjusted for disability was used to compare health locus of control between both groups. Differences were described as mean differences and 95% confidence intervals. RESULTS: Treatment group scored higher for external locus of control and lower for internal locus of control than control group. Mean differences (95% confidence intervals) were 2.7 points on possible 30-points difference (0.5 to 4.8) for external locus of control and -2.8 points (-5.4 to -0.1) for internal subscale. CONCLUSION: Health locus of control was found to be different between treatment and control groups. Participants being treated had higher external locus of control and lower internal locus of control than control group.

CONTEXTUALIZAÇÃO: Pessoas com dor lombar com altos níveis de lócus de controle externo têm piores prognósticos e necessitam de melhores intervenções ativas, uma vez que elas são consideradas mais valiosas. Se os níveis de lócus de controle diferem entre os participantes com dor lombar e aqueles que esperam o tratamento, a relação do atendimento-paciente não está clara. OBJETIVO: Investigar se existem diferenças no lócus de controle entre os indivíduos com dor lombar crônica em tratamento (grupo tratamento) e aqueles que esperam tratamento (grupo controle). MÉTODOS: Cem participantes (50 por grupo) com sintomas lombares por pelo menos três meses, com um episódio atual de dor lombar e com idades entre 18 e 60 anos foram recrutados. O Questionário Multidimensional de Lócus de Controle da Saúde (MHLC) foi usado para coleta das crenças dos participantes. Realizou-se uma regressão linear múltipla ajustada para incapacidade e para comparação do lócus de controle entre os grupos. As diferenças foram descritas com médias e intervalos de confiança de 95%. RESULTADOS: O grupo tratamento teve escore mais alto para o lócus de controle externo e mais baixo para o lócus de controle interno quando comparado com o grupo controle. As diferenças médias (intervalo de confiança de 95%) foram 2,7 pontos em possível diferença de até 30 pontos (0,5 a 4,8) para lócus de controle externo e -2,8 pontos (-5,4 a -0,1) para lócus de controle interno. CONCLUSÃO: O lócus de controle da saúde encontrado para o grupo tratamento e o controle foi diferente. Os participantes em tratamento tinham um alto lócus de controle externo e um baixo lócus de controle interno quando comparados com os do grupo controle.

Escoliose idiopática do adolescente: análise do grau de correção obtido com o uso de parafusos pediculares / Adolescent idiopathic scoliosis: analysis of the degree of correction obtained with pedicle screws

Objetivo: Avaliar o grau de correção obtido durante o tratamento cirúrgico da escoliose idiopática do adolescente, por meio da estabilização com parafusos pediculares. Método: Entre 2006 e 2008, foram avaliados 21 pacientes com escoliose idiopática do adolescente, os quais foram submetidos ao tratamento cirúrgico, com seguimento médio de 2 anos. Este estudo foi feito por meio de radiografias no plano frontal com mensuração da correção da deformidade pelo método de Cobb. Foi analisada, também, a rotação da vértebra apical pós-cirúrgica através da classificação de Nash e Moe. Resultados: Foi identificada melhora média de 24,1 graus nas deformidades pós-operatórias torácicas e de 18,78 graus nas deformidades lombares. Isso reflete em uma melhora do ângulo de Cobb de 61,36% para as curvas torácicas e de 53,65% para as curvas lombares. Também foi constatada melhora de 1 grau na Classificação de Nash e Moe presente em 11 (52,38%) pacientes do estudo. Nos demais 10 (47,62%) pacientes, não houve alteração do grau de rotação pré e pós-operatório na Classificação de Nash e Moe. Conclusões: A fixação com parafusos pediculares, tanto na região lombar quanto torácica, mostrou-se um método seguro com um bom grau de correção nos três planos (sagital, coronal e rotacional).

Objective: To assess the degree of correction obtained from surgical stabilization of adolescent idiopathic scoliosis with pedicle screws. Method: Between 2006 and 2008, 21 adolescents with idiopathic scoliosis submitted to surgical treatment were assessed, with a mean follow-up of two years. The assessment was based on frontal plane X-rays with measurement of the deformity correction by the Cobb method. The post-surgical apical vertebra rotation was also assessed, using the Nash-Moe classification. Results: Fast postoperative improvement of 24.1 degrees for thoracic and 18.78 degrees for lumbar deformities was identified. This reflects an improvement of the Cobb angle of 61.36% for thoracic curves and 53.65% for lumbar curves. One-degree improvement of the Nash-Moe classification in 11 (52.38%) study patients was also verified. The remaining 10 (47.62%) patients showed no change in the pre and post-surgical rotation degree, in the Nash-Moe classification.áConclusion: The fixation with pedicle screws, either lumbar or thoracic, has been shown to be a safe method, resulting in a good degree of correction on the three planes (sagittal, coronal and rotational).

Hand-assisted right laparoscopic nephrectomy in living donor

OBJECTIVE: To assess results obtained with the authors' technique of right hand-assisted laparoscopic nephrectomy in living kidney donors. MATERIALS AND METHODS: We retrospectively analyzed 16 kidney donors who underwent hand-assisted right laparoscopic nephrectomy from February 2001 to July 2004. Among these patients, 7 were male and 9 were female, with mean age ranging between 22 and 58 years (mean 35.75). RESULTS: Surgical time ranged from 55 to 210 minutes (mean 127.81 min) and warm ischemia time from 2 to 6 minutes (mean 3.78 min) with mean intra-operative blood loss estimated at 90.62 mL. There was no need for conversion in any case. Discharge from hospital occurred between the 3rd and 6th days (mean 3.81). On the graft assessment, immediate diuresis was seen in 15 cases (93.75 percent) and serum creatinine on the 7th post-operative day was 1.60 mg/dL on average. Renal vein thrombosis occurred in 1 patient (6.25 percent) who required graft removal, and lymphocele was seen in 1 recipient (6.25 percent). CONCLUSION: Hand-assisted right laparoscopic nephrectomy in living donors is a safe and effective alternative to open nephrectomy. Despite a greater technical difficulty, the procedure presented low postoperative morbidity providing good morphological and functional quality of the graft on the recipient.

Hand-assisted laparoscopic nephrectomy in living donor

OBJECTIVE: Report the authorsÆ initial experience with hand-assisted laparoscopic nephrectomy technique in renal donors for transplantation. MATERIALS AND METHODS: Twenty-seven donors submitted to hand-assisted laparoscopic nephrectomy were retrospectively analyzed from February 2001 to June 2002. Technical aspects of the donor surgery, results, and complications, are discussed, as well as recipientÆs complications and outcomes. RESULTS: Among 27 hand-assisted laparoscopic nephrectomies, left kidney was withdrew in 18 donors (66.6 percent), and right kidney in 9 (33.3 percent). The operative time ranged from 55 to 210 minutes (mean 132.7 ± 37.6 min), and the time of hot ischemia ranged from 2 to 11 minutes (mean 4.7 ± 2.5 min), with an estimated mean blood loss during the intraoperative period of 133.3 mL. Conversion to open surgery was necessary for 1 (3.7 percent) patient due to vascular lesion. In graft evaluation, immediate diuresis was observed in 26 (96.3 percent) cases, and mean serum creatinine in PO day 7 was 1.5 ± 1.1 mg/dL. Renal vein thrombosis occurred in 1 (3.7 percent) patient requiring graft removal. Lymphocele was observed in 3 recipients (11.1 percent), and urinary leakage due to ureteral necrosis in 1 case (3.7 percent). CONCLUSION: Hand-assisted laparoscopic nephrectomy in living donors is a safe procedure and an effective alternative to open nephrectomy. In this series, the procedure presented low morbidity after surgery providing to the recipient a good morphological and functional quality of the graft