Anatomy of the Dorsomedial Cutaneous Nerve to Hallux and Surgical Implications According to the Severity of Hallux Valgus Deformity: A Cadaveric Study.

The dorsomedial cutaneous nerve to hallux provides sensation to the dorsomedial aspect of the first metatarsophalangeal joint and hallux. Postoperative damage to the dorsomedial cutaneous nerve to hallux have been reported with the dorsomedial approach and symptoms can be very debilitating. The present study aims to understand how the distance between this nerve and the extensor hallucis longus tendon are affected by the severity of the hallux valgus deformity, at the level of the first metatarsophalangeal joint. We performed a cadaveric study using 35 cadaveric lower extremities (N = 35). Each specimen was classified according to the hallux valgus severity through a 30 kg partial weight-bearing antero-posterior radiograph. Before dissection, the lower extremities' greater saphenous vein was injected with black latex to simplify the distinction between anatomical structures. We concluded that as the hallux valgus angle and the first intermetatarsal angle increase, the distance between the dorsomedial cutaneous nerve to hallux and the extensor hallucis longus tendon also increases, ranging from 12 mm in normal feet to 19 mm in severely deformed feet. Hallux valgus is a three-dimensional deformity that changes traditional surgical landmarks. To avoid harming this nerve, we established a danger zone ranging from 12 mm to 19 mm medial from the extensor hallucis longus tendon, at the level of the first metatarsophalangeal joint. The mid-medial approach to MTP should be preferred as it is out of the danger zone.

Vascular anatomy of the first metatarsal bone and surgical implications according to the severity of hallux valgus deformity: A cadaveric study.

BACKGROUND: Vascular injury after hallux valgus surgery is a rare condition but serious complications can ensue. METHODS: We performed an anatomical study using 26 cadaveric lower extremities. We enhanced first metatarsal bone's (FMB) vascularization by injecting latex. Each specimen was classified according to the severity of hallux valgus deformity (HVD). Then we measured two distances: one between the first tarsometatarsal joint (FTMJ) to the first dorsal branch's origin, the other between the first metatarsophalangeal joint (MTP) to the dorsal plexus's origin. RESULTS: The distance between the FTMJ and the first dorsal branch to the FMB ranges from 10 mm in normal feet to 15 mm in severe deformed feet. The distance between the MTP and the dorsal plexus' origin ranges from 20 mm in normal feet to 25 mm in severe deformed feet. CONCLUSIONS: Understanding the foot's vascular anatomy has allowed us to adapt surgical landmarks to the severity of the HVD and to avoid post-operative complications.

The prevalence of Listeria monocytogenes in meat products in Brazil: A systematic literature review and meta-analysis.

Listeria monocytogenes, a foodborne pathogen that causes human listeriosis, is commonly found in meat products. This study aimed to estimate the prevalence of L. monocytogenes in a variety of Brazilian meat products, using a meta-analysis of data from the literature. A total of 29 publications from five databases, published between January 1, 2009, and December 31, 2019, were included in the study. Estimated by the random-effects model, the combined prevalence of L. monocytogenes was 13%, ranging from 0 to 59%. The combined prevalence of L. monocytogenes was 14% and 11% for raw meat and ready-to-eat (RTE) meat, respectively. The prevalence of L. monocytogenes was higher in the swine species' meat products and the Southeast region of Brazil. Regarding the type of establishment, it was the retail market that presented the highest combined prevalence rate (19%). The most prevalent serotypes of L. monocytogenes were 4b, 1/2a, 1/2b, and 1/2c. The knowledge of differences in the prevalence levels of L. monocytogenes in different meat products can guide in its efficient control by the competent authorities and by industry.

Outcomes of a novel bariatric stent in the management of sleeve gastrectomy leaks: a multicenter study.

BACKGROUND: The management of laparoscopic sleeve gastrectomy leaks remains a challenge. This can be treated with placement of self-expandable metal stents, which are most effective in the acute and early settings. However, migration is a frequent adverse event (AE). Novel, fully covered stents with a larger proximal flare to limit migration designed specifically to treat postsleeve leaks were recently introduced. OBJECTIVES: The aim of this study was to evaluate the safety and efficacy of a novel stent specifically designed for postsleeve leaks treatment. SETTING: Multicenter retrospective study. METHODS: This is a multicenter study, including patients with acute and early post laparoscopic sleeve gastrectomy leaks, treated with a large bariatric stent. The outcomes include technical success, clinical success, and safety profile. A multivariable regression was performed to assess predictors of success. RESULTS: Thirty-seven patients were included (10 acute and 27 early leaks), with 30 stents in the postpyloric (POST) and 7 in the prepyloric position. Technical success was 100%. Mean stent dwell time was 29.08 days. Clinical success was achieved in 78.37%. Leak duration, leak size, and stent dwell time did not correlate with clinical success. During follow-up, 8 patients had stent migration (21.62%) and all were in a POST position. AE poststent removal were also evaluated (prepyloric: 57.14% vs POST: 33.3%, P = .45). There was no difference between prepyloric and POST position in the severe AE analysis. CONCLUSIONS: This novel, large-caliber, fully covered stent specifically designed for sleeve leaks appears to be effective at treating acute and early leaks. However, the large flanges and long stent length do not appear to reduce migration rate and may be associated with higher overall severe AE rates. Avoiding placement in the POST position may help mitigate migration risk; however, owing to the risk profile this stent should be used with caution.

A novel mutation in IRF6 resulting in VWS-PPS spectrum disorder with renal aplasia.

Popliteal pterygium syndrome (PPS) and Van der Woude syndrome (VWS) are caused by mutations in the gene interferon regulatory factor 6 (IRF6). Skeletal, genital malformations and involvement of the skin occur in PPS and orofacial clefting and lip pits occur in both. We report on a patient with unilateral cleft lip and palate, ankyloblepharon, paramedian lip pits, unilateral renal aplasia, and a coronal hypospadias. By sequencing IRF6, we detected a novel missense mutation (Arg339Ile). The other family members were unaffected and had no IRF6 mutations, including the patient's brother who was also born with hypospadias. The patient and his brother were both conceived by in vitro fertilization (IVF). It is discussed whether the renal malformation in the patient is related to the IVF procedure or to the IRF6 mutation.

Can an aversive, extinction-resistant memory trigger impairments in walking adaptability? An experimental study using adult rats.

Cognitive demands can influence the adaptation of walking, a crucial skill to maintain body stability and prevent falls. Whilst previous research has shown emotional load tunes goal-directed movements, little attention has been given to this finding. This study sought to assess the effects of suffering an extinction-resistant memory on skilled walking performance in adult rats, as an indicator of walking adaptability. Thus, 36 Wistar rats were divided in a two-part experiment. In the first part (n=16), the aversive, extinction-resistance memory paradigm was established using a fear-conditioning chamber. In the second, rats (n=20) were assessed in a neutral room using the ladder rung walking test before and tree days after inducing an extinction-resistance memory. In addition, the elevated plus-maze test was used to control the influence of the anxiety-like status on gait adaptability. Our results revealed the shock group exhibited worse walking adaptability (lower skilled walking score), when compared to the sham group. Moreover, the immobility time in the ladder rung walking test was similar to the controls, suggesting that gait adaptability performance was not a consequence of the fear generalization. No anxiety-like behavior was observed in the plus maze test. Finally, correlation coefficients also showed the skilled walking performance score was positively correlated with the number of gait cycles and trial time in the ladder rung walking test and the total crossings in the plus maze. Overall, these preliminary findings provide evidence to hypothesize an aversive, extinction-resistant experience might change the emotional load, affecting the ability to adapt walking.

Laparoscopic Thrombectomy of Renal Angiomyolipoma Level III

PURPOSE: Renal angiomyolipoma (AML) is a benign tumor, corresponding to approximately 3 percent of solid renal tumors, which has in its composition endothelial cells, myocytes and adipocytes. One of the rare complications of this type of tumor is linfonodal involvement and tumor venous dissemination forming thrombus in the renal vein and inferior vena cava and may even reach the right atrium. Surgical treatment of this type of tumor is performed mainly by open surgery, but this video shows the laparoscopic approach for level III of angiomyolipoma, showing that this approach is feasible and reproducible by any trained and experienced surgeon. MATERIALS AND METHODS: Woman of 65 years with back pain, ultrasound examination showed a tumor in the right kidney, and follow-up computed tomography revealed aspects of angiomyolipoma. We performed radical nephrectomy with thrombectomy by laparoscopy. RESULTS: The patient recovered well, enjoying all the benefits of laparoscopic surgery. There were no complications during surgery. CONCLUSIONS: The surgical approach of laparoscopic renal angiomyolipoma is a perfectly feasible, bringing numerous benefits to the patient, and can establish itself as a breakthrough in treating this type of tumor.

Regulação sanitária por um enfoque judicial: o horário de funcionamento de farmácias e drogarias no estado de São Paulo / Sanitary regulation for a judicial approach: the schedule of pharmacy functioning and you would drug in the state of São Paulo

O presente trabalho tem como base a visão judicial da regulação sanitária no Estado de São Paulo no tocante à abertura e funcionamento de farmácias e drogarias em finais de semana e feriados fora dos horários previstos em lei. Essa é uma questão que enseja a atuação da Administração Pública por meio da Vigilância Sanitária e seus respectivos representantes legais e pode ocasionar autuações e fechamentos irregulares desses estabelecimentos. A função de regulação no âmbito da ação sanitária tem assumido, nos dias atuais, a agregação de sentido par a além da regulamentação ou controle do risco sanitário, ampliando significação no campo econômico.