Assessment of inter- and intraobserver agreement for META score in distinguishing osteoporotic from multiple myeloma vertebral fractures.

PURPOSE: To conduct an independent assessment of inter- and intraobserver agreement for the META score as a tool for differentiating osteoporotic vertebral fractures and multiple myeloma vertebral fractures. METHODS: This is a retrospective observational study. The magnetic resonance imaging analysis was made by two independent spinal surgeons. We designated a Subjective assessment, in which the surgeon should establish a diagnostic classification for each vertebral fracture based on personal experience: secondary to osteoporosis, categorized as a benign vertebral fracture (BVF), or attributed to multiple myeloma, categorized a malign vertebral fracture (MVF). After a 90-day interval, both surgeons repeated the evaluations. For the next step, the observers should establish a diagnosis between BVF and MVF according to the META score system, and both observers repeated the evaluations after a 90-day interval. The intra and interobserver reliability of the Subjective evaluation was studied using the kappa (κ) test. Then, the META evaluations were paralleled using the intraclass correlation coefficient (ICC). RESULTS: A total of 220 patients who had the potential to participate in the study were initially enrolled, but after applying the exclusion criteria, 44 patients were included. Thirty-three patients had BVF, and 12 patients presented MVF. Interobserver agreement for both Subjective evaluations moments (initial and 90-days interval) found a slight agreement for both moments (0.35 and 0.40 respectively). Kappa test for both META evaluations moments (initial and 90-days interval) found a moderate interobserver agreement for both moments (0.54 and 0.48 respectively). It was observed that the ICC calculated for the Initial evaluation using META score was 0.680 and that in the 90-days interval was 0.726, indicating regular to good agreement. Kappa test for intraobserver agreements for the Subjective evaluation presented moderate agreement for both Surgeons. On the other side, Kappa test for intraobserver agreements for the META evaluation presented substantial agreement for both Surgeons. The Intraclass Correlation Coefficient of the META score found presented an almost perfect agreement for both Surgeons. CONCLUSION: Intra and interobserver agreement for both surgeons were unsatisfactory. The lack of consistent reproducibility by the same observer discourages and disfavors the routine use of the META score in clinical decision making, when potentially cases of multiple myeloma may be present.

The modified Nice knot has improved mechanical performance compared to the cinch stitch for meniscal root repair.

PURPOSE: According to previous biomechanical studies, the success of meniscus root repair depends on the suture-meniscus interface and optimisation of this procedure seems to be critical. A progressive, reliable and adjustable knot has numerous advantages in meniscal repair since the surgeon can adapt and meticulously tune the final strength of the fixation. We hypothesised that a single passage of one tape at two different points of the posterior meniscal root with a modified Nice knot configuration may allow similar or superior fixation for root repair compared to the cinch stitch suture technique. METHODS: Posterior root repair of medial and lateral meniscus was performed on 26 porcine knees. In group (A), two simple cinch stitches were applied, and in group (B), a modified Nice knot was used in a crossmatch configuration. For both groups, two passages through the meniscus with a 2-mm braided tape were used, and a single transosseous tibial tunnel technique was performed and tested in pull-out conditions. RESULTS: The modified Nice knot showed an improved biomechanical performance considering the maximum failure load for both the medial (600.7 ± 77.5 N) and lateral (686.1 ± 83.5 N) (p = 0.006) posterior root fixation when compared to a double cinch stitch (558.0 ± 123.9 N) and (629.0 ± 110.2 N) (p = 0.178) for medial and lateral fixation, respectively. The maximum stiffness was also higher for the modified Nice knot configuration for both medial (17.1 ± 1.5 vs. 13.3 ± 1.6 N/mm) and lateral meniscus (20.0 ± 2.6 vs. 13.8 ± 2.3 N/mm), being this difference statistically significative (p = 0.001). CONCLUSIONS: The modified Nice knot allowed better adaptation in the pull-out tests and presented higher fixation strength, stiffness and reproducibility, with lower standard deviation, being at the same time economically advantageous, since only one tape is needed. LEVEL OF EVIDENCE: Level III.

Adverse remodeling in atrial fibrillation following isolated aortic valve replacement surgery.

BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia with adverse clinical outcomes. Aortic valve replacement (AVR) is one of the most frequently performed cardiac surgeries, although there is scarce evidence on arrhythmic outcomes. We aimed to evaluate AF during the first year post- isolated aortic valve replacement surgery and its clinical, analytical, and echocardiographic predictors. METHODS: Severe aortic stenosis patients with no prior atrial fibrillation submitted to isolated aortic valve replacement surgery were included in our study, of which 316 remained in sinus rhythm and 24 developed AF. We performed logistic regression searching for AF predictors and a longitudinal comparison between pre and post-operative echocardiographic data. RESULTS: Postoperative AF (POAF), diabetes, and follow-up indexed Left Atrium Diameter (iLAD) were significantly higher in the group of patients developing AF. POAF and iLAD were independent AF predictors at follow-up. No differences between groups were found regarding baseline and follow-up echocardiographic data except for indexed Left Ventricle End-diastolic Diameter (LVED), which failed to decrease after surgery in the AF group. CONCLUSIONS: POAF and iLAD independently predicted AF at 1 year following isolated AVR surgery in aortic stenosis patients with no AF history. iLVED did not decrease significantly at follow-up in AF patients, possibly reflecting adverse ventricular remodeling.

The Self-Report Delinquency Scale From the National Longitudinal Study of Adolescent to Adult Health Among At-Risk for Delinquency Youths.

Juvenile delinquency is a universal problem, with serious personal, economic, and social consequences that span national boundaries. Thus, cross-culturally valid and reliable measures of delinquency are critical to providing a better understanding of the causes, correlates, and outcomes of delinquency. The main aim of the present study was to examine the psychometric properties of a Portuguese version of the self-report delinquency measure items created for the National Longitudinal Study of Adolescent Health (Add Health). A sample (N = 412) of male (n = 200) and female (n = 212) at-risk for delinquency youths agreed to participate in the present study. The measure demonstrated satisfactory psychometric properties, namely in terms of its two-factor structure (violent and nonviolent delinquency), internal consistency, convergent validity, discriminant validity, criterion-related validity, and known-groups validity. Findings suggest the Add Health Self-Report Delinquency (AHSRD) is an interculturally valid and reliable measure of violent and nonviolent delinquency among at-risk male and female youths.

Blood and urine biomarkers for the diagnosis of early stages of knee osteoarthritis: A systematic review.

Purpose: To identify biomarkers in human blood or urine at an early stage of knee osteoarthritis (OA) and to elucidate if any can accurately differentiate between healthy controls and early knee OA patients and be considered as a candidate for widespread clinical use for early diagnosis of the disease. Methods: Medline, Embase and Web of Science were screened to identify comparative studies measuring differences in blood or urine biomarkers between healthy controls and knee OA patients at an early stage (grade 1 or 2 Kellgren-Laurence). Two independent reviewers screened the abstracts for eligibility, reviewed the full texts, assessed the methodological quality and extracted the data. The Joanna Briggs Institute critical appraisal tool for diagnostic test accuracy studies was used to assess the quality of the included studies. Due to relevant heterogeneity, meta-analysis was not appropriate. Results: Five studies met the eligibility criteria. The examined biomarkers were adropin, collagen type II metabolite, C-terminal cross-linked telopeptide of type II collagen, C-terminal cross-linked telopeptide of type I collagen, cartilage oligomeric matrix protein, matrix metalloproteinase 3, N-terminal propeptide of procollagen type IIA, type I procollagen N-terminal propeptides, N-terminal osteocalcin, angiopoietin-2, follistatin, granulocyte colony-stimulating factor, hepatocyte growth factor, interleukin-8, leptin, platelet-derived growth factor-BB, platelet endothelial cell adhesion molecule-1, vascular endothelial growth factor and calprotectin and totalling 19 biomarkers. All of the biomarkers were studied only once in the selected papers. Conclusions: There is no reliable biomarker available to differentiate between early knee OA in patients and healthy controls, but a potential role of a cluster of biomarkers to close this gap. There are several limitations, including inappropriate study designs, small sample sizes, nonconsecutive patient groups and inadequate statistical methods for evaluating biomarker performance in studies included. Level of Evidence: Level III.

Laparoscopic Versus Open Pancreatoduodenectomy for Periampullary Tumors: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

PURPOSE: Laparoscopic pancreatoduodenectomy (LPD) has emerged as an alternative to open technique in treating periampullary tumors. However, the safety and efficacy of LPD compared to open pancreatoduodenectomy (OPD) remain unclear. Thus, we conducted an updated meta-analysis to evaluate the efficacy and safety of LPD versus OPD in patients with periampullary tumors, with a particular focus on the pancreatic ductal adenocarcinoma patient subgroup. METHODS: According to PRISMA guidelines, we searched PubMed, Embase, and Cochrane Library in December 2023 for randomized controlled trials (RCTs) that directly compare LPD versus OPD in patients with periampullary tumors. Endpoints and sensitive analysis were conducted for short-term endpoints. All statistical analysis was performed using R software version 4.3.1 with a random-effects model. RESULTS: Five RCTs yielding 1018 patients with periampullary tumors were included, of whom 511 (50.2%) were randomized to the LPD group. Total follow-up time was 90 days. LPD was associated with a longer operation time (MD 66.75; 95% CI 26.59 to 106.92; p = 0.001; I2 = 87%; Fig. 1A), lower intraoperative blood loss (MD - 124.05; 95% CI - 178.56 to - 69.53; p < 0.001; I2 = 86%; Fig. 1B), and shorter length of stay (MD - 1.37; 95% IC - 2.31 to - 0.43; p = 0.004; I2 = 14%; Fig. 1C) as compared with OPD. In terms of 90-day mortality rates and number of lymph nodes yield, no significant differences were found between both groups. CONCLUSION: Our meta-analysis of RCTs suggests that LPD is an effective and safe alternative for patients with periampullary tumors, with lower intraoperative blood loss and shorter length of stay.

Memory complaint in a middle-income country: a four-year longitudinal study in a cohort with low-education.

BACKGROUND: Memory complaints are frequent in older adults and are associated with higher risk of cognitive decline. OBJECTIVE: To investigate the functional outcome of individuals with memory complaints followed up at primary care centers. METHODS: Data were collected between 2016 e 2020 in primary health care centers in Brazil. Patients underwent the Brief Cognitive Screening Battery, and the Functional Activities Questionnaire. RESULTS: The initial sample (2016) comprised 91 individuals classified into those with subjective cognitive decline (SCD, n = 15), mild cognitive impairment (MCI, n = 45), or dementia (n = 31). During follow-up, 8 individuals (8.8% of the initial sample) died and 26 (28.5% of the initial sample) were not found. Fifty-seven participants underwent clinical reassessment. Of 15 individuals with SCD, 7 were not found (46.7%), 4 (26.7%) progressed to MCI, and 4 (26.7%) remained stable. Of 45 individuals with MCI, 11 were not found (24.4%), 2 (4.4%) died, 6 (13.4%) progressed to dementia, 12 (26.7%) regressed to SCD, and 14 (31.1%) remained stable. Of 31 individuals with dementia, 8 were not found (25.8%), 6 (19.4%) died, 2 (6.5%) regressed to SCD, 7 (22.6%) regressed to MCI, and 8 remained stable (25.8%). Clinical improvement was due to the treatment of reversible causes, such as B12 hypovitaminosis and mood disorders. Older age, lower Mini-Mental State Examination, and higher scores of memory complaint, but not the use of benzodiazepines and of proton pump inhibitors, were predictors of functional status. CONCLUSION: Despite their limits (short sample size, missing data), these results support the idea that adequate screening, follow-up, and treatment of reversible causes of dementia in primary care are essential.

ANTECEDENTES: Queixas de memória são frequentes em idosos e estão associadas ao maior risco de declínio cognitivo. OBJETIVO: Investigar o desfecho funcional de indivíduos com queixas de memória acompanhados em centros atenção primária. MéTODOS: Os dados foram coletados entre 2016 e 2020 em centros de atenção primária à saúde no Brasil. Os pacientes foram submetidos à Bateria Cognitiva Breve e ao Questionário de Atividades Funcionais. RESULTADOS: A amostra inicial (2016) foi composta por 91 indivíduos, classificados como tendo declínio cognitivo subjetivo (DCS, n = 15), comprometimento cognitivo leve (CCL, n = 45), ou demência (n = 31). Durante o seguimento, 8 indivíduos (8,8% da amostra inicial) faleceram e 26 (28,5% da amostra inicial) não foram encontrados. Cinquenta e sete participantes foram submetidos à reavaliação clínica. Dos 15 indivíduos com DCS, 7 não foram encontrados (46,7%), 4 (26,7%) declinaram para CCL e 4 (26,7%) permaneceram estáveis. Dos 45 indivíduos com CCL, 11 não foram encontrados (24,4%), 2 (4,4%) morreram, 6 (13,4%) declinaram para demência, 12 (26,7%) evoluíram para DCS e 14 (31,1%) permaneceram estáveis. Dos 31 indivíduos com demência, 8 não foram encontrados, (25,8%), 6 (19,4%) morreram, 2 (6,5%) evoluíram para DCS e 7 (22,6%) para CCL; e 8 permaneceram estáveis (25,8%). A melhora clínica deveu-se ao tratamento de causas reversíveis, como hipovitaminose B12 e transtornos de humor. A idade avançada, a baixa pontuação no Mini-Exame do Estado Mental e os escores de queixa de memória mais altos, mas não o uso de benzodiazepínicos e inibidores da bomba de prótons, foram preditores de declínio funcional. CONCLUSãO: Apesar de suas limitações (amostra pequena, dados ausentes), esses resultados corroboram que a triagem adequada, o acompanhamento e o tratamento de causas reversíveis de demência na atenção primária são essenciais.

Fibroma of the Patellar Tendon Sheath: A New Paradigm.

The authors present a case of fibroma of the tendon sheath with intra-articular location in the knee, more specifically in the infrapatellar fat; with this specific location, this is the fourth case described of an entity that rarely affects large joints. Clinical and epidemiological aspects, but especially the imaging findings on magnetic resonance imaging scans, are essential for the differential and definitive diagnosis, which was nevertheless established only after a histological study of the excised mass by miniarthrotomy.

Effects of Heat Input on Weld Microstructure and Properties in Keyhole TIG Welding of Invar 36 Alloy.

The Invar alloy is widely used for aircraft wing mould manufacturing. In this work, keyhole-tungsten inert gas (K-TIG) butt welding was used to join 10 mm thick Invar 36 alloy plates. The effect of heat input on the microstructure, morphology and mechanical properties was studied by using scanning electron microscopy, high energy synchrotron X-ray diffraction, microhardness mapping, tensile and impact testing. It was shown that regardless of the selected heat input, the material was solely composed of austenite, although the grain size changed significantly. The change in heat input also led to texture changes in the fusion zone, as qualitatively determined with synchrotron radiation. With increases in heat input, the impact properties of the welded joints decreased. The coefficient of thermal expansion of the joints was measured, which demonstrated that the current process is suitable for aerospace applications.

In Vitro Transdifferentiation Potential of Equine Mesenchymal Stem Cells into Schwann-Like Cells.

Schwann cells (SCs) are essential for the regenerative processes of peripheral nerve injuries. However, their use in cell therapy is limited. In this context, several studies have demonstrated the ability of mesenchymal stem cells (MSCs) to transdifferentiate into Schwann-like cells (SLCs) using chemical protocols or co-culture with SCs. Here, we describe for the first time the in vitro transdifferentiation potential of MSCs derived from equine adipose tissue (AT) and equine bone marrow (BM) into SLCs using a practical method. In this study, the facial nerve of a horse was collected, cut into fragments, and incubated in cell culture medium for 48 h. This medium was used to transdifferentiate the MSCs into SLCs. Equine AT-MSCs and BM-MSCs were incubated with the induction medium for 5 days. After this period, the morphology, cell viability, metabolic activity, gene expression of glial markers glial fibrillary acidic protein (GFAP), myelin basic protein (MBP), p75 and S100ß, nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), and glial cell-derived neurotrophic factor (GDNF), and the protein expression of S100 and GFAP were evaluated in undifferentiated and differentiated cells. The MSCs from the two sources incubated with the induction medium exhibited similar morphology to the SCs and maintained cell viability and metabolic activity. There was a significant increase in the gene expression of BDNF, GDNF, GFAP, MBP, p75, and S100ß in equine AT-MSCs and GDNF, GFAP, MBP, p75, and S100ß in equine BM-MSCs post-differentiation. Immunofluorescence analysis revealed GFAP expression in undifferentiated and differentiated cells, with a significant increase in the integrated pixel density in differentiated cells and S100 was only expressed in differentiated cells from both sources. These findings indicate that equine AT-MSCs and BM-MSCs have great transdifferentiation potential into SLCs using this method, and they represent a promising strategy for cell-based therapy for peripheral nerve regeneration in horses.

COVID-19 in kidney transplant recipients: what have we learned one year later? A cohort study from a tertiary center.

INTRODUCTION: Kidney transplant (KT) recipients have a high risk for adverse outcomes from infections, such as COVID-19. METHODS: We have retrospectively reviewed all KT recipients with documented COVID-19 between March 1, 2020, and March 15, 2021, and analyzed patients' characteristics, clinical course, treatment, and outcomes. RESULTS: We identified 123 patients, 72% were male, with a mean age of 54.5±13.0 years. Twenty percent were asymptomatic, 7% had a nosocomial transmission, and 36% of the remainder required hospitalization. Almost all admitted patients received oxygen, 30% required invasive mechanical ventilation (IMV), more than a half had acute kidney injury, with 10% requiring dialysis, and 20% died. Incidence was comparable to that of the Portuguese population, but the mortality rate was almost four times higher (SMR of 3.768 (95% CI:1.723-7.154). Higher body mass index (OR 1.275, P=0.001), lower baseline graft function (OR 0.968, P=0.015), and nosocomial transmission (OR 13.836, P=0.019) were associated with oxygen demand, whereas female gender (OR 3.801, P=0.031) and lower baseline kidney graft function (OR 0.955, P=0.005), but not body mass index, were associated with IMV and/or death. CONCLUSION: Mortality rate in KT patients was higher than in the general population and lower baseline kidney function was the most consistent marker for adverse outcomes.

Allele Frequency of APAF1 Mutation in Holstein Cattle in Brazil.

APAF1 is an autosomal recessive inherited mutation, associated with Holstein haplotype 1 (HH1) and characterized by a substitution of cytosine for a thymine (c.1741C>T) in chromosome 5. The mutation causes fetal and embryonic loss, between 60 and 200 days of gestation, and reduced conception rate. The ARMS-PCR is considered a simple and low-cost method to determine single nucleotide polymorphism (SNP) with no need for genetic sequencing of the animal genome. This study aimed to verify the allelic frequency of APAF1 mutation in Brazilian Holstein cattle. A total of 248 Holstein DNA samples (210 cows and 38 bulls) were analyzed, and synthetic genes were manufactured to validate the primers developed by the authors. All animals assessed in this study were classified as wild-type for APAF1 mutation. The primers and protocol developed for the ARMS-PCR technique work with 100% specificity and efficiency since the amplicon formations are as expected according to the genotypes. In conclusion, the mutation responsible for APAF1 was not detected in the Brazilian Holstein cattle population assessed in this prevalence study, although it is not possible to affirm that APAF1 does not occur in Brazilian Holstein animals. The tetra-primer ARMS-PCR protocol for APAF1 mutation that has been validated here may be a relatively simple and economical method to determine the animals' genotype.

Why Donors Do Not Donate: A Living Donation Program Experience.

BACKGROUND: A living donor (LD) kidney transplant is the best therapeutic option for end-stage kidney disease. Potential donors must undergo multiple analyses and the rates of live donation can be as low as 8% to 18%. Here, we report on the live kidney donor program in our unit with emphasis on the reasons why potential donors do not proceed to donation. METHODS: We performed a single-center retrospective study of all potential kidney donors with a first LD appointment at Centro Hospitalar Universitário do Porto between January 2016 and December 2020. RESULTS: In our cohort there were 395 potential donors. From the potential donors who finished assessment, 131 were approved for donation and 239 dropped out. After assessment, 104 (28.1%) recipients received a living kidney transplant, 24 of which received a living kidney transplant through the kidney paired exchange program. The individuals who did not proceed to the surgery (n = 239) had a median age of 46.5 years, 64.4% were female, and 34 pairs were ABO-incompatible. The most frequent donor-recipient relationships were spouses, siblings and parents. The 2 most important causes of dropout were due to medical, surgical or psychological contraindications and the donor's voluntary withdrawal. When we evaluated the variables most related to dropout, they were not because of being a spouse and ABO incompatibility. CONCLUSIONS: When compared to other studies, we showed a relatively higher rate of successful live donations, possibly aided by the presence of cross-over transplantation. Targeted education and support at an earlier stage of the donor assessment process may lead to a better engagement and lower probability of early dropout.

Forgotten guidewire: A case report.

Introduction: The Seldinger technique for implanting central venous catheters is the most used in the world. A metallic guidewire is employed in it, introduced through the lumen of a venipuncture needle, which serves as a path for the introduction of the central venous catheter. Complications directly related to this technique are of several types, such an insertion of a long-winded segment of the guidewire, which can lead to venous perforation, cardiac perforation, arrhythmias or even guidewire retention/embolization. Presentation of the case: We report the case of a patient with a late diagnosis of a guidewire retained in her venous system. The distal end of the guidewire pierced the pulmonary artery, crossed the chest wall and remained in the left breast tissue. It was removed by laparotomy, through an extra-peritoneal access to the right common iliac vein. Discussion: Different factors have been identified as responsible for the increase in the number of guidewires retained after central venous catheterizations. Lack of supervision, in procedures performed by training physicians, has been identified as one of the most important risk factor in the cases reported in the literature. Conclusion: The present report demonstrates that central venous catheterization, despite being a relatively straight forward procedure, should not be underestimated and should be performed by properly trained physicians or by training physicians under supervision.

Pulmonary embolism in patients with COVID-19 and D-dimer diagnostic value: A retrospective study.

BACKGROUND: D-dimer levels are significantly higher in COVID-19 patients with Pulmonary Thromboembolism (PTE) as compared to those without PTE, but its clinical utility is still uncertain. PURPOSE: To determine the D-dimer performance for ruling out PTE in patients with COVID-19. We also assessed clinical and laboratory factors associated with the presence of PTE on CT Pulmonary Angiogram (CTPA). METHODS: Retrospective study involving all patients who presented at a tertiary care hospital from March 2020 to May 2021 with severe acute respiratory syndrome from COVID-19, who underwent CTPA and had D-dimer collected within 48 hours from CTPA. The D-dimer ability to classify patients with or without PTE according to CTPA was evaluated. RESULTS: A total of 697 patients [382 (54.8%) men; mean (SD) age, 59 (20.5) years] were included, of which 71.5% required intensive care admission, 32.4% had PTE, and 35.6% died during hospitalization. PTE was independently associated with mortality [42.5% vs. 32.3%; p = 0.038]. D-dimer levels were higher in patients with PTE [9.1 (3.9; 20) vs. 2.3 (1.2; 5.1); p < 0.001]. Using the D-dimer cutoff of 0.5 µg/mL or above, sensitivity was 98.2% and specificity 5.7%. The 0.3 µg/mL threshold was associated with 100% of sensitivity for the presence of PTE, with which 99.1% of patients had increased values. ROC curve AUC was 0.77, demonstrating moderate discriminative power of D-dimers to detect PTE. CONCLUSIONS: D-dimer levels are higher among COVID-19 hospitalized patients with PTE as compared to those without PTE and have moderate discriminative power to detect PTE, but its use to exclude PTE in this population may have limited clinical utility.

Robust, maintainable, emergency invasive mechanical ventilator. / Ventilador mecânico invasivo de emergência resistente e de fácil manutenção.

OBJECTIVE: To develop a simple, robust, safe and efficient invasive mechanical ventilator that can be used in remote areas of the world or war zones where the practical utility of more sophisticated equipment is limited by considerations of maintainability, availability of parts, transportation and/or cost. METHODS: The device implements the pressure-controlled continuous mandatory ventilation mode, complemented by a simple assist-control mode. Continuous positive airway pressure is also possible. The consumption of compressed gases is minimized by avoiding a continuous flow of oxygen or air. Respiratory rates and inspiration/expiration time ratios are electronically determined, and an apnea/power loss alarm is provided. RESULTS: The pressure profiles were measured for a range of conditions and found to be adjustable within a ± 2.5cmH2O error margin and stable well within this range over a 41-hour period. Respiratory cycle timing parameters were precise within a few percentage points over the same period. The device was tested for durability for an equivalent period of four months. Chemical and biological tests failed to identify any contamination of the gas by volatile organic compounds or microorganisms. A ventilation test on a large animal, in comparison with a well established ventilator, showed that the animal could be adequately ventilated over a period of 60 minutes, without any noticeable negative aftereffects during the subsequent 24-hour period. CONCLUSION: This ventilator design may be viable, after further animal tests and formal approval by the competent authorities, for clinical application in the abovementioned atypical circumstances.

OBJETIVO: Desenvolver um ventilador mecânico invasivo simples, resistente, seguro e eficiente que possa ser utilizado em áreas remotas do mundo ou zonas de guerra, em que a utilidade prática de equipamentos mais sofisticados é limitada por questões de manutenção, disponibilidade de peças, transporte e/ou custo. MÉTODOS: O dispositivo implementa o modo de ventilação mandatória contínua com pressão controlada, complementado por um simples modo assisto-controlado. Pode-se também utilizar a pressão positiva contínua nas vias aéreas. Ao se evitar o fluxo contínuo de oxigênio ou ar, minimiza-se o consumo de gases comprimidos. As taxas respiratórias e as relações de tempo de inspiração e expiração são determinadas eletronicamente. Além disso, conta com um alarme de apneia/falta de energia. RESULTADOS: Os perfis de pressão foram medidos para uma série de condições, sendo considerados ajustáveis dentro de uma margem de erro de ± 2,5cmH2O, e foram considerados bem estáveis dentro dessa variação durante um período de 41 horas. Os parâmetros de tempo do ciclo respiratório foram precisos dentro de alguns pontos percentuais durante o mesmo período. O dispositivo foi testado quanto à durabilidade por um período equivalente a 4 meses. Os testes químicos e biológicos não conseguiram identificar qualquer contaminação do gás por compostos orgânicos voláteis ou micro-organismos. Em comparação com um ventilador bem estabelecido, o teste de ventilação em um animal de grande porte mostrou que este poderia ser ventilado adequadamente durante um período de 60 minutos, sem quaisquer efeitos negativos perceptíveis durante o período subsequente de 24 horas. CONCLUSÃO: Este projeto de ventilador pode ser viável após novos testes em animais e aprovação formal pelas autoridades competentes, para aplicação clínica nas circunstâncias atípicas anteriormente mencionadas.

Behavioral and biochemical consequences of Danio rerio larvae exposure to polylactic acid bioplastic.

The literature has largely shown the toxicity of petroleum-based PLA biomicroplastics (PLABioMPs) and encouraged the production of alternative materials to replace their use, such as biopolymers. However, knowledge concerning the effects of biopolymers on aquatic organisms remains under development. The hypothesis that the acute exposure (five days) to polylactic acid (PLA) biopolymers may lead to behavioral and biochemical changes and to their accumulation in Danio rerio larvae was tested. Based on the results, PLA biomicroplastics (PLA BioMPs) at concentration of 3 and 9 mg/L decreased swimming distance and speed of larvae in the open field test. This outcome suggests effects on animals' locomotor and exploration activities. Larvae's longer immobility time and greater permanence in the peripheral zone of the apparatus is indicative of anxiety-like behavior caused by the exposure to PLA BioMPs. Zebrafish larvae accumulated PLA BioMPs and their acetylcholinesterase activity was inhibited by their presence, which reinforces the accumulative potential of biopolymers and their direct or indirect role as anxiogenic agents, even at sublethal concentrations. The decreased activity of acetylcholinesterase reinforces the neurotoxic action in groups exposed to PLA BioMPs. The current study has confirmed the initial hypothesis and is an insight about the toxicity of these biopolymers in D. rerio larvae, since it deepens the discussion about the environmental risk of these substances in freshwater ecosystems.

Assessment of the quality of Primary Health Care in Fortaleza, Brazil, from the perspective of adult service users in 2019. / Avaliação da qualidade da Atenção Primária à Saúde em Fortaleza, Brasil, na perspectiva dos usuários adultos no ano de 2019.

Primary Health Care (PHC) is the "front door" and keystone of Brazil's public health system, meaning that the evaluation of the quality of primary care services is of utmost importance. Using the Primary Care Assessment Tool (PCAT), this study evaluated the performance of public PHC services in Fortaleza from the view of adult service users. We conducted a cross-sectional study of 233 adult service users from 19 primary care centers (PCCs) between June and December 2019, collecting data on the sociodemographic and epidemiological characteristics of users and structural features of PCCs. The association between user and PCC characteristics and primary care attribute scores was measured by multilevel logistic regression. Most participants were women, aged between 30 and 59 years, brown, house owners, had completed high school, did not own health insurance, and belonged to families with at least 4 members. The lowest and highest-scoring attributes were "first contact accessibility" and "first contact utilization" (2.8 and 8.1, respectively). The overall essential and general scores were 6.0 and 5.7, respectively. Having complete health teams, more community health workers, and a family and community medicine residency program had a positive effect on the general score (p<0.05). Overall, the public services analyzed in Fortaleza received a low performance rating from the adult service users.

A Atenção Primária à Saúde (APS) é porta de entrada e eixo estruturante do Sistema de Saúde brasileiro, o que impõe a necessidade de avaliação de sua qualidade. Este estudo objetivou avaliar os serviços públicos de Atenção Básica quanto aos atributos da APS por meio do PCATool na ótica de usuários em Fortaleza. Trata-se de um estudo transversal, de junho a dezembro de 2019, com 233 usuários adultos de 19 Unidades de APS (UAPS). Foram coletados dados sociodemográficos e epidemiológicos dos usuários e sobre a estrutura das UAPS. Utilizou-se modelo multinível para analisar características de usuários e UAPS em relação ao escore de APS medido via PCATool. Participantes foram, na maioria, mulheres, de 30 a 59 anos, pardos, com Ensino Médio completo, sem seguro privado, com moradia própria do tipo casa, de famílias até 4 pessoas. "Acessibilidade" obteve o menor escore, 2,8, e "Utilização" obteve o maior escore, 8,1. O Escore Essencial da APS foi 6,0, enquanto o Escore Geral foi 5,7. Houve influência positiva (p<0,05) no Escore Geral por: equipes completas, maior número de agentes comunitários e presença de residência de Medicina de Família e Comunidade. Concluiu-se que os serviços públicos de Fortaleza avaliados possuem baixo desempenho de APS na ótica dos usuários adultos.

Return to play after three ipsilateral anterior cruciate ligament reconstructions in an elite soccer player: A case report.

INTRODUCTION: Despite the reasonable success of ACL reconstruction, some athletes are not able to regain the level of play they once had. PRESENTATION OF CASE: Here, we report the case of a 32-year-old male professional soccer player who sustained an ACL injury in his right knee. The patient had a history of two prior ipsilateral ACL injuries, which was reconstructed with ipsilateral hamstring autograft (first surgery) and ipsilateral patellar tendon autograft (revision surgery). Imaging examination revealed a small narrowing of the medial femoro-tibial compartment, a complete ACL rupture, partial medial meniscectomy, small cartilage lesions in the medial condyle, a 7° varus knee, an enlarged tibial tunnel, and a femoral tunnel positioned high above the intercondylar roof. A one-step re-revision surgery using a fresh-frozen, cadaveric, non-irradiated Achilles tendon allograft was planned. After surgery, physiotherapy was conducted once per day during 4 months. The patient started running at the 6th month, and returned to full training 8 months after surgery. The player returned to full competitive play 9 months after surgery and has been competing for the last 36 months at the highest level of play without any limitation, inflammation, pain, or perception of instability. CONCLUSION: In professional sports, when re-revision ACL reconstruction is indicated and the patient expects to return to competition, surgery should not be delayed. In these cases, the usefulness of Achilles tendon allograft should be taken into consideration for re-revision ACL reconstruction.

Video-based computer navigation in knee arthroscopy for patient-specific ACL reconstruction.

PURPOSE: The anterior cruciate ligament tear is a common medical condition that is treated using arthroscopy by pulling a tissue graft through a tunnel opened with a drill. The correct anatomical position and orientation of this tunnel are crucial for knee stability, and drilling an adequate bone tunnel is the most technically challenging part of the procedure. This paper presents the first guidance system based solely on intra-operative video for guiding the drilling of the tunnel. METHODS: Our solution uses small, easily recognizable visual markers that are attached to the bone and tools for estimating their relative pose. A recent registration algorithm is employed for aligning a pre-operative image of the patient's anatomy with a set of contours reconstructed by touching the bone surface with an instrumented tool. RESULTS: Experimental validation using ex-vivo data shows that the method enables the accurate registration of the pre-operative model with the bone, providing useful information for guiding the surgeon during the medical procedure. Experiments also demonstrate that the guided drilling of the tunnel leads to errors as low as 2.5 mm in the footprint and [Formula: see text] in orientation, which compares favourably to other works in the field. CONCLUSION: The high accuracy and short time overhead evinced by the experimental validation combined with no additional incisions or capital equipment make this video-based computer-aided arthroscopy solution an appealing alternative to the existing approaches.