Flexed elbow, abducted shoulder, forearm supinated (FABS) reconstruction from three-dimensional elbow MRI: diagnostic performance assessment in biceps head anatomy and pathology.

AIM: To determine inter-reader analysis and diagnostic performance on digitally reconstructed virtual flexed, abducted, supinated (FABS) imaging from three-dimensional (3D) isotropic elbow magnetic resonance imaging (MRI). MATERIALS AND METHODS: Six musculoskeletal radiologists independently evaluated elbow MRI images with virtual FABS reconstructions, blinded to clinical findings and final diagnoses. Each radiologist recorded a binary result as to whether the tendon was intact and if both heads were visible, along with a categorical value to the type of tear and extent of retraction in centimetres where applicable. Kappa and interclass correlation (ICC) were reported with 95% confidence intervals. Areas under the receiver operating curve (AUC) were reported. RESULTS: FABS reconstructions were obtained successfully in all 48 cases. With respect to tendon intactness, visibility of both heads, and type of tear, the Kappa values were 0.66 (0.53-0.78), 0.24 (0.12-0.37), and 0.55 (0.43-0.66), respectively. For the extent of retraction, the ICC was 0.85 (0.79-0.91) when including the tendons with and without retraction and 0.78 (0.61-0.91) when only including tendons with retraction. For tear versus no tear, AUC values were 0.82 (0.74-0.89) to 0.96 (0.91-1.01). CONCLUSION: Digital reconstruction of FABS positioning is feasible and allows good assessment of individual tendon head tears and retraction with high diagnostic performance.

The applicability of the "surprise question" as a prognostic tool in patients with severe chronic comorbidities in a university teaching outpatient setting.

BACKGROUND: Life expectancy in recent decades has increased the prevalence of chronic diseases in the population, requiring an approach to new health topics, such as discussions on quality of life and expectations about death and dying. The concept of advance directives (ADs) gives individuals the opportunity to make known their decisions about the treatments they would like to receive at the end of life. Despite the recognition of relevance in clinical practice, the applicability of the concept presents challenges, including establishing the appropriate prognosis for each patient and the ideal time to approach the patient. Some prognostic tools were developed, such as the surprise question (SQ): "Would you be surprised if your patient died in 12 months?", which is used in some clinical settings to predict patient deaths and to make decisions regarding ADs. The main objective of the present study was to evaluate the behavior of second-year resident physicians (PGY-2) when the SQ was applied. METHOD: In our observational study, from July 1, 2016, to February 28, 2017, (PGY-2) in the Internal Medicine Residency Program (IMRP) applied SQ to all patients with multiple and varied chronic no communicable comorbidities, who were followed up at the general medicine outpatient clinic (GMOC) of a tertiary university hospital in São Paulo- Brazil. The frequency of the outcome (death or non-death within 12 months) was analyzed by correlating it with the clinical data (impact of the studied variables). RESULTS: Eight hundred forty patients entered the study. Fitfty-two of them (6.2%) died within one year. PGY-2 predicted that two hundred and fourteen patients (25.5% of total) would die within a year (answer No to SQ), of which, 32 (14.9%) did so. The correct residents' prognosis for the subgroup of 626 patients (answer "Yes" to SQ) was NPV = 96.8% (CI = 95.4%-98.2%) and PPV = 14.9% (CI 10.1%-19, 6%). Answering "Yes" to SQ correlated negatively to addressing AD while the outcomes death and the answer No to SQ were positively correlated, according to the number of comorbidities. CONCLUSION: The SQ, in addition to care, contributed to health education, communication and care planning shared by the doctor and patient.

Natural history of longitudinally extensive transverse myelitis in 35 Hispanic patients with systemic lupus erythematosus: good short-term functional outcome and paradoxical increase in long-term mortality.

Background and objective Acute transverse myelitis (TM) is an infrequent neurological complication of systemic lupus erythematosus (SLE). Short-term outcome varies widely between cohorts. Little is known about the epidemiology and long-term functional outcome of TM associated to SLE. Methods Patients with SLE and acute TM were identified during hospital admission, visits to the Emergency Room or the Neurology Outpatient Clinic. We evaluated ambispectively those patients with SLE presenting with clinical myelopathy and corroborated with spinal MRI. Cases were divided as partial (non-paralyzing) or complete (paralyzing). We determined long-term functional outcome as well as mortality in those patients with follow-up periods of at least five years. Results We identified 35 patients (partial, n = 15; complete, n = 20) in which complete clinical and imaging data were available (26 with follow-up ≥ 5 years). Patients with complete TM were significantly older than those with partial forms. Positive antiphospholipid antibodies were observed in 80% of patients, suggesting a possible mechanistical role. Surprisingly, functional recovery at one year was in general good; however, we observed a five-year mortality of 31% because of sepsis (in 10 cases) or pulmonary embolism (in one case). Conclusions Short-term outcome of SLE-related TM is generally good, and recurrence rate is low. However, we observed a long-term fatality rate of 31% for reasons unrelated to TM, suggesting that TM is a manifestation of severe immune dysregulation and a predictor of severity and mortality in patients with SLE.

Betacoronavirus 1 in alpacas (Vicugna pacos) in the High Peruvian Andes.

Genetic sequences highly related to Bovine coronavirus (BCoV) were detected in fecal samples from Peruvian 1-3 week old alpaca crias located on six farms in Puno department, some of which shared pastures with cattle. A total of 60 samples were screened for coronavirus using a nested PCR amplification of a fragment of the RNA-dependent RNA polymerase (RdRp) gene. Sequences from 11 positive samples were highly similar to the Kakegawa, Quebec and Mebus BCoV strains (99.5-100.0%) and 99.2% identical to an alpaca Coronavirus (CoV) previously detected in the USA. The detection of genetic sequences related to BCoV from Peruvian alpaca crias suggests possible role of this virus on enteric disorders etiology in the High Andes.

Virtual pollination trade uncovers global dependence on biodiversity of developing countries.

Nations' food consumption patterns are increasingly globalized and trade dependent. Natural resources used for agriculture (e.g., water, pollinators) are hence being virtually exchanged across countries. Inspired by the virtual water concept, we, herein, propose the concept of virtual biotic pollination flow as an indicator of countries' mutual dependence on biodiversity-based ecosystem services and provide an online tool to visualize trade flow. Using information on 55 pollinator-dependent crop markets (2001-2015), we show that countries with higher development level demand high levels of biodiversity-based services to sustain their consumption patterns. Such patterns are supported by importation of virtual biotic pollination (up to 40% of national imports of pollinator-dependent crops) from developing countries, stimulating cropland expansion. Quantifying virtual pollination flow can help develop new global socioeconomic policies to meet the interconnected challenges of biodiversity loss, ecosystem health, and social justice.

Toll-like receptors blocking restores in vitro microbicidal activity in latent tuberculosis-infected subjects.

BACKGROUND: Latent tuberculous infection (LTBI) can function as a 'reservoir' for Mycobacterium tuberculosis. Given that T-regulatory cell (Treg) numbers are augmented in LTBI, it is likely that Toll-like receptors (TLRs) may have a role in Treg function. Elucidation of the immune mechanisms associated with tuberculosis (TB) development may help to control M. tuberculosis spread.OBJECTIVE: To investigate the role of TLR2, TLR4 and TLR9 in hindered in vitro microbicidal activity and increase Treg number during LTBI. DESIGN: Whole blood cell cultures from individuals with LTBI and healthy controls (HCs) infected with live M. tuberculosis H37Rv strain were used to investigate the effect of TLR2, TLR4 and TLR9 on Treg number, microbicidal activity, and interferon-gamma and interleukin (IL)10 production. RESULTS: LTBI subjects were characterised by increased Treg number and impaired microbicidal activity when compared with HCs. Specific blockade of TLR4 and TLR9 led to a significant reduction in Treg number, a decrease in IL-10 production and substantial upregulation of microbicidal activity. CONCLUSION: M. tuberculosis infection may activate TLR4 and TLR9 pathways to suppress M. tuberculosis-specific immune responses. Here, we show that activation of TLR4 and TLR9 hinder microbicidal activity during LTBI.

Polarization microscopy as a tool for quantitative evaluation of collagen using picrosirius red in different stages of CKD in cats.

Chronic kidney disease (CKD) is a relevant disease in feline clinic. The tubulointerstitial damage, with collagen deposition and fibrosis, is an important result of this process. The aim of this study was to quantify and correlate the deposition of collagen and severity of interstitial fibrosis (IF) in the kidney from cats in different stages of CKD. Kidney fragments from 10 adult cats with CKD were analyzed and stained by Masson's trichrome (MT) and Picrosirius red (PSR) for circular polarized microscopy. Random quantitative analysis was performed on MT sections to classify the degree of IF, per field area, with and without circular polarization. Statistics correlations were performed by Spearman's (ρ; p < .05). There was a significant correlation of IF quantification with the area of interstitial collagen deposition by polarized PSR (PSRp) (r = .7939, p = .0098) and nonpolarized PSR (PSRn) (r = .7781, p = .0080). There was a positive correlation of serum creatinine (sCr) at different stages of CKD with PSRp (r = .7939, p = .0098), PSRn (r = .8667, p = .0027) and MT (r = .7818, p = .0117). Correlations between the percentage of quantified area was also positive from PSRp to PSRn (r = .9030, p = .0009) and PSRp to MT (r = .7939, p = .0098). The PSRN was also correlated with MT (r = .9273, p = .0001). The correlation with IF and sCr follows the disease evolution and the quantification of collagen by PSR is an excellent tool for analyzing the disease severity at different stages.

Laparoscopic pneumoperitoneum in acute peritonitis does not increase bacteremia or aggravate metabolic or hemodynamic disturbances.

The use of laparoscopy in generalized peritonitis has become increasingly frequent in recent years. However, CO2 pneumoperitoneum in association with increased intraperitoneal pressure may have deleterious effects in patients with hemodynamic or metabolic disturbances caused by bacterial peritonitis. The purpose of this study was to investigate the effect of CO2 pneumoperitoneum on bacteremia, mean arterial pressure, and blood gas disturbances in an animal model of bacterial peritonitis. Dogs were anesthetized, orally intubated, and subjected to experimental peritonitis by intraperitoneal inoculation of a suspension containing Escherichia coli and sterile dog feces. The animals were randomly assigned to two groups: control animals were maintained under anesthesia, and the insufflated animals were subjected to intraperitoneal CO2 insufflation. Bacterial peritonitis provoked the appearance of bacteremia and a significant decrease in mean arterial pressure, pH, bicarbonate, and base deficit. The induction of bacterial peritonitis did not significantly influence pH in the control group and partial pressure of arterial CO2 in either group. Thirty minutes of CO2 pneumoperitoneum did not influence the effect of bacterial peritonitis on the analyzed variables. These results suggest that laparoscopic CO2 pneumoperitoneum does not aggravate bacteremia or metabolic and hemodynamic disturbances induced by bacterial peritonitis.

Septic Arthritis of the Knee with Toxoplasma gondii in a Patient with Rheumatoid Arthritis.

Toxoplasmosis is a parasitic infection that may affect several viscera. The locomotor system is rarely involved, and no case has been published of a septic arthritis in which Toxoplasma gondii was identified in the cultures of the joint fluid and of the synovial specimen.We describe a patient with septic arthritis of the knee in which Toxoplasma gondii was found by culture in a patient with seropositive rheumatoid arthritis treated with corticosteroids and gold salts who developed multi-visceral toxoplasmosis.

Resin composite class I restorations: a 54-month randomized clinical trial.

The objective of this longitudinal clinical randomized trial was to evaluate the clinical performance of a nanofilled and a nanohybrid resin composite in Class I occlusal restorations of posterior teeth over the course of 54 months. Forty-one adolescents participated in the study. The teeth were restored with Adper Single Bond 2 (3M ESPE) and nanofilled (Filtek Z350, 3M ESPE), nanohybrid (Esthet-X, Dentsply) and microhybrid Filtek Z250 (3M ESPE) used as a control. After 54 months, the restorations were evaluated in accordance with the modified United States Public Health Service criteria. The McNemar and Friedman tests were used for statistical analysis, at a level of significance of 5%. Five failed restorations were observed during the follow-up. A change to unacceptable restoration occurred for one Esthet-X, two Filtek Z350, and two Filtek Z250 restorations, which received the clinically unacceptable score, Charlie, for both anatomic form and marginal adaptation. Secondary caries and postoperative sensitivity occurred in one Filtek Z250 and one Filtek Z350 restoration. When the five evaluation periods (baseline and six, 12, 30, and 54 months) were compared, significant differences were found in the marginal adaptation of Filtek Z250 and Filtek Z350. Significant differences in the roughness criteria (p=0.005) were also observed when the three composites were compared after 54 months (Filtek Z350 > Filtek Z250 > Esthet-X), always within clinically acceptable limits. The materials investigated showed acceptable clinical performance for Class I restoration after 54 months. Long-term reevaluations are necessary for a more detailed analysis of these composites.

Serum concentrations of acute phase proteins and immunoglobulins of calves with rotavirus diarrhea / Concentração sérica de proteínas de fase aguda e imunoglobulinas em bezerros acometidos por diarreia por rotavírus

The aim of the present study was to characterize changes in acute phase protein levels according to the occurrence of rotavirus diarrhea in calves in the first month of life. Blood and fecal samples were taken before colostrum intake and at 1, 2, 7, 15, 21 and 30 days of age from 24 Holstein calves allotted in three experimental groups: calves that did not present diarrhea (group A), calves that presented diarrhea, but tested negative for rotavirus in feces (group B), and calves that presented diarrhea and tested positive for rotavirus in feces (group C) (experiment 1). When the animals presented episodes of diarrhea, blood and fecal samples were taken at 24-hour intervals until the end of clinical signs (experiment 2). Serum proteins were separated by SDS-PAGE technique and rotavirus in feces was detected by PAGE. Data of experiment 1 were analyzed by ANOVA and Tukey's test, considered significant at P<0.05. Data of experiment 2 were subjected to the HSD test. Total protein, globulins, and IgG concentrations were lower in group C than in groups A and B. Ceruloplasmin and transferrin levels were higher in group C than in groups A and B. Serum concentrations of haptoglobin and α1-acid glycoprotein did not differ significantly between groups throughout the experimental period. Calves presented diarrhea between 10.4 and 14.6 days of age in group B, and between 10.3 and 14.6 days of age in group C. In the moments of diarrhea manifestation, least square means of IgA, haptoglobin and α1-acid glycoprotein concentrations did not differ significantly between groups B and C, but ceruloplasmin and transferrin concentrations were higher in group C than in group B, as opposed to what occurred with IgG levels. These findings show that optimizing passive immunity transfer of immunoglobulins decrease the likelihood of calves developing diarrhea caused by rotavirus. In addition, ceruloplasmin presents characteristics of a biomarker of rotavirus infection in calves.(AU)

O objetivo do presente estudo foi avaliar alterações nos teores de proteínas de fase aguda de acordo com a ocorrência de diarreia por rotavírus em bezerros no decorrer do primeiro mês de vida. Amostras de sangue e fezes de 24 bezerros da raça Holandesa foram coletadas antes da ingestão de colostro e com um, dois, sete, quinze, vinte um e trinta dias de idade, sendo os bezerros alocados em três grupos: bezerros que não apresentaram diarreia (grupo A), bezerros que apresentaram diarreia, mas foram negativos para a detecção de rotavírus nas fezes (grupo B) e bezerros que apresentaram diarreia e foram positivos para detecção de rotavírus nas fezes (grupo C) (experimento 1). Sempre que os animais apresentavam episódio de diarreia, amostras de sangue e fezes eram coletadas em intervalos de 24 horas até o término dos sinais clínicos (experimento 2). As proteínas séricas foram separadas por meio da técnica de SDS-PAGE e a pesquisa de rotavírus nas fezes foi realizada por meio da técnica de PAGE. Os resultados do experimento 1 foram analisados por meio de ANOVA e do teste de Tukey, considerado significativo quando P<0,05. Os dados do experimento 2 foram submetidos ao teste HSD. Os teores de proteína total, globulinas e IgG foram menores no grupo C que nos grupos A e B, os teores de ceruloplasmina e transferrina foram maiores no grupo C que nos grupos A e B e as concentrações séricas de haptoglobina e α1-glicoproteína ácida não diferiram significativamente entre grupos. Os bezerros manifestaram diarreia, em média, com 10,4 a 14,6 dias de idade no grupo B e com 10,3 a 14,6 dias de idade no grupo C. Nos momentos de manifestação de diarreia, os teores de IgA, haptoglobina e α1-glicoproteína ácida não diferiram significativamente entre os grupos B e C, mas os teores de ceruloplasmina e transferrina foram maiores no grupo C que no grupo B, oposto ao verificado para o teor de IgG. Esses achados mostram que a otimização da transferência de imunidade passiva de imunoglobulinas reduz a probabilidade de os animais apresentarem diarreia por rotavírus. Adicionalmente, a ceruloplasmina apresenta características de um biomarcador da infecção por rotavírus em bezerros.(AU)

Antimicrobial activity in the tick Rhipicephalus (Boophilus) microplus eggs: Cellular localization and temporal expression of microplusin during oogenesis and embryogenesis.

Arthropods display different mechanisms to protect themselves against infections, among which antimicrobial peptides (AMPs) play an important role, acting directly against invader pathogens. We have detected several factors with inhibitory activity against Candida albicans and Micrococcus luteus on the surface and in homogenate of eggs of the tick Rhipicephalus (Boophilus) microplus. One of the anti-M. luteus factors of the egg homogenate was isolated to homogeneity. Analysis by electrospray mass spectrometry (ESI-MS) revealed that it corresponds to microplusin, an AMP previously isolated from the cell-free hemolymph of R. (B.) microplus. Reverse transcription (RT) quantitative polymerase chain reactions (qPCR) showed that the levels of microplusin mRNA gradually increase along ovary development, reaching an impressive highest value three days after the adult females have dropped from the calf and start oviposition. Interestingly, the level of microplusin mRNA is very low in recently laid eggs. An enhance of microplusin gene expression in eggs is observed only nine days after the onset of oviposition, achieving the highest level just before the larva hatching, when the level of expression decreases once again. Fluorescence microscopy analysis using an anti-microplusin serum revealed that microplusin is present among yolk granules of oocytes as well as in the connecting tube of ovaries. These results, together to our previous data, suggest that microplusin may be involved not only in protection of adult female hemocele, but also in protection of the female reproductive tract and embryos, what points this AMP as a considerable target for development of new methods to control R. (B.) microplus as well as the vector-borne pathogens.

Radiografia intraoral e convencional da hemiarcada superior direita de gatos domésticos / Intraoral and convencional radiography of the right maxilla hemiarcade of domestic cats

A proposta com este trabalho foi avaliar a hemiarcada superior direita de gatos domésticos por meio de técnicas radiográficas odontológicas do paralelismo, empregando-se filmes intraorais aos posicionadores de Han Shin. As imagens obtidas por essa metodologia foram correlacionadas com as técnicas radiográficas convencionais (extraorais), com o intuito de se estabelecerem vantagens ou desvantagens para detectar possíveis afecções dentais e periodontais. Foram utilizados 30 gatos, sem raça definida, 17 machos e 13 fêmeas, faixa etária entre um e três anos, confinados em gatis do Departamento de Zootecnia da Universidade Federal de Lavras/MG. Com os animais sob anestesia geral, foram realizadas radiografias da hemiarcada superior direita, incluindo três incisivos, um canino, três pré-molares e um molar em radiografias intraorais e extraorais. As imagens radiográficas foram analisadas e efetuaram-se comparações qualitativas entre pares intraorais e convencionais dos mesmos animais. Para se estabelecer a técnica radiográfica dental mais bem adaptada, foram realizadas análises estatísticas pelo teste de McNemar (qui-quadrado modificado). A técnica intraoral mostrou ser superior à extraoral (P<0,05), para achados referentes a espaço periodontal aumentado, canal radicular amplo e arredondamento de ápice, e também para a avaliação mais bem detalhada de dentes caninos, pré-molares e molares em gatos.

The aim of this research was to evaluate the right maxilla hemiarcade of cats through parallel dental radiographic techniques, applying Han Shin intraoral film positioner. Images obtained with this method were correlated with conventional radiographic techniques (extraoral). The goal was to establish the advantages and disadvantages to detect possible dental and periodontal diseases. Thirty mixed breed cats were evaluated, 17 males and 13 females, ages one to three years old, confined in catteries in the Department of Zootecnia of the Federal University of Lavras/MG. Radiographies of the right maxilla were taken with the animals under general anesthesia, and three incisors, one canine, three premolars and one molar teeth were included in the intraoral and extraoral images. The radiographic images were analyzed and a qualitative comparison of pairs of intraoral and conventional images from the same animals was achieved. To establish the dental image procedures that were better adapted for cats, the McNemar Test (Modified Qui-Square) was used for statistical analysis. The intraoral technique was superior than the extra oral (P<0,05), for findings relating to increased periodontal space, broad root canal and rounded apex, and also for a more detailed evaluation of canine, premolar and molar teeth in cats.

[Immune response to heart in rabbits: study of cellular and humoral immunity (author's transl)]. / Aspectos da resposta imune anti-coração em coelhos. Estudo da imunidade sérica e celular

Four groups of rabbits injected with cardiac tissue and complete Freund's adjuvant or aluminum hydroxide gel adjuvant and two groups only injected with aluminum hydroxide gel adjuvant or complete Freud's adjuvant were studied. The humoral and cellular immunity in immunized animals was studied using heart soluble and insoluble extracts. The tests results from hemagglutination, immunoelectrophoresis and immunofluorescence have presented cross-reactions among sera and hearts of the several species. Similar cross-reactions were not revealed by immunodiffusion. The immunoelectrophoresis and hemagglutination reactions were related to heart soluble extract and the immunofluorescence reactions were related to insoluble extract located in sarcolemal, subsarcolemal and intermyofibrilar sites. By hemagglutination, it was verified the presence of antibodies to heart and skeletal muscle in the antisera. Is was not possible to negative completely the reactivity of these antibodies to heart by absorptions with skeletal muscle. Inhibition tests to leucocytes migration revealed that leucocytes from immunized animals present migration inhibition when faced to antigens sedimented at.....56.500 g.

Efeitos do verapamil sobre a pressão arterial e a frequência cardiaca de animais acordados portadores de hipertensão neurogenica e hipertensão renal / Effects of verapamil in arterial blood pressure and heart rate in awaked animals with neurogenic and renal hypertension

O efeito hipotensor do verapamil foi estudado em animais normais e em portadores de dois modelos experimentais de hipertensao: hipertensao neurogenica aguda e hipertensao renal.Para o estudo foram utilizados ratos acordados, com o proposito de evitar a depressao produzida por anestesia, dos reflexos cardiovasculares que controlam a pressao arterial e a frequencia cardiaca. O verapamil foi injetado, por via venosa, em infusao continua por 30 minutos, nas doses de 4 a 22 ug/min/100g.Os resultados mostraram que a pressao arterial media diminui tanto nos animais normais como nos hipertensos, sendo a hipotensao mais rapida e intensa no grupo de ratos com hipertensao neurologica aguda.A frequencia cardiaca aumentou nos ratos normais e com hipertensao renal devido a hipotensao provocada pelo verapamil. Nos ratos com hipertensao neurogenica aguda, ocorreu bradicardia devido a inatividade dos pressoreceptores evidenciando a acao cronotropica negativa do verapamil. Os resultados obtidos recomendariam seu uso nas crises hipertensivas em pacientes sem depressao de reflexos cardiovasculares