Risk Factors for Postoperative Complications After Surgical Treatment of Type B and C Injuries of the Thoracolumbar Spine

BACKGROUND

Unstable thoracolumbar spinal injuries benefit from surgical fixation. However, perioperative complications significantly affect outcomes in surgicallytreated spine patients. We evaluated associations between risk factors and postoperative complications in patients surgically treated for thoracolumbar spine fractures.

METHODS

We conducted a retrospective multicenter study collating data from 21 spine centers across 9 countries on the treatment of AOSpine types B and C injuries of the thoracolumbar spine treated via a posterior approach. Comparative analysis was performed between patients with postoperative complications and those without. Univariate and multivariable analyses were performed.

RESULTS

Among 535 patients, at least 1 complication occurred in 43%. The most common surgical complication was surgical-site infection (6.9%), while the most common medical complication was urinary tract infection (13.8%). Among 136 patients with American Spinal Injury Association (ASIA) Impairment Scalelevel A disability, 77.9% experienced at least 1 complication. The rate of complications also rose sharply among patients waiting >3 days for surgery (P<0.001), peaking at 68.4% among patients waiting ≥30 days. On multivariable analysis, significant predictors of complications were surgery at a governmental hospital (odds ratio = 3.38, 95% confidence interval = 1.73-6.60), having ≥1 comorbid illness (2.44, 1.61-3.70), surgery delayed due to health instability (2.56, 1.50-4.37), and ASIA Impairment Scalelevel A (3.36, 1.78-6.35), while absence of impairment (0.39, 0.22-0.71), ASIAlevel E (0.39, 0.22-0.67) and, unexpectedly, delay caused by operating room unavailability (0.60, 0.36-0.99) were protective.

CONCLUSIONS

Types B and C thoracolumbar spine injuries are associated with a high risk of postoperative complications, especially common at governmental hospitals, and among patients with comorbidity, health instability, longer delays to surgery, and worse preoperative neurologic status.

Metabolically healthy obesity in a young population assisted by the Family Health Strategy in Brazil

Background

Obesity is increasing in younger populations, and is associated with a high cardiovascular (CV) risk, however, it is not clear whether metabolically healthy obesity (MHO) may have a lower CV risk or if it is just an earlier stage of the disease.

Objective

To evaluate the prevalence and CV risk factors associated with MHO in a young population assisted by a Family Health Care unit in a large urban center in Brazil.

Methods

A cross-sectional population study for CV risk assessment in adults aged 20-50 years old from a FHC unit in Rio de Janeiro. Demographic, anthropometric data and CV risk factors were recorded. All underwent office blood pressure (OBP) measurements, laboratory evaluation (lipid and glycidic profile). Obesity was defined as a BMI ≥ 30 kg/m2 and MHO are those who have less than 3 of the following criteria: hypertension, diabetes, total cholesterol ≥ 200 mg/dL, HDL&lt;40 mg/dL (men) and 50 mg/dL (women), triglycerides&gt;150 mg/dL and increased waist circumference.

Results

A total of 632 individuals were evaluated (60% female; mean age 37 ± 9 years). The prevalence of obesity was 26%, of which 73% were classified as MHO. Obeses are older, with a higher prevalence of physical inactivity (51% vs 41%, p = 0.03), hypertension (44% vs 19%, p &lt; 0.001), dyslipidemia (50% vs 36%, p = 0.002) and diabetes (7% vs 2%, p = 0.001) with higher systolic OBP. MHO compared to unhealthy ones are significantly younger and smoke less. Despite being obese, they have lower BMI (33.6 vs 35.2 kg/m2, p = 0.02) and abdominal circumference (102 vs 110 cm, p = 0.03), with lower diastolic BP.

Conclusions

MHO was more prevalent in this young population and seems to have a lower CV risk, however it is not clear whether these younger and less obese individuals are only at an earlier stage of the disease. Perhaps the CV diseases onset is postponed for a few years. Even so, these individuals should not be excluded from public health policies as a form of primary prevention.

Key messages

In this young population, MHO was more prevalent and presented a lower CV risk. The follow-up of MHO will show if they are really healthy or if they are at an early stage of the disease.

Investigating the effect of germanium on the structure of SiO2-ZnO-CaO-SrO-P2O5 glasses and the subsequent influence on glass polyalkenoate cement formation, solubility and bioactivity

A series of germanium (Ge)-containing glasses were synthesized based on a starting glass composition of SiO₂-ZnO-CaO-SrO-P₂O₅. Additions of GeO₂ (6 and 12 mol%) were incorporated at the expense of SiO_2, which retained the amorphous character, and each glass was processed to present similar particle size and surface area. Glass characterization using x-ray photoelectron spectroscopy (XPS) and magic angle spinning nuclear magnetic resonance (MAS-NMR) determined that the addition of GeO₂ increased the fraction of lower Q-speciation and subsequently the concentration of non-bridging oxygens (NBO). Glass Polyalkenoate Cements (GPC) were formulated from each glass with 40, 50 and 60 wt% PAA, and presented time dependent solubility profiles (1, 10, 100, 1000 h) for the release of Si⁴⁺ (4-140 mg/l), Ca²⁺ (1-8 mg/l), Zn²⁺ (<6 mg/l), Sr²⁺ (2-37 mg/l), PO₄^3- (2-43 mg/l) and Ge⁴⁺ (20-911 mg/l) and attained pH values close to 7.5 after 1000 h. Ge-GPCs containing 40 wt% polyacrylic acid (PAA) presented appropriate working time (T_w) and setting times (T_s), and the corresponding compressive strengths ranged from (14-30 MPa). The Ge-GPCs (40, 50 wt%) presented a linear increase (R²-0.99) with respect to time. Simulated Body Fluid (SBF) testing resulted in the Ge-GPCs encouraging the precipitation of crystalline hydroxyapatite on the GPC surface, more evidently after 100 and 1000 h incubation.

Comparison between different epidural analgesia modalities for labor

INTRODUCTION

In recent years new modalities of epidural analgesia maintenance (EA) have been introduced.

OBJECTIVE

The objective of this study is to compare different modalities of EA maintenance for childbirth relating the time of expulsive and dilatation, motor blockade and delivery instrumentation (caesarean section, sucker, forceps, eutocic delivery or non-instrumented delivery).

MATERIAL AND METHODS

Patients admitted for labor in the University Hospital Nuestra Señora de Candelaria between January 2013 and December 2015 were included. Independent modalities of EA, continuous infusion (CI), continuous infusion plus analgesia patient controlled epidural analgesia were determined as independent variables (CI+PCEA) and intermittent programmed epidural boluses plus patient controlled epidural analgesia (PIEB+PCEA).

RESULTS

There are no differences in expulsive time or dilation. There is a difference in the type of instrumentation, caesarean section, sucker, forceps, eutocic delivery or non-instrumented delivery (P>.05), with the percentage of eutocic deliveries in PIEB+PCEA of 66 versus 60 in CI and 65 in CI+PCEA. The percentage of caesarean sections was 23 in CI, in CI+PCEA and PIEB+PCEA of 17. CI increases by 27% the possibility of instrumented deliveries respect to PIEB+PCEA, there is no difference between CI+PCEA and PIEB+PCEA. The motor blockade at 60 and 90minutes reaches lower values with PIEB+PCEA with an average of 0 and a range of 0-1, compared to CI+PCEA 0 (0-4). Satisfaction with CI+PCEA ranges from 2-10 and with PIEB+PCEA 0-10.

CONCLUSION

It is possible to say that PIEB+PCEA is associated with higher frequency of non-instrumented deliveries. The possibility of instrumented deliveries increases with CI versus PIEB+PCEA. There is less motor block with PIEB+PCEA than with CI+PCEA. There are no differences in time of dilatation, expulsion, or patient satisfaction.

In vitro susceptibility and multilocus sequence typing of Fusarium isolates causing keratitis

Fungal keratitis is recognized as a significant cause of ocular morbidity and blindness especially in developing countries. In this study, we aimed to present the molecular identification and susceptibility of Fusarium isolates causing fungal keratitis in a university hospital in southern Brazil. The samples were identified using the second largest subunit of the RNA polymerase gene (RPB2) and the translation elongation factor 1-alpha (TEF1), while the antifungal susceptibility was tested by the broth microdilution method according to the Clinical and Laboratory Standards Institute (CLSI) methodology. The majority of the isolates belonged to the Fusarium solani species complex (F. solani, F. keratoplasticum and F. falciforme) and Fusarium oxysporum species complex. Antifungal susceptibility has shown that amphotericin B and natamycin were the most effective antifungals across all isolates, followed by voriconazole. Variation among Fusarium complexes in their antifungal sensitivities was observed in our study. The identification of Fusarium species from human samples is important not only from an epidemiological viewpoint, but also for choosing the appropriate antifungal agent for difficult-to-treat Fusarium infections such as keratitis.

Larval development and allometric growth of the black-faced blenny Tripterygion delaisi

Larval development and allometric growth patterns of the black-faced blenny Tripterygion delaisi are described from a larval series (body length, L_B  = 3·30-12·10 mm) caught by light traps at the Arrábida Marine Park, Portugal. Larvae of T. delaisi possess distinctive morphometric and meristic characteristics which can be used to identify this species from related taxa. Pigmentation is sparse but characteristic, consisting of pigmented eyes, gas bladder pigmentation in the dorsal region, anal pigmentation and a row of regularly spaced postanal ventral melanophores. This pattern is present from as early as the yolk-sac stage and persists throughout all stages with just the addition of head and caudal pigmentation during the flexion and postflexion stages, respectively. The majority of fin development (with the exception of the caudal fin), occurs in the later stages of development. Myomere counts range between 37 and 45 for all stages. Growth is allometric during larval development. When inflexion points of growth were detected, growth was found to be biphasic with the inflexion points occurring within a very narrow range of L_B (8·70-8·90 mm) close to the mean ± s.d. (9·44 ± 1·48 mm L_B ) of postflexion larvae. Considering allometric growth patterns and ontogenetic descriptions together, the first developmental phase includes the preflexion and flexion stage larvae, while the second phase characterises the postflexion larvae prior to the transition from larvae to juvenile.

Critical swimming speeds of wild-caught sand-smelt Atherina presbyter larvae

Swimming abilities of wild-caught sand-smelt Atherina presbyter larvae were assessed as critical swimming speed (Ucrit ) throughout ontogeny. The mean Ucrit increased with size, ranging from 3·6 to 18·7 cm s(-1) , over the size range of 6·6-21·0 mm LT . This indicates that at hatching A. presbyter larvae, far from being passive floaters, are already capable of active behaviours, which may influence their dispersal patterns.

Zinner's syndrome: an up-to-date review of the literature based on a clinical case

The authors made an up-to-date review of the literature concerning the management of Zinner's syndrome and evaluated a young patient with Zinner's syndrome who had presented with urinary and ejaculatory complaints. Physical examination and transrectal ultra-sonography showed a 7.0 cm right seminal vesicle cyst. Magnetic resonance imaging (MRI) confirmed the diagnosis of Zinner's syndrome. Oligoasthenoteratozoospermia was present at the two seminal analyses. Symptomatic improvement was achieved with conservative measures. Actually, the patient is still on a follow-up programme. The diagnosis is usually established at the age of increased sexual activity. Patients may be asymptomatic or present pain, irritative urinary or ejaculatory symptoms and infertility. MRI has proved to be the best imaging examination. Treatment should be adapted to symptoms, surveillance being the best option in the absence of clinical manifestations. Surgical approach may be adequate when conservative measures prove ineffective. Zinner's syndrome should be suspected if a male young patient presents with unilateral renal agenesis and pelvic complaints and has a supraprostatic mass on digital rectal examination. The initial approach should be medical, but invasive procedures may be the only way to solve the patient's complaints. Nowadays, laparoscopic and robotic techniques must replace the open surgical approach.

Measuring secretion in chromaffin cells using electrophysiological and electrochemical methods

Our present understanding of exocytosis of catecholamines has benefited tremendously from the arrival of single-cell electrochemical methods (amperometry and voltammetry), electrophysiological techniques (whole-cell and patch capacitance) and from the combination of both techniques (patch amperometry). In this brief review, we will outline the strengths and limitations of amperometric and electrophysiological methods and highlight the major contribution obtained with the use of these techniques in chromaffin cells.

Histogenesis and morphofunctional characteristics of chromaffin cells

This article reviews the current status of research about the histogenesis and morphofunctional characteristics of chromaffin cells in the adrenal medulla. First, this study reports the selective migration, transcription and activation factors, and the morphological events of the chromaffin cell precursors during adrenal medulla development. Subsequently, the morphofunctional characteristics of adrenergic and non-adrenergic cells are considered, with particular reference to the characteristics of chromaffin granules and their biological steps, including their formation, traffic (storage, targeting and docking), exocytosis in the strict sense and recapture. Moreover, the relationship of chromaffin cells with other tissue components of the adrenal medulla is also revised, comprising the ganglion cells, sustentacular cells, nerves and connective-vascular tissue.

Chronic hypoxia up-regulates alpha1H T-type channels and low-threshold catecholamine secretion in rat chromaffin cells

alpha(1H) T-type channels recruited by beta(1)-adrenergic stimulation in rat chromaffin cells (RCCs) are coupled to fast exocytosis with the same Ca(2+) dependence of high-threshold Ca(2+) channels. Here we show that RCCs exposed to chronic hypoxia (CH) for 12-18 h in 3% O(2) express comparable densities of functional T-type channels that depolarize the resting cells and contribute to low-voltage exocytosis. Following chronic hypoxia, most RCCs exhibited T-type Ca(2+) channels already available at -50 mV with the same gating, pharmacological and molecular features as the alpha(1H) isoform. Chronic hypoxia had no effects on cell size and high-threshold Ca(2+) current density and was mimicked by overnight incubation with the iron-chelating agent desferrioxamine (DFX), suggesting the involvement of hypoxia-inducible factors (HIFs). T-type channel recruitment occurred independently of PKA activation and the presence of extracellular Ca(2+). Hypoxia-recruited T-type channels were partially open at rest (T-type 'window-current') and contributed to raising the resting potential to more positive values. Their block by 50 microm Ni(2+) caused a 5-8 mV hyperpolarization. The secretory response associated with T-type channels could be detected following mild cell depolarizations, either by capacitance increases induced by step depolarizations or by amperometric current spikes induced by increased [KCl]. In the latter case, exocytotic bursts could be evoked even with 2-4 mm KCl and spike frequency was drastically reduced by 50 microm Ni(2+). Chronic hypoxia did not alter the shape of spikes, suggesting that hypoxia-recruited T-type channels increase the number of secreted vesicles at low voltages, without altering the mechanism of catecholamine release and the quantal content of released molecules.

[Multiple schwannoma of the penis]

Schwannoma or neurilemmoma designate a tumour that originates in the Schwann cells of peripheral nerves, therefore occurring anywhere in the body. They are very rare in the penis. In the literature are reported twenty seven cases of penile schwannoma. We report a case of multiple schwannoma of the penis and make a brief literature revision about this rare pathology.

Immunotherapy of american cutaneous leishmaniasis in Venezuela during the period 1990-99

Of a total of 11532 Venezuelan patients with American cutaneous leishmaniasis (ACL) receiving immunotherapy with a combined vaccine containing heat-killed Leishmania promastigotes and bacille Calmette-Guerin (BCG) during the period 1990-99, we evaluated 5341 from 4 widely separated geographical states. Clinical healing varied from 91.2 to 98.7%, with an average of 95.7%. Adverse reactions were mild and limited to those associated with BCG vaccination alone. Immunotherapy failures in 143 patients included 54.5% with typical localized ulcers and 45.5% with non-mucosal intermediate cutaneous leishmaniasis (ICL). Less than 2% of the patients in this study had lesions suggestive of ICL. The disproportionately large number of immunotherapy failures in the ICL group suggests that it should not be used as monotherapy in this group. Weaker reactivity to purified protein derivative in immunotherapy failures, while not statistically significant in the small group reported here, suggests the possibility that these patients develop a relatively torpid immune response. The high percentage of clinical cures achieved with immunotherapy, associated with few secondary effects and low cost, support the use of immunotherapy in the routine treatment of localized ACL.

The rat adrenal gland in the study of the control of catecholamine secretion

Catecholamine secretion in the rat can be studied in freely moving and anaesthetized animals, in isolated-perfused adrenals, medullae slices and isolated cultured cells. In addition the rat offers the advantage over the more widely used bovine adrenal model that researchers can have access to animals of the same age, sex and feeding conditions. Catecholamine release is similar to other species although it gives robust secretion in response to stimuli such as muscarinic agonists, bradykinin or VIP. It also allows the study of neurotransmission at the splanchnic-adrenal synapse. The use of single-cell preparations (patch-clamp, microfluorimetry, amperometry or capacitance) has overcome the limitations of the number of cells obtained from a gland. It is possible to study secretion in animal models of hypertension, chronic stress or diabetes and rats can be genetically modified.

[Exocytosis as the mechanism for neural communication. A view from chromaffin cells]

Exocytosis constitutes the main cellular mechanism for secreting neurotransmitters. It entails the fusion of a secretory vesicle with plasma membrane, thus promoting the release of its soluble content. Among the cell models that have provided insight into molecular machinery underlying the succesive steps of exocytosis, adrenal chromaffin cells have taken a prominent place. Exocytosis gave support to the classical quantal theory, which maintains that neurotransmitters are released as discrete packages from the nerve terminals towards the postsynaptic cell. We present here a brief review of the estate of our knowlegments about the secretory vesicle traffic towards the cell membrane and how exocytosis takes place through the so called SNARE hypothesis. We also review the novel mechanisms implicated in the regulation of the late steps of exocytosis as well as their possible role as target for drug therapy

Allergy to local anaesthetics in dentistry. Myth or reality?

BACKGROUND

Local anesthetics (LA) are frequently used in dentistry. Although these drugs are usually well-tolerated, they can sometimes provoke adverse reactions of various types and severity. The true incidence of LA allergic reactions is unknown. The objectives of this study were (i) to evaluate the incidence of immediate adverse events in subjects requiring local anesthetic injection in order to receive dental treatment; (ii) to assess the incidence of anaphylactic allergic reactions among those recorded as adverse events and (iii) to analyze the relationship between the atopic antecedents of these patients and documented allergic reactions.

MATERIALS AND METHODS

A prospective, open-label, non-comparative study including 5,018 subjects who received LA during dental treatment, despite their age, was carried out in 7 private or public odontological centers. All the possible reactions that could appear during the first hour of anesthetic administration were assessed.

RESULTS

Twenty-five adverse reactions were diagnosed, representing 0.5 % of the study population. None of these reactions was due to an allergic cause. Most (22/25) were mild, quickly reversible psychogenic or vasovagal reactions. One case was related to defects in the anesthetic technique. In two further cases, allergic etiology was ruled out after skin and dose provocative challenge tests with the anesthetic. In conclusion, allergic reactions to LA are very rare. Most adverse reactions are psychogenic or vasovagal. Physicians and dentists should be aware of these facts in order to minimize the frequent fears and myths concerning the use of LA in the dentist's office.